Выписной эпикриз

Паспорные данные:___________________________________________________________

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Направлен:___________________________________________________________________

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Диагноз при поступлении:_____________________________________________________

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Жалобы:_____________________________________________________________________

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Anamnesis morbi:______________________________________________________________

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Anamnesis vitae:_______________________________________________________________

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Объективное исследование:____________________________________________________

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Данные дополнительного обследования:_________________________________________

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Динамика за время лечения:___________________________________________________

Заключительный диагноз: Основной____________________________________________

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Осложнения__________________________________________________________________

Сопутствующие заболевания___________________________________________________

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Рекомендации:________________________________________________________________

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Отметка о трудоспособности:___________________________________________________

Лечащий врач:_________________________ Зав. отделением:_______________________

ПРОГНОЗ

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