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Tesis Dr. Vera TESIS FINAL.pdf - Repositorio de la Universidad ...

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Sensibilidad superficial________________________________________________________<br />

ESTADO MENTAL<br />

Sueño__________________________________ Memoria____________________________<br />

Estados emotivos irritabilidad_____________________ Angustia_____________________<br />

Depresion___________________________________________________________________<br />

EXAMENES DE LABORATORIO<br />

Sangre Biometría Hemática___________________________________________________<br />

Grupo Sanguíneo_______________________ Serología (VDRL)_______________<br />

Orina Elemental y microscópico______________________________________________<br />

Heces fecales________________________________________________________________<br />

RADIOGRAFIAS<br />

Pulmonar__________________________________ Otras_____________________________<br />

INFORME MEDICO GENERAL<br />

___________________________________________________________________________<br />

___________________________________________________________________________<br />

___________________________________________________________________________<br />

Aptitud para el trabajo Si____________ No____________<br />

Lugar y fecha________________________________________________________________<br />

Nombre <strong>de</strong>l medico que realiza el examen__________________________________________<br />

113<br />

____________________________<br />

Firma

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