kasallik tarixi rasmiy blankasi

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щзбекистон республикаси o‘zbekiston respublikasi soliqni saqlash vazirligi ________________________________ muassasaning nomi qtut bo‘yicha muassasa kodi _______ o‘zb.rssv 25.12.2017y. №777 buyruq bilan tasdiqlangan 003-raqamli tibbiy hujjat shakli shifoxonadagi bemorning tibbiy bayonnomasi № ____________ kasalxonaga yotqizilgan kuni va vaqti_______________________________________ kasalxonadan chiqarilgan kuni va vaqti______________________________________ __________________________bo‘limi, xona №_____________________________ bo‘limga_____________________________________________________________ ___________________________________________________________ o‘tkazilgan ______________________________________kun yotib davolangan______________ bemorni olib yurish turlari: aravachada, zambilda, o‘zi yura oladi (chizing) qon guruhi______________________rezus mansubligi________________________ dorilarning nojo‘ya ta’siri ___________________________________________________________________ (dorining nomi, nojo‘ya ta’sirning ko‘rinishi) ___________________________________________________________________ 1. familiyasi, ismi ___________________________________________________ ____________________________2. jinsi________________________________ 3. yoshi______________(to‘liq yosh, bolalar uchun: 1 yoshgacha-oylar hisobida 2 oygacha-kunlar hisobida) 4. doimiy yashash joyi:shahar, qishloq (chizing) ___________________________________________________________________ (yashash joyi ko‘rsatilsin, viloyat va tumanlardan kelganlar uchun manzili va yaqin ___________________________________________________________________ qarindoshlarining yashash joyi va telefon raqamlari ko‘rsatilsin) 5. ish joyi, kasbi, lavozimi____________________________________________ ________________________________________________________________________ (o‘quvchilar uchun-o‘qish joyi: bolalar uchun-bolalar muassasasining nomi, ___________________________________________________________________ nogironlar uchun-nogir

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onlikning turi va guruhi; urush nogironi ___________________________________________________________________ ha, yo‘q) 6. bemor qaerdan yuborilgan______________________________________________ (davolash muassasasining nomi) 7. kasalxonaga shoshilinch ravishda keltirilgan: ‘a, yo‘q__________________________ qanday transportda____________________________________________________ kasallik boshlangandan so‘ng o‘tgan vaqt,jarohatdan so‘ng, rejali ravishda (chizing) 8. bemor yo‘llanmasidagi tashxisi__________________________________________ ___________________________________________________________________ ___________________________________________________________________ 9. qabulxonada qo‘yilgan tashxis___________________________________________ 10. kasalxonada qo‘yilgan tashhis kasallik aniqlangan sana shifokor imzosi 11. kasalxonada qo‘yilgan yakuniy tashxis a) asosiy_____________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ b) asosiy kasallikning asorati_____________________________________________ ____________________________________________________________________ v) aniqlangan hamroh kasalliklar___________________________________________ ____________________________________________________________________ __________________________________________________________________ 12. mazkur yil davomida shu kasallik bo‘yicha kasalxonaga yotishi: birinchi marta,qayta (chizing) hammasi bo‘lib______________________________marta 13. jarrohlik operatsiyalari, og‘riqsizlantirish usullari va operatsiyadan keyingi asoratlar operatsiya nomi vaqti, soati og‘riqsizlantirish usuli asoratlari 1. 2. 3. operatsiya qiluvchi_________________________________ 14. davolashning boshqa turlari (ko‘rsating)__________________________________ ____________________________________________________________________ 15.mehnatga yaroqsizliq varog‘i yoki ma’lumotnoma

