疝气修补手术同意书.docx

疝气修补手术同意书

姓名：__________性别：□男□女年龄：__________科室：__________床号：__________住院号：__________身份证号：________________________联系地址：________________________诊断：________________________疝分型：□原发性腹股沟斜疝□原发性腹股沟直疝□股疝□切口疝□脐疝□造口旁疝□复发疝□嵌顿疝□绞窄疝□其他：__________手术指征：________________________拟定手术日期：______年_____