日期: |
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姓: |
名: |
地址: |
出生日期: |
主訴: ............................................................................................ |
健康保險: ............................................................................................ |
手術及住院治療史: ............................................................................................ |
藥物及飲食服用史: ............................................................................................ |
病史: ............................................................................................ |
胃口: ............................................................................................ |
口渴: ............................................................................................ |
腸蠕動: ............................................................................................ |
小便: ............................................................................................ |
排汗: ............................................................................................ |
月經史: ............................................................................................ |
呼吸次數: ............................................................................................ |
臟腑器官: ............................................................................................ |
神志: ............................................................................................ |
睡眠: ............................................................................................ |
氣候感覺: ............................................................................................ |
感覺器官: ............................................................................................ ............................................................................................ |
疼痛(位置及性質): ............................................................................................ |
脈象: ............................................................................................ |
舌苔: ............................................................................................ |