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INFORMACION DEL PACIENTE Y EL EMBARAZO
  

INFORMACION DEL PACIENTE Y EL EMBARAZO











INFORMACIÓN SOBRE SU PAREJA (Si está embarazada, “pareja” se refiere al papá del bebé)






INFORMACIÓN PARA COMUNICARNOS CON EL PACIENTE Y AUTORIZACIÓN





No
móvil casa trabajo
No Sí        Si su respuesta es “Sí”, complete a continuación:



  • Usted como paciente tiene el derecho de revocar este permiso
  • El paciente asume responsabilidad por la información dejada en el correo de voz confidencial

INFORMACIÓN DEL DOCTOR O CLINICA QUE LE REFIRIÓ:






INFORMACIÓN SOBRE EXPOSICIONES Y EL EMBARAZO

NO
NO


Desde que se embarazó, ha tenido o tomado:

(o si no está embarazada indique a que ha estado expuesta)

NO
NO SÍ     
NO SÍ     
NO SÍ     
NO SÍ     

¿Tiene usted las siguientes condiciones?

NO
NO
NO
NO
NO

TODA LA INFORMACIÓN ANTES MENCIONADA ES CORRECTA SEGÚN MI SABER Y ENTENDER



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What our patients say

"I just wanted to say THANK YOU. I have read up on quite a bit of expecting moms experiences with their ultrasounds around the country and they were less then favorable, some horrible. But our (my husband and I) visit to your Baptist office was wonderful. The office is nice and decor is great. The tech was patient and educated. She answered all our questions, some before we even asked. She gave us her undivided attention and took her time. I am looking forward to my next appointment. Great service provided!" Ronnita W.,  Miami

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6200 Sunset Drive, Suite 301, South Miami, FL 33143, Office: (305) 669-9521, Emergency: (305) 669-9521, Fax: (305) 669-9735
11760 S.W. Bird Road, Suite 329, The Atrium Medical Building, Miami, FL 33175, Office: (786) 621-5300, Fax: (786) 621-5303
Mount Sinai Medical Center, Professional Medical Building, 4308 Alton Road, Suite 730, Tel: (305) 403-1234, Fax: (305) 403-0345
Ft. Lauderdale Office, 3107 Stirling Rd, Suite 106, Ft Lauderdale, Fl 33312, Tel: 305-859-7809, Fax: (305) 859-7790
North Shore Medical Ctr. 1190 NW 95 ST, Suite 204, Miami, FL 33150, Office: (305) 691-2180, Fax (305) 691-2182
Hialeah Hospital Medical Arts 777 East 25 ST, Suite 402, Hialeah, FL 33013, Tel: 305-835-7909, Fax: 305-835-9353