Kasallik tarixi bajardi: Qabul qildi: Pasportga oid ma’lumotlar

KASALLIK TARIXI
Bajardi:_____________________________________________

Qabul qildi:_____________________________________________

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 _________________________________________________________________
   

_____________________________________________________________________________________

9. 
   Kelgan vaqti – ________20_____, ketgan vaqti – ________20_____
   

Bemorning kasalxonaga tushgandagi shikoyatlari:

Asosiy shikoyatlar: ___________________________________________________________________ _____________________________________________________________________________________

Ikkinchi darajali shikoyatlar: _________________________________________________________ _____________________________________________________________________________________

Anamnesis morbi:

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