Medical Record Synopsis - ‫רפואי‬

‫תיק תקציר‬

:Id Number / ‫זהות מספר‬ XXXX9388-6 :Patient Name / ‫מטופל‬ ‫אפ‬

‫שם‬
:Date Of Birth / ‫לידה‬ 09/05/1959 :Sex / ‫מין‬ ‫ז‬
‫תאריך‬

Dosage Form Medication Name Recent Consumption Date Start Date

‫תרופות קבועות שאינן נרכשות‬
CLICKFINE PEN.NDL 31G 8MM
‫ שנפטרה‬14/11/2017
‫ של אימו‬victoza28/01/2020
:‫בקופה‬
1.2 ‫במינון של‬
‫טבליות‬ MICROPIRIN 75 MG 30 TAB 25/12/2019 07/02/2017

‫טבליות‬ FUSID 40 MG 30 TAB 25/12/2019 19/03/2018

:Regular Medications / ‫קבועות‬
‫תרופות‬
‫טבליות‬ TRITACE 5 MG 28 TAB 17/02/2020 02/02/2016

‫זריקה ביחידות‬ INS. TOUJEO 300U\ML 1.5ML 17/02/2020 28/01/2020

‫צורת הגשה‬ ‫שם תרופה‬ ‫תאריך צריכה אחרון‬ ‫תאריך התחלה‬
‫טבליות‬ GLIMEPIRIDE 4 MG 30 TAB 17/02/2020 28/01/2020

‫עט‬/‫מזרק‬ VICTOZA 6 MG/ML 2 PEN 17/02/2020 28/01/2020

‫ טבליות‬BONDORMIN 0.25 MG 10 TAB 15/03/2020 17/12/2018

‫טבליות‬ CYMBALTA 60 MG 28 TAB 15/03/2020 05/11/2018

‫טבליות‬ LIPITOR 40 MG 30 TAB 15/03/2020 01/06/2016

‫טבליות‬ NORVASC 10 MG 30 TAB 15/03/2020 19/03/2018

‫טבליות‬ ALPRALID 0.5 MG 30 TAB 15/03/2020 25/03/2019

‫טבליות‬ CIALIS 20 MG 4 TAB 15/03/2020 19/05/2019

‫טבליות‬ TRITACE COMP 15/03/2020 14/06/2016

2.5MG+12.5MG
NORMOPRESAN 150 MCG
‫טבליות‬ 15/03/2020 16/02/2020
30TAB
 ‫טבליות‬ CARDILOC 2.5 MG 30 TAB 15/03/2020 18/12/2018

:Diagnosis / ‫רפואיות אבחנות‬

‫ התחלה תאריך‬Start Date ‫ אבחנה‬Diagnose

20/09/2002 PENILE DISORDER, UNSPECIFIED 607.9

26/06/2005 BACKGROUND DIABETIC RETINOPATHY 362.01

08/03/2006 HYPERLIPIDEMIA, OTHER AND UNSPECIFIED 272.4

DIABETES MELLITUSTYPE
NEPHROPATHY, WITH2RENAL MANIFESTATIONS/DIABETIC
OR UNSPECIFIED 250.42
TYPE, UNCONTROLLED
01/05/20
06
01/05/2006 CHOLELITHIASIS 574

05/06/2006 HYPERTENSION, ESSENTIAL 401

28/11/2006 RENAL FAILURE, UNSPECIFIED 586

15/05/2007 DIABETIC RETINOPATHY 362.0

20/04/2009 CERVICAL ROOT LESIONS, NOT ELSEWHERE CLASSIFIED 353.2

07/11/2011 HYPERTROPHY(BENIGN) OF PROSTATE-BPH 600.0

09/04/2012 [ERECTILE DYSFUNCTION OF NONORGANIC ORIGIN [IMPOTENCE
302.721

08/08/2013 [OBESITY[OVERWEIGHT 278.00

29/12/2013 CATARACT, OTHER 366.8

11/02/2014 INSOMNIA, OTHER 780.52

DIABETES MELLITUS WITH OPHTHALMIC 250.52

04/12/2014 MANIFESTATIONS/DIABETIC RETINOPATHY, TYPE 2 OR UNSPECIFIED

TYPE, UNCONTROLLED

04/05/2015 HYPERURICEMIA 790.608

10/06/2015 CHRONIC KIDNEY DISEASE, STAGE III (MODERATE)-CKD STAGE III 585.3

15/12/2016 PRESBYOPIA 367.4

ARGON
[LASER LASER-DESTRUCTION OFRETINAL
PHOTOCOAGULATION-PAN CHORIORETINAL LESION BY 14.24
PHOTOCOAGULATION[PRP
01/10/20
17
01/10/2017 PSEUDOEXFOLIATION OF LENS CAPSULE 366.11

01/10/2017 VITREOUS DETACHMENT-PVD 379.211

 01/10/2017 BLEPHARITIS, UNSPECIFIED 373.00

23/07/2018 CHRONIC KIDNEY DISEASE, UNSPECIFIED-CKD 585.9

02/08/2018 POLYNEUROPATHY IN DIABETES 357.2

OSTEOARTHROSIS[-ITIS], LOCALIZED, PRIMARY, INVOLVING

08/10/2018
715.18 OTHER SPECIFIED SITES

28/01/2020 DISORDERS, TYPE 2 OR UNSPECIFIED TYPE, UNCONTROLLED

DIABETES MELLITUS WITH PERIPHERAL CIRCULATORY 250.72

28/01/2020 BLINDNESS, ONE EYE; LOW VISION OTHER EYE 369.10

DIABETES MELLITUS
250.50 MANIFESTATIONS/DIABETIC WITH OPHTHALMIC
RETINOPATHY TYPE 2
17/02/20 CONTROLLED
30/01/2020 TREMOR, ESSENTIAL AND OTHER SPECIFIED FORMS 333.1
20
:Allergies / Hypersensitivities /
‫רגישויות‬

‫ התחלה תאריך‬Start Date ‫ רגישות שם‬Allergy / Hypersensitivity

‫ רגישות סוג‬Allergy / Hypersensitivity Type

:Vaccines / ‫חיסונים‬

Vaccine Place Execution Date Vaccine Name

‫החיסון‬ ‫מקום‬
‫רמות **סגור‬ ‫תאריך ביצוע‬
06/12/2017 ‫החיסון‬
VAXIGRIP ADULT ‫שם‬
MEDICI

‫רמות **סגור‬ 31/10/2016 VAXIGRIP ADULT MEDICI

‫רמות **סגור‬ 27/10/2015 INFLUVAC 0.5 ML

‫אשקלון שמשון‬ 02/12/2014 FLUARIX 0.5 ML 1 DOSE

‫אשקלון שמשון‬ 14/11/2013 VAXIGRIP ADULT MEDICI