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  • (lần thứ ................. ) : Phiếu Chiếu/ Chụp X-Quang

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    (lần thứ ................. ) : Phiếu Chiếu/ Chụp X-Quang

    Uploaded by

    Nguyễn Chiến

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    Sở Y tế: ..............................

    PHIẾU CHIẾU/ CHỤP X-QUANG MS: 19/BV-01


    BV: .................................... (lần thứ .................) Số: ..............................

    - Họ tên người bệnh: .............................................................. Tuổi: ........................... Nam/Nữ


    - Địa chỉ: ..................................................................................................................................................................
    - Khoa: ....................................................................................... Buồng: .....................................Giường:..............
    - Chẩn đoán:.............................................................................................................................................................

    YÊU CẦU CHIẾU/ CHỤP

    .............................................................................................................................................................................
    .............................................................................................................................................................................
    .............................................................................................................................................................................
    .............................................................................................................................................................................
    .............................................................................................................................................................................
    Ngày ....... tháng ....... năm .............
    BÁC SĨ ĐIỀU TRỊ

    \
    Họ tên: ........................................
    KẾT QUẢ CHIẾU/ CHỤP
    ............................................................................................................................................................................
    ............................................................................................................................................................................
    ............................................................................................................................................................................
    ............................................................................................................................................................................
    ............................................................................................................................................................................
    ............................................................................................................................................................................
    ............................................................................................................................................................................
    ............................................................................................................................................................................
    ............................................................................................................................................................................
    ............................................................................................................................................................................
    ............................................................................................................................................................................
    ............................................................................................................................................................................
    ............................................................................................................................................................................
    ............................................................................................................................................................................

    Ngày ....... tháng ....... năm .............


    Lời dặn của BS chuyên khoa: BÁC SĨ CHUYÊN KHOA

    Họ tên: ...........................................
    Hướng dẫn: In khổ A4 dọc

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