Código: DS-AT-FT-058
Versión: 001 Nota operatoria
Fecha: 03-09-2021
FECHA________________________________________________________________________________________________
PACIENTE ____________________________________________________________________________________________
OPERADOR ___________________________________________________________________________________________
AUXILIAR _____________________________________________________________________________________________
DOCENTE ASESOR ___________________________________________________________________________________
DIAGNÓSTICO PREOPERATORIO ___________________________________________________________________
DIAGNÓSTICO POSTOPERATORIO _________________________________________________________________
HALLAZGOS __________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
DESCRIPCIÓN DEL PROCEDIMIENTO
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
FIRMA DEL PACIENTE O RESPONSABLE __________________________________________________
FIRMA DEL ESTUDIANTE _________________________________________________
FIRMA DEL DOCENTE __________________________________________________
Página 1 de 1
