Pasportga oid ma’lumotlar. Bemorning ism sharifi familiyasi

1. 
   Pasportga oid ma’lumotlar.
   

Bemorning ism sharifi familiyasi :________________________________________
Bemorning yoshi:_____________________________________________________
Ma’lumoti:___________________________________________________________
Ish joyi:______________________________________________________________
Millati:______________________________________________________________
Turar joyi: __________________________________________________________
Bemorning yo’llanmadagi diagnozi______________________________________
Dastlabki diagnoz:____________________________________________________
Bemorning shifoxonaga kelgan vaqti: ________________
Ketgan vaqti : _________________


Bemorning kasalxonaga tushgandagi shikoyatlari
Asosiy shikoyatlar: _________________________________________________________________
___________________________________________________________________________________
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Ikkinchi darajali shikoyatlar: ______________________________________________________
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2. 
   Anamnesis morbi
   

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3. 
   Anamnesis vitae