FISA DE EVIDENTA SI EVALUARE
Pentru optimizarea timpului petrecut in centrul nostru, puteti completa aceasta fisa inainte de consultatie, astfel medicii nostri vor sti deja cu ce probleme va confruntati .
Nume si prenume *
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Data nasterii
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Telefon
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Email
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Profesie
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Ocupatie
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Numar de ore lucrate zilnic
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Greutate in kg
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Inaltime in cm
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Activitate fizica
Istoric Medical boli avute anterior:
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Tratamente urmate, alopate, naturiste :
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Internari in spital anul /perioada / problema .
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Problema medicala pentru care ati solicitat consultatia
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Ce medicamente luati in prezent
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Ce analize aveti si rezultatele lor
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Intolerante alimentare sau alergii alimentare
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Alte probleme:
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