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  • Phieu Kham San Loc

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    đông TiMo
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    1) The document is a health screening form for COVID-19 vaccination of children. 2) It collects information such as the child's name, date of birth, contact details, medical history, and current symptoms. 3) The form concludes with recommendations on whether vaccination is appropriate that day, should be postponed, or the child should be referred to a hospital for vaccination based on their screening results and medical history.

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    PHIEU KHAM SAN LOC

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    1) The document is a health screening form for COVID-19 vaccination of children. 2) It collects information such as the child's name, date of birth, contact details, medical history, and current symptoms. 3) The form concludes with recommendations on whether vaccination is appropriate that day, should be postponed, or the child should be referred to a hospital for vaccination based on their screening results and medical history.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    8 views1 page

    Phieu Kham San Loc

    Uploaded by

    đông TiMo
    1) The document is a health screening form for COVID-19 vaccination of children. 2) It collects information such as the child's name, date of birth, contact details, medical history, and current symptoms. 3) The form concludes with recommendations on whether vaccination is appropriate that day, should be postponed, or the child should be referred to a hospital for vaccination based on their screening results and medical history.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 1

    PHVLVC

    (Ban hanh kern thea Quy~t dinh s6 5.002IQEJ-BYt ngaY29.thimgl.O ndm 2021)

    co sa TIEM CHiING CONG HOA xA HOI CHU NGHiA VI~T NAM


    DQcl,p - TV do - HlJnh phiic

    BANG KIEM TRUOC TIEM CHUNG VAc XIN PHONG COVID-19 DOl VOl TRE EM

    HQ va ten tre: Ngay sinh: ./. ./.......... Nam D Nfr D


    CCCD/CMT/HO chieu (neu c6): sb di~n thoai: .
    Dia chi lien he: .
    HQ ten bblmtt/ngm'yi giam hQ: ss dien thoai: .
    Da tiem miii 1 v~c xin phong COVID-19:
    D Chua tiem
    r.~ " I . vac
    .:,xln:..................
    . N'gay hem:
    .,
    D va hem, 0<;11 .
    I. Sang lQc
    Than nhiet: 0 C Mach: l~n/phUt
    I. Tien su ro rang phan v~ voi v~c xin phong COVID-19 Ifilltruce hoac cac thanh phan cua Khong 0 C60
    vc1cxin phong COVID-19

    2. Dang mc1cbenh cciptinh, man tinh ti6n trien Khong 0 C60

    3. Tien su di irng voi beltky di nguyen nao Khong 0 C60

    4. R6i 10<;1n
    tri giac, r6i 10<;1n
    hanh vi Khong 0 C60
    5. Mc1ccac benh bcim sinh, benh man tinh (1 tim, phoi, h~ thong tieu h6a, ti6t nieu, mau ... Khong 0 C60

    6. Nghe tim, ph6i belt thirong' Khong 0 C60

    7. Phan v~ dQ 3 tro len voi beltky dj nguyen mio (ghi r5 tac nMn dj ung: ................................ ) KhOng 0 C60

    8. Cae ch6ng chi djnhltri hoan khacii (n6u c6, ghi r5) Khong 0 C60

    ......................................................................................................................................................

    II. K~t lu~n


    - Du di~u ki~n tiem chung ngay: Du diSu ki~n tiem chung ngay: Telt ca dSu KHONG c6 diSm belt thuang 0
    va K!lONG c6 chbng chi dinh, tiem v~c xin theo hu6np d~n su d\mg cua nM san xUelt
    - ChOng chi dinh tiem chUng vilc xin cung 10(li:Khi CO bat thuang t<;1i
    m\lc 1 0
    - Tri hoan tiem chung: Khi CO belt ky mot diSm belt thuang t<;1i
    m\lc 2 0
    - Nh6m th~n trQng khi tiem chung: Khi CO beltky mot di~m belt thuang t<;1i cac m\lc 3, 4 0
    - Chuy~n kham sang iQc, tiem chUng t<;1ib~nh vi~n: Khi CO belt thuang t<;1i
    m\lC 5, 6, 7 0
    Lydo: .
    Thin gian: gia phut, ngay thimg nam .....
    NgU'Oith\fc hi~n sang lQc
    (kj, ghi ro hr va ten)
    ..~
    '.
    I

    iChi djnh tiem t~i b~nh vi~n n~u danh gia tinh tr~ng hi~n t~i kh6ng co chi djnh dp Clm.
    Cac trucmghqp ch6ng chi djnh/tri hoan thea huang din cua nM san xuAtd6i v6i lo~i v~c xin COVID-19 su d\mg
    ii

    ho~c pMt hi~n co cac y~u t6 bAtthuang khac.

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