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

Siydik ajratish organlarini tekshirish:
Bemorning shikoyatlari:___________________________________________________________
Bemorning buyraklar soxalari ko’zdan kechirilganda:__________________________________ ________________________________________________________________________________________________________________________________________________________________


Asab-ruxiy sfera va sezgi organlari:
Bemorning shikoyatlari:___________________________________________________________
Bemor ko’zdan kechirilganda: _______________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Dastlabki taxminiy diagnoz:

• 
  Dastlabki tashxis ________________________________________________________________
  

____________________________________________________________________________________

• 
  Asorati: _______________________________________________________________________
  

Tekshiruvlar rejasi:

Tekshiruvlar ro’yxati

Laboratoriya va instrumental tekshirish natijalari:
___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________