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CUESTIONARIO DE PLOMO

Nombre del Paciente: _________________________________________________ Fecha de Nacimiento: _____________________________ ______________________________________________________________________ Nombre de Persona completando cuestionario _________________________________ Relación del Paciente

POR FAVOR CONTESTE TODAS LAS PREGUNTAS. ESTO LE VA AYUDAR A LAS DOCTORAS DECIDIR SI SU NINO O NINA NECESITA UN ORDEN ESPECIAL DE SANGRE.

SI NO

1.+ ¿Su niño o niña vive en o regularmente visita una casa con pintura que

se despega o esta despegando construida antes del año 1960? Esto puede incluir guardería, preescolar, la casa de una niñera, o familiar, etc. ___ ___

2.+ ¿Su niño o niña vive o visita regularmente una casa construida antes del ano 1960 con renovación o reconstrucción? ___ ___

3.+ ¿Su niño o niña tiene un hermano o hermana, amigo o amiga con tratamientos para plomo? ___ ___

4.+ ¿Su niño o niña vive con un adulto o frecuentemente se contacta con un adulto cual su trabajo se involucra exposición a plomo? (Construcción, soldadura, cerámica, fundación de latón/cobre, taller de automóviles) ___ ___

5.+ ¿Su niño o niña come comida o toma jugo que viene guardado en cerámica de México o que han estado guardados en lata abiertas, particularmente si las latas están importadas? ___ ___

6.+ ¿Su niño o niña vive cerca de un lugar que produce plomo o cosas conteniendo plomo? ___ ___

7.+ ¿Usted da a su niño o niña medicina tradicional que pueda contener plomo? ___ ___

8.+ ¿Su niño o niña vive cerca de una carretera principal que pueda contener plomo? ___ ___

9. ¿Su casa tiene plomería que tiene pipas de plomo o de cobre? ___ ___

10. ¿Usted tiene preguntas sobre este cuestionario para su doctora? ___ ___ !!!!!!!!!!!

Qué Usted Necesita Saber Sobre el SeguroIntercambio de Información de Salud

Los médicos y hospitales le puede daruna mejor atención médica compartiendo su información de salud electrónicamente. Esto es muy importante en casos de emergencia. Este intercambio se hace electrónicamente a través de Health Current, el intercambio de información de salud de Arizona (HIE).

Muchas oficinas de médicos y hospitales están pasando de registros médicos en papel a registros médicos electrónicos. Durante la visita de su médico más reciente, usted puede haber notado a su médico usando un portátil o una tableta para escribir su información de salud. Ahora que su información de salud se almacena de forma segura en una computadora, se puede compartir más fácilmente entre las oficinas de sus médicos, hospitales, laboratorios y centros de radiología. Su información de salud se comparte de forma segura a través del HIE.

El intercambio seguro de su información de salud tiene muchos beneficios: · Mejor tratamiento en una emergencia porque sus médicos tendrán información sobre sus alergias y sus

problemas anteriores.· Prevención de errores y de interacciones dañinas entre los medicamentos.· Disminuir los costos generales de la atención médica evitando pruebas duplicadas, procedimientos y

prescripciones.

Para obtener detalles sobre cómo su información de salud será compartida y cómo va a ser protegido, por favor leer el Aviso de Prácticas de Información de Salud que recibe en el consultorio de su médico.

NOTA: Si usted no desea que su información de salud sea compartida a través de HIE, por favor pregunte a su proveedor por un de exclusión “opt-out ”. Para obtener más información, visite www.healthcurrent.org y haga clic en el botón Derechos del Paciente.

H-HealthCurrentWhatYouNeedtoKnowSpanish_Final_Generic_03-09-18

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