Conocer los resultados que se obtengan con respecto al niño

Respeto a la integridad física y moral del mismo, que se mantenga la máxima discreción en todo momento y el manejo confidencial de la información recogida.

Retirarme en cualquier momento del estudio si tal es mi deseo.

Nombre:                                                                                                        

CI                                                                                                     

Firma:                                                                                                            

Nombre del participante                                                                                             

Edad:                         

Anexo Nº 2. UNIVERSIDAD DE CARABOBO. FACULTAD DE CIENCIAS DE LA SALUD. ESCUELA DE MEDICINA

DATOS DEL ESTUDIANTE:

Nombre:                                                                                                                               

Apellidos:                                                                                                                             

Dirección:                                                                                                                             

Número telefónico de contacto: ____________________________

Fecha y lugar de nacimiento:                                                                                                 

Edad: __________

Sexo:               F                      M

Antecedentes familiares directos de:

DM _________ Sobrepeso ___________ Obesidad ____________

Estratificación Social: Método de Graffar:

Peso_________ Talla_________

IMC: ________________ Dx nutricional_______________________________

TA_______________

Glicemia en ayunas_______________

Colesterol total __________ HDL ___________ TAG ___________ LDL ___________

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