Extras/Epicriz

Numele, prenumele bolnavului ___________________________________________________________

Data naterii________________ Numrul de identitate______________________________________
Adresa________________________________________________________________________________
Locul de munc, studii: _________________________________________________________________
Data internrii_________________________________________________________________________
Data externrii_________________________________________________________________________
Diagnosticul___________________________________________________________________________
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Data clinice la internare _________________________________________________________________
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Investigaii diagnostice:
Hemoleucograma
Data Hb Tromb. erit Leuc. Nes seg eoz limf mon VSH

Urograma
Data Densitatea Prot. Epiteliu Eritro Leucoci Glucoza Corp Cilindri Mucos Sru Bact. Cor.
ceton cet

Probe biochimice
Data Bilirubin ALT AST Timol Ureea Creatinin Glucoza CGTP - BLP Indice
amil. protr.

Markerii hepatitelor virale

Data AgHBS AntiHbcor AntiHBs AntiHCV AntiHDV AntiHBcor AntihBcor AntiHCV AntiHDV AntiHAV
sum sumar sumar IgM IgG IgM IgM IgM

Date bacteriologice:________________________________________________________
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Investigaii instrumentale: ECG_____________________________________________

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Radiografia:_______________________________________________________________
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EUS - ficatul l.dr._____l.st.____v.porta_____v.splenica___Colecistul________________

pereii__________________calculi___________coledocul_________________________
Pancreasul_________________________________________________________________
splina dimens. ____________________________________________________________
rinichii dimens. r. drept_____________________r. stng__________________________
Stratul____________________________________________________________________
Concluzie EUS:___________________________________________________________
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Alte investigaii:
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Tratamentul:_______________________________________________________________
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Date clinice la externare:___________________________________________________
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Recomandri:_____________________________________________________________
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Data _________________________20___

Medic_______________________________