内科入院记录 - 副本

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1、金堂县中医医院内科入院记录（一）姓名性别年龄科别床号住院号民族婚否职业单位或住址入院日期记录时间病史陈述者发病节气主诉：___________________________________________________________________________________现病史：______________________________________________________________________________________________________________________________________

2、_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3、_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4、___________________________________________仍需治疗的合并疾病情况：__________________________________________________________________________________________________________________________________________________________________________________________________________________________________

5、________________________________________________________________________既往史：一般健康状况：良好一般较差疾病史：无有________________________________________________________________________________________________________________________________________________传染病史:无有___________________________________

6、_______________________________预防接种史:无有不祥预防接种疫苗：__________________________________________手术外伤史：手术：无有名称及时间：________________________________________外伤：无有外伤情况及时间：_____________________________________输血史：无有输血反应:无有______________________________________________食物或药物过敏史：无有不祥过敏药品和食物名称：__

7、________________________________________________________个人史：出生地：______________经常居留地_____________寄生虫疫水接触史______________第页内科入院记录（二）姓名科别床号住院号吸烟史：无有：平均___支/日，时间___年戒烟：否是时间______饮酒史：无有：平均___克（两）/日，时间__年戒烟：否是时间______其他：____________________________________________________________________

8、______婚育史：结婚年龄_____岁，妊娠______次,足月