Formulario Emp PDF Details

At the heart of public health efforts to support adult wellness lies the detailed and comprehensive Formulario Emp form, a document designed to streamline the collection of essential health data within community health centers. This form encapsulates a wide range of health screenings tailored for adults from the age of 15 and beyond, including assessments for alcohol use, smoking habits, obesity, hypertension, diabetes mellitus, syphilis in those at high risk, and tuberculosis. It does not stop at identifying health issues but further guides the next steps toward healthier lifestyle choices through counseling or referrals for more detailed examinations. For women aged 25 to 64, there's a special focus on cervical cancer screening, with recommendations for Pap smear tests, and for those 40 years and older, it checks for dyslipidemia to assess the risk of heart disease. Additionally, women 50 years and older are advised on breast cancer screening through mammography. This form serves not only as a snapshot of an individual's current health status but as a proactive approach to mitigating potential health risks, underpinning the importance of early detection and prevention in maintaining long-term health and well-being.

QuestionAnswer
Form NameFormulario Emp
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesemp pdf, formulario emp pdf, formulario de medicina, formulario empa pdf

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COMUNA

CENTRO฀DE฀SALUD

Nº฀DE฀FICHA

SECTOR

FECHA

EXAMEN฀DE฀MEDICINA฀PREVENTIVA฀DEL฀ADULTO

IDENTIFICACIÓN

NOMBRE:

Fecha฀de฀Nacimiento

Dirección

PREVISIÓN

SEXO M

Edad:

 

 

años

R.U.T.:

 

 

 

 

 

Fono:

F

PERSONAS DE 15 AÑOS Y MÁS

a.฀฀฀฀Beber฀Problema

฀฀฀฀฀฀฀¿Consume฀bebidas฀alcohólicas?

b.฀฀฀฀Tabaquismo

 

 

c.฀฀฀฀Obesidad

 

 

 

 

 

 

 

 

 

Kg

Peso

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IMC

 

 

 

 

 

 

 

Talla

 

 

 

 

 

 

Kg

 

 

 

 

 

 

 

 

 

Circunferencia฀Cintura:฀

d.฀฀฀฀Hipertensión฀arterial

 

 

 

 

 

mmHg

PAS

 

 

 

 

 

 

 

 

 

mmHg

 

 

PAD

 

 

 

 

 

 

 

 

 

 

 

 

 

No฀

¿Usted฀fuma?No฀

25-29 Sobrepeso No฀

30

Obesidad

No฀

cm

 

Mujer฀≥฀฀88฀cms

No฀

 

Hombre ≥฀฀102฀cms

No฀

 

 

≥฀฀140฀mm฀Hg No฀

 

 

≥ ฀90฀mm฀Hg

No฀

Si

Si

Si Si

Si

Si

Si Si

AUDIT

 

 

puntos Consejería฀según฀tipo฀de฀consumo

 

 

 

 

Consejería฀Breve

Consejería฀en฀alimentación฀saludable฀y฀actividad฀física

Referir฀a฀Perfil฀de฀Presión฀Arterial

e.฀฀฀฀Diabetes฀Mellitus฀(DM)

Mayor฀40฀años,฀obeso฀o฀antec.฀DM฀en฀padre,฀฀madre฀o฀hermanos

 

Glicemia฀ayunas

 

 

 

mg/dL

100฀-฀125฀mg/dL฀

No฀

 

 

 

 

 

 

 

 

≥ ฀126฀mg/dL฀

No฀

 

 

 

 

 

f.฀฀฀฀฀Sífilis฀en฀persona฀con฀conductas฀de฀riesgoNo฀

Hombres฀que฀tienen฀sexo฀con฀otros฀hombres, trabajadores฀sexuales,฀los฀que฀intercambian฀drogas por฀sexo฀y฀las฀personas฀en฀centros฀de฀reclusión.฀

g.฀฀฀฀Tuberculosis

¿Ha฀tenido฀tos฀productiva฀por฀más฀de฀15฀días?No฀

Si

Si

Si

Si

Consejería฀en฀alimentación฀saludable฀y฀actividad฀física

Referir฀a฀confirmación฀diagnóstica

VDRL฀o฀RPR Negativo

Positivo

 

฀Referir฀a฀Programa฀ETS

 

 

 

Baciloscopía

(1a฀muestra฀de฀inmediato฀y฀entrega฀de฀2a฀caja)

MUJERES DESDE 25 A 64 AÑOS

Cáncer฀cervicouterino

Fecha฀último฀Papanicolaou

PERSONAS DE 40 Y MÁS AÑOS

Dislipidemia

Colesterol฀total

2

0

0

 

PAP฀vigente

Si฀

mg/dL

200฀-฀239฀mg/dL

No฀

 

≥ ฀240฀mg/dL

No฀

No

Si

Si

Toma฀de฀PAP

NormalAlterado

Consejería฀en฀alimentación฀saludable฀y฀actividad฀física Referir฀a฀confirmación฀diagnóstica

MUJERES DE 50 AÑOS

Cáncer฀de฀mama

Mamografía

No฀

Mamografía฀a฀otras฀edades

No฀

Si

Si

Normal

 

Alterada

Normal

 

Alterada

 

 

 

 

 

Observaciones:

Nombre del responsable:

 

Firma:

 

How to Edit Formulario Emp Online for Free

There is nothing complex about completing the empa formulario once you open our PDF editor. By following these simple steps, you'll receive the fully filled out document in the minimum time period possible.

Step 1: The initial step should be to click the orange "Get Form Now" button.

Step 2: At this point, you can begin editing your empa formulario. The multifunctional toolbar is available to you - insert, eliminate, change, highlight, and conduct many other commands with the text in the form.

Fill out the empa formulario PDF by providing the data necessary for every single section.

entering details in formulario examen de medicina preventiva del adulto part 1

In the PERSONAS DE AÑOS Y MÁS, aBeberProblema, bTabaquismo, Ustedfuma, cObesidad, Peso, Talla, IMC, Sobrepeso, Obesidad, CircunferenciaCintura, Mujercms, dHipertensiónarterial, PAS, and PAD field, note down your information.

Entering details in formulario examen de medicina preventiva del adulto stage 2

In the field referring to VDRLoRPR, Negativo, Positivo, ReferiraProgramaETS, gTuberculosis, Hatenidotosproductivapormásdedías, Baciloscopía, and amuestradeinmediatoyentregadeacaja, you need to note down some significant data.

part 3 to filling out formulario examen de medicina preventiva del adulto

The Cáncercervicouterino, FechaúltimoPapanicolaou, PERSONAS DE Y MÁS AÑOS, PAPvigente, TomadePAP, Normal, Alterado, Colesteroltotal, mgdL, mgdL, mgdL, MUJERES DE AÑOS Cáncerdemama, Mamografía, Mamografíaaotrasedades, and Observaciones field is going to be place to put the rights and obligations of either side.

step 4 to filling out formulario examen de medicina preventiva del adulto

Step 3: Select "Done". Now you can upload the PDF file.

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