Include P12 V2 - HSPAHR82

HSPAHR82.CH

 #DEFINE STR0001 FWI18NLang("HSPAHR82","STR0001",1)
#DEFINE STR0002 FWI18NLang("HSPAHR82","STR0002",2)
#DEFINE STR0003 FWI18NLang("HSPAHR82","STR0003",3)
#DEFINE STR0004 FWI18NLang("HSPAHR82","STR0004",4)
#DEFINE STR0005 FWI18NLang("HSPAHR82","STR0005",5)
#DEFINE STR0006 FWI18NLang("HSPAHR82","STR0006",6)
#DEFINE STR0007 FWI18NLang("HSPAHR82","STR0007",7)
#DEFINE STR0008 FWI18NLang("HSPAHR82","STR0008",8)
#DEFINE STR0009 FWI18NLang("HSPAHR82","STR0009",9)
#DEFINE STR0010 FWI18NLang("HSPAHR82","STR0010",10)
#DEFINE STR0011 FWI18NLang("HSPAHR82","STR0011",11)
#DEFINE STR0012 FWI18NLang("HSPAHR82","STR0012",12)
#DEFINE STR0013 FWI18NLang("HSPAHR82","STR0013",13)
#DEFINE STR0014 FWI18NLang("HSPAHR82","STR0014",14)
#DEFINE STR0015 FWI18NLang("HSPAHR82","STR0015",15)
#DEFINE STR0016 FWI18NLang("HSPAHR82","STR0016",16)
#DEFINE STR0017 FWI18NLang("HSPAHR82","STR0017",17)
#DEFINE STR0018 FWI18NLang("HSPAHR82","STR0018",18)
#DEFINE STR0019 FWI18NLang("HSPAHR82","STR0019",19)
#DEFINE STR0020 FWI18NLang("HSPAHR82","STR0020",20)
#DEFINE STR0021 FWI18NLang("HSPAHR82","STR0021",21)
#DEFINE STR0022 FWI18NLang("HSPAHR82","STR0022",22)
#DEFINE STR0023 FWI18NLang("HSPAHR82","STR0023",23)
#DEFINE STR0024 FWI18NLang("HSPAHR82","STR0024",24)
#DEFINE STR0025 FWI18NLang("HSPAHR82","STR0025",25)
#DEFINE STR0026 FWI18NLang("HSPAHR82","STR0026",26)
#DEFINE STR0027 FWI18NLang("HSPAHR82","STR0027",27)
#DEFINE STR0028 FWI18NLang("HSPAHR82","STR0028",28)
#DEFINE STR0029 FWI18NLang("HSPAHR82","STR0029",29)
#DEFINE STR0030 FWI18NLang("HSPAHR82","STR0030",30)
#DEFINE STR0031 FWI18NLang("HSPAHR82","STR0031",31)
#DEFINE STR0032 FWI18NLang("HSPAHR82","STR0032",32)
#DEFINE STR0033 FWI18NLang("HSPAHR82","STR0033",33)
#DEFINE STR0034 FWI18NLang("HSPAHR82","STR0034",34)
#DEFINE STR0035 FWI18NLang("HSPAHR82","STR0035",35)
#DEFINE STR0036 FWI18NLang("HSPAHR82","STR0036",36)
#DEFINE STR0037 FWI18NLang("HSPAHR82","STR0037",37)
#DEFINE STR0038 FWI18NLang("HSPAHR82","STR0038",38)
#DEFINE STR0039 FWI18NLang("HSPAHR82","STR0039",39)
#DEFINE STR0040 FWI18NLang("HSPAHR82","STR0040",40)
#DEFINE STR0041 FWI18NLang("HSPAHR82","STR0041",41)
#DEFINE STR0042 FWI18NLang("HSPAHR82","STR0042",42)
#DEFINE STR0043 FWI18NLang("HSPAHR82","STR0043",43)
#DEFINE STR0044 FWI18NLang("HSPAHR82","STR0044",44)
#DEFINE STR0045 FWI18NLang("HSPAHR82","STR0045",45)
#DEFINE STR0046 FWI18NLang("HSPAHR82","STR0046",46)
#DEFINE STR0047 FWI18NLang("HSPAHR82","STR0047",47)
#DEFINE STR0048 FWI18NLang("HSPAHR82","STR0048",48)
#DEFINE STR0049 FWI18NLang("HSPAHR82","STR0049",49)
#DEFINE STR0050 FWI18NLang("HSPAHR82","STR0050",50)
#DEFINE STR0051 FWI18NLang("HSPAHR82","STR0051",51)
#DEFINE STR0052 FWI18NLang("HSPAHR82","STR0052",52)
#DEFINE STR0053 FWI18NLang("HSPAHR82","STR0053",53)
#DEFINE STR0054 FWI18NLang("HSPAHR82","STR0054",54)
#DEFINE STR0055 FWI18NLang("HSPAHR82","STR0055",55)
#DEFINE STR0056 FWI18NLang("HSPAHR82","STR0056",56)
#DEFINE STR0057 FWI18NLang("HSPAHR82","STR0057",57)
#DEFINE STR0058 FWI18NLang("HSPAHR82","STR0058",58)
#DEFINE STR0059 FWI18NLang("HSPAHR82","STR0059",59)
#DEFINE STR0060 FWI18NLang("HSPAHR82","STR0060",60)
#DEFINE STR0061 FWI18NLang("HSPAHR82","STR0061",61)
#DEFINE STR0062 FWI18NLang("HSPAHR82","STR0062",62)
#DEFINE STR0063 FWI18NLang("HSPAHR82","STR0063",63)
#DEFINE STR0064 FWI18NLang("HSPAHR82","STR0064",64)
#DEFINE STR0065 FWI18NLang("HSPAHR82","STR0065",65)
#DEFINE STR0066 FWI18NLang("HSPAHR82","STR0066",66)
#DEFINE STR0067 FWI18NLang("HSPAHR82","STR0067",67)
#DEFINE STR0068 FWI18NLang("HSPAHR82","STR0068",68)
#DEFINE STR0069 FWI18NLang("HSPAHR82","STR0069",69)
#DEFINE STR0070 FWI18NLang("HSPAHR82","STR0070",70)
#DEFINE STR0071 FWI18NLang("HSPAHR82","STR0071",71)
#DEFINE STR0072 FWI18NLang("HSPAHR82","STR0072",72)
#DEFINE STR0073 FWI18NLang("HSPAHR82","STR0073",73)
#DEFINE STR0074 FWI18NLang("HSPAHR82","STR0074",74)
#DEFINE STR0075 FWI18NLang("HSPAHR82","STR0075",75)
#DEFINE STR0076 FWI18NLang("HSPAHR82","STR0076",76)
#DEFINE STR0077 FWI18NLang("HSPAHR82","STR0077",77)
#DEFINE STR0078 FWI18NLang("HSPAHR82","STR0078",78)
#DEFINE STR0079 FWI18NLang("HSPAHR82","STR0079",79)
#DEFINE STR0080 FWI18NLang("HSPAHR82","STR0080",80)
#DEFINE STR0081 FWI18NLang("HSPAHR82","STR0081",81)
#DEFINE STR0082 FWI18NLang("HSPAHR82","STR0082",82)
#DEFINE STR0083 FWI18NLang("HSPAHR82","STR0083",83)
#DEFINE STR0084 FWI18NLang("HSPAHR82","STR0084",84)
#DEFINE STR0085 FWI18NLang("HSPAHR82","STR0085",85)
#DEFINE STR0086 FWI18NLang("HSPAHR82","STR0086",86)
#DEFINE STR0087 FWI18NLang("HSPAHR82","STR0087",87)
#DEFINE STR0088 FWI18NLang("HSPAHR82","STR0088",88)
#DEFINE STR0089 FWI18NLang("HSPAHR82","STR0089",89)
#DEFINE STR0090 FWI18NLang("HSPAHR82","STR0090",90)
#DEFINE STR0091 FWI18NLang("HSPAHR82","STR0091",91)
#DEFINE STR0092 FWI18NLang("HSPAHR82","STR0092",92)
#DEFINE STR0093 FWI18NLang("HSPAHR82","STR0093",93)
#DEFINE STR0094 FWI18NLang("HSPAHR82","STR0094",94)
#DEFINE STR0095 FWI18NLang("HSPAHR82","STR0095",95)
#DEFINE STR0096 FWI18NLang("HSPAHR82","STR0096",96)
#DEFINE STR0097 FWI18NLang("HSPAHR82","STR0097",97)
#DEFINE STR0098 FWI18NLang("HSPAHR82","STR0098",98)
#DEFINE STR0099 FWI18NLang("HSPAHR82","STR0099",99)
#DEFINE STR0100 FWI18NLang("HSPAHR82","STR0100",100)
#DEFINE STR0101 FWI18NLang("HSPAHR82","STR0101",101)
#DEFINE STR0102 FWI18NLang("HSPAHR82","STR0102",102)
#DEFINE STR0103 FWI18NLang("HSPAHR82","STR0103",103)
#DEFINE STR0104 FWI18NLang("HSPAHR82","STR0104",104)
#DEFINE STR0105 FWI18NLang("HSPAHR82","STR0105",105)
#DEFINE STR0106 FWI18NLang("HSPAHR82","STR0106",106)
#DEFINE STR0107 FWI18NLang("HSPAHR82","STR0107",107)
#DEFINE STR0108 FWI18NLang("HSPAHR82","STR0108",108)
#DEFINE STR0109 FWI18NLang("HSPAHR82","STR0109",109)
#DEFINE STR0110 FWI18NLang("HSPAHR82","STR0110",110)
#DEFINE STR0111 FWI18NLang("HSPAHR82","STR0111",111)
#DEFINE STR0112 FWI18NLang("HSPAHR82","STR0112",112)
