Professional Documents
Culture Documents
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Gii:
Nam
N
Tui:...............................
S CMND hoc H chiu: .......................... cp ngy....../..../..............
ti.
Ch hin ti:.............................
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L do khm sc khe:...............................................................................
H tn, ch k
ca Bc s
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H tn, ch k
ca Bc s
Ni dung khm
7. Da liu: .....................................................................................................................................................
Phn loi:.....................................................................................................................................................
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Ni dung khm
1. Xt nghim mu:
a) Cng thc mu: S lng HC: .....................................................................................
S lng Bch cu: .......................................................................
S lng Tiu cu:.........................................................................
b) Sinh ha mu: ng mu: ............................................................................................
Ur:..................................................................... Creatinin:.........................................................
ASAT (GOT):.......................................... ALAT (GPT): ...........................................
c) Khc (nu c):...............................................................................................................................
2. Xt nghim nc tiu:
a) ng: ...............................................................................................................................................
b) Prtin: ..............................................................................................................................................
c) Khc (nu c): .............................................................................................................................
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IV. KT LUN
1. Phn loi sc khe:..................................................... ..................................................................................
2. Cc bnh, tt (nu c): ............................................ ...................................................................................
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