Ўзбекистон Республикаси Соғлиқни сақлаш вазирлиги Муассаса номи
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027-Тиббий муассасадаги беморнинг тиббий баённомасидан кучирма
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- Кўчирма юборилаётган муассаса номи, манзили
- Ўзбекистон Республикаси
Формат А–5
Тиббий муассасадаги беморнинг амбулатор картасиданКЎЧИРМА ______ ______________________________________________________________________________ ______________________________________________________________________________ Кўчирма юборилаётган муассаса номи, манзили1. Ф.И.Ш. _____________________________________________________________________ 2. Туғилган сана, кун_____ой__________________йил _______________________________ 3. Яшаш жойи __________________________________________________________________ 4. Иш жойи, бажарадиган вазифаси ________________________________________________ 5. Саналар: а) амбулаторияда: касаллик ___________________________________________ шифохонага йўлланди _________________________________________________ б) шифохонада: қабул қилинди ___________________________________________ чиқарилди ___________________________________________________ 6. Тўлиқ ташхис (асосий касаллик, асорати)_________________________________________ _______________________________________________________________________________ 7. Қисқача анамнез, диагностик текширув, касалликнинг давомийлиги, жаррохлик амалиёти утказилганлиги, амалиётдан кейинги холати, бемор келгандаги ва шифохонадан чикарилгандаги холати ________________________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________ ____________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________ ____________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________ Даво ва меҳнат тавсияномаси ___________________________________________ ____________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________ ОТКТМП мудири: Шифокор: Формат А–5
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