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: №__________________________dan ___________________gacha №_____________________dan_________________gacha 16. davolash natijasi: kasalxonadan javob berildi: tuzaldi, bir oz yaxshilandi, o‘zgarishsiz, og‘irlashgan holda, o‘ldi, boshqa muassasaga o‘tkazildi ____________________________________________________________________ (davolash muassasasining nomi) qabulxonada vafot etdi, homiladorlikning 28-haftasigacha vafot etdi, homiladorlikning 28-haftasidan keyin vafot etdi, tug’ish oldidan vafot etdi, tuqqandan so‘ng vafot etdi. 17. mehnat qobiliyati tiklandi, sustlashdi, vaqtincha yo‘qoldi, mazkur kasallik sababli butunlay yo‘qoldi, boshqa sabablarga ko‘ra (chizing). 18. ekspertizaga yuborish uchun xulosa________________________________________ ____________________________________________________________________ 19. alohida belgilar____________________________________________________ 20. qabul qilinganda tekshirildi a) qonrw va oits b) axlat posevi v) pedikulyoz g) mavhum kasalliklar_____________________________________________________ davolash shifokori__________________ bo‘lim mudiri____________________ familiya imzo imzo qabulxona vrachining yozuvi bemor f.i. ______________________________________________________ yoshi_________ sana _________ harorat ____________puls______________ nafas _________________ vazni ________ (vazn yetishmov ___________) bo‘yi________ (bo‘y yetishmov___________) bemorning shikoyatlari _________________________________________________________ ________________________________________________________________________________________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ anam. morbi bola qachondan beri kasal ______________________________________________________ kasallik qanday boshlangan ____________________________________________________ ____________________________

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________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ kasallikning kechishi __________________________________________________________ ________________________________________________________________________________________________________________________________________________________ ____________________________________________________________________________ qayerlarda davolangan _________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ davolanish natijalari_________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________dori-darmonlarga reaksiyasi ____________________________________________________ ____________________________________________________________________________ anam.vitae nechanchi homiladorlikdan __________________ nechanchi farzand ____________________ onada homiladorlik qanday kechgan: toksikoz______________________________________, homiladorlik asoratlari ______________________________________________________, homiladorlik paytida ovqatlanishi_________________________________________, tug‘ruq jarayonining kechishi_____________________________________________________, tug‘ilgandagi vazni_________________ bo‘yi_________, 1-marta ko‘krakga qachon berilgan_________________________, kindik yarasi qachon bitgan___________, chaqaloqlik davrida o‘tkazgan kasalliklari________________________________________ ______________________________________________________

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______________________ __________________________________________________________________________________________________________________________________________________________ tug‘ruqxonadan qachon uyga chiqarilgan______________, bolaning rivojlanishi _____________________________________, bolaning ovqatlanishi___________________ ___________________________________________________________________________, tishlari qachon chiqa boshlagan____________________________________________, o‘tkazgan kasalliklari________________________________________________________ ____________________________________________________________________________ ___________________________________________________________________________, profilaktik emlashlar_______________________________________________________ ota-onasining salomatlik holati _______________________________________________ nasliy kasalliklar ___________________________________________________________ epid. anamnez har bir yuqumli kasallikning eng uzoq muddatli yashirin davri davomida yashash yoki ro‘yxatda turish, ish yoki o‘qish joyida (tagiga chizilsin) yuqumli kasalliklar (ich terlama, paratif, boshqa salmonellyoz, dizenteriya, boshqa uii, virusli gepatitlar, sil, tanosil kasalliklari) (tagiga chizilsin) bilan og‘rigan bemor bilan muloqotda bo‘lganmi (qaysi vaqtdan qaysi vaqtga qadarligi qayd etilsin) _____________________________________ ushbu kasallikka chalingunga qadar oyining 2 haftasi ichida aholi yashash joyidan tashqariga chiqqanmi. bo‘lgan joyi va qaytib kelgan sanasi __________________________ ____________________________________________________________________________ (qayd etilsin) qaysi yuqumli kasalliklar bilan kasallangan? ____________________________________ _______________________________________________________________________________________________________________________________________________________ ____________________________________________________________________________ (qayd etilsin) statsio

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щзбекистон республикаси o‘zbekiston respublikasi soliqni saqlash vazirligi ________________________________ muassasaning nomi qtut bo‘yicha muassasa kodi _______ o‘zb.rssv 25.12.2017y. №777 buyruq bilan tasdiqlangan 003-raqamli tibbiy hujjat shakli shifoxonadagi bemorning tibbiy bayonnomasi № ____________ kasalxonaga yotqizilgan kuni va vaqti_______________________________________ kasalxonadan chiqarilgan kuni va vaqti______________________________________ __________________________bo‘limi, xona №_____________________________ bo‘limga_____________________________________________________________ ___________________________________________________________ o‘tkazilgan ______________________________________kun yotib davolangan______________ bemorni olib yurish turlari: aravachada, zambilda, o‘...

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