Download - Formato de Indicaciones de Alta
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HOSPITAL REGIONAL LAMBAYEQUE SERVICIO DE PEDIATRIA
Servicio de Pediatría
Fecha: ___ /___ /2014 Hora: _____
INDICACIONES MÉDICAS
NOMBRE: ______________________________________________________
Dx.: 1. ____________________________________________________
2. ____________________________________________________
3. ____________________________________________________
4. ____________________________________________________
5. ____________________________________________________
Peso al ingreso: __________ Peso al alta:__________
DIETA:
_________________________________________________________________________
_________________________________________________________________________
MEDICACIÓN:
1. _____________ : ___________________________________________
2. _____________ : ___________________________________________
3. _____________ : ___________________________________________
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HOSPITAL REGIONAL LAMBAYEQUE SERVICIO DE PEDIATRIA
Servicio de Pediatría
4. _____________ : ___________________________________________
5. _____________ : ___________________________________________
Citas:
- Control por consultorio externo de : ____________________________
- Control por consultorio externo de : ____________________________
- Control ___________________________________________________
- Control ___________________________________________________
Signos de alarma:
- _________________________________________________________
- _________________________________________________________
- _________________________________________________________
- _________________________________________________________
- _________________________________________________________
- _________________________________________________________
- _________________________________________________________
- _________________________________________________________
- _________________________________________________________
- _________________________________________________________
- _________________________________________________________