Pasportga oid ma’lumotlar. Bemorning ism sharifi familiyasi

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Касаллик тарихи ИКП1

Millati
Bemorning shifoxonaga kelgan vaqti

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 : _________________

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