#DEFINE STR0113 FWI18NLang("HSPAHR82","STR0113",113)
#DEFINE STR0114 FWI18NLang("HSPAHR82","STR0114",114)
#DEFINE STR0115 FWI18NLang("HSPAHR82","STR0115",115)
#DEFINE STR0116 FWI18NLang("HSPAHR82","STR0116",116)
#DEFINE STR0117 FWI18NLang("HSPAHR82","STR0117",117)
#DEFINE STR0118 FWI18NLang("HSPAHR82","STR0118",118)
#DEFINE STR0119 FWI18NLang("HSPAHR82","STR0119",119)
#DEFINE STR0120 FWI18NLang("HSPAHR82","STR0120",120)
#DEFINE STR0121 FWI18NLang("HSPAHR82","STR0121",121)
#DEFINE STR0122 FWI18NLang("HSPAHR82","STR0122",122)
#DEFINE STR0123 FWI18NLang("HSPAHR82","STR0123",123)
#DEFINE STR0124 FWI18NLang("HSPAHR82","STR0124",124)
#DEFINE STR0125 FWI18NLang("HSPAHR82","STR0125",125)
#DEFINE STR0126 FWI18NLang("HSPAHR82","STR0126",126)
#DEFINE STR0127 FWI18NLang("HSPAHR82","STR0127",127)
#DEFINE STR0128 FWI18NLang("HSPAHR82","STR0128",128)
#DEFINE STR0129 FWI18NLang("HSPAHR82","STR0129",129)
#DEFINE STR0130 FWI18NLang("HSPAHR82","STR0130",130)
#DEFINE STR0131 FWI18NLang("HSPAHR82","STR0131",131)
#DEFINE STR0132 FWI18NLang("HSPAHR82","STR0132",132)
#DEFINE STR0133 FWI18NLang("HSPAHR82","STR0133",133)
#DEFINE STR0134 FWI18NLang("HSPAHR82","STR0134",134)
#DEFINE STR0135 FWI18NLang("HSPAHR82","STR0135",135)
#DEFINE STR0136 FWI18NLang("HSPAHR82","STR0136",136)
#DEFINE STR0137 FWI18NLang("HSPAHR82","STR0137",137)
#DEFINE STR0138 FWI18NLang("HSPAHR82","STR0138",138)
#DEFINE STR0139 FWI18NLang("HSPAHR82","STR0139",139)
#DEFINE STR0140 FWI18NLang("HSPAHR82","STR0140",140)
#DEFINE STR0141 FWI18NLang("HSPAHR82","STR0141",141)
#DEFINE STR0142 FWI18NLang("HSPAHR82","STR0142",142)
#DEFINE STR0143 FWI18NLang("HSPAHR82","STR0143",143)
#DEFINE STR0144 FWI18NLang("HSPAHR82","STR0144",144)
#DEFINE STR0145 FWI18NLang("HSPAHR82","STR0145",145)
#DEFINE STR0146 FWI18NLang("HSPAHR82","STR0146",146)
#DEFINE STR0147 FWI18NLang("HSPAHR82","STR0147",147)
#DEFINE STR0148 FWI18NLang("HSPAHR82","STR0148",148)
#DEFINE STR0149 FWI18NLang("HSPAHR82","STR0149",149)
#DEFINE STR0150 FWI18NLang("HSPAHR82","STR0150",150)
#DEFINE STR0151 FWI18NLang("HSPAHR82","STR0151",151)
#DEFINE STR0152 FWI18NLang("HSPAHR82","STR0152",152)
#DEFINE STR0153 FWI18NLang("HSPAHR82","STR0153",153)
#DEFINE STR0154 FWI18NLang("HSPAHR82","STR0154",154)
#DEFINE STR0155 FWI18NLang("HSPAHR82","STR0155",155)
#DEFINE STR0156 FWI18NLang("HSPAHR82","STR0156",156)
#DEFINE STR0157 FWI18NLang("HSPAHR82","STR0157",157)
#DEFINE STR0158 FWI18NLang("HSPAHR82","STR0158",158)
#DEFINE STR0159 FWI18NLang("HSPAHR82","STR0159",159)
#DEFINE STR0160 FWI18NLang("HSPAHR82","STR0160",160)
#DEFINE STR0161 FWI18NLang("HSPAHR82","STR0161",161)
#DEFINE STR0162 FWI18NLang("HSPAHR82","STR0162",162)
#DEFINE STR0163 FWI18NLang("HSPAHR82","STR0163",163)
#DEFINE STR0164 FWI18NLang("HSPAHR82","STR0164",164)
#DEFINE STR0165 FWI18NLang("HSPAHR82","STR0165",165)
#DEFINE STR0166 FWI18NLang("HSPAHR82","STR0166",166)
#DEFINE STR0167 FWI18NLang("HSPAHR82","STR0167",167)
#DEFINE STR0168 FWI18NLang("HSPAHR82","STR0168",168)
#DEFINE STR0169 FWI18NLang("HSPAHR82","STR0169",169)
#DEFINE STR0170 FWI18NLang("HSPAHR82","STR0170",170)
#DEFINE STR0171 FWI18NLang("HSPAHR82","STR0171",171)
#DEFINE STR0172 FWI18NLang("HSPAHR82","STR0172",172)
#DEFINE STR0173 FWI18NLang("HSPAHR82","STR0173",173)
#DEFINE STR0174 FWI18NLang("HSPAHR82","STR0174",174)
#DEFINE STR0175 FWI18NLang("HSPAHR82","STR0175",175)
#DEFINE STR0176 FWI18NLang("HSPAHR82","STR0176",176)
#DEFINE STR0177 FWI18NLang("HSPAHR82","STR0177",177)
#DEFINE STR0178 FWI18NLang("HSPAHR82","STR0178",178)
#DEFINE STR0179 FWI18NLang("HSPAHR82","STR0179",179)
#DEFINE STR0180 FWI18NLang("HSPAHR82","STR0180",180)
#DEFINE STR0181 FWI18NLang("HSPAHR82","STR0181",181)
#DEFINE STR0182 FWI18NLang("HSPAHR82","STR0182",182)
#DEFINE STR0183 FWI18NLang("HSPAHR82","STR0183",183)
#DEFINE STR0184 FWI18NLang("HSPAHR82","STR0184",184)
#DEFINE STR0185 FWI18NLang("HSPAHR82","STR0185",185)
#DEFINE STR0186 FWI18NLang("HSPAHR82","STR0186",186)
#DEFINE STR0187 FWI18NLang("HSPAHR82","STR0187",187)
#DEFINE STR0188 FWI18NLang("HSPAHR82","STR0188",188)
#DEFINE STR0189 FWI18NLang("HSPAHR82","STR0189",189)
#DEFINE STR0190 FWI18NLang("HSPAHR82","STR0190",190)
#DEFINE STR0191 FWI18NLang("HSPAHR82","STR0191",191)
#DEFINE STR0192 FWI18NLang("HSPAHR82","STR0192",192)
#DEFINE STR0193 FWI18NLang("HSPAHR82","STR0193",193)
#DEFINE STR0194 FWI18NLang("HSPAHR82","STR0194",194)
#DEFINE STR0195 FWI18NLang("HSPAHR82","STR0195",195)
#DEFINE STR0196 FWI18NLang("HSPAHR82","STR0196",196)
#DEFINE STR0197 FWI18NLang("HSPAHR82","STR0197",197)
#DEFINE STR0198 FWI18NLang("HSPAHR82","STR0198",198)
#DEFINE STR0199 FWI18NLang("HSPAHR82","STR0199",199)
#DEFINE STR0200 FWI18NLang("HSPAHR82","STR0200",200)
#DEFINE STR0201 FWI18NLang("HSPAHR82","STR0201",201)
#DEFINE STR0202 FWI18NLang("HSPAHR82","STR0202",202)
#DEFINE STR0203 FWI18NLang("HSPAHR82","STR0203",203)
#DEFINE STR0204 FWI18NLang("HSPAHR82","STR0204",204)
#DEFINE STR0205 FWI18NLang("HSPAHR82","STR0205",205)
#DEFINE STR0206 FWI18NLang("HSPAHR82","STR0206",206)
#DEFINE STR0207 FWI18NLang("HSPAHR82","STR0207",207)
#DEFINE STR0208 FWI18NLang("HSPAHR82","STR0208",208)
#DEFINE STR0209 FWI18NLang("HSPAHR82","STR0209",209)
#DEFINE STR0210 FWI18NLang("HSPAHR82","STR0210",210)
 

HSPAHR82_EN.TRES

 0001#STR0001#ALL#REPORT OF PRODUCT CONSUMPTION BY PATIENT
0002#STR0002#ALL#The purpose of this program is to generate reports 
0003#STR0003#ALL#according to parameters entered by the user.
0004#STR0004#ALL#Attend. Dt.
0005#STR0005#ALL#Attend.
0006#STR0006#ALL#Name
0007#STR0007#ALL#ICD
0008#STR0008#ALL#ICD Description
0009#STR0009#ALL#Grand Patient Total
0010#STR0010#ALL#Prod. Code
0011#STR0011#ALL#Description
0012#STR0012#ALL#Total Qty
0013#STR0013#ALL#Total Sales Vl.
0014#STR0014#ALL#Grand Total of Day 
0015#STR0015#ALL#Grand Total of Period 
0016#STR0016#ALL#Service Grand Total
0017#STR0017#ALL#Exp. Date
0018#STR0018#ALL#Service Reg.
