Include P12 V2 - HSPAHF05

HSPAHF05.CH

 #DEFINE STR0001 FWI18NLang("HSPAHF05","STR0001",1)
#DEFINE STR0002 FWI18NLang("HSPAHF05","STR0002",2)
#DEFINE STR0003 FWI18NLang("HSPAHF05","STR0003",3)
#DEFINE STR0004 FWI18NLang("HSPAHF05","STR0004",4)
#DEFINE STR0005 FWI18NLang("HSPAHF05","STR0005",5)
#DEFINE STR0006 FWI18NLang("HSPAHF05","STR0006",6)
#DEFINE STR0007 FWI18NLang("HSPAHF05","STR0007",7)
#DEFINE STR0008 FWI18NLang("HSPAHF05","STR0008",8)
#DEFINE STR0009 FWI18NLang("HSPAHF05","STR0009",9)
#DEFINE STR0010 FWI18NLang("HSPAHF05","STR0010",10)
#DEFINE STR0011 FWI18NLang("HSPAHF05","STR0011",11)
#DEFINE STR0012 FWI18NLang("HSPAHF05","STR0012",12)
#DEFINE STR0013 FWI18NLang("HSPAHF05","STR0013",13)
#DEFINE STR0014 FWI18NLang("HSPAHF05","STR0014",14)
#DEFINE STR0015 FWI18NLang("HSPAHF05","STR0015",15)
#DEFINE STR0016 FWI18NLang("HSPAHF05","STR0016",16)
#DEFINE STR0017 FWI18NLang("HSPAHF05","STR0017",17)
#DEFINE STR0018 FWI18NLang("HSPAHF05","STR0018",18)
#DEFINE STR0019 FWI18NLang("HSPAHF05","STR0019",19)
#DEFINE STR0020 FWI18NLang("HSPAHF05","STR0020",20)
#DEFINE STR0021 FWI18NLang("HSPAHF05","STR0021",21)
#DEFINE STR0022 FWI18NLang("HSPAHF05","STR0022",22)
#DEFINE STR0023 FWI18NLang("HSPAHF05","STR0023",23)
#DEFINE STR0024 FWI18NLang("HSPAHF05","STR0024",24)
#DEFINE STR0025 FWI18NLang("HSPAHF05","STR0025",25)
#DEFINE STR0026 FWI18NLang("HSPAHF05","STR0026",26)
#DEFINE STR0027 FWI18NLang("HSPAHF05","STR0027",27)
#DEFINE STR0028 FWI18NLang("HSPAHF05","STR0028",28)
#DEFINE STR0029 FWI18NLang("HSPAHF05","STR0029",29)
#DEFINE STR0030 FWI18NLang("HSPAHF05","STR0030",30)
#DEFINE STR0031 FWI18NLang("HSPAHF05","STR0031",31)
#DEFINE STR0032 FWI18NLang("HSPAHF05","STR0032",32)
#DEFINE STR0033 FWI18NLang("HSPAHF05","STR0033",33)
#DEFINE STR0034 FWI18NLang("HSPAHF05","STR0034",34)
#DEFINE STR0035 FWI18NLang("HSPAHF05","STR0035",35)
#DEFINE STR0036 FWI18NLang("HSPAHF05","STR0036",36)
#DEFINE STR0037 FWI18NLang("HSPAHF05","STR0037",37)
#DEFINE STR0038 FWI18NLang("HSPAHF05","STR0038",38)
#DEFINE STR0039 FWI18NLang("HSPAHF05","STR0039",39)
#DEFINE STR0040 FWI18NLang("HSPAHF05","STR0040",40)
#DEFINE STR0041 FWI18NLang("HSPAHF05","STR0041",41)
#DEFINE STR0042 FWI18NLang("HSPAHF05","STR0042",42)
#DEFINE STR0043 FWI18NLang("HSPAHF05","STR0043",43)
#DEFINE STR0044 FWI18NLang("HSPAHF05","STR0044",44)
#DEFINE STR0045 FWI18NLang("HSPAHF05","STR0045",45)
#DEFINE STR0046 FWI18NLang("HSPAHF05","STR0046",46)
#DEFINE STR0047 FWI18NLang("HSPAHF05","STR0047",47)
#DEFINE STR0048 FWI18NLang("HSPAHF05","STR0048",48)
 

