Щзбекистон Республикаси бхут бщйича шакил коди

O’zbekiston Respublikasi Sog’liqni saqlash vazirligi ______________________ Muassasa nomi

O’zbekistonRespublikasi Sog’liqni saqlash vazirining 2022 yil 17 yanvardagi 16-sonli buyrug’i bilan tasdiqlangan 113- raqamli tibbiy hujjat shakli

Ambulatoriya poliklinika muassasasining

ALMASHISH KARTASI

Homilador ayol haqida ma’lumoti (har bir
homilador uchun to’ldirilib, 30 haftada uning qo’liga beriladi)

1. Familiya, ismi __________________________________________________________________

2. Yoshi__________3. Yashash joyi__________________________________________________
4 Umumiy, ginekologik kassaliklar bilan kasallangan, operatsiyalar_________________________ ________________________________________________________________________________
5.Avvalgi xomiladorlik, tug’ish, tug’ishdan keyingi davr o’ziga xos kechishi
_______________________________________________________________________________
6.Nechanchi homila__________________tug’ish_______________________________________
7.Abortlar bo’lgan _______________________(qanday, ko’rsatilsin)
8.Muddatdan ilgari tug’ruq _____________________________ yil ______________muddati
Muddatdagi tug’ruqlar_____________________________________________________________
sana, oy, yil
9.Oxirgi hayz___________________________________________________________________^.
10.Birinchi kelishida aniqlangan ___________ homiladorlik ____________muddati___________
haftalik__________________________________________________________________________
___________________”___”______________20___y
11.Jami qatnashlar soni____________________________________________________________
12.Homilaning birinchi bor qimirlashi (sana, oy, yil.)_____________________________________
13.Mazkur homiladorlik davrining o’ziga xos kechishi ____________________________________
________________________________________________________________________________
14.Chanoqning hajmi:_____________________________________________________________
D___________________________________D_________________________________________
Bo’yi__________________________Vazni____________________________________________
(birinchi bor kelganida)
15.Homilaning joylashish xolati_______________________________ kelib turgan qism: boshi,
dumbachasi, aniqlab bo’lmadi_______________________________________________________
Homila yurak urishi: aniq, ravon,____________________1 yurak urishlar soni_________________
CHap, o’ngda____________________________________________________________________
Laborator va boshqa tekshiruvlar:_____________________________________________________
1 ”___”___________20___y.; 2”___”_____________20___y.
Rezus-musbat, manfiy, qon turi, antitelolar titri_________________________________ qon guruhi
Erining qon rezusi_________ Toksoplazmoz: (KBR), teridagi sinov_________________________
Klinik taxlillar: qon______________, WR I __________________WR II ________________________
OIV _______________ 20 ____ y Hbs ag I _____________ 20 ____ y Hbs ag II _____________ 20 ____ y
Gonokokk _______________ Toksoplazmoz _____________ boshqa tekshiruv _______________
________________________
siydik____________, qindagi surtma tahlili (mazok) _____________________________________

Gijja tuxumlarini aniqlash uchun axlat taxlili___________________________________________

16.Jismoniy tarbiya______________________ Mashg’ulotlar soni__________________________
17.Psixoprofilaktik tayyorlov _________________Mashg’ulotlar soni________________________
18.Onalar maktabi_________________________________________________________________
19.Stafilokokk anatoksini yuborilgandagi sana: 1marta____________________________________
II marta_______________________________III marta___________________________________

A.K/B
20.Sana

21.Tug’ruqqa qadar ta’til bo’yicha mehnatga layoqatsizlik varog’ini berish sanasi

”__”_____20__y
22.Tug’ishning taxminiy muddati”___”___________20__y.

Akusher – ginekolog shifokori_______________________