Formulario Médico Tratante (Indicador)

Formulario

Paso 1 de 4

# Pensionado:*
Folio:*
Fecha:*
DD barra MM barra AAAA
Habitación:*
Ingreso por:*
- Urgencia
- Accidente
- Admisión
- Enfermedad
- Ambulantorio
- Embarazo
Fecha de Ingreso:*
DD barra MM barra AAAA
Hora de Ingreso:*

: Horas

Minutos
Fecha de Egreso:*
DD barra MM barra AAAA
Hora de Egreso:*

: Horas

Minutos

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Formulario Médico Tratante (Indicador)

Formulario

Paso 1 de 4

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