英文病历模版

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1、.Name:______________Sex:__________Age:___________Nation:___________BirthPlace:________________________________MaritalStatus:____________Work-organization&Occupation:_______________________________________LivingAddress&Tel:_________________________________________________Dateofadmission:____

2、___Dateofhistorytaken:_______Informant:__________ChiefComplaint:___________________________________________________HistoryofPresentIllness:________________________________________________________________________________________________________________________________________________________

3、___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4、___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

5、____________________________________________________________________________________________PastHistory:GeneralHealthStatus:1.good2.moderate3.poorDiseasehistory:(ifany,pleasewritedownthedateofonset,briefdiagnostic..andtherapeuticcourse,andtheresults.)Respiratorysystem:1.None2.Repeatedpharyn

6、gealpain3.chroniccough4.expectoration:5.Hemoptysis6.asthma7.dyspnea8.chestpain_______________________________________________________________Circulatorysystem:1.None2.Palpitation3.exertionaldyspnea4..cyanosis5.hemoptysis6.Edemaoflowerextremities7.chestpain8.syncope9.hypertension____________

7、___________________________________________________Digestivesystem:1.None2.Anorexia3.dysphagia4.sourregurgitation5.eructation6.nausea7.Emesis8.melena9.abdominalpain10.diarrhea11.hematemesis12.Hematochezia13.jaundice_______________________________________