Ficha Diag.docx

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FECHA DIAGNOSTICA DE LA ALUMNA I. DATOS PERSONALES Apellidos y nombres:………………………………………………………………………………………………………………………. Dirección:………………………………………………………………………………………………………………………………………… Teléfono:………………………………………………….Fecha de Nacimiento:…………………………….Edad:…………….. Lugar: ……………………………………………………………………………………………………………………………………………….Talla: …………………………………. Peso:……………………… Sufre de alguna enfermedad (especificar la enfermedad que tiene y presentar certificado médico si lo tuviese): ………………………………………………………………………….………………………………………………………………………………………………………………..

Firma del Padre

Frof. Benigno Gomez Huaroc

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