0019#STR0019#ALL#Gen. Reg.
0020#STR0020#ALL# Place of Work:___________________________
0021#STR0021#ALL#Section:__________________________________  Secretary:___________________________   Phone:___________________
0022#STR0022#ALL#Class:           Employee (   )                  Beneficiary (   )                   Private (   )
0023#STR0023#ALL#Father Name: 
0024#STR0024#ALL#Mother Name: 
0025#STR0025#ALL#                    Reg. No.___________________
0026#STR0026#ALL#Person Responsible: 
0027#STR0027#ALL#                     Phone:_________________
0028#STR0028#ALL#Responsible Address:_______________________________________________________________   Phone:_________________
0029#STR0029#ALL#Place of Work:_____________________________________________________________________   Phone:_________________
0030#STR0030#ALL#Notify:______________________________________________________________   Kinship degree: _____________________
0031#STR0031#ALL#Admission Diagnosis:____
0032#STR0032#ALL#Doctor that authorized admission:
0033#STR0033#ALL#Date:
0034#STR0034#ALL#Clinic: 
0035#STR0035#ALL#ICD:
0036#STR0036#ALL#DISCHARGE SUMMARY:
0037#STR0037#ALL#Discharge Diagnosis:
0038#STR0038#ALL#Days of Hospitalization:   
0039#STR0039#ALL#DISCHARGE TYPE
0040#STR0040#ALL#Doctor Request
0041#STR0041#ALL#Transfer
0042#STR0042#ALL#By request       
0043#STR0043#ALL#Abandon          
0044#STR0044#ALL#Indiscipline     
0045#STR0045#ALL#Death            
0046#STR0046#ALL#TREATMENT RESULT       
0047#STR0047#ALL#Cure       
0048#STR0048#ALL#Bettered   
0049#STR0049#ALL#Unchanged  
0050#STR0050#ALL#Worsened   
0051#STR0051#ALL#DOCTOR NOTES
0052#STR0052#ALL#Main Complaint
0053#STR0053#ALL#Current Illness History
0054#STR0054#ALL#Family and Personal History
0055#STR0055#ALL#Nutrition and Development
0056#STR0056#ALL#Special Physical Exams
0057#STR0057#ALL#Positive data from other equipments or systems
0058#STR0058#ALL#Diagnosis
0059#STR0059#ALL# -Phone: 
0060#STR0060#ALL#-ZipC: 
0061#STR0061#ALL#Name: 
0062#STR0062#ALL#    Record:    
0063#STR0063#ALL#    Bed:   
0064#STR0064#ALL#INFIRMARY NOTES        
0065#STR0065#ALL#DATE
0066#STR0066#ALL#TIME
0067#STR0067#ALL#PATIENT DEVELOPMENT 
0068#STR0068#ALL# - CNPJ: 
0069#STR0069#ALL#Philantropy Purposes Certificate - Process 44006.002144/97-02 - UPUB.-FED.DEC. 64.412-280469
0070#STR0070#ALL#Liability statement      
0071#STR0071#ALL#The undersigned,       
0072#STR0072#ALL#responsible for the patient 
0073#STR0073#ALL#authorizes the doctors that treat 
0074#STR0074#ALL#him, to end the treatment related to his illness to carry out 
0075#STR0075#ALL#investigations which will be necessary in his diagnoses, 
0076#STR0076#ALL#as well as, compromise him/herself to all general dispostions which 
0077#STR0077#ALL#are part of the Institution Regulation.
0078#STR0078#ALL# from 
0079#STR0079#ALL#Reponsible Signature
0080#STR0080#ALL#Witness:________________________________________
0081#STR0081#ALL#The undersigned,        
0082#STR0082#ALL#,   person
0083#STR0083#ALL#responsible for the patient 
0084#STR0084#ALL#Certifies that he/she has left the Installa- 
0085#STR0085#ALL#tions against the doctors opinion in this Institution, assuming the entire 
0086#STR0086#ALL#responsibility for his/her acts.
0087#STR0087#ALL#HOSPITAL INFECTION CONTROL GROUP
0088#STR0088#ALL#INFECTION CONTROL FORM
0089#STR0089#ALL#1- IDENTIFICATION
0090#STR0090#ALL#Male 
0091#STR0091#ALL#Fem.
0092#STR0092#ALL#   BthD.: 
0093#STR0093#ALL#Record:    
0094#STR0094#ALL#            Bed:   
0095#STR0095#ALL#          Hospitalization date:
0096#STR0096#ALL#N.B. Weight              (  ) < 1.500g      (  ) 1.501g to2.500g     (  ) > 2.500g
0097#STR0097#ALL#2- HOSPITALIZATION INFO         Prev. Hospitalization in this Hospital Yes( ) No( )
0098#STR0098#ALL#2.1.MAIN DIAGNOSIS:_______________________________________________________________
0099#STR0099#ALL#2.2.SECONDARY DIAGNOSIS:__________________________________________________________
0100#STR0100#ALL#2.3.SURGERY:______________________________________________________________________
0101#STR0101#ALL#Surgery Importan.   Surgery Type                            Status                
0102#STR0102#ALL#2.3.1.HIGH    ( )   2.3.4 CLEAN                       ( )   2.3.8  ELECTIVE    ( )
0103#STR0103#ALL#2.3.2.MEDIUM  ( )   2.3.5 POTENTIALLY CONTAMINATED    ( )   2.3.9  URGENCY     ( )
0104#STR0104#ALL#2.3.3.LOW     ( )   2.3.6 CONTAMINATED                ( )   2.3.10 EMERGENCY   ( )
0105#STR0105#ALL#                    2.3.7 INFECTED                    ( )                         
0106#STR0106#ALL#3- DIAGNOSTIC/THERAPEUTIC PROCEDURES      
0107#STR0107#ALL#3.1.ANTIMICROBIAL      ( ) 3.8. DRAINS               ( )  3.15.LUMBAR PUNCTION ( )
0108#STR0108#ALL#3.2.ASPIRATION         ( ) 3.9. ENDOSCOPY            ( )  3.16.PLEURAL FUNCTION( )
0109#STR0109#ALL#3.3.BIOPSY             ( ) 3.10.ENDOTRACHEO TUBE     ( )  3.17.ARTF. BREATHING ( )
0110#STR0110#ALL#3.4.VENOUS CATHETER    ( ) 3.11.HEMODIALYSIS         ( )  3.18.VENOUS THERAPY  ( )
0111#STR0111#ALL#3.5.VESICAL CATHETER   ( ) 3.12.NEBULIZATION         ( )  3.19.TRACHEOTOMY     ( )
0112#STR0112#ALL#3.6.CORTICOID          ( ) 3.13.PARENTERAL NUTR.     ( )  3.20.BLOOD TRANSFUS. ( )
0113#STR0113#ALL#3.7.PERITONIAL DIALYSIS( ) 3.14.PARACENTESIS         ( )  3.21.OTHERS          ( )
0114#STR0114#ALL#Note   (S)=no infection,(A)= infection before procedure,  (D) after procedure     
0115#STR0115#ALL#4- MICROBIOLOGY EXAMS:      CULTURE( ) CULTURE w/ANTIBIOGRAM ( ) BACTERIOSCOPY ( )
0116#STR0116#ALL#4.1.SECRETION      ( )     4.3.URINE         ( )         4.5.LIQUOR            ( )
0117#STR0117#ALL#4.2.BLOOD          ( )     4.4.FECAL         ( )         4.6.OTHERS            ( )
0118#STR0118#ALL#                                                         4.7.NOT ACCOMPLISHED  ( )
0119#STR0119#ALL#5- DATA REFERENT TO INFECTION
0120#STR0120#ALL#5.1. CARDIOVASCULAR    ( )      ( )        ( )     ( )
0121#STR0121#ALL#5.2. SURGICAL          ( )      ( )        ( )     ( )
0122#STR0122#ALL#5.3. UMBILICAL WALL    ( )      ( )        ( )     ( )
0123#STR0123#ALL#5.4. CUTANEOUS         ( )      ( )        ( )     ( )
0124#STR0124#ALL#5.5. GASTROINTESTINAL  ( )      ( )        ( )     ( )
0125#STR0125#ALL#5.6. GENITAL           ( )      ( )        ( )     ( )
0126#STR0126#ALL#5.7. OPTICAL           ( )      ( )        ( )     ( )
0127#STR0127#ALL#5.8. OSTEOARTICULAR    ( )      ( )        ( )     ( )
0128#STR0128#ALL#5.9. AUDITION          ( )      ( )        ( )     ( )
0129#STR0129#ALL#5.10.PUERPERAL         ( )      ( )        ( )     ( )
0130#STR0130#ALL#5.11.SEPTICEMIA        ( )      ( )        ( )     ( )
0131#STR0131#ALL#5.12.INF.BREATH TREAT. ( )      ( )        ( )     ( )
0132#STR0132#ALL#5.13.SUP.BREATH TREAT. ( )      ( )        ( )     ( )
0133#STR0133#ALL#5.14.URINARY           ( )      ( )        ( )     ( )
0134#STR0134#ALL#5.15.OTHERS            ( )      ( )        ( )     ( )
0135#STR0135#ALL#TOPOGRAPHIC LOCALIZATION
0136#STR0136#ALL#ISOLATED MICROORGANISM
0137#STR0137#ALL#IN HOSPITALIZ.
