Anamnez
|
|
Hayoti davomida qanday kasalliklarga chalingan va qayerda davolangan
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
|
Qanday jarohatlar olgan va operatsiya bo‘lgan ___________________________
___________________________________________________________________
___________________________________________________________________
|
Asosiy kasallikning boshlanishi va kechishi, asosiy kasalliklari bo‘yicha qayerda va qancha vaqt davolangan, o‘tkazilgan davolanish muolajalari
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
|
Obyektiv tekshirish ma’lumotlari:
|
1. Bo‘yi _______sm. Vazni ______kg.
| | |
2. Tana terisi va shilliq pardalari holati _____________________________
___________________________________________________________________
___________________________________________________________________
|
3. Muskul va suyak tizimi, bo‘g‘inlar holati ______________________________
___________________________________________________________________
___________________________________________________________________
|
4. Nafas olish a’zolari ______________________________________________
___________________________________________________________________
___________________________________________________________________
|
5. Yurak, qon-tomir a’zolari _________________________________________
___________________________________________________________________
___________________________________________________________________
|
6. Ovqat hazm qilish a’zolari _________________________________________
___________________________________________________________________
___________________________________________________________________
|
7. Siydik yo‘llari va jinsiy a’zolar tizimi ___________________________
___________________________________________________________________
___________________________________________________________________
|
8. Asab tizimi va ruhiy holati _______________________________________
___________________________________________________________________
___________________________________________________________________
|
9. Ko‘rish holati ____________________________________________________
___________________________________________________________________
___________________________________________________________________
|
10. Quloq, tomoq va burun a’zolari h�lati ______________________________
___________________________________________________________________
___________________________________________________________________
|
11. Rentgen tekshiruvi natijalari ____________________________________
___________________________________________________________________
___________________________________________________________________
|
12. Laboratoriya tekshiruvlari natijalari _____________________________
___________________________________________________________________
___________________________________________________________________
|
Yakuniy tashxis: _____________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
|
O‘zbekiston Respublikasi Ichki ishlar vazirligi va O‘zbekiston Respublikasi Sog‘liqni saqlash vazirligining 2008-yil 13-avgustdagi 12 va 9-sonli hamkorlikdagi qarori bilan tasdiqlangan “Mahkumlarni kasalligi tufayli jazoni o‘tashdan ozod qilishga taqdim etish uchun asos bo‘ladigan kasalliklar Ro‘yxati”ning _______bandiga asosan mahkum_____________________________________________________________
___________________________________________________________________
___________________________________________________________________
|
|
(familiyasi, ismi, sharifi)
| |
jazo muddatini o‘tashdan ozod qilishga tavsiya etiladi.
|
|
