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История болезни:

Выполнил студент(ка)________________________________________________гр.______курса___________________________________факультета

1.СВЕДЕНИЯ О БОЛЬНОМ:

Ф.И.О____________________________________________________________

ВОЗРАСТ________________________________________________________

МЕСТО ЖИТЕЛЬСТВА____________________________________________

ПРОФЕССИЯ_____________________________________________________

ИНВАЛИДНОСТЬ_________________________________________________

КЛИНИЧЕСКИЙ ДИАГНОЗ________________________________________

ДАТА ПОСТУПЛЕНИЯ В КЛИНИКУ________________________________

ДАТА КУРАЦИИ__________________________________________________

2.ЖАЛОБЫ БОЛЬНОГО:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3.ИСТОРИЯ НАСТОЯЩЕГО:

ЗАБОЛЕВАНИЯ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4. ИСТОРИЯ ЖИЗНИ_____________________________________________________________________________________________________________________________

СПОРТИВНЫЙ______________________________________________________________________________________________________________________

Характер питания_____________________________________________________________________________________________________________________________

Аллергологический анамнез_____________________________________________________________________________________________________________________________

5.РЕЗУЛЬТАТЫ ОБЩЕКЛИНИЧЕСКОГО ОСМОТРА___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

6. РЕЗУЛЬТАТЫ СПЕЦИАЛЬНОГО ОСМОТРА (ПОСИСТЕМНОЕ ОБСЛЕДОВАНИЕ)_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

7.РЕЗУЛЬТАТЫ ДОПОЛНИТЕЛЬНЫХ МЕТОДОВ ОБСЛЕДОВАНИЯ:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

8.ОЦЕНКА ФИЗИЧЕСКОГО РАЗВИТИЯ:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

9. ЗАКЛЮЧЕНИЕ ПО ПРОВЕДЕННОМУ ОБЩЕМУ И СПЕЦИАЛЬНОМУ КЛИНИЧЕСКОМУ ОБСЛЕДОВАНИЮ:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

10.ПРОГРАММА ФИЗИЧЕСКОЙ РЕАБИЛИТАЦИИ:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

11.ДНЕВНИК ВРАЧЕБНО-ПЕДАГОГИЧЕСКИХ НАБЛЮДЕНИЙ:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

12.РЕКОМЕНДАЦИИ ПО ФИЗИЧЕСКОЙ РЕАБИЛИТАЦИИ НА МОМЕНТ ВЫПИСКИ:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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