Клінічний діагноз:
Основний:_________________________________________________________________________________________
___________________________________________________________________________________________________
Ускладнення: _______________________________________________________________________________________
____________________________________________________________________________________________________
Супровідний:____________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
План лікування:
____________________________________________________________________________________________________
____________________________________________________________________________________________________ ____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Очікуваний результат:
Підпис лікаря.
Рецензія куратора.