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1、鼠疫个案调查表国标码口口口口口口病例编码口口口口1.一般情况1.1病人姓名1.2性别（1）男（2）女口1.3年龄（岁）口口1.4家庭住址地区（市）县（区）乡（农场、镇、街道）1.5职业（1）农民（2）民工（3）渔民（3）工人（4）学生（5）干部职员（6）医务人员（7）做家务及待业（8）不详口1.6父母姓名单位住址单位住址1.7发病时间年月日1.8发病地点1.9初诊日期年月日1.10初诊单位1.11住院日期年月日1.12出院日期年月日1.13住院单位1.14报告单位1.15报告时间年月日1.16诊断（
2、1）是（2）否口1.17死亡日期年月日1.18病程天2.临床表现2.1淋巴结肿大（部位：）（1）有（2）无口2.2（1）咳嗽（2）胸痛（3）泡沫痰口口口2.3呼吸困难（1）有（2）无口2.4皮肤黏膜发绀（1）有（2）无口2.5恶寒、高热（1）是（2）否口2.6最高体温（℃）口口2.7剧烈头痛（1）有（2）无口2.8（1）狂躁（2）谵妄（3）神志不清口口口2.9（1）皮下及黏膜出血（2）血尿（3）血便（4）血性呕吐物口口口口2.10血压mmHg2.11胸透goodprocessingperforman
3、ce,withsufficientrigidity.Templateselectedtemplatesurfaceshouldbeflatandsmooth,plywoodcoatedhighstrength,goodwearresistance,waterresistance,durability,physicalandchemicalpropertiesofstableandsmoothsurface,nopollution,nodamage,clean.Templatestraightkeel
4、,specifications,andpanelsclose,firmlyattached,havesufficientrigidity.Templatesmaynotplaytheink,paintandwritenumberstoavoidcontaminationofconcretesurfaces.Templatedesignsetofboltholesthroughwalls,butnotfreetoplayholes,openings,portrayal,nailing.Releasea
5、gentusedonconcretesurfacequalityandcolordoesnotaffectthereleaseagent.Pullboltspecificationsandvarietiesshouldbeaccordingtotheconcretelateralpressure,wallwaterproofing,airdefencerequirementsandtemplatePanelselection,boltsusedshouldhavesufficientstrength
6、topulltheboltcasingandplugshouldbedeterminedaccordingtothediameterofthebolt,thechoiceofplastics,rubber,nylonandothermaterials.Topstitchingcross-sectionaccordingtothecircumstances,therequestcanteardown,shouldadoptthetrapezoid,square,roundedsquare;canbem
7、adeforhardwood,nylon,plastic,aluminum,stainlesssteelandothermaterials.Depthisnotgreaterthan20mm.SteelframeinfrontoftheAssemblymustbestraightened,woodjoistrequiresthatyouhavesufficientrigidity.Keelasfaraspossiblewithoutjoints,ifitprovesnecessarytoconnec
8、t,theconnectionmustbestaggered.Templateprocessingmustbecarriedoutinwoodprocessingplant,processingmaterialswhencuttinglinecutting,precisesize,angle,surfacesmooth,tightjoints.Fieldspellusingatemplatebeforethetemplate,onthesurfacesmoothnes
