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    Fiha Medica

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    Giaggo Dantas
    This document contains a health form/medical exam for players in a regional youth soccer league in Ucayali, Peru. The form includes sections for the player's personal information, anthropometric data, medical history, clinical exam findings, and exam results. The form is used to determine if a player is medically cleared/approved or disqualified from participating in the league.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Fiha Medica

    Uploaded by

    Giaggo Dantas
    8 views3 pages
    This document contains a health form/medical exam for players in a regional youth soccer league in Ucayali, Peru. The form includes sections for the player's personal information, anthropometric data, medical history, clinical exam findings, and exam results. The form is used to determine if a player is medically cleared/approved or disqualified from participating in the league.

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    FIHA MEDICA

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    This document contains a health form/medical exam for players in a regional youth soccer league in Ucayali, Peru. The form includes sections for the player's personal information, anthropometric data, medical history, clinical exam findings, and exam results. The form is used to determine if a player is medically cleared/approved or disqualified from participating in the league.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    8 views3 pages

    Fiha Medica

    Uploaded by

    Giaggo Dantas
    This document contains a health form/medical exam for players in a regional youth soccer league in Ucayali, Peru. The form includes sections for the player's personal information, anthropometric data, medical history, clinical exam findings, and exam results. The form is used to determine if a player is medically cleared/approved or disqualified from participating in the league.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    COMISIÓN REGIONAL DE FUTBOL DE COMISIÓN REGIONAL DE FUTBOL DE

    MENORES DE UCAYALI MENORES DE UCAYALI

    FICHA SANITARIA FICHA SANITARIA


    EXAMEN PRELIMINAR EXAMEN PRELIMINAR
    1.- FILIACIÓN INDIVIDUAL 1.- FILIACIÓN INDIVIDUAL

    Apellidos y Nombres: Apellidos y Nombres:


    Edad: Años Raza: Edad: Años Raza:
    Profesión anterior: Natural de: Profesión anterior: Natural de:
    Condición: 3.-ANTECEDENTES PATOLÓGICOS Condición: 3.-ANTECEDENTES PATOLÓGICOS
    Hereditarios: Hereditarios:
    2.- DATOS ANTROPOMÉTRICOS 2.- DATOS ANTROPOMÉTRICOS
    Estatura cms. Estatura cms.
    Personales: Personales:
    Peso: Kls. Peso: Kls.
    Extensión toráxica: cms. Extensión toráxica: cms.
    4.- EXAMEN CLÍNICO 4.- EXAMEN CLÍNICO
    Ap. Respiratorio Tegumento Externo Ap. Respiratorio Tegumento Externo

    Examen Radiolog. Pulm. (2) Sistema Linfático Endocrino Examen Radiolog. Pulm. (2) Sistema Linfático Endocrino

    Ap. Circulatorio Sistema Nervioso Ap. Circulatorio Sistema Nervioso

    Ap. Digestivo y anexos Organo de Visión Ap. Digestivo y anexos Organo de Visión

    Ap. Génito Urinario Organo de Audición Ap. Génito Urinario Organo de Audición

    Ap. Locomotor Dental Ap. Locomotor Dental

    5.- RESULTADO 5.- RESULTADO


    Apto: Causa Apto: Causa
    Inapto: Fecha: Inapto: Fecha:
    Lugar: Firma: Lugar: Firma:
    FICHA SANITARIA
    EXAMEN PRELIMINAR

    1.- FILIACIÓN INDIVIDUAL

    Apellidos y Nombres:
    Edad: Años Raza:
    Profesión anterior: Natural de:
    Condición: 3.-ANTECEDENTES PATOLÓGICOS
    Hereditarios:
    2.- DATOS ANTROPOMÉTRICOS
    Estatura cms.
    Personales:
    Peso: Kls.
    Extensión toráxica: cms.
    4.- EXAMEN CLÍNICO
    Ap. Respiratorio Tegumento Externo

    Examen Radiolog. Pulm. (2) Sistema Linfático Endocrino

    Ap. Circulatorio Sistema Nervioso

    Ap. Digestivo y anexos Organo de Visión

    Ap. Génito Urinario Organo de Audición

    Ap. Locomotor Dental

    5.- RESULTADO
    Apto: Causa
    Inapto: Fecha:
    Lugar: Firma:
    LIGA DEPORTIVA PROVINCIAL DE FUTBOL
    DE CORONEL PORTILLO

    FICHA SANITARIA
    EXAMEN PRELIMINAR

    1.- FILIACIÓN INDIVIDUAL

    Apellidos y Nombres:
    Edad: Años Raza:
    Profesión anterior: Natural de:
    Condición: 3.-ANTECEDENTES PATOLÓGICOS
    Hereditarios:
    2.- DATOS ANTROPOMÉTRICOS
    Estatura cms.
    Personales:
    Peso: Kls.
    Extensión toráxica: cms.
    4.- EXAMEN CLÍNICO
    Ap. Respiratorio Tegumento Externo

    Examen Radiolog. Pulm. (2) Sistema Linfático Endocrino

    Ap. Circulatorio Sistema Nervioso

    Ap. Digestivo y anexos Organo de Visión

    Ap. Génito Urinario Organo de Audición

    Ap. Locomotor Dental

    5.- RESULTADO
    Apto: Causa
    Inapto: Fecha:
    Lugar: Firma:

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