NAME: ____________________________AGE: _____ PHONE: __________________HEIGHT: _____ WEIGHT:_____ CHIEF COMPLAINT: _____________________________________________________________________________ ______________________________________________________________________________________________ SUBJECTIVE SIGNS AND SYMPTONS: ________________________________________________________________ ______________________________________________________________________________________________ PREVIOUS TREATMENT: __________________________________________________________________________ ______________________________________________________________________________________________ OTHER PODIATRIC PROBLEMS: _________________________________________________________________________________
BUNIONS CORNS CALLUSES INGROWN NAILS HEEL PAIN ARCH PAIN ANKLE PAIN METATARSALGIA
HOME TREATMENT FOR THIS CONDITION: __________________________________________________________________________________ _____________________________________________________________________________________________________________________________ HAVE YOU PERSONALLY EVER BEEN TREATED FOR ANY OF THE FOLLOWING CONDITIONS?
CHEST PAIN ASTHMA KIDNEY PROB ANEMIA LIVER DISEASE BLEEDING PROB FOOT ULCERS
HEART PROB ARTHRITIS BLOOD CLOTS STROKE NEUROPATHY HIGH CHOLESTEROL GOUT
SICKLE CELL DIABETES THYROID PROB CANCER STOMACH ULCERS HIGH BLOOD PRESSURE
OTHER: _____________________________________________________________________________________________________________________
I AM NOT CURRENTLY BEING TREATED FOR ANY CONDITIONS. HAS ANYONE IN YOUR IMMEDIATE FAMILY EVER BEEN TREATED FOR ANY OF THE FOLLOWING CONDITIONS?
CHEST PAIN ASTHMA KIDNEY PROB ANEMIA LIVER DISEASE BLEEDING PROB FOOT ULCERS
HEART PROB ARTHRITIS BLOOD CLOTS STROKE NEUROPATHY HIGH CHOLESTEROL GOUT
SICKLE CELL DIABETES THYROID PROB CANCER STOMACH ULCERS HIGH BLOOD PRESSURE
OTHER: ____________________________________________________________________________________ ADOPTED
NO ONE IN MY IMMEDIATE FAMILY HAS EVER BEEN TREATED FOR ANY OF THE ABOVE CONDITIONS.
PREVIOUS SURGERIES: __________________________________________________________________________________________ ______________________________________________________________________________________________ ALCOHOL: _____ NONE SOCIAL MODERATE HEAVY TOBACCO: CIG/DAY ______ HOW LONG? ______ ARE YOU PREGNANT? ______ CURRENT MEDICATIONS: ______________________________________________________________________________________ ________________________________________________________________________________________________________________
ALLERGIES: I HAVE NO ALLERGIES. I AM ALLERGIC TO THE FOLLOWING:
TYLENOL TAPE ASA KEFLEX CODIENE LATEX IODINE
PENICILLIN SULFA MORTIN DARVON NOVOCAINE DEMEROL SHELL FISH
OTHER: _________________________________________________________________________
In the Push for Global Gender Equality, Is Rhetoric Beating Out Reality?: Knowledge@Wharton( ) In the Push for Global Gender Equality, Is Rhetoric Beating Out Reality? One of the most important jobs for the United Nations inthe 21st Century is its peacekeeping missions. Becausethe U.N. has an aggressive agenda for gender equity,you might instinctively think it would ensure thatwomen play
CURRICULUM VITAE RESUMIDO Nombre Completo: Fecha de Nacimiento Posición Actual Coordinador de Infectología del Instituto Sacre CourConsultor permanente de Infectología del Hospital Municipal de Chivilcoy. Coordinador científico de ClinicalREC (www.clinicalrec.com.ar) Dirección Profesional Teléfono : (+5411)4854-4027 Móvil : (+54911)4400-7468 e-mail1: djcurcio@gm