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Evaluación Inicial de tu Caso
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Nombre y Apellido 
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Fecha de nacimiento
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Cédula 
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Teléfono
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Ciudad
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Historial del Paciente
Motivo de consulta
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¿Te has practicado alguna cirugía nasal previamente? 
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Si es "Si" especifique e incluya la fecha
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¿Has sufrido alguna fractura nasal? 
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¿Te has realizado algún tratamiento de rinomodelación? 
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¿Respiras bien por la nariz?

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Si es "No" especifique
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Describa brevemente los objetivos que pretende alcanzar con la cirugía
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Vista frontal
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Vista Perfil Derecho
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Vista Perfil Izquierdo 
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Vista Oblicua Derecha
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Vista basal 
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Vista Oblicua Izquierda
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