ficha dermatologica
-
Upload
raul-eduardo-yaipen -
Category
Documents
-
view
4.801 -
download
28
Transcript of ficha dermatologica
Piel Seca:_____________________Piel Hidratada:___________________________________________
Piel Seca Atípica:________________Piel Seca Senil:_______________________________________
Piel Grasa:_______________________Piel Grasa Asticciada:________________________________
Piel Grasa Sensible:_____________________________________________________________________
Piel Grasa Seborreica Afluente:________________________________________________________
Piel Mixta y Acne:________________________________________________________________________
VII. DIAGNOSTICO:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
VII. TRATAMIENTO: UNEPEELING QUIMICO
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
FECHA PRODUCTO QUIMICO
TIEMPO DE TOLERANCIA
EFECTO
FICH A DE DIAGNOSTICO
I DATOS PERSONALES
Nombres y Apellidos:__________________________________________________________________________
Fecha de Nacimiento:_____________________________________________________________
Estado Civil:_______________________________________________________________________
Dirección:__________________________________________________________________________
Teléfono:___________________________________________________________________________
Correo Electrónico:_______________________________________________________________
Tratamiento:______________________________________________________________________
Profesión:__________________________________________________________________________
II. DATOS PATOLOGICOS
DIABETES:______________________________________________________________________________
CANCER:________________________________________________________________________________
ASMA:___________________________________________________________________________________
PROBLEMAS HORMONALES:_________________________________________________________
CIRUGIA RECIENTE:___________________________________________________________________
V. CARACTERISTICAS
Textura Gruesa:___________________________________________________________________________
Textura Delgada:__________________________________________________________________________
Textura Aspera:___________________________________________________________________________
Textura Lisa y Fina:_______________________________________________________________________
Textura Granulosa:_______________________________________________________________________
Antibioticos:____________________Alcohol:__________________Tabaco:___________________
III. CIRUGIAS ESTETICAS
Rinoplastia:____________________________________________________________________________
Abdominoplastia:_____________________________________________________________________
Implantes Faciales:___________________________________________________________________
Blefaroplastia:________________________________________________________________________
Liftin Facial:__________________________________________________________________________
IV. ALTERACIONES CUTANEAS
Nevus:______________________________Cloasma:________________________________________
Petequias:____________________________Papula:________________________________________
Vasicula:________________________Comedones:________________________________________
Lentigus:____________________________Cicatriz:________________________________________
Telegentasia:________________________________________________________________________
Costra:________________________________________________________________________________
Melasma:_____________________________________________________________________________
Milliun:_______________________________________________________________________________
Acne:_________________________________________________________________________________
Textura Opaca:____________________________________________________________________________
Poros cerrados:_______________________Dilatados:_________________________________________
Poco Visible: ______________________________________________________________________________
Color Rosada:_________________________Palida:_____________________________________________
Gris:_____________________________Amarillenta:____________________________________________
Amarilla:_________________________Enrojecida:____________________________________________
Untuosa:___________________Oleosa:__________________Brillosa:____________________________
Comedones Negros o Blancos:__________________________________________________________
Arrugas y Líneas de Expresión:_________________________________________________________
Entrecejos Periorbiculares:_____________________________________________________________
Naso Geniano:____________________________________________________________________________
Peribucales:_______________________________________________________________________________
VI BIOTIPO CUTANEO:
EUDERMICA O NORMAL:_______________________________________________________________
_____________________________________________________________________________________________
_________________________ ______________________
Firma del Paciente Cosmeatra