HSPAHF05_EN.TRES

 0001#STR0001#ALL#F O R M    F O R    M E D I C A L    R E P O R T 
0002#STR0002#ALL#MEDICAL REPT
0003#STR0003#ALL#S U S  -  U n i f i e d   H e a l t h   S y s t e m
0004#STR0004#ALL#Health Ministry
0005#STR0005#ALL#STATE GOVERNMENT 
0006#STR0006#ALL#Special Department for Social Protection - Executive Health Department
0007#STR0007#ALL#MEDICAL REPORT FOR ISSUING AIH
0008#STR0008#ALL#Dossier: _____________   Hospital: 
0009#STR0009#ALL#1-Authorization Code:_______________
0010#STR0010#ALL#2-Origin Unit:_________________________________  3-CNPJ:__________________
0011#STR0011#ALL#4-Destination Unit:________________________________  5-CNPJ:__________________
0012#STR0012#ALL#6-Patient Name: 
0013#STR0013#ALL#7-Age:   
0014#STR0014#ALL#8-Dt. Birth: 
0015#STR0015#ALL#9-Gender: 
0016#STR0016#ALL#10-Address..: 
0017#STR0017#ALL#11-Distr.: 
0018#STR0018#ALL#12-ZIP: 
0019#STR0019#ALL#13-City:
0020#STR0020#ALL#14-State
0021#STR0021#ALL#15-DOC Type.:__________     16-Doc. Number: 
0022#STR0022#ALL#17-Name of Responsible: 
0023#STR0023#ALL#18-Doc.Reque.:______________________________ 19-CPF Clinic Dir.:________________
0024#STR0024#ALL#20-Bed number: 
0025#STR0025#ALL#     21-Infirmary No.: _______
0026#STR0026#ALL#22-Nature of Admission:______________     23-Date of Admission: 
0027#STR0027#ALL#Complete in case of traffic accident
0028#STR0028#ALL#24-External cause: ________________________ 25-CNPJ of Insur.:__________________
0029#STR0029#ALL#26-Ticket No.  :________________________ 27-Series:___________________________
0030#STR0030#ALL#Complete in case of workplace accident
0031#STR0031#ALL#28-Communication work accident_________________________________________________
0032#STR0032#ALL#29-CNPJ of Employer: :__________________________________
0033#STR0033#ALL#TECHNICAL REPORT AND ADMISSION JUSTIFICATI.
0034#STR0034#ALL#30-Principal signals and clinic symptoms:                                       
0035#STR0035#ALL#31-Conditions justifying admission:                                             
0036#STR0036#ALL#32-Principal results of diagnostic exams:                                
0037#STR0037#ALL#33-Initial diagnosis:                     34-ICD:                               
0038#STR0038#ALL#35-Clinic:   1-Surgery    (  )    2-Obstetric    (  )    3-Medical         (  )
0039#STR0039#ALL#              4-F.P.T      (  )    5-Psychiatry   (  )    6-Tsiopneumology  (  )
0040#STR0040#ALL#              7-Pediatric (  )    8-Rehabilitat. (  )    8-Others          (  )
0041#STR0041#ALL#36-Proc.Requested:__________________________________ 37-Proc.Cod:______________
0042#STR0042#ALL#38-Reque.Doctor.:_________________________ 39-Clinic.Dir:______________________
0043#STR0043#ALL#                     Signature/Seal                          Signature/Seal    
0044#STR0044#ALL#40-CPF Supervisor Med.:____________________ 41-Supervisor Med.:___________________
0045#STR0045#ALL#                                                             Signature/Seal 
0046#STR0046#ALL#42-Authorization date: _____/_____/_____                                       
0047#STR0047#ALL#Male 
0048#STR0048#ALL#Female 
 

