AMBULATOR TIBBIY KARTA № 1.Familiya.Ismi Muxammadov Lazizbek
2.Tug`ilgan sana kuni_____oy_________________yil____________
3.Jinsi:er,ayol(chizing)
4.Yashash joyi, tuman (shahar)________________,qishloq____________________________________
ko`cha_______________________uy_______xona_________telefon__________________________
5.doyimiy yashash joyi_________________________________________________________________
6.Vaqtincha yashaydi: boshqa shahar, qishloqdan kelgan(chizing)_______________________________
7. Ish (uqish) joyi_______________________________________________________________________
8. Ro`yxattan chiqqan sana_______________________________________________________________
9. Ro`yxattan chiqish sababi ko`rsatilsin_____________________________________________________
_____________________________________________________________________________________
10. Dispanserizatsiya:___________________________________________________________________
10.1. Aynan shu muassasada_____________________________________________________________
(shifokorlik xudud № va xudud nomi)
10.2. Boshqa muassasada________________________________________________________________
(tashkilot nomi)