0138#STR0138#ALL#AFTER 72 Hs
0139#STR0139#ALL#AFTER DISCHARGE
0140#STR0140#ALL#DIAGNOSIS PERIOD
0141#STR0141#ALL#6- USE OF ANTIBIOTICS
0142#STR0142#ALL#6.1.YES  (  )      NO (  )
0143#STR0143#ALL#6.2.ANTIMICROBIAL(S) USED:________________________________________________________
0144#STR0144#ALL#6.3.CLINICAL PROPHYLATIC (  )             SURGICAL   (  )
0145#STR0145#ALL#6.4.THERAPIST ACCORDING TO CULTURE AND ANTIBIOGRAM   (  )        EMPIRIC  (  )
0146#STR0146#ALL#Turn the sheet and confirm printing at the back of the CCIH form!
0147#STR0147#ALL#Wait for printing on the back of the sheet
0148#STR0148#ALL#7- DISCHARGE CONDITIONS
0149#STR0149#ALL#7.1.CURED   (  )           7.2.BETTERED   (  )        7.3.UNALTERED   (  )
0150#STR0150#ALL#Disch. Date  ____/____/____
0151#STR0151#ALL#8- DISCHARGE TP
0152#STR0152#ALL#       (  ) DOCTOR REQUEST       (  ) TRANSFERENCE       (  ) BY REQUEST          
0153#STR0153#ALL#       (  ) UNDISCIPLINE         (  ) ABANDON            (  ) DEATH               
0154#STR0154#ALL#                                                         (  ) DEATH BY INFECTION  
0155#STR0155#ALL#9- DOCTOR RESPONS.:_____________________  SIG.__________________  CRM:____________
0156#STR0156#ALL#   NURSE RESPONSIBLE:___________________  SIG.__________________  COREN:__________
0157#STR0157#ALL#10- BACTERIAS
0158#STR0158#ALL#10.1.Acinetobacter SP                 10.24.Pseudomonas SP                        
0159#STR0159#ALL#10.2.Alcaligenes SP                      10.25.Pseudomonas Aeruginosa             
0160#STR0160#ALL#10.3.Bordetella SP                       10.26.Salmonella SP                      
0161#STR0161#ALL#10.4.Citrobacter SP                      10.27.Salmonella Enteridis               
0162#STR0162#ALL#10.5.Clostridium SP                      10.28.Salmodella Typi                    
0163#STR0163#ALL#10.6.Corynebacterium Difteriae           10.29.Serratia SP                        
0164#STR0164#ALL#10.7.Edwardsiella                        10.30.Shigella SP                        
0165#STR0165#ALL#10.8.Escherichia Coli                    10.31.Shigella Dysenteriae (Subgroup A)  
0166#STR0166#ALL#10.9.E. Coli. Enteroinvasora             10.32.Shigella Boydii (Subgroup C)       
0167#STR0167#ALL#10.10.E.Coli. EnteroPatog�nico           10.33.Shigella Flexneri (Subgroup B)     
0168#STR0168#ALL#10.11.EnteroBacter SP                    10.34.Shigella Sonnei (Subgroup D)       
0169#STR0169#ALL#10.12.Haemophilus                     10.35.Staphylococcus Auraus                 
0170#STR0170#ALL#10.13.Klebsiella                      10.36.Staphylococcus Epidemidis             
0171#STR0171#ALL#10.14.Lactobacillus SP                   10.37.Staphylococcus SaproPhyticus       
0172#STR0172#ALL#10.15.Listeria Monocytogenes             10.38.Staphylococcus SP                  
0173#STR0173#ALL#10.16.Myco Bacterium SP               10.39.Streptococcus SP                      
0174#STR0174#ALL#10.17.Neisseria Meningitidis             10.40.Streptococcus - not Hemolytic      
0175#STR0175#ALL#10.18.Neisseria Gonoraheae               10.41.Streptococcus Virindas             
0176#STR0176#ALL#10.19.Proteus SP                         10.42.Streptococcus Beta Hemolytic (A)   
0177#STR0177#ALL#10.20.Proteus Morganii                   10.43.Streptococcus Beta Hemolytic       
0178#STR0178#ALL#10.21.Proteus Rettgeri                10.44.Streptococcus Fecalis                 
0179#STR0179#ALL#10.22.Proteus Vulgaris                   10.45.Streptococcus Pneumoniea           
0180#STR0180#ALL#10.23.Provid�ncia SP                     10.46.Others                             
0181#STR0181#ALL#11- VIRUS
0182#STR0182#ALL#11.1.Hepatitis A Virus   (  ) 11.3.non-A non-B Hepatitis Virus    11.5.Others (  )
0183#STR0183#ALL#11.2.Hepatitis B Virus   (  ) 11.4.HTLV 3 Virus                                   
0184#STR0184#ALL#12- FUNGUS
0185#STR0185#ALL#12.1.Candida Albicans    (  ) 12.3.Criptococcus Neoformans        12.5.Others (  )
0186#STR0186#ALL#12.2.Candida Others      (  ) 12.4.Criptococcus SP                                
0187#STR0187#ALL#13- INFECTION TYPE
0188#STR0188#ALL#    (  ) Community Infection       (  ) No Infection                
0189#STR0189#ALL#    (  ) Hospital Infection        (  ) Infection in other Hospital*
0190#STR0190#ALL#* SPECIFY THE HOSPITAL AND TOPOGRAPHY ABOUT INFECTION
0191#STR0191#ALL#CCIH DOCTOR OR NURSE
0192#STR0192#ALL#Turn the sheet and confirm Doctor�s Notes printing on the back
0193#STR0193#ALL#Wait for printing on back page
0194#STR0194#ALL#Warning
0195#STR0195#ALL#   Date:  
0196#STR0196#ALL#  Time: 
0197#STR0197#ALL#      Age:   
0198#STR0198#ALL#    I.D.: 
0199#STR0199#ALL#Phone no.:
0200#STR0200#ALL#    City:      
0201#STR0201#ALL#Address:   
0202#STR0202#ALL# -District:
0203#STR0203#ALL#The undersigned,       
0204#STR0204#ALL#, person
0205#STR0205#ALL#responsible for the patient   
0206#STR0206#ALL#fully authorizes the doctors of     
0207#STR0207#ALL#that assist him/her to treat his/her disease,                               
0208#STR0208#ALL#to conduct the researches they deem necessary for diagnosis and      
0209#STR0209#ALL#and agrees to be subject to all the general regulations of the              
0210#STR0210#ALL#Institution's Regulations. 
 

HSPAHR82_ES.TRES

 0001#STR0001#ALL#INFORME DE CONSUMO DE PRODUCTOS POR PACIENTE
0002#STR0002#ALL#Este programa tiene como objetivo imprimir informe 
0003#STR0003#ALL#de acuerdo con los parametros informados por el usuario.
0004#STR0004#ALL#Fch. Atenc.
0005#STR0005#ALL#Atenc.
0006#STR0006#ALL#Nombre
0007#STR0007#ALL#CIE
0008#STR0008#ALL#Descripcio CIE
0009#STR0009#ALL#Total General del Paciente
0010#STR0010#ALL#Cod Prod
0011#STR0011#ALL#Descripcion
0012#STR0012#ALL#Cant. Total
0013#STR0013#ALL#Val. Tot. Venta
0014#STR0014#ALL#Total General del Dia 
0015#STR0015#ALL#Total General del Periodo 
0016#STR0016#ALL#Total General de la Atencion
0017#STR0017#ALL#Fch. Gasto
0018#STR0018#ALL#Reg. Atenc.
0019#STR0019#ALL#Reg. Gen.
0020#STR0020#ALL# Lugar de Trabajo: _______________________
0021#STR0021#ALL#Reparticion:______________________________  Secretaria:__________________________    Tel.:___________________
0022#STR0022#ALL#Clas:            Servidor (   )                 Beneficiario (   )                Particular (   )
0023#STR0023#ALL#Nombre Padre:
0024#STR0024#ALL#Nome Madre:  
0025#STR0025#ALL#                    N� Reg.___________________
0026#STR0026#ALL#Persona Responsable:
0027#STR0027#ALL#                      Tel.:_________________
0028#STR0028#ALL#Direccion Responsable:_____________________________________________________________    Tel.:_________________
0029#STR0029#ALL#Lugar de Trabajo: _________________________________________________________________    Tel.:_________________
0030#STR0030#ALL#Notificacion a:______________________________________________________   Parentesco:__________________________
0031#STR0031#ALL#Diagnostico de Admision:
0032#STR0032#ALL#Medico que autorizo la admision:
0033#STR0033#ALL#Fcha:
0034#STR0034#ALL#Clinica:
0035#STR0035#ALL#CID:
0036#STR0036#ALL#SUMARIO DE ALTA:
0037#STR0037#ALL#Diagnostico al Alta:
0038#STR0038#ALL#Dias de Internacion:   
0039#STR0039#ALL#TIPO DE ALTA
0040#STR0040#ALL#Iniciativa Medica
0041#STR0041#ALL#Transferencia    
0042#STR0042#ALL#A Pedido         
0043#STR0043#ALL#Abandono         
0044#STR0044#ALL#Indisciplina     
0045#STR0045#ALL#Muerte           
0046#STR0046#ALL#RESULTADO TRATAMIENTO  
0047#STR0047#ALL#Cura       
0048#STR0048#ALL#Mejorado   
0049#STR0049#ALL#Sin modif. 
0050#STR0050#ALL#Empeorado 
0051#STR0051#ALL#OBSERV. MEDICA   
0052#STR0052#ALL#Queja Principal
0053#STR0053#ALL#Hist. Enfermedad Actual  
0054#STR0054#ALL#Antecedentes Familiares y Personales
0055#STR0055#ALL#Alimentacion y Desarrollo    
0056#STR0056#ALL#Examen Fisico Espec.
