宫腔镜探查+输卵管通液手术同意书.docx

宫腔镜探查+输卵管通液手术同意书

姓名：__________性别：□女年龄：______岁住院号：__________床号：__________

身份证号：__________________________联系电话：__________________________

术前诊断：____________________________________________________________________

手术指征：____________________________________________________________________

拟施手术及操作：宫腔镜