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XI .ПРОТОКОЛ РЕГИСТРАЦИИ ФИЗИОЛОГИЧЕСКИХ ПОКАЗАТЕЛЕЙ
Фамилия, имя, отчество ________________________________________________________________________
Отделение _________________________ Палата № ___________ Лечащий врач ____________________________
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| Даты
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| Дни проведенные в стационаре
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| 1.
| 2.
| 3.
| 4.
| 5.
| 6.
| 7.
| 8.
| 9.
| 10.
| П
| АД
| To
| у
| в
| у
| в
| у
| в
| у
| в
| у
| в
| у
| в
| у
| в
| у
| в
| у
| в
| у
| в
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| | | | | | | | | | | | | | | | | | | | |
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| 40,8
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| 40,6
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| 40,5
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| 40,4
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| 40,2
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| 39,8
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| 39,6
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| 39,5
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| 39,4
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| 39,2
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| 38,8
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| 38,6
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| 38,5
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| 38,4
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| 38,2
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| 37,8
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| 37,6
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| 37,5
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| 37,4
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| 37,2
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| 36,8
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| 36,6
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| 36,4
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| 36,2
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| 35,5
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Частота дыхания
| | | | | | | | | | | | | | | | | | | | | Вес
| | | | | | | | | | | | | | | | | | | | | Выпито
жидкости
| | | | | | | | | | | | | | | | | | | | |
| | | | | | | | | | | | | | | | | | | | |
| | | | | | | | | | | | | | | | | | | | |
| | | | | | | | | | | | | | | | | | | | | Стул
| | | | | | | | | | | | | | | | | | | | | Ванна
| | | | | | | | | | | | | | | | | | | | |
| | | | | | | | | | | | | | | | | | | | |
| | | | | | | | | | | | | | | | | | | | |
| | | | | | | | | | | | | | | | | | | | |
| | | | | | | | | | | | | | | | | | | | | Подпись
сестры
| | | | | | | | | | | | | | | | | | | | |
XI.ПРОТОКОЛ РЕГИСТРАЦИИ ФИЗИОЛОГИЧЕСКИХ ПОКАЗАТЕЛЕЙ
Фамилия, имя, отчество ________________________________________________________________________
Отделение _________________________ Палата № ___________ Лечащий врач ____________________________
|
|
| Даты
|
|
|
|
|
|
|
|
| | |
|
|
|
|
|
|
| Дни проведенные в стационаре
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|
|
| 11.
| 12.
| 13.
| 14.
| 15.
| 16.
| 17.
| 18.
| 19.
| 20.
| 21.
| П
| АД
| To
| у
| в
| у
| в
| у
| в
| у
| в
| у
| в
| у
| в
| у
| в
| у
| в
| у
| в
| у
| в
| у
| в
|
|
|
| | | | | | | | | | | | | | | | | | | | | | |
|
| 40,8
| | | | | | | | | | | | | | | | | | | | | | |
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| 40,6
| | | | | | | | | | | | | | | | | | | | | | |
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| 40,5
| | | | | | | | | | | | | | | | | | | | | | |
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| 40,4
| | | | | | | | | | | | | | | | | | | | | | |
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| 40,2
| | | | | | | | | | | | | | | | | | | | | | |
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| | | | | | | | | | | | | | | | | | | | | | |
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| 39,8
| | | | | | | | | | | | | | | | | | | | | | |
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| 39,6
| | | | | | | | | | | | | | | | | | | | | | |
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| 39,5
| | | | | | | | | | | | | | | | | | | | | | |
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| 39,4
| | | | | | | | | | | | | | | | | | | | | | |
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| 39,2
| | | | | | | | | | | | | | | | | | | | | | |
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| | | | | | | | | | | | | | | | | | | | | | |
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| 38,8
| | | | | | | | | | | | | | | | | | | | | | |
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| 38,6
| | | | | | | | | | | | | | | | | | | | | | |
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| 38,5
| | | | | | | | | | | | | | | | | | | | | | |
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| 38,4
| | | | | | | | | | | | | | | | | | | | | | |
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| 38,2
| | | | | | | | | | | | | | | | | | | | | | |
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| 37,8
| | | | | | | | | | | | | | | | | | | | | | |
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| 37,6
| | | | | | | | | | | | | | | | | | | | | | |
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| 37,5
| | | | | | | | | | | | | | | | | | | | | | |
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| 37,4
| | | | | | | | | | | | | | | | | | | | | | |
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| 37,2
| | | | | | | | | | | | | | | | | | | | | | |
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| | | | | | | | | | | | | | | | | | | | | | |
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| 36,8
| | | | | | | | | | | | | | | | | | | | | | |
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| 36,6
| | | | | | | | | | | | | | | | | | | | | | |
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| 36,4
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| 36,2
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| 35,5
| | | | | | | | | | | | | | | | | | | | | | |
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|
| | | | | | | | | | | | | | | | | | | | | | |
Частота дыхания
| | | | | | | | | | | | | | | | | | | | | | | Вес
| | | | | | | | | | | | | | | | | | | | | | | Выпито
жидкости
| | | | | | | | | | | | | | | | | | | | | | |
| | | | | | | | | | | | | | | | | | | | | | |
| | | | | | | | | | | | | | | | | | | | | | |
| | | | | | | | | | | | | | | | | | | | | | | Стул
| | | | | | | | | | | | | | | | | | | | | | | Ванна
| | | | | | | | | | | | | | | | | | | | | | |
| | | | | | | | | | | | | | | | | | | | | | |
| | | | | | | | | | | | | | | | | | | | | | |
| | | | | | | | | | | | | | | | | | | | | | |
| | | | | | | | | | | | | | | | | | | | | | | Подпись
сестры
| | | | | | | | | | | | | | | | | | | | | | |
XIII. ПРОТОКОЛ КОНСУЛЬТАЦИИ СПЕЦИАЛИСТОМ
___________________________________________________________________________________________-
(дерматолог, невропатолог, окулист, оториноларингологии, терапевт, хирург, эндокринолог и др)
Цель
консультации
| ____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
Подпись лечащего врача______________________________
___
| Жалобы ___________________________________________________________________
___________________________________________________________________________
| Анамнез ___________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Общее состояние ____________________________________________________________
___________________________________________________________________________
Краткие объективные данные _________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Заключение о динамике_______________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
ВЫВОДЫ, РЕКОМЕНДАЦИИ,
___________________________________________________________________________
___________________________________________________________________________
____________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
| Дата________________Время ______________ Подпись врача консультанта___________________
|
XIII. ПРОТОКОЛ КОНСУЛЬТАЦИИ СПЕЦИАЛИСТОМ
___________________________________________________________________________________________-
(дерматолог, невропатолог, окулист, оториноларингологии, терапевт, хирург, эндокринолог и др)
Цель
консультации
| ____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
Подпись лечащего врача______________________________
___
| Жалобы ___________________________________________________________________
___________________________________________________________________________
| Анамнез ___________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Общее состояние ____________________________________________________________
___________________________________________________________________________
Краткие объективные данные _________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Заключение о динамике_______________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
ВЫВОДЫ, РЕКОМЕНДАЦИИ,
___________________________________________________________________________
___________________________________________________________________________
____________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
| Дата________________Время ______________ Подпись врача консультанта___________________
|
XV. КАРТА ВЫПОЛНЕНЫХ РЕНТГЕНОРАДИОЛОГИЧЕСКИХ
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