0057#STR0057#ALL#Datos positivos de otros aparatos o sistemas  
0058#STR0058#ALL#Impresion Diagnostica
0059#STR0059#ALL# - Tel.: 
0060#STR0060#ALL#- CP:  
0061#STR0061#ALL#Nomb: 
0062#STR0062#ALL#     Registro: 
0063#STR0063#ALL#    Cama:  
0064#STR0064#ALL#ANOTACIONES ENFERMERIA 
0065#STR0065#ALL#FCHA
0066#STR0066#ALL#HORA
0067#STR0067#ALL#EVOLUCION PACIENTE  
0068#STR0068#ALL# - CNPJ: 
0069#STR0069#ALL#Certificado Fines Filantropicos- Processo 44006.002144/97-02 - U PUB.-FED.DEC. 64.412-280469
0070#STR0070#ALL#Acta de Responsabilidad  
0071#STR0071#ALL#El  abajofirmante      
0072#STR0072#ALL#responsable por el paciente   
0073#STR0073#ALL#da plena autorizacion a los medicos 
0074#STR0074#ALL#que  lo asisten para llevar a cabo el tratamiento de su enfermedad, a llevar
0075#STR0075#ALL#a cabo las investigaciones que juzguen necesarias para el diagnostico de su 
0076#STR0076#ALL#mal, asi como se compromete a someterse a todas las disposiciones generales 
0077#STR0077#ALL#del Reglamento de la Institucion.      
0078#STR0078#ALL# de 
0079#STR0079#ALL#Firma del Responsable    
0080#STR0080#ALL#Testigo:   _____________________________________
0081#STR0081#ALL#El abajofirmante        
0082#STR0082#ALL#,  persona
0083#STR0083#ALL#responsable por el paciente      
0084#STR0084#ALL#certifica que dejo las instalaciones de
0085#STR0085#ALL#contra el parecer de los medicos de esta institucion, asumiento entera respon- 
0086#STR0086#ALL#sabilidad por su acto.        
0087#STR0087#ALL#COMISION CONTROL DE INFECCION HOSPITALARIA 
0088#STR0088#ALL#HOJA DE CONTROL DE INFECCION 
0089#STR0089#ALL#1-IDENTIFICACION
0090#STR0090#ALL#Masc.
0091#STR0091#ALL#Fem.
0092#STR0092#ALL#   Nac.:  
0093#STR0093#ALL#Registro:  
0094#STR0094#ALL#             Cama: 
0095#STR0095#ALL#          Fecha de Internacion:
0096#STR0096#ALL#R.N. Peso al Nacer       (  ) < 1.500g      (  ) 1.501g a 2.500g     (  ) > 2.500g
0097#STR0097#ALL#2- DATOS DE HOSPITALIZACION     Inter. Anterior en este Hospital Si (  )   No (  )
0098#STR0098#ALL#2.1.DIAGNOSTICO PRINCIPAL:________________________________________________________
0099#STR0099#ALL#2.2.DIAGNOSTICO(S) SECUNDARIO(S)__________________________________________________
0100#STR0100#ALL#2.3.CIRUGIA: _____________________________________________________________________
0101#STR0101#ALL#Porte Cirugia       Clasificacion de la Cirugia             Situacion             
0102#STR0102#ALL#2.3.1.GRANDE  ( )   2.3.4 LIMPIA                      ( )   2.3.8  SELECTIVA   ( )
0103#STR0103#ALL#2.3.2.MEDIANA ( )   2.3.5 POTENCIALMENTE CONTAMINADA  ( )   2.3.9  URGENCIA    ( )
0104#STR0104#ALL#2.3.3.PEQUENA ( )   2.3.6 CONTAMINADA                 ( )   2.3.10 EMERGENCIA  ( )
0105#STR0105#ALL#                    2.3.7 INFECTADA                   ( )                         
0106#STR0106#ALL#3-PROCEDIMIENTOS DIAGNOSTICOS/TERAPEUTICOS
0107#STR0107#ALL#3.1.ANTIMICROBIANO     ( ) 3.8. DRENAJES             ( )  3.15.PUNCION LUMBAR  ( )
0108#STR0108#ALL#3.2.ASPIRACION         ( ) 3.9. ENDOSCOPIA           ( )  3.16.PUNCION PLEURAL ( )
0109#STR0109#ALL#3.3.BIOPSIA            ( ) 3.10.INTUB. ENDOTRAQUEAL  ( )  3.17.RESP.MECANICO   ( )
0110#STR0110#ALL#3.4.CATETER VENOSO     ( ) 3.11.HEMODIALISIS         ( )  3.18.TERAPIA VENOSA  ( )
0111#STR0111#ALL#3.5.CATETER VESICAL    ( ) 3.12.NEBULIZACION         ( )  3.19.TRAQUEOTOMIA    ( )
0112#STR0112#ALL#3.6.CORTICOIDE         ( ) 3.13.NUTR. PARENTERAL     ( )  3.20.TRANSF. SANGRE  ( )
0113#STR0113#ALL#3.7.DIALISIS PERITONIAL( ) 3.14.PARACENTESIS         ( )  3.21.OTROS           ( )
0114#STR0114#ALL#Anotar (S)=Sin Infecc., (A)= Infecc. anterior procedim.,  (D) post procedimento     
0115#STR0115#ALL#4- EXAMENES MICROBIOLOGICOS:CULTIVO( ) CULTIVO c/ANTIBIOGRAMA( ) BACTERIOSCOPIA( )
0116#STR0116#ALL#4.1.SECRECIONES    ( )     4.3.ORINA         ( )         4.5.LIQUIDO           ( )
0117#STR0117#ALL#4.2.SANGRE         ( )     4.4.HECES         ( )         4.6.OTROS             ( )
0118#STR0118#ALL#                                                         4.7.NO REALIZO        ( )
0119#STR0119#ALL#5- DATOS REFERENTES A LA INFECCION
0120#STR0120#ALL#5.1. CARDIOVASCULAR    ( )      ( )        ( )     ( )
0121#STR0121#ALL#5.2. QUIRURGICA        ( )      ( )        ( )     ( )
0122#STR0122#ALL#5.3. PARED ABDOMINAL   ( )      ( )        ( )     ( )
0123#STR0123#ALL#5.4. CUTANEA           ( )      ( )        ( )     ( )
0124#STR0124#ALL#5.5. GASTROINTESTINAL  ( )      ( )        ( )     ( )
0125#STR0125#ALL#5.6. GENITAL           ( )      ( )        ( )     ( )
0126#STR0126#ALL#5.7. OCULAR            ( )      ( )        ( )     ( )
0127#STR0127#ALL#5.8. OSTEOARTICULAR    ( )      ( )        ( )     ( )
0128#STR0128#ALL#5.9. OIDO              ( )      ( )        ( )     ( )
0129#STR0129#ALL#5.10.PUERPERAL         ( )      ( )        ( )     ( )
0130#STR0130#ALL#5.11.SEPTICEMIA        ( )      ( )        ( )     ( )
0131#STR0131#ALL#5.12.TRACTO RESP. INF. ( )      ( )        ( )     ( )
0132#STR0132#ALL#5.13.TRACTO RESP. SUP. ( )      ( )        ( )     ( )
0133#STR0133#ALL#5.14.URINARIA          ( )      ( )        ( )     ( )
0134#STR0134#ALL#5.15.OTRAS             ( )      ( )        ( )     ( )
0135#STR0135#ALL#LOCALIZACION TOPOGRAF. 
0136#STR0136#ALL#MICROORGANISMO AISLADO
0137#STR0137#ALL#EN INTERNAC. 
0138#STR0138#ALL#DESP. 72Hs
0139#STR0139#ALL#POST ALTA 
0140#STR0140#ALL#EPOCA DE DIAGNOSTICO
0141#STR0141#ALL#6- USO DE ANTIBIOTICO
0142#STR0142#ALL#6.1. SI  (  )      NO (  )
0143#STR0143#ALL#6.2.ANTIMICROBIANO(S) UTILIZADO(S):_______________________________________________
0144#STR0144#ALL#6.3.PROFILACTICO CLINICO (  )             QUIRURGICO (  )
0145#STR0145#ALL#6.4.TERAPEUTICO DE ACUERDO CON CULTIVO Y ANTIBIOGRAMA(  )        EMPIRICO (  )
0146#STR0146#ALL#�Voltee la pagina y confirme impresion en el reverso de la ficha de CCIH!
