Medical Record FIRST NAME (Nombre): _____________________________________ LAST NAME (Apellido): ___________________________________ GENDER (Género): M □ F □ DATE OF BIRTH (Fecha de nacimiento): Day_______ Month________________ Year _______ PLACE OF BIRTH (Lugar de nacimiento): ______________________________________________________________________________ FATHER’S NAME (Nombre del padre): ________________________________________________________________________________ BUSINESS PHONE (Teléfono oficina): _______________________ HOME PHONE (Teléfono casa): ____________________________ MOTHER’S NAME (Nombre de la madre): _____________________________________________________________________________ BUSINESS PHONE (Teléfono oficina): _______________________ HOME PHONE (Teléfono casa): _____________________________ DOCTOR TO CONTACT IN CASE OF EMERGENCY (Nombre PERSON TO CONTACT IN CASE OF EMERGENCY (Nombre
del médico a llamar en caso de emergencia)
de persona a llamar en caso de emergencia)
_______________________________________________________
_______________________________________________________
PHONE (Teléfono): ____________________________________ PHONE (Teléfono): ____________________________________ THE FOLLOWING SHOULD BE FILLED IN BY THE PEDIATRICIAN OR FAMILY DOCTOR (Las siguientes informaciones deben ser
llenadas por el pediatra o medico de la familia).
A. NUTRITION (Nutrición) ____________________________ HEIGHT (Tamaño) ___________________________________ WEIGHT (Peso) _______________________________________ BLOOD PRESSURE (Presión arterial) ___________________ EYES (Ojos): LEFT (Izquierdo) ___________________________ RIGHT (Derecho) ___________________________________ EARS (Oídos): LEFT (Izquierdo) _________________________ RIGHT (Derecho) ___________________________________ NOSE (Nariz): ADENOIDS (Adenoides) __________________ NASAL OBSTRUCTION (Obstrucción nasal) ___________ THROAT (Garganta): Tonsillitis (amigdalitis) _________________ Frequent Colds (Resfriados frecuentes) ______________ Laryngitis (Larengitis) __________________________________ SKIN (Piel): _________________________________________ GLANDS: Hypertrophy of Lymphatic ganglion ___________ LUNGS: ______________________ HEART: Apex _________________ ABDOMEN: Palpable Mass _____________________________
Hernia _____________________________________________
NERVIOUS SYSTEM: ____________________________________
Reflex _____________________________________________
ORTHOPEDIC: __________________________________________________________________________________________________ IS PATIENT ON TREATMENT FOR ASTHMA OR CONVULTIONS? SPECIFY TYPE OF MEDICATION AND DOSAGE ___________
________________________________________________________________________________________________________________
ANY RESTRICTION TO PARTICIPATE IN ANY SPORT ACTIVITY? _______________________________________________________ REASON ____________________________________________________________________________________________________ SPECIFY ANY OTHER PHYSICAL CONDITION OR ILLNESS THAT MAY AFFECT THE CHILD AND SHOULD BE NOTIFIED TO THE SCHOOL (Especifique otra condición médica o enfermedad que pueda afectar al niño(a) y que el colegio deba estar
enterado) _____________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
ALLERGIES (Alergias) ___________________________________________________________________________________________________ CBC: Hect. _______________________________ Hb. ___________________________ Urine (Orina) ________________________________ BLOOD TYPE (Tipo de sangre) _________________________________
B. INMUNIZATIONS DATES (Fechas inmunizaciones):
Chicken Pox (Varicela) ____________________ BCG _____________________ MMR ____________________________
C. PAST ILLNESS (Enfermedades anteriores):
Chicken Pox (Varicela) ________ Tonsillitis (Amigdalitis) _______ Rheumatic Fever (Fiebre reumática) _______
Measles (Sarampión) __________ Meningitis __________ Otitis __________ Geman Measles _________________
Epilepsy __________ TB _________ Mumps (Papera) __________ Hepatitis ____________ Diabetes ____________
Polio ____________ Pneumonia __________ Surgeries (Operaciones) __________________ Diphteria ___________
Bronchitis __________ Other (Otros) _____________________________________________________________________
III. MEDICATION TO BE GIVEN (Medicamentos que el alumno debe tomar):
If any of the following symptoms occur, you may give the child (Si el alumno padece de algunos de los síntomas descritos
1. Headeache or fever (Dolor de cabeza o fiebre): Winasorb tablet Yes _______
3. Allergies (Alergias): Loratadine/Atarax/Claritine D Syrup Yes ______
4. In case of Asthma (en caso de asma): Salbutamol
5. Nasal Congestion (Congestión nasal): Ambroxol
DATE OF PHYSICAL EXAM (Fecha de examen físico) ______________________________________________________________________ DOCTOR’S PHONE (Teléfono del doctor) ________________________________________________________________________________ DOCTOR’S NAME (Nombre del doctor) __________________________________________________________________________________ DOCTOR’S SIGNATURE (Firma del doctor) ________________________________________________________________________________
Office of the SheriffAnderson County, Tennessee FOR IMMEDIATE RELEASE Undercover Drug Operation Nets 163 Indictments One hundred sixty-three indictments for eighty-eight persons on drug related charges havebeen returned by an Anderson County Grand Jury after investigations by the AndersonCounty Sheriff’s Department in cooperation with the Tennessee Bureau of Investigation,the Oak Ridge, La
Perl version 5.12.2 documentation - perlgpl perlgpl - the GNU General Public License, version 1 SYNOPSIS You can refer to this document in Pod via "L<perlgpl>" Or you can see this document by entering "perldoc perlgpl" DESCRIPTION Perl is free software; you can redistribute it and/or modify it under the terms of either: a) the GNU General Public License as publi
Medical Record