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REPORTE EVENTO ADVERSO
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Fecha
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Regional
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Nombre Completo del Paciente
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Número de identificación del paciente reportado
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Edad del paciente
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Realice una descripción del evento evidenciado
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Clasificación inicial del evento
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Evento Adverso
Incidente
Complicación
Nombre de quien reporta
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Cargo de quien reporta
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