英文病历模版.pdfVIP

。 Name: ______________ Sex: __________ Age: ___________ Nation: ___________ Birth Place: ________________________________ Marital Status:____________ Work-organization Occupation: _______________________________________ Living Address Tel: _________________________________________________ Date of admission: _______Date of history taken:_______ Informant:__________ Chief Complaint: ___________________________________________________ History of Present Illness: __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ 。 I 。 ______________ Past History: General Health Status: 1. good 2.moderate 3.poor Disease history: (if any, please write downthe date of onset, brief diagnostic and therapeutic course, and the results.) Respiratory system: 1. None 2.Repeated pharyngeal pain 3.chronic cough 4.expectoration: 5. Hemoptysis 6.asthma