000654

9 MEDICAL CARD of in-patient № _____ Date and time of admission _____________________________________ The date and time of discharge ____________________________________ Department ____________________ ward No. ______________________ Transferred to the Department _____________________________________ Bed-days spent _________________________________________ Types of transportation: on a gurney, on a wheelchair, able to go Blood type_________________ Rh accessory __________ Side effects of drugs (intolerance) _________________ ______________________________________________________________ the name of the drug, the nature of the side effects 1. First name & surname ____________________________________ __________________________________ 2. Male or female ______________ 3. Age ______ (full years, for children: up to 1 year-months, up to 1 month-days 4. Permanent residence: town, village (underline) ____ ______________________________________________________________ write the address, for visitors-region, district, town, address, relatives, and phone N 5. Place of work, profession or position _____________________ ______________________________________________________________ for students-place of study; for children – the name of the child ______________________________________________________________ institutions, schools; for disabled persons – kind and group of disability 6. Who directed the patient _____________________________________ name of medical institution 7. Delivered to the hospital for emergency indications: Yes, no through _________ hours after the onset of the disease, receiving injury, hospitalized in a planned manner (to emphasize). 8. Diagnosis of the sending institution ___________________________ 9. Diagnosis upon admission ___________________________________ 10.Clinical diagnosis ¦ date of establishment _______________________________________¦______________________ (a) basic: _________________________________________________ b) complication of the main: _____________________________________ C) accompanying: ____________________________________________ 11. Hospitalized in this year about this diseases: for the first time, repeatedly (to emphasize), all -… time. Fig.2. Medical card of in-patient Transportation of the patient to the Department The method of transportation depends on the severity of the patient’s condition. In determining the possibility of transportation all patients are divided into transportable (able to transfer the transportation of lying, sitting or half-sitting) and non-transportable (whose lives may be threatened by transportation).