O’zbekiston Respublikasi O’zbekiston Respublikasi
Sog’liqni saqlash vazirligi Sog’liqni saqlash vazirining
________________________________ 2022 yil 17 yanvardagi №16-sonli
Muaccaca nomi buyrug’i bilan tasdiqlangan
025-2.1-raqamli tibbiy hujjat shakli
Ambulatoriya poliklinika muassasasining
ALMASHISH KARTASI
Homilador ayol xaqida ma’lumoti (har bir
homilador uchun to’ldirilib, 30 haftasida qo’liga beriladi)
1. Familiyasi, ismi________________________________________________________________
2. Yoshi
____________ 3.
Manzili ________________________________________________
4. Umumiy, ginekologik kasalliklar,
operatsiyalar _______________________________________ ________________________________________________________________________________
5. Avvalgi homilalar, tug’ish, tug’ishdan keyingi davr o’ziga
xos kechishi ____________________ ________________________________________________________________________________
6. Nechanchi homila
___________________ tug’ish
_____________________________________
7. Abortlar bo’lgan
_______________________(qanday ko’rsatilsin)
________________________
8. Muddatidan ilgari tug’ruq
_____________________________ yil
________________muddati
Muddatdagi tug’ruqlar
____________________________________________________________
9.
Oxirgi xayz __________________________________________________________________
10. Birinchi kelishida aniqlangan
________________homiladorlik
________________________ muddati
_______________haftalik
_______________________ “____ “___________20 ___ yil
11.
Jami qatnashlar soni __________________________________________________________
12. Homilaning birinchi bor qimirlashi (sana, oy, yil)
___________________________________
13. Mazkur homiladorlik davrining o’ziga xos kechishi
__________________________________
