Post on 04-Mar-2016
INFORME MEDICO PROTOCOLIZADO
COMPIN
Subsecretara de Salud Pblica
Ministerio de Salud
INFORME MEDICO
(Se solicita escribir con letra imprenta, legible y llenar todos los campos)1. Nombre trabajador(a): _____________________________________________________
RUN :_______________________
2. DIAGNOSTICO(S)
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Breve historia con fundamentos clnicos y/o de laboratorio y/o de imagenologa en que se basa el diagnstico:
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Evolucin, tratamientos mdicos y/o quirrgicos efectuados (fecha de operacin, si procede), resultados obtenidos:
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Indicar pronstico de la enfermedad desde el punto de vista laboral y fecha probable de alta.
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3. Conclusin u otros comentarios
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En caso de irrecuperabilidad:
Debe iniciar trmite de invalidez a contar de:____________________________
4. Datos del mdico tratante:
_____________________________________________________________________________Nombre
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Direccin de la consulta o Institucin a la cual pertenece._____________________________________________________________________________Nombre, firma y timbre de mdico tratante.
(Favor no poner el timbre sobre el nombre)Telfono:_____________________Fecha del informe : _____/_____/____
Correo electrnico: __________________________________________