日期: |
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名: |
地址: |
出生日期: |
主诉: ............................................................................................ |
健康保险: ............................................................................................ |
手术及住院治疗史: ............................................................................................ |
药物及饮食服用史: ............................................................................................ |
病史: ............................................................................................ |
胃口: ............................................................................................ |
口渴: ............................................................................................ |
肠蠕动: ............................................................................................ |
小便: ............................................................................................ |
排汗: ............................................................................................ |
月经史: ............................................................................................ |
呼吸次数: ............................................................................................ |
脏腑器官: ............................................................................................ |
神志: ............................................................................................ |
睡眠: ............................................................................................ |
气候感觉: ............................................................................................ |
感觉器官: ............................................................................................ |
疼痛(位置及性质): ............................................................................................ |
脉象: ............................................................................................ |
舌苔: ............................................................................................ |