0147#STR0147#ALL#Espera para impresion en el reverso
0148#STR0148#ALL#7- CONDIC. DE SALIDAS 
0149#STR0149#ALL#7.1.CURADO  (  )           7.2. MEJORADO  (  )        7.3.SIN MODIFIC.(  )
0150#STR0150#ALL#Fecha Alta   ____/____/____
0151#STR0151#ALL#8- TIPO DE ALTA
0152#STR0152#ALL#       (  ) INICIATIVA MEDICA    (  ) TRANSFERENCIA      (  ) A PEDIDO            
0153#STR0153#ALL#       (  ) INDISCIPLINA         (  ) ABANDONO           (  ) MUERTE              
0154#STR0154#ALL#                                                         (  ) MUERTE POR INFECCION
0155#STR0155#ALL#9- MEDICO ASISTENTE: ___________________  FIRMA:________________  CRM:____________
0156#STR0156#ALL#   ENFERM. ASISTENTE:___________________  FIRMA:________________  COREN:__________
0157#STR0157#ALL#10- BACTERIAS
0158#STR0158#ALL#10.1.Acinetobacter SP                 10.24.Pseudomonas SP                        
0159#STR0159#ALL#10.2.Alcaligenes SP                      10.25.Pseudomonas Aeruginosa             
0160#STR0160#ALL#10.3.Bordetella SP                       10.26.Salmonella SP                      
0161#STR0161#ALL#10.4.Citrobacter SP                      10.27.Salmonella Enteridis               
0162#STR0162#ALL#10.5.Clostridium SP                      10.28.Salmodella Typi                    
0163#STR0163#ALL#10.6.Corynebacterium Difteriae           10.29.Serratia SP                        
0164#STR0164#ALL#10.7.Edwardsiella                        10.30.Shigella SP                        
0165#STR0165#ALL#10.8.Escherichia Coli                    10.31.Shigella Dysenteriae (Subgrupo A)  
0166#STR0166#ALL#10.9.E. Coli. Enteroinvasora             10.32.Shigella Boydii (Subgrupo C)       
0167#STR0167#ALL#10.10.E.Coli. EnteroPatogenico           10.33.Shigella Flexneri (Subgrupo B)     
0168#STR0168#ALL#10.11.EnteroBacter SP                    10.34.Shigella Sonnei (Subgrupo D)       
0169#STR0169#ALL#10.12.Haemophilus                     10.35.Staphylococcus Auraus                 
0170#STR0170#ALL#10.13.Klebsiella                      10.36.Staphylococcus Epidemidis             
0171#STR0171#ALL#10.14.Lactobacillus SP                   10.37.Staphylococcus SaproPhyticus       
0172#STR0172#ALL#10.15.Listeria Monocytogenes             10.38.Staphylococcus SP                  
0173#STR0173#ALL#10.16.Myco Bacterium SP               10.39.Streptococcus SP                      
0174#STR0174#ALL#10.17.Neisseria Meningitidis             10.40.Streptococcus - no Hemolitico      
0175#STR0175#ALL#10.18.Neisseria Gonoraheae               10.41.Streptococcus Virindas             
0176#STR0176#ALL#10.19.Proteus SP                         10.42.Streptococcus Beta Hemolitico (A)  
0177#STR0177#ALL#10.20.Proteus Morganii                   10.43.Streptococcus Beta Hemolitico      
0178#STR0178#ALL#10.21.Proteus Rettgeri                10.44.Streptococcus Fecalis                 
0179#STR0179#ALL#10.22.Proteus Vulgaris                   10.45.Streptococcus Pneumoniea           
0180#STR0180#ALL#10.23.Providencia SP                     10.46.Otros                              
0181#STR0181#ALL#11- VIRUS
0182#STR0182#ALL#11.1.Virus de Hepatitis A(  ) 11.3.Virus de Hepatitis no A no B   11.5. Otros (  )
0183#STR0183#ALL#11.2.Virus de Hepatitis B(  ) 11.4.Virus HTLV 3                                   
0184#STR0184#ALL#12- HONGOS
0185#STR0185#ALL#12.1.Candida Albicans    (  ) 12.3.Criptococcus Neoformans        12.5. Otros (  )
0186#STR0186#ALL#12.2.Candida Outras      (  ) 12.4.Criptococcus SP                                
0187#STR0187#ALL#13-TIPO DE INFECCION
0188#STR0188#ALL#    (  ) Infeccion Comunitaria     (  ) No hubo Infeccion           
0189#STR0189#ALL#    (  ) Infeccion Hospitalaria    (  ) Infeccion de Otro Hospital *
0190#STR0190#ALL#* ESPECIFICAR HOSPITAL Y TOPOGRAFIA DE LA INFECCION
0191#STR0191#ALL#MEDICO O ENFERMERO DE CCIH
0192#STR0192#ALL#Gire la pagina y confirme impresion de Observac. Medicas al reverso 
0193#STR0193#ALL#Espera para impresion al reverso
0194#STR0194#ALL#Atencion
0195#STR0195#ALL#   Fecha.: 
0196#STR0196#ALL#  Hora: 
0197#STR0197#ALL#      Edad: 
0198#STR0198#ALL#    R.G.: 
0199#STR0199#ALL#Telefono: 
0200#STR0200#ALL#    Municipio: 
0201#STR0201#ALL#Domicilio: 
0202#STR0202#ALL# - Barrio: 
0203#STR0203#ALL#El   abajo   firmante  
0204#STR0204#ALL#, persona
0205#STR0205#ALL#responsable  por el  paciente 
0206#STR0206#ALL#autoriza plenamente a los medicos del 
0207#STR0207#ALL#que lo asisten para llevar a cabo el tratamiento de su enfermedad, a
0208#STR0208#ALL#realizar las investigaciones que juzguen necesarias en el diagnostico asi como
0209#STR0209#ALL#se  compromete  a  someterse  a  todas  as  disposiciones generales contenidas en el
0210#STR0210#ALL#Reglamento de la Institucion.
 

HSPAHR82_PT-BR.TRES

 0001#STR0001#ALL#RELAT�RIO DE CONSUMO DE PRODUTOS POR PACIENTE
0002#STR0002#ALL#Este programa tem como objetivo imprimir relat�rio 
0003#STR0003#ALL#de acordo com os par�metros informados pelo usu�rio.
0004#STR0004#ALL#Dt. Atend
0005#STR0005#ALL#Atend.
0006#STR0006#ALL#Nome
0007#STR0007#ALL#CID
0008#STR0008#ALL#Descri��o CID
0009#STR0009#ALL#Total Geral do Paciente
0010#STR0010#ALL#Cod Prod
0011#STR0011#ALL#Descri��o
0012#STR0012#ALL#Qtd Total
0013#STR0013#ALL#Val Tot Venda
0014#STR0014#ALL#Total Geral do Dia 
0015#STR0015#ALL#Total Geral do Per�odo 
0016#STR0016#ALL#Total Geral do Atendimento
0017#STR0017#ALL#Dt. Desp
0018#STR0018#ALL#Reg. Atend.
0019#STR0019#ALL#Reg. Ger.
0020#STR0020#ALL# Local de Trabalho:_______________________
0021#STR0021#ALL#Reparti��o:_______________________________  Secret�ria:__________________________    Fone:___________________
0022#STR0022#ALL#Class:           Servidor (   )                 Benefici�rio (   )                Particular (   )
0023#STR0023#ALL#Nome do Pai: 
0024#STR0024#ALL#Nome do M�e: 
0025#STR0025#ALL#                    N�. Reg.___________________
0026#STR0026#ALL#Pessoa Responsavel: 
0027#STR0027#ALL#                      Fone:_________________
0028#STR0028#ALL#Endere�o Responsavel: _____________________________________________________________    Fone:_________________
0029#STR0029#ALL#Local de Trabalho:_________________________________________________________________    Fone:_________________
0030#STR0030#ALL#Notifica��o a:_______________________________________________________   Parentesco:__________________________
0031#STR0031#ALL#Diagn�stico de Admiss�o:
0032#STR0032#ALL#M�dico que autorizou a admiss�o:
0033#STR0033#ALL#Data:
0034#STR0034#ALL#Cl�nica:
0035#STR0035#ALL#CID:
0036#STR0036#ALL#SUM�RIO DE ALTA:
0037#STR0037#ALL#Diagn�stico na Alta:
0038#STR0038#ALL#Dias de Hospitaliza��o:
0039#STR0039#ALL#TIPO DE ALTA
0040#STR0040#ALL#Iniciativa M�dica
0041#STR0041#ALL#Transferencia    
0042#STR0042#ALL#A Pedido         
0043#STR0043#ALL#Abandono         
0044#STR0044#ALL#Indisciplina     
0045#STR0045#ALL#�bito            
0046#STR0046#ALL#RESULTADO DE TRATAMENTO
0047#STR0047#ALL#Cura       
0048#STR0048#ALL#Melhorado  
0049#STR0049#ALL#Inalterado 
0050#STR0050#ALL#Piorado    
0051#STR0051#ALL#OBSERVA��O M�DICA
0052#STR0052#ALL#Queixa Principal
0053#STR0053#ALL#Hist�rico da Doen�a Atual
0054#STR0054#ALL#Antecedentes Familiares e Pessoais
0055#STR0055#ALL#Alimenta��o e Desenvolvimento
0056#STR0056#ALL#Exames F�sico Especial
0057#STR0057#ALL#Dados positivos de outros aparelhos ou sitemas
0058#STR0058#ALL#Impress�o Diagn�stica
0059#STR0059#ALL# - Fone: 
0060#STR0060#ALL#- CEP: 
0061#STR0061#ALL#Nome: 
0062#STR0062#ALL#     Registro: 
0063#STR0063#ALL#    Leito: 
0064#STR0064#ALL#ANOTA��ES DE ENFERMAGEM
0065#STR0065#ALL#DATA
0066#STR0066#ALL#HORA
0067#STR0067#ALL#EVOLU��O DO PACIENTE
0068#STR0068#ALL# - CNPJ: 
0069#STR0069#ALL#Certificado Fins Filantr�picos - Processo 44006.002144/97-02 - U PUB.-FED.DEC. 64.412-280469
0070#STR0070#ALL#Termo de Responsabilidade
0071#STR0071#ALL#O   abaixo   assinado  
0072#STR0072#ALL#respons�vel   pelo   paciente 
0073#STR0073#ALL#da plena autoriza��o aos m�dicos do 
0074#STR0074#ALL#que  o  assistem  para  levarem  a  cabo o tratamento de sua enfermidade,  a
0075#STR0075#ALL#realizarem  as  investiga��es que julguem necess�rias no diagn�stico do  seu
0076#STR0076#ALL#mal, bem como  se  compromete, a submeter-se a todas as disposi��es   gerais
0077#STR0077#ALL#contidas no Regulamento da Institui��o.
