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Specialized Urology Previous contact

Previous contact

Every collaboration begins
with the dialog, request a

consult us

NOMBRE COMPLETO 01

TELÉFONO / FIJO / MÓVIL02

CORREO ELECTRÓNICO 03

SEXO 04

FECHA DE NACIMIENTO 05

ESTADO CIVIL 06

Have you been referred or referred by another doctor? Yes, No, who refers you? 07

Reason for querying
Explain why you are querying 08

History of current disease
Briefly describe the symptoms, when they started and the treatment received so far 09

Have you suffered from any of the following conditions?

Others: Which ones have you suffered? 10

Past Surgical History 11 Surgery Performed, Date, Reason for surgery

Have you ever had any of the following treatments or procedures? 12 01. Radiation therapy / Why? Number of treatments or sessions / In which hospital? & nbsp; 02. Chemotherapy / Why? What drugs did they use? Where was the Treatment administered? & nbsp; 03. Transfusions / Why?

Has there been a history of cancer or hereditary disease in the family? 13 If it is cancer, explain the type of tumor and who in the family presented it

List all medications you are currently taking. Include if you take vitamins or natural products. 14 Indicate the name of the medicine, how often you take it and the dose (mg or tab)

Have you had allergies to medications or to another substance? 15 If so, please mention the drug or substance and what type of reaction did it occur.

Describe your weight and height. 16 Have you had a change in weight in the last year? Explain how many kilograms.

Do you smoke or have you smoked? / If yes, 17 How many cigarettes do you smoke a day? How long have you smoked? If I already quit smoking, when did you quit?

Comments or additional questions 18 that you have for the specialist

He leído y acepto las condiciones de tratamiento de datos // Click here.

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address/ cra 48 # 19a-40 cons. 1614

torre médica ciudad del río

phone/ 4448874 /304 418 0860

dirección /Calle 78B No.69-240 / cons. 146

Hospital Pablo Tobón Uribe Medellín - Colombia.

teléfono / 445 9146 / 304 396 5303

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Specialized Urology Previous contact

VISIT US

Torre Médica Ciudad del Río
Cra. 48 No. 19A - 40
Medellín - Colombia.

GOOGLE MAPS

Hospital Pablo Tobón Uribe Calle 78B No.69-240 Medellín - Colombia.

GOOGLE MAPS

Every collaboration begins
with the dialog, request a

consult us

Have you suffered from any of the following conditions?

address/ cra 48 # 19a-40 cons. 1614

torre médica ciudad del río

phone/ 4448874 /304 418 0860

dirección /Calle 78B No.69-240 / cons. 146

Hospital Pablo Tobón Uribe Medellín - Colombia.

teléfono / 445 9146 / 304 396 5303

Facebook Twitter Instagram

Data protection policy

Conoce nuestro perfil

Specialized Urology Previous contact

VISIT US

Torre Médica Ciudad del RíoCra. 48 No. 19A - 40Medellín - Colombia.

GOOGLE MAPS

Hospital Pablo Tobón Uribe Calle 78B No.69-240 Medellín - Colombia.

GOOGLE MAPS

Every collaboration begins with the dialog, request a

consult us

Have you suffered from any of the following conditions?

address/ cra 48 # 19a-40 cons. 1614

torre médica ciudad del río

phone/ 4448874 /304 418 0860

dirección /Calle 78B No.69-240 / cons. 146

Hospital Pablo Tobón Uribe Medellín - Colombia.

teléfono / 445 9146 / 304 396 5303

Facebook Twitter Instagram

Data protection policy

Torre Médica Ciudad del Río
Cra. 48 No. 19A - 40
Medellín - Colombia.

Every collaboration begins
with the dialog, request a