23.3 foaie obs clinica generala (1)

11
7/23/2019 23.3 Foaie Obs Clinica Generala (1) http://slidepdf.com/reader/full/233-foaie-obs-clinica-generala-1 1/11 Judeţul BUCURE TI Ș  4 2  Nr. înregistrare SC 9098 Localitatea BUCURE TI S.I Ș CNP pacient 2710326253217 Spitalul Clin. Nerologie Carol !a"ila # # $ % 4 & 'ntoc(it de) !r. Topor Liliana  parafa medicului Secţia NE*R+L+,IE -  - - - FOAIE DE OBSERVAŢIE CLINICĂ GENERALĂ Statut asigurat) /sigurat CN/S X  /sigurare "oluntar0 Neasigurat  /sig. o1lig. C/S X  /sig. acultati"0 C/S Eurocard /corduri internaţionale Categ. asig. CNAS) salariat -3 coasig. 23 pensionar $3 copil5-% ani 43 ele"6ucenic6student -%728 ani &3  gra"id0 83 "eteran 93 re"oluţionar %3 :andicap 3 ;NS -#3 a<utor social --3 =o(a< -23 alte -$3 2 Tipul iter!rii) urgenţ0 -3 tri(it. >* 23 tri(it. a(1ulatoriu $3 transer interspit. 43 la cerere &3 alte 3 2 Criteriu iterare) urgenţ0 -3 diagnostic 23 trata(ent $3 nedeplasa1il 43 epide(iologic &3 (edic =e 83 " Diag#sti$ul %e tri&itere) .................................................................................................................................  ................................ .......................................... ................................ ................................ ........................... Diag#sti$ul la iterare) S'ONDILO(A CERVICALĂ  ................................ ................................ ....................... ........ .............................................. Se(n0tura =i paraa (edicului ................................................ Diag#sti$ul la )2 %e #re) .............................. ................................ ................................ ................................ ................................ .............................. ................................................................................................................................................................................................................................................................. Diag#sti$ul pri$ipal la e*terare)................................ ................................ ..................... ...............................................  ................................ ................................ ........................................ ................................ ................................ ........................................... Diag#sti$e se$u%are la e*terare +$#&pli$a,ii - $#&#ri%it!,i/ ) -. ................................ ................................ ........................................ ................................ ................................ ........................................... 2. ................................ ................................ ........................................ ................................ ................................ ........................................... $. ................................ ................................ ........................................ ................................ ................................ ...........................................  NU>ELE COTIRI Ă Ț  ;RENU>ELE ELENA Se?ul >6* F Data a0terii) @i 21  lun0 "  an 34)3  ,rup sang"in) /6B6/B6# R: A 6 7 D#&i$iliul legal) <udeţul 56 Localitatea DROBETA T7RN7 SEVERIN  /lergic la) NEAGĂ Sect. >ediul U6R 7 Str.  ALEEA 5ĂRGĂRITAR7L7I  Nr.  "  !ata intern0rii) ora # # 8 Re0e%i,a) <udeţul 56 Localitatea DROBETA T7RN7 SEVERIN  @i 2 9 lun0 - - an 2 # - & Sect. >ediul U6R Str. ALEEA 5ĂRGĂRITAR7L7I  Nr.  "  !ata e?tern0rii) ora # % - # Cet!,eie) Ro(n X  Str0in .... Greutatea la a0tere +#u !s$u,i/  gra(e @i  # 2  lun0 - 2 an 2 # - & O$upa,ia) 0r0 ocupaţie -3 salariat 23 lucr0tor pe cont propriu $3  Nr. @ile spitali@are 1 (ILE   patron 43 agricultor &3 ele"6 student 83 =o(er 93 pensionar %3 8 L#$ul %e &u$! ..............................................................................  Nr. @ile c.(. la e?ternare .........................  Ni9el %e istruire) 0r0 studii -3 ciclu pri(ar 23 ciclu gi(na@ial $3 =coal0 proesional0 43 liceu &3  =coal0 postliceal0 83 studii superioare de scurt0 durat0 93 studii superioare %3 nespeciicat 3 4 C.I - B.I.  seria 56  Nr. 24144  Certiicat na=tere copil3 seria Nr.

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Page 1: 23.3 Foaie Obs Clinica Generala (1)

7/23/2019 23.3 Foaie Obs Clinica Generala (1)

http://slidepdf.com/reader/full/233-foaie-obs-clinica-generala-1 1/11

Judeţul BUCURE TIȘ   4 2   Nr. înregistrare SC 9 0 9 8

Localitatea BUCURE TI S.IȘ CNP pacient 2 7 1 0 3 2 6 2 5 3 2 1 7

Spitalul Clin. Nerologie Carol!a"ila

# # $ % 4 &

'ntoc(it de) !r. Topor Liliana  parafa mediculuiSecţia NE*R+L+,IE -   - - -

FOAIE DE OBSERVAŢIE CLINICĂ GENERALĂ

Statut asigurat) /sigurat CN/S X   /sigurare "oluntar0 Neasigurat

  /sig. o1lig. C/S X   /sig. acultati"0 C/S Eurocard /corduri internaţionale

Categ. asig. CNAS) salariat -3 coasig. 23 pensionar $3 copil5-% ani 43 ele"6ucenic6student -%728 ani &3  gra"id0 83 "eteran 93 re"oluţionar %3 :andicap 3 ;NS -#3 a<utor social --3 =o(a< -23 alte -$3 2

Tipul iter!rii) urgenţ0 -3 tri(it. >* 23 tri(it. a(1ulatoriu $3 transer interspit. 43 la cerere &3 alte 3 2

Criteriu iterare) urgenţ0 -3 diagnostic 23 trata(ent $3 nedeplasa1il 43 epide(iologic &3 (edic =e 83 "

Diag#sti$ul %e tri&itere) ................................................................................................................................. ................................ .......................................... ................................ ................................ ...........................Diag#sti$ul la iterare) S'ONDILO(A CERVICALĂ ................................ ................................ ....................... ........ ..............................................

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D#&i$iliul legal) <udeţul 56Localitatea DROBETA T7RN7SEVERIN   /lergic la) NEAGĂ

Sect. >ediul U6R  7Str. ALEEA 5ĂRGĂRITAR7L7I   Nr. "   !ata intern0rii) ora # # 8

Re0e%i,a) <udeţul 56Localitatea DROBETA T7RN7SEVERIN   @i 2 9 lun0 - - an 2 # - &

Sect. >ediul U6R 

Str. ALEEA 5ĂRGĂRITAR7L7I   Nr. "   !ata e?tern0rii) ora # % - #

Cet!,eie) Ro(n X   Str0in ....

Greutatea la a0tere +#u !s$u,i/   gra(e @i # 2   lun0 - 2 an 2 # - &

O$upa,ia) 0r0 ocupaţie -3 salariat 23 lucr0tor pe cont propriu $3   Nr. @ile spitali@are 1 (ILE  patron 43 agricultor &3 ele"6 student 83 =o(er 93 pensionar %3 8L#$ul %e &u$! ..............................................................................   Nr. @ile c.(. la e?ternare .........................

  Ni9el %e istruire) 0r0 studii -3 ciclu pri(ar 23 ciclu gi(na@ial $3 =coal0 proesional0 43 liceu &3

  =coal0 postliceal0 83 studii superioare de scurt0 durat0 93 studii superioare %3 nespeciicat 3 4C.I - B.I. seria 56   Nr. 2 4 1 4 4   Certiicat na=tere copil3 seria Nr.

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