Sakura Clinic Questionnaire.pdf

.pdf
Preview of Sakura Clinic Questionnaire
🔗 Source: sacra.greater.jp
📊 Size: 221 KB
📄 Pages: 2 pages
⬇️ Downloads: 93

Summary

- 診察券番号、初診・再診、担当医師
- フリガナ、生年月日、職業、婚姻状況、住所、連絡先
- 身長、体重、BMI
- 生理、妊娠、分娩、性交、子宮がん検診、薬アレルギー、病気、手術、内服薬、授乳、梅毒・B型肝炎・C型肝炎・HIV
- 今日の来院理由(子宮がん検査、婦人科定期検診、妊娠希望、妊娠確認、ピル、更年期、月経調整、緊急避妊、他院紹介)
- 症状、症状発生時期
- スタッフ記入欄、EDC、LMP、OVD、 マイナンバーカード利用同意

Description

- 診察券番号、初診・再診、担当医師
- フリガナ、生年月日、職業、婚姻状況、住所、連絡先
- 身長、体重、BMI
- 生理、妊娠、分娩、性交、子宮がん検診、薬アレルギー、病気、手術、内服薬、授乳、梅毒・B型肝炎・C型肝炎・HIV
-...

Technical Information

  • File Format: PDF
  • File Size: 221 KB
  • Pages: 2
  • Language: EN
  • Total Downloads: 93
  • Last Updated: 1 week ago

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