Nervous System (Нервная система)

Preliminary diagnosis (Предварительный диагноз)

Last of required investigations with anticipated results (План обследования с предполагаемыми результатами)

……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………...................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

INVESTIGATIONS

ДОПОЛНИТЕЛЬНЫЕ МЕТОДЫ ИСЛЕДОВАНИЯ

1. Complete blood count (Общий анализ крови)

дата
RBC(эритроциты)	Х10¹²/l	X10¹²/l	X10¹²/l
WBC(лейкоциты)	X10⁹/l	X10¹²/l	X10⁹/l
Hb(гемоглобин)	g/l	g/l	g/l
Colour index(цветной показатель)
Baso(базофилы)
Eosino(эозинофилы)
Neutro(нейтрофилы):

Stab(палочкоядерные)
Segmento(сегментоядерные)
Lympho(лимфоциты)
Mono(моноциты)
Platelet count(тромбоциты)
ESR(СОЭ)	Mm/h	Mm/h	Mm/h

Assessment (Клиническая оценка):

2.Biochemistry (Биохимический анализ крови)

Item/Date Показатель/дата	Normal values норма

Assessment (клиническая оценка):

3.Urinatysis (общий анализ мочи)

Показатель/дата Item/date
Color(цвет)
Transparence(прозрачность)
Density(плотность)
Albumen(белок)
Epithelium(Эпителиальные клетки)
WBC(лейкоциты)
RBC(Эритроциты)

Assessment (клинический анализ):

ECG (экг)

Other investigation techniques subspecialty consultation

(Данные дополнительных методов исследования и консультаций специалистов)

………………………………………………………………………………………………………………………

THE CLINICAL DIAGNOSIS(DIAGNOSIS)

КЛИНИЧЕСКИЙ ДИАГНОЗ

Principal diagnosis(основное заболевание)……………………………………………………………………………………………………………….……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..…

Background diagnosis (фоновое заболевание)……………………………………………………………………………………………………………….……………………………………………………………………………………………………………………………………..………………………………………………………………………………………………………………………………………….….

Complications(осложнение)…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….…

Other conditions(сопутствующие заболевания)………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

THE SUBSTANTIATION OF DIAGNOSIS

ОБОСНОВАНИЕ ДИАГНОЗА

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

PRINCIPLES OF TREATMENT

ОСНОВНЫЕ ПРИНЦИПЫ ЛЕЧЕНИЯ

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Treatment (Лечение)

Regimen режим)……………………………………………………………………………………………………………..

Diet диета)………………………………………………………………………………………………………………………

Препарат(Drug)	Доза и кратность назначения(Dosage and how many times a day )	Путь введения(Route)
1
2
3
4
5
6
7
8
9
10
11
12

PROGRESS NOTES (CURSUS MORBI)

ДНЕВНИК КУРАЦИИ

DATE, Bp, Ps (дата АД ,пульс)	Clinical status Клинические данные	Treatment Лечение

CONCLUSION (EPIKRISIS)

ЭПИКРИЗ

PROGNOSIS

ПРОГНОЗ

For life (для жизни)

For health (для здоровья)

For work (для труда)

THE LITERATURE USED

СПИСОК ЛИТЕРАТУРЫ

1. …………………………………………………………………………………………………………………….

2. …………………………………………………………………………………………………………………….

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8. …………………………………………………………………………………………………………………….

9. …………………………………………………………………………………………………………………….

10. …………………………………………………………………………………………………………………….

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