DOSAR CLINIC PODOLOGIC CARD Nr____

Nume complet: _________________________________________________________________________________________

Sex:________
Abordare : ____________________________________________________________________________________________
Telefon: __________________________F.Naștere:________________________ Vârsta:_____________________
Ocupația:________________________________________________________________________________________________
Centrul de
recomandare:________________________________________________________________________________________________

Boala de care suferi:

XD HTA Artrita Osteoartrita Altele:___________________________________
Medicamente :___________________________________________________________________________________________
SIMBOLULE Greutate: _______kilograme

Înălțime:_______mt

Nr. încălțăminte:________

EXAMENUL PICIORULUI

PULS PEDIUM (+) (-)

Dreapta stanga

PULS TIBIAL (+) (-)

dreapta stanga

TEMPERATURA

Rece Normal Cald

PROBLEME DE CIRCULARE

Dar

BLANĂ

Uscat Normal Umed

OBSERVATII: TRATAMENT : INDICAȚII:

___________________________
ASEPSIS ___________________________
Încălțăminte adecvată Inadecvată Foarte inadecvată
CATAPLASMĂ ___________________________
_____________________________________________
CURĂȚAREA RANDURILOR ___________________________
_____________________________________________ ONICOTOMIE ________________________
_____________________________________________ DESPICULIZAREA ________________________
_____________________________________________ uscat ________________________
_____________________________________________ HELOTOMIE ________________________
_________________________________________________
ASRUPTAT ________________________
___________________________________________ LUSTRUIT ________________________
___________________________________________ ASEPSIS FINAL ________________________
___________________________________________ ALTE : ________________________
____________________________________________________________________________ ________________________
____________________________________________________________________________ ________________________
____________________________________________________________________________ ________________________
____________________________________________________________________________
___________________________________________ _________________________________ DATA :____/____/________
___________________________________________ _________________________________
__________________________________________ _________________________________ DEALER:
__________________________________________ _________________________________
__________________________________________
__________________________________________