Pasport qism
F.I.SH:_______________________________________________________
Yoshi:________________________
Jinsi____________________________
2. Anamnez va bemor holati haqida qisqacha ma’lumotlar:
Shikoyatlari:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________’
Qisqacha kasallik anamnezi: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Hayot anamnezi: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Dori moddalar bilan bog’liq anamnez: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Kasallik davolashda qaysi dorilarga, qanday va qabul qilgandan qancha vaqtdan keyin nojo’ya ta’sirlari bo’ladi: ____________________________________________________________________________________________________________________________________________________________________________________
Qaysi dorilar bilan uzoq va ko’p miqdorda davolangan: ____________________________________________________________________________________________________________________________________________________________________________________
Vaksina va zardoblar qabul qilganmi va nojo’ya ta’sirlari bo’lganmi: ____________________________________________________________
________________________________________________________________________________________________________________________
To’r parda va terida zamburug’li toshmalar bormi: ____________________________________________________________________________________________________________________________________________________________________________________
Hayvonlar bilan bog’liq kasalliklar asoratlari bo’lganmi: ____________________________________________________________________________________________________________________________________________________________________________________
Kasallik boshlanish ananezi: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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