0078#STR0078#ALL# de 
0079#STR0079#ALL#Assinatura do respons�vel
0080#STR0080#ALL#Testemunha:_____________________________________
0081#STR0081#ALL#O   abaixo   assinado   
0082#STR0082#ALL#,   pessoa
0083#STR0083#ALL#respons�vel    pelo    paciente  
0084#STR0084#ALL#Certifica que deixou as instala��es do 
0085#STR0085#ALL#Contra   o  parecer  dos   m�dicos   desta   institui��o,   assumindo   inteira
0086#STR0086#ALL#responsabilidade pelo seu ato.
0087#STR0087#ALL#COMISS�O DE CONTROLE DE INFEC��O HOSPITALAR
0088#STR0088#ALL#FOLHA DE CONTROLE DE INFEC��O
0089#STR0089#ALL#1- IDENTIFICA��O
0090#STR0090#ALL#Masc.
0091#STR0091#ALL#Fem.
0092#STR0092#ALL#   Nasc.: 
0093#STR0093#ALL#Registro:  
0094#STR0094#ALL#            Leito: 
0095#STR0095#ALL#          Data da Interna��o.: 
0096#STR0096#ALL#R.N. Peso ao Nascer      (  ) < 1.500g      (  ) 1.501g a 2.500g     (  ) > 2.500g
0097#STR0097#ALL#2- DADOS DA HOSPITALIZA��O      Inter. Anterior neste Hospital  Sim (  )  N�o (  )
0098#STR0098#ALL#2.1.DIAGN�STICO PRINCIPAL:________________________________________________________
0099#STR0099#ALL#2.2.DIAGN�STICO(S) SECUND�RIO(S)__________________________________________________
0100#STR0100#ALL#2.3.CIRURGIA:_____________________________________________________________________
0101#STR0101#ALL#Porte Cirurgia      Classifica��o da Cirurgia               Situa��o              
0102#STR0102#ALL#2.3.1.GRANDE  ( )   2.3.4 LIMPA                       ( )   2.3.8  ELETIVA     ( )
0103#STR0103#ALL#2.3.2.MEDIANA ( )   2.3.5 POTENCIALMENTE CONTAMINADA  ( )   2.3.9  URGENCIA    ( )
0104#STR0104#ALL#2.3.3.PEQUENA ( )   2.3.6 CONTAMINADA                 ( )   2.3.10 EMERG�NCIA  ( )
0105#STR0105#ALL#                    2.3.7 INFECTADA                   ( )                         
0106#STR0106#ALL#3- PROCEDIMENTOS DIAGN�STICOS/TERAPEUTICOS
0107#STR0107#ALL#3.1.ANTIMICROBIANO     ( ) 3.8. DRENOS               ( )  3.15.FUN��O LOMBAR   ( )
0108#STR0108#ALL#3.2.ASPIRA��O          ( ) 3.9. ENDOSCOPIA           ( )  3.16.FUN��O PLEURAL  ( )
0109#STR0109#ALL#3.3.BIOPSIA            ( ) 3.10.ENTUB. ENDOTRAQUIAL  ( )  3.17.RESP.MEC�NICO   ( )
0110#STR0110#ALL#3.4.CATETER VENOSO     ( ) 3.11.HEMODI�LISE          ( )  3.18.TERAPIA VENOSA  ( )
0111#STR0111#ALL#3.5.CATETER VESICAL    ( ) 3.12.NEBULIZA��O          ( )  3.19.TRAQUEOSTOMIA   ( )
0112#STR0112#ALL#3.6.CORTIC�IDE         ( ) 3.13.NUTR.PARENTERAL      ( )  3.20.TRANSF.SANGUE   ( )
0113#STR0113#ALL#3.7.DIALISE PERITONIAL ( ) 3.14.PARACENTESE          ( )  3.21.OUTROS          ( )
0114#STR0114#ALL#Anotar (S)=Sem Infec�o, (A)= Infec��o antes procedimento, (D) ap�s Procedimento   
0115#STR0115#ALL#4- EXAMES MICROBIOL�GICOS:  CULTURA( ) CULTURA c/ANTIBIOGRAMA( ) BACTERIOSCOPIA( )
0116#STR0116#ALL#4.1.SECRE��ES      ( )     4.3.URINA         ( )         4.5.LIQUOR            ( )
0117#STR0117#ALL#4.2.SANGUE         ( )     4.4.FEZES         ( )         4.6.OUTROS            ( )
0118#STR0118#ALL#                                                         4.7.N�O REALIZOU      ( )
0119#STR0119#ALL#5- DADOS REFERENTES A INFEC��O
0120#STR0120#ALL#5.1. CARDIOVASCULAR    ( )      ( )        ( )     ( )
0121#STR0121#ALL#5.2. CIR�RGICA         ( )      ( )        ( )     ( )
0122#STR0122#ALL#5.3. COLO UMBILICAL    ( )      ( )        ( )     ( )
0123#STR0123#ALL#5.4. CUT�NEA           ( )      ( )        ( )     ( )
0124#STR0124#ALL#5.5. GASTRO INTESTINAL ( )      ( )        ( )     ( )
0125#STR0125#ALL#5.6. GENITAL           ( )      ( )        ( )     ( )
0126#STR0126#ALL#5.7. OCULAR            ( )      ( )        ( )     ( )
0127#STR0127#ALL#5.8. OSTEO-ARTICULAR   ( )      ( )        ( )     ( )
0128#STR0128#ALL#5.9. OUVIDO            ( )      ( )        ( )     ( )
0129#STR0129#ALL#5.10.PUERPERAL         ( )      ( )        ( )     ( )
0130#STR0130#ALL#5.11.SEPTICETEMIA      ( )      ( )        ( )     ( )
0131#STR0131#ALL#5.12.TRATO RESP.INF.   ( )      ( )        ( )     ( )
0132#STR0132#ALL#5.13.TRATO RESP.SUP.   ( )      ( )        ( )     ( )
0133#STR0133#ALL#5.14.URIN�RIA          ( )      ( )        ( )     ( )
0134#STR0134#ALL#5.15.OUTRAS            ( )      ( )        ( )     ( )
0135#STR0135#ALL#LOCALIZA��O TOPOGR�FICA
0136#STR0136#ALL#MICROORGANISMO ISOLADO
0137#STR0137#ALL#NA INTERNA��O
0138#STR0138#ALL#AP�S 72 Hs
0139#STR0139#ALL#AP�S ALTA
0140#STR0140#ALL#�POCA DO DIAGN�STICO
0141#STR0141#ALL#6- USO DE ANTIBI�TICO
0142#STR0142#ALL#6.1.SIM  (  )     N�O (  )
0143#STR0143#ALL#6.2.ANTIMICROBIANO(S) UTILIZADO(S):_______________________________________________
0144#STR0144#ALL#6.3.PROFIL�TICO CL�NICO  (  )             CIR�RGICO  (  )
0145#STR0145#ALL#6.4.TERAPEUTICO DE ACORDO COM CULTURA E ANTIBIOGRAMA (  )        EMP�RICO (  )
0146#STR0146#ALL#Vire a folha e confirme a impressao no verso da ficha de CCIH!
