Temas Variados / HISTORIA CLÌNICA EN INGLÈS
HISTORIA CLÌNICA EN INGLÈSTrabajos: HISTORIA CLÌNICA EN INGLÈS
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Enviado por: BeereSalazar 17 diciembre 2012
Palabras: 419 | Páginas: 2
Occupation: Place of Birth:
• MEDICAL HISTORY
Reason for consultation
Do you suffer from any illness? (if so, which one)
Are you taking any medication? (which?)
Are you allergic to any medication, food or other? (specify which)
Have you received any surgery or traumatism? (specify which and when)
Have you received a blood transfusion? (specify when)
WOMEN< are you experiencing any of the following at the present time?
Time of bride
Has any family member or partner had (or has at the present time) the following illnesses?
YES NO YES NO
Cancer Heart disease
Arterial Hypertension Depresision
Asthma Rheutmatoid Arthritis
Date of last dental visit?
What was the reason for the consultation?
Have you been administered local or general anesthetic? Yes No
Did you experience any unfavorable reactions to this? Yes No
Have there been any negative experiences with previous dental visits? Yes No
For what reason?
Have you suffered trauma to the mouth, teeth or head? Yes No
When and how?
Do you have any of the following habits?
Breathing through the mouth Grinding teeth Biting nails
Biting or chewing lips xxxxxxxxxxxxxxxxxxx Other
Do you brush your teeth daily? Yes No
Do you use dental floss? Yes No
Do you use mouth wash? Yes No
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