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Epicrisis

Surname, name, patronymic ________________________________________________________________

Was on hospitalization in surgical unit ____________________________

With _________________________________ on _______________________________________________

The diagnosis at entering ___________________________________________________________________

The diagnosis discharge from hospital

The basic ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Complications __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Accompanying ___________________________________________________________________________

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Treatment ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Result of treatment - convalescence, improvement, without changes, deterioration (to emphasize).

The given inspections

Date

Hb

Er

The Central Committee

Le

Е

Bs

J

П

С

Мм

Limph

SOYA

The general analysis urine

Date

Color

Ph

Specific gravity

Protein

sugar

Epithelium

L

Erythrocytes.

Salts

Other analyses ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

The analysis of a feces ____________ eggs a worm are found out, not found out.

Roengenography examination______________________________________________________________

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

The working capacity is restored, temporarily lost, lost.

Hospital leaf _______________ with _______________________ on ____________________________

It is recommended ______________________________________________________________________­_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Date _________________________________________________ the Signature ___________________