HSPAHF05_ES.TRES

 0001#STR0001#ALL#F O R M U L A R I O     P A R A     L A U D O      M E D I C O 
0002#STR0002#ALL#LAUDO MEDICO
0003#STR0003#ALL#S U S  -  S i s t e m a   U n i c o   d e   S a l u d
0004#STR0004#ALL#Ministerio de Salud
0005#STR0005#ALL#GOBIERNO DE ESTADO 
0006#STR0006#ALL#Secretaria Especial de Proteccion Social - Secretaria Ejecutiva de Salud
0007#STR0007#ALL#LAUDO MEDICO PARA EMISION DE AIH
0008#STR0008#ALL#Ficha:__________________   Hospital: 
0009#STR0009#ALL#1-Codigo de Autorizacion:_______________
0010#STR0010#ALL#2-Unidad de Origen:_________________________________  3-CNPJ:__________________
0011#STR0011#ALL#4-Unidad de Destino:________________________________  5-CNPJ:__________________
0012#STR0012#ALL#6-Nombre del Paciente: 
0013#STR0013#ALL#7-Edad: 
0014#STR0014#ALL#8-Fecha Nac.: 
0015#STR0015#ALL#9-Sexo.: 
0016#STR0016#ALL#10-Direccion.: 
0017#STR0017#ALL#11-Barrio: 
0018#STR0018#ALL#12-CP: 
0019#STR0019#ALL#13-Municipio:
0020#STR0020#ALL#14-EST.:
0021#STR0021#ALL#15-Tipo DOC.:__________     16-Numero Doc.: 
0022#STR0022#ALL#17-Nombre del Responsable: 
0023#STR0023#ALL#18-Med.Solic.:______________________________ 19-CPF Dir. Clinico:_______________
0024#STR0024#ALL#20-Nro. de Cama: 
0025#STR0025#ALL#     21-Enfermeria No.: _______
0026#STR0026#ALL#22-Caracter de Internacion:______________     23-Fcha de Internac. : 
0027#STR0027#ALL#Rellenar en caso de Accidente de Transito
0028#STR0028#ALL#24-Causa Externa:__________________________ 25-CNPJ de la Aseg.:________________
0029#STR0029#ALL#26-Nro. de billete:________________________ 27-Serie:___________________________
0030#STR0030#ALL#Completar en caso de accidente de trabajo 
0031#STR0031#ALL#28-Comunicado Accidente Trabajo_________________________________________________
0032#STR0032#ALL#29-CNPJ del Empleador :__________________________________
0033#STR0033#ALL#LAUDO TECNICO Y JUSTIFICACION DE INTERNACION
0034#STR0034#ALL#30-Principales senales y sintomas clinicos:                                     
0035#STR0035#ALL#31-Condiciones que justifican la internacion:                                   
0036#STR0036#ALL#32-Principales resultados de pruebas diagnosticas:                              
0037#STR0037#ALL#33-Diagnostico Inicial:                   34-CID:                               
0038#STR0038#ALL#35-Clinica:   1-Cirurgica (  )    2-Obstetricia   (  )    3-Medica          (  )
0039#STR0039#ALL#              4-F.P.T      (  )    5-Psiqui�trica (  )    6-Tisio-neumonolog(  )
0040#STR0040#ALL#              7-Pedi�trica (  )    8-Reabilitacion(  )    8-Otros           (  )
0041#STR0041#ALL#36-Proc.Solicitado:__________________________________ 37-Cod. Proc:_____________
0042#STR0042#ALL#38-Medico Solic.:_________________________ 39-Dir. Clinico:_____________________
0043#STR0043#ALL#                    Firma/Sello                              Firma/Sello        
0044#STR0044#ALL#40-CPF Med.Supervisor:____________________ 41-Med.Supervisor:___________________
0045#STR0045#ALL#                                                             Firma/Sello        
0046#STR0046#ALL#42-Fecha Autorizacion:  _____/_____/_____                                       
0047#STR0047#ALL#Masculino
0048#STR0048#ALL#Femenino
 

HSPAHF05_PT-BR.TRES

 0001#STR0001#ALL#F O R M U L A R I O     P A R A     L A U D O      M E D I C O 
0002#STR0002#ALL#LAUDO MEDICO
0003#STR0003#ALL#S U S  -  S i s t e m a   U n i c o   d e   S a u d e
0004#STR0004#ALL#Ministerio da Saude
0005#STR0005#ALL#GOVERNO DO ESTADO 
0006#STR0006#ALL#Secretaria Especial de Protecao Social - Secretaria Executiva de Saude
0007#STR0007#ALL#LAUDO MEDICO PARA EMISSAO DE AIH
0008#STR0008#ALL#Prontuario:_____________   Hospital: 
0009#STR0009#ALL#1-Codigo de Autorizacao:_______________
0010#STR0010#ALL#2-Unidade de Origem:_________________________________  3-CNPJ:__________________
0011#STR0011#ALL#4-Unidade de Destino:________________________________  5-CNPJ:__________________
0012#STR0012#ALL#6-Nome do Paciente: 
0013#STR0013#ALL#7-Idade: 
0014#STR0014#ALL#8-Data Nasc.: 
0015#STR0015#ALL#9-Sexo.: 
0016#STR0016#ALL#10-Endereco.: 
0017#STR0017#ALL#11-Bairro: 
0018#STR0018#ALL#12-CEP: 
0019#STR0019#ALL#13-Municipio:
0020#STR0020#ALL#14-U.F.:
0021#STR0021#ALL#15-Tipo DOC.:__________     16-Numero Doc.: 
0022#STR0022#ALL#17-Nome do Responsavel: 
0023#STR0023#ALL#18-Med.Solic.:______________________________ 19-CPF Dir.Clinico:________________
0024#STR0024#ALL#20-Nro. do Leito: 
0025#STR0025#ALL#     21-Enfermaria No.: _______
0026#STR0026#ALL#22-Carater da Internacao:______________     23-Data da Internacao: 
0027#STR0027#ALL#Preencher em caso de Acidente de Transito
0028#STR0028#ALL#24-Causa Externa:__________________________ 25-CNPJ da Segur.:__________________
0029#STR0029#ALL#26-Nro. do Bilhete:________________________ 27-Serie:___________________________
0030#STR0030#ALL#Preencher em caso de Acidente de Trabalho
0031#STR0031#ALL#28-Comunicado Acidente Trabalho_________________________________________________
0032#STR0032#ALL#29-CNPJ do Empregador:__________________________________
0033#STR0033#ALL#LAUDO TECNICO E JUSTIFICATIVA DA INTERNACAO
0034#STR0034#ALL#30-Principais Sinais e Sintomas Clinicos:                                       
0035#STR0035#ALL#31-Condicoes que justificam a Internacao:                                       
0036#STR0036#ALL#32-Principais Resultados de Provas Diagnosticas:                                
0037#STR0037#ALL#33-Diagnostico Inicial:                   34-CID:                               
0038#STR0038#ALL#35-Clinica:   1-Cirurgica  (  )    2-Obstetrica   (  )    3-Medica          (  )
0039#STR0039#ALL#              4-F.P.T      (  )    5-Psiqui�trica (  )    6-Tsiopneumol�gica(  )
0040#STR0040#ALL#              7-Pedi�trica (  )    8-Reabilitacao (  )    8-Outros          (  )
0041#STR0041#ALL#36-Proc.Solicitado:__________________________________ 37-Cod.Proc:______________
0042#STR0042#ALL#38-Medico Solic.:_________________________ 39-Dir.Clinico:______________________
0043#STR0043#ALL#                    Assinatura/carimbo                       Assinatura/carimbo 
0044#STR0044#ALL#40-CPF Med.Supervisor:____________________ 41-Med.Supervisor:___________________
0045#STR0045#ALL#                                                             Assinatura/carimbo 
0046#STR0046#ALL#42-Data da Autorizacao: _____/_____/_____                                       
0047#STR0047#ALL#Masculino
0048#STR0048#ALL#Feminino
 

HSPAHF05_PT-PT.TRES

 0001#STR0001#ALL#F o r m u l � r i o     p a r a     r e l a t � r i o    m � d i c o 
0002#STR0002#ALL#Relat�rio M�dico
0003#STR0003#ALL#S u s  -  s i s t e m a   � n i c o   d e   s a � d e
0004#STR0004#ALL#Minist�rio Da Sa�de
0005#STR0005#ALL#Governo do distrito 
0006#STR0006#ALL#Secretaria Especial De Protec��o Social - Secretaria Executiva De Sa�de
0007#STR0007#ALL#Relat�rio M�dico Para Emiss�o De Aih
0008#STR0008#ALL#Prontu�rio:_____________   hospital: 
0009#STR0009#ALL#1-c�digo De Autoriza��o:_______________
0010#STR0010#ALL#2-unidade de origem:_________________________________  3-nr contribuinte:__________________
0011#STR0011#ALL#4-unidade de destino:________________________________  5-nr contribuinte:__________________
0012#STR0012#ALL#6-nome do paciente: 
0013#STR0013#ALL#7-idade: 
0014#STR0014#ALL#8-data nasc.: 
0015#STR0015#ALL#9-sexo.: 
0016#STR0016#ALL#10-morada.: 
0017#STR0017#ALL#11-localidade: 
0018#STR0018#ALL#12-c�digo postal: 
0019#STR0019#ALL#13-concelho:
0020#STR0020#ALL#14-distrito:
0021#STR0021#ALL#15-tipo doc.:__________     16-n�mero doc.: 
0022#STR0022#ALL#17-nome do respons�vel: 
0023#STR0023#ALL#18-m�d.solic.:______________________________ 19-nr Contribuinte Dir.cl�nico:________________
0024#STR0024#ALL#20-nr. da cama: 
0025#STR0025#ALL#     21-enfermaria nr.: _______
0026#STR0026#ALL#22-car�cter do internamento:______________     23-data do internamento: 
0027#STR0027#ALL#Preencher Em Caso De Acidente De Tr�nsito
0028#STR0028#ALL#24-causa Externa:__________________________ 25-nr Contribuinte Da Segur.:__________________
0029#STR0029#ALL#26-nr. do bilhete:________________________ 27-s�rie:___________________________
0030#STR0030#ALL#Preencher Em Caso De Acidente De Trabalho
0031#STR0031#ALL#28-comunicado Acidente Trabalho_________________________________________________
0032#STR0032#ALL#29-nr Contribuinte Do Empregador:__________________________________
0033#STR0033#ALL#Relat�rio T�cnico E Justificativa Do Internamento
0034#STR0034#ALL#30-principais sinais e s�ntomas cl�nicos:                                       
0035#STR0035#ALL#31-condi��es que justificam o internamento:                                       
0036#STR0036#ALL#32-principais resultados de provas diagn�sticas:                                
0037#STR0037#ALL#33-diagn�stico inicial:                   34-cid:                               
0038#STR0038#ALL#35-cl�nica:   1-cir�rgica  (  )    2-obst�trica   (  )    3-m�dica          (  )
0039#STR0039#ALL#              4-f.p.t      (  )    5-psiqui�trica (  )    6-tsiopneumol�gica(  )
0040#STR0040#ALL#              7-pedi�trica (  )    8-reabilita��o (  )    8-outros          (  )
0041#STR0041#ALL#36-proc.solicitado:__________________________________ 37-c�d.proc:______________
0042#STR0042#ALL#38-m�dico solic.:_________________________ 39-dir.cl�nico:______________________
0043#STR0043#ALL#                    assinatura/carimbo                       assinatura/carimbo 
0044#STR0044#ALL#40-cpf m�d.supervisor:____________________ 41-m�d.supervisor:___________________
0045#STR0045#ALL#                                                             assinatura/carimbo 
0046#STR0046#ALL#42-data da autoriza��o: _____/_____/_____                                       
 

HSPAHF05_RU.TRES

 0001#STR0001#ALL#F O R M    F O R    M E D I C A L    R E P O R T 
0002#STR0002#ALL#MEDICAL REPT
0003#STR0003#ALL#S U S  -  S i s t e m a   U n i c o   d e   S a u d e
0004#STR0004#ALL#Health Ministry
0005#STR0005#ALL#STATE GOVERNMENT 
0006#STR0006#ALL#Special Department for Social Protection - Executive Health Department
0007#STR0007#ALL#MEDICAL REPORT FOR ISSUING AIH
0008#STR0008#ALL#Dossier: _____________   Hospital: 
0009#STR0009#ALL#1-Authorization Code:_______________
0010#STR0010#ALL#2-Origin Unit:_________________________________  3-CNPJ:__________________
0011#STR0011#ALL#4-Destination Unit:________________________________  5-CNPJ:__________________
0012#STR0012#ALL#6-Patient Name: 
0013#STR0013#ALL#7-Age:   
0014#STR0014#ALL#8-Dt. Birth: 
0015#STR0015#ALL#9-Gender:
0016#STR0016#ALL#10-Address..: 
0017#STR0017#ALL#11-Distr.: 
0018#STR0018#ALL#12-ZIP: 
0019#STR0019#ALL#13-City:
0020#STR0020#ALL#14-State
0021#STR0021#ALL#15-DOC Type.:__________     16-Doc. Number: 
0022#STR0022#ALL#17-Name of Responsible: 
0023#STR0023#ALL#18-Doc.Reque.:______________________________ 19-CPF Clinic Dir.:________________
0024#STR0024#ALL#20-Bed number: 
0025#STR0025#ALL#     21-Infirmary No.: _______
0026#STR0026#ALL#22-Nature of Admission:______________     23-Date of Admission: 
0027#STR0027#ALL#Complete in case of traffic accident
0028#STR0028#ALL#24-External cause: ________________________ 25-CNPJ of Insur.:__________________
0029#STR0029#ALL#26-Ticket No.  :________________________ 27-Series:___________________________
0030#STR0030#ALL#Complete in case of workplace accident
0031#STR0031#ALL#28-Communication work accident_________________________________________________
0032#STR0032#ALL#29-CNPJ of Employer: :__________________________________
0033#STR0033#ALL#TECHNICAL REPORT AND ADMISSION JUSTIFICATI.
0034#STR0034#ALL#30-Principal signals and clinic symptoms:                                       
0035#STR0035#ALL#31-Conditions justifying admission:                                             
0036#STR0036#ALL#32-Principal results of diagnostic exams:                                
0037#STR0037#ALL#33-Initial diagnosis:                     34-ICD:                               
0038#STR0038#ALL#35-Clinic:   1-Surgery    (  )    2-Obstetric    (  )    3-Medical         (  )
0039#STR0039#ALL#              4-F.P.T      (  )    5-Psychiatry   (  )    6-Tsiopneumology  (  )
0040#STR0040#ALL#              7-Pediatric (  )    8-Rehabilitat. (  )    8-Others          (  )
0041#STR0041#ALL#36-Proc.Requested:__________________________________ 37-Proc.Cod:______________
0042#STR0042#ALL#38-Reque.Doctor.:_________________________ 39-Clinic.Dir:______________________
0043#STR0043#ALL#                     Signature/Seal                          Signature/Seal    
0044#STR0044#ALL#40-CPF Supervisor Med.:____________________ 41-Supervisor Med.:___________________
0045#STR0045#ALL#                                                             Signature/Seal 
0046#STR0046#ALL#42-Authorization date: _____/_____/_____                                       
0047#STR0047#ALL#���.
0048#STR0048#ALL#���.