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Interconsulta 3
Interconsulta 3
NOMBRE:
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EMPRESA:
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ESPECIALIDAD MÉDICA:
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MOTIVO DE CONSULTA:
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FIRMA Y SELLO
MEDICO OCUPACIONAL
RESPUESTA A LA INTERCONSULTA
EVALUACIÓN:
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DIAGNÓSTICO:
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INDICACIONES MÉDICAS:
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FIRMA
CMP: