You are on page 1of 1

* MU BNH N(vim ph qun mn tnh)

Ngi bnh cung cp y thng tin:


+ H v Tn:..Tui:..(Bt buc)
+ a ch:. S CMND: (Bt buc)
+ S lin lc c nh hoc di ng:..(Bt buc)
+ Thi gian b bnh: Ko di bao nhiu nm.(Bt buc)
+ Th trng: Cn nng..CaoMu daTnh hnh sc kho hin
ti:(Bt buc)
+ Triu chng ton thn: nh huyt p, n, ng, i tiu tin,.. .

..(Bt buc khai cng chi tit cng tt)


+ Kt qu tr bnh hoc khm chuyn khoa gn y nht(Chp
X.Quang lng ngc,hoc CT): ..(Bt buc).