Диссертация (1154326), страница 46
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- 2000. - Vol.6. – N. 5. -Р. 474 - 478.265Приложение 1ГБУЗКО «КАЛУЖСКАЯ ОБЛАСТНАЯ КЛИНИЧЕСКАЯ БОЛЬНИЦА»МЕДИКО - ГЕНЕТИЧЕСКАЯ КОНСУЛЬТАЦИЯГЕНЕТИЧЕСКАЯ КАРТА №Дата обращения_______________________________________________________________________Ф.И.О.Обратившегося___________________________________________________________________Родственное отношение кпробанду________________________________________________________________________Домашний адрес,№,телефона______________________________________________________________________Кем направлен_______________________________________________________________________Цель обращения_______________________________________________________________________Причинаобращения______________________________________________________________________ПРОБАНДФ.И.О._____________________________________________________________________Национальность_____________________________________________________________Дата и месторождения___________________________________________________________________Образование ________________________________________________________________Место работы_______________________________________________________________Специальность______________________________________________________________Профессиональныевредности __________________________________________________________________Материальноеположение семьи____________________________________________________________Дата или возрастк началу заболевания_________________________________________________________Диагноз____________________________________________________________________Где и когдапоставлен __________________________________________________________________Лечение и егоэффективность_________________________________________________________________________________________________________________________________________Исход болезни______________________________________________________________Анамнез жизни пробандаотносительно консультируемоговопроса_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________266267_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Дополнительные сведения______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________СИБСЫ ПРОБАНДАПорядковый номерФ.И.О.Дата рожденияВозраст родителей кмоменту рожденияВ случае смерти указатьпричинуДополнительные сведения268РОДСТВЕННИКИ ПРОБАНДАРодственноеотношение к пробандуФ.И.О.Дата и место рожденияНациональностьВозраст к моментурождения пробандаОбразованиеТрудовая деятельностьМесто работыСпециальностьПроф.
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