In this paper, we propose a mobile technology model to collection information of self-assisted clinical history. The model allows the collection of patient information through a mobile application with the aim of facilitating care in health centers and clinics of Peru.It should be noted that the patient is autonomous to record their health history obtained until the date of their consultation. This technology model is implemented under a Cloud Computing platform that allows integration with the various devices for the process of capturing medical information. It also considers the flow of data processing through the services acquired, the privacy and security of data for the use of sensitive data that makes up the patient's clinical history and, finally, the management and treatment of data to ensure its availability. The transfer of patient health information is done through a security code generated in the application, in such a way that the sensitive data of the patient is visible to the doctor who requests this information.