0147#STR0147#ALL#Espera para impress�o no Verso
0148#STR0148#ALL#7- CONDI��ES DE SA�DAS
0149#STR0149#ALL#7.1.CURADO  (  )           7.2.MELHORADO  (  )        7.3.INALTERADO  (  )
0150#STR0150#ALL#Data da Alta ____/____/____
0151#STR0151#ALL#8- TIPO DE ALTA
0152#STR0152#ALL#       (  ) INICIATIVA M�DICA    (  ) TRANSFER�NCIA      (  ) A PEDIDO            
0153#STR0153#ALL#       (  ) INDISCIPLINA         (  ) ABANDONO           (  ) �BITO               
0154#STR0154#ALL#                                                         (  ) �BITO POR INFEC��O  
0155#STR0155#ALL#9- M�DICO ASSISTENTE:___________________  ASS.__________________  CRM:____________
0156#STR0156#ALL#   EMFER. ASSISTENTE:___________________  ASS.__________________  COREN:__________
0157#STR0157#ALL#10- BACT�RIAS
0158#STR0158#ALL#10.1.Acinetobacter SP                 10.24.Pseudomonas SP                        
0159#STR0159#ALL#10.2.Alcaligenes SP                      10.25.Pseudomonas Aeruginosa             
0160#STR0160#ALL#10.3.Bordetella SP                       10.26.Salmonella SP                      
0161#STR0161#ALL#10.4.Citrobacter SP                      10.27.Salmonella Enteridis               
0162#STR0162#ALL#10.5.Clostridium SP                      10.28.Salmodella Typi                    
0163#STR0163#ALL#10.6.Corynebacterium Difteriae           10.29.Serratia SP                        
0164#STR0164#ALL#10.7.Edwardsiella                        10.30.Shigella SP                        
0165#STR0165#ALL#10.8.Escherichia Coli                    10.31.Shigella Dysenteriae (Sub Grupo A) 
0166#STR0166#ALL#10.9.E. Coli. Enteroinvasora             10.32.Shigella Boydii (Sub Grupo C)      
0167#STR0167#ALL#10.10.E.Coli. EnteroPatog�nico           10.33.Shigella Flexneri (Sub Grupo B)    
0168#STR0168#ALL#10.11.EnteroBacter SP                    10.34.Shigella Sonnei (Sub Grupo D)      
0169#STR0169#ALL#10.12.Haemophilus                     10.35.Staphylococcus Auraus                 
0170#STR0170#ALL#10.13.Klebsiella                      10.36.Staphylococcus Epidemidis             
0171#STR0171#ALL#10.14.Lactobacillus SP                   10.37.Staphylococcus SaproPhyticus       
0172#STR0172#ALL#10.15.Listeria Monocytogenes             10.38.Staphylococcus SP                  
0173#STR0173#ALL#10.16.Myco Bacterium SP               10.39.Streptococcus SP                      
0174#STR0174#ALL#10.17.Neisseria Meningitidis             10.40.Streptococcus - n�o Hemol�tico     
0175#STR0175#ALL#10.18.Neisseria Gonoraheae               10.41.Streptococcus Virindas             
0176#STR0176#ALL#10.19.Proteus SP                         10.42.Streptococcus Beta Hemol�tico (A)  
0177#STR0177#ALL#10.20.Proteus Morganii                   10.43.Streptococcus Beta Hemol�tico      
0178#STR0178#ALL#10.21.Proteus Rettgeri                10.44.Streptococcus Fecalis                 
0179#STR0179#ALL#10.22.Proteus Vulgaris                   10.45.Streptococcus Pneumoniea           
0180#STR0180#ALL#10.23.Provid�ncia SP                     10.46.Outros                             
0181#STR0181#ALL#11- V�RUS
0182#STR0182#ALL#11.1.V�rus A da Hepatite (  ) 11.3.V�rus n�o A n�o B da Hepatite  11.5.Outros (  )
0183#STR0183#ALL#11.2.Virus B da Hepatite (  ) 11.4.Virus HTLV 3                                   
0184#STR0184#ALL#12- FUNGOS
0185#STR0185#ALL#12.1.Candida Albicans    (  ) 12.3.Criptococcus Neoformans        12.5.Outros (  )
0186#STR0186#ALL#12.2.Candida Outras      (  ) 12.4.Criptococcus SP                                
0187#STR0187#ALL#13- TIPO DE INFEC��O
0188#STR0188#ALL#    (  ) Infec��o Comunit�ria      (  ) N�o Houve Infec��o          
0189#STR0189#ALL#    (  ) Infec��o Hospitalar       (  ) Infec��o de Outro Hospital *
0190#STR0190#ALL#* ESPECIFICAR O HOSPITAL E A TOPOGRAFIA DA INFEC��O
0191#STR0191#ALL#M�DICO OU ENFERMEIRO DA CCIH
0192#STR0192#ALL#Vire a folha e confirme a impressao das Observa��es M�dicas no verso
0193#STR0193#ALL#Espera para impress�o no Verso
0194#STR0194#ALL#Aten��o
0195#STR0195#ALL#   Data.: 
0196#STR0196#ALL#  Hora: 
0197#STR0197#ALL#      Idade: 
0198#STR0198#ALL#    R.G.: 
0199#STR0199#ALL#Telefone: 
0200#STR0200#ALL#    Munic�pio: 
0201#STR0201#ALL#Domicilio: 
0202#STR0202#ALL# - Bairro: 
0203#STR0203#ALL#O   abaixo   assinado  
0204#STR0204#ALL#, pessoa
0205#STR0205#ALL#respons�vel   pelo   paciente 
0206#STR0206#ALL#da plena autoriza��o aos m�dicos do 
0207#STR0207#ALL#que  o  assistem  para  levarem  a  cabo o tratamento de sua enfermidade,  a
0208#STR0208#ALL#realizarem  as investiga��es que julguem necess�rias no diagn�stico bem como
0209#STR0209#ALL#se  compromete  a  submeter-se  a  todas  as  disposi��es gerais contidas no
0210#STR0210#ALL#Regulamento da Institui��o.
 

HSPAHR82_PT-PT.TRES

 0001#STR0001#ALL#Listagem  de consumo de artigos por paciente
0003#STR0003#ALL#De acordo com os par�metro s informados pelo utilizador.
0007#STR0007#ALL#Cid
0008#STR0008#ALL#Descri��o  cid
0009#STR0009#ALL#Total Geral Do Paciente
0014#STR0014#ALL#Total geral do dia 
0015#STR0015#ALL#Total geral do per�odo  
0016#STR0016#ALL#Total Crial do Atendimento
0017#STR0017#ALL#Dt. Desp.
0019#STR0019#ALL#Reg. Cria.
0020#STR0020#ALL# Local De Trabalho:_______________________
0021#STR0021#ALL#Reparti��o:_______________________________  Secret�ria:__________________________    Telefone:___________________
0022#STR0022#ALL#Class:           servidor (   )                 benefici�rio (   )                particular (   )
0023#STR0023#ALL#Nome do pai: 
0024#STR0024#ALL#Nome da m�e: 
0025#STR0025#ALL#                    Nr. Reg.___________________
0026#STR0026#ALL#Pessoa respons�vel: 
0027#STR0027#ALL#                      Telefone:_________________
0028#STR0028#ALL#Morada Do Respons�vel: _____________________________________________________________    Telefone:_________________
0029#STR0029#ALL#Local De Trabalho:_________________________________________________________________    Telefone:_________________
0030#STR0030#ALL#Notifica��o A:_______________________________________________________   Parentesco:__________________________
0031#STR0031#ALL#Diagn�stico De Admiss�o:
0035#STR0035#ALL#Cid:
0036#STR0036#ALL#Sum�rio De Alta:
0037#STR0037#ALL#Diagn�stico Na Alta:
0038#STR0038#ALL#Dias De Hospitaliza��o:
0039#STR0039#ALL#Tipo De Alta
0041#STR0041#ALL#Transfer�ncia    
0042#STR0042#ALL#A pedido         
0045#STR0045#ALL#�bito            
0046#STR0046#ALL#Resultado De Tratamento
0048#STR0048#ALL#Melhorou  
0050#STR0050#ALL#Piorou    
0051#STR0051#ALL#Observa��o M�dica
0053#STR0053#ALL#Hist�rico Da Doen�a Actual
0054#STR0054#ALL#Antecedentes Familiares E Pessoais
0055#STR0055#ALL#Alimenta��o E Desenvolvimento
0058#STR0058#ALL#Impress�o Diagn�stico
0059#STR0059#ALL# - telefone: 
0060#STR0060#ALL#- c�digo postal: 
0062#STR0062#ALL#     registo: 
0063#STR0063#ALL#    cama: 
0064#STR0064#ALL#Anota��es De Enfermagem
0065#STR0065#ALL#Data
0066#STR0066#ALL#Hora
0067#STR0067#ALL#Evolu��o Do Paciente
0068#STR0068#ALL# � nr. contrib.: 
0069#STR0069#ALL#Certificado fins filantr�picos - processo 44006.002144/97-02 - u pub.-fed.dec. 64.412-280469
0070#STR0070#ALL#Termo De Responsabilidade
0072#STR0072#ALL#Respons�vel   pelo   paciente 
0073#STR0073#ALL#D� plena autoriza��o aos m�dicos do 
0074#STR0074#ALL#Que  o  assistem  para  levarem  a  cabo o tratamento da sua enfermidade,  a
0075#STR0075#ALL#Realizarem  as  investiga��es que julguem necess�rias ao diagn�stico da  sua
0076#STR0076#ALL#Doen�a, bem como  se  compromete, a submeter-se a todas as disposi��es   gerais
0077#STR0077#ALL#Contidas No Regulamento Da Institui��oo.
0083#STR0083#ALL#Respons�vel    pelo    paciente  
0086#STR0086#ALL#Responsabilidade pelo seu acto.
0087#STR0087#ALL#Comiss�o De Controlo De Infec��o Hospitalar
0088#STR0088#ALL#Folha De Controlo De Infec��o
0089#STR0089#ALL#1- Identifica��o
0092#STR0092#ALL#   nasc.: 
0093#STR0093#ALL#Registo:  
0094#STR0094#ALL#            cama: 
0095#STR0095#ALL#          data de internamento.: 
0096#STR0096#ALL#R.n. peso ao nascer      (  ) < 1.500g      (  ) 1.501g a 2.500g     (  ) > 2.500g
0097#STR0097#ALL#2- dados da hospitaliza��o      inter. anterior neste hospital  sim (  )  n�o (  )
0098#STR0098#ALL#2.1.diagn�stico Principal:________________________________________________________
0099#STR0099#ALL#2.2.diagn�stico(s) Secund�rio(s)__________________________________________________
0100#STR0100#ALL#2.3.cirurgia:_____________________________________________________________________
0101#STR0101#ALL#Porte cirurgia      classifica��o da cirurgia               situa��o              
0102#STR0102#ALL#2.3.1.grande  ( )   2.3.4 limpa                       ( )   2.3.8  electiva     ( )
0103#STR0103#ALL#2.3.2.mediana ( )   2.3.5 potencialmente contaminada  ( )   2.3.9  urg�ncia    ( )
0104#STR0104#ALL#2.3.3.pequena ( )   2.3.6 contaminada                 ( )   2.3.10 emerg�ncia  ( )
0105#STR0105#ALL#                    2.3.7 infectada                   ( )                         
0106#STR0106#ALL#3- Procedimentos Diagn�sticos/terap�uticos
0107#STR0107#ALL#3.1.antimicrobiano     ( ) 3.8. drenos               ( )  3.15.fun��o lombar   ( )
0108#STR0108#ALL#3.2.aspira��o          ( ) 3.9. endoscopia           ( )  3.16.fun��o pleural  ( )
0110#STR0110#ALL#3.4.cat�ter venoso     ( ) 3.11.hemodi�lise          ( )  3.18.terapia venosa  ( )
0111#STR0111#ALL#3.5.cat�ter vesical    ( ) 3.12.nebuliza��o          ( )  3.19.traqueostomia   ( )
0112#STR0112#ALL#3.6.corticoide         ( ) 3.13.nutr.parenteral      ( )