Fisa Med.sintetica
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Dosar nr.____________________________________ Data inregistrarii _______________________________ Numele medicului ______________________________ Sef serviciu____________________________________ FIŞĂ MEDICALĂ SINTETICĂ Nume _______________________________ Prenume _________________________________ Vârstă _________ I. Anamneza _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ ____________________________________________________ II. Diagnosticul medical (se specifica si nr. cod ICD 10) - principal _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _______________________________________ - altele _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ ____________________________________________________ Certificatele medicale actuale (se specifică nr., data, instituţia emitentă şi numele medicului care a eliberat certificatul) _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ ____________________________________________________ III. Tratamente urmate şi recomandate
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Transcript of Fisa Med.sintetica
Dosar nr
Dosar nr.____________________________________
Data inregistrarii _______________________________Numele medicului ______________________________Sef serviciu____________________________________ FI MEDICAL SINTETIC
Nume _______________________________ Prenume _________________________________ Vrst _________
I. Anamneza ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________II. Diagnosticul medical (se specifica si nr. cod ICD 10) - principal __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
- altele ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Certificatele medicale actuale (se specific nr., data, instituia emitent i numele medicului care a eliberat certificatul) ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
III. Tratamente urmate i recomandateNr.
crtTipul tratamentelor
Tratamente urmate (scurta descriere )Tratamente recomandate (se bifeaza )
1Medicamentoase
2Recuperare neuromotorie
3Protezare
4Psihoterapie
5Protezare
6Psihoterapie
7Recuperare psihica
8Oftalmologie
9Audiologie
10O.R.L.
11Cardiologie
12Fizioterapie
13Endocrinologie
14Gastroenterologie
15Neurologie
16Altele (cu specificatie)
IV. Rezultatul tratamentelor urmate ( per ansamblu): __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________n cazul absenei oricrui tratament, enumerai motivele pe care le invoc familia : ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________V. Stadiul actual al bolii (nconjurai etapa care se potrivete): de debut, de stare evolutiv sau stabilizat, terminal. ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________VI. Concluzii i recomandri ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Data Semntura i parafa medicului _____________ __________________________
