O’zbekiston Respublikasi Sog’liqni saqlash vazirligi sog’liqni saqlash vazirining

O’zbekiston Respublikasi O’zbekiston Respublikasi
Sog’liqni saqlash vazirligi sog’liqni saqlash vazirining
____________________ 2020-yil 31-dekabrdagi №363-sonli
Muasasa nomi buyrug’I bilan tasdiqlangan
027-raqamli tibbiy hujjat shakli

Tibbiy muassasadagi bemorning tibbiy kartasidan
Ko’chirma №______________
________________________________________________________________________________________
Ko’chirma yuborilayotgan muassasa nomi, manzili
F.I.Sh____________________________________________________________________________________
Tug’ilgan sana kun ________oy________________ yil ____________________________________________
Yashash joyi ______________________________________________________________________________
Ish joyi, bajaradigan vazifasi _________________________________________________________________
Sanalar: a) ambulatoriyada: kasallik ___________________________________________________________
Shifoxonaga yo’llandi_______________________________________________________________
b) shifoxonada: qabul qilindi _________________________________________________________
chiqarildi____________________________________________________________
To’liq tashxis (asosiy kasallik, asorati)__________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Bosh shifokor muovini:_________________________________________________________________
Bo’lim mudiri:________________________________________________________________________
Davolovchi shifokor:___________________________________________________________________