Buxoro davlat tibbiyot instituti

O’ZBEKISTON RESPUBLIKASI SOG’LIQNI SAQLASH VAZIRLIGI

BUXORO DAVLAT TIBBIYOT INSTITUTI

FAKULTET:_______________________________________________

GURUH: __________________________________________________
KAFEDRA: ________________________________________________
FAN: _____________________________________________________
KASALLIK TARIXI

Bajardi:___________________________

Qabul qildi:__________________________

Buxoro- 2023

1. 
   Pasportga oid ma’lumotlar:
   

1. 
   Bemorning familiyasi, ismi, otasining ismi __________________________________________
   
2. 
   Yoshi __________
   
3. 
   Ma’lumoti____________________________________________________________________
   
4. 
   Ish joyi ______________________________________________________________________
   
5. 
   Millati _______________________________________________________________________
   
6. 
   Turar joyi ____________________________________________________________________
   
7. 
   Bemorning yo'llanmadagi diagnozi _______________________________________________
   

_______________________________________________________________________________

8. 
   Dastlabki diagnoz ______________________________________________________________
   

_______________________________________________________________________________

2. 
   Bemorning kasalxonaga tushgandagi shikoyatlari:
   

Asosiy shikoyatlar _______________________________________________________________ _______________________________________________________________________________

Ikkinchi darajali shikoyatlar:________________________________________________________ ________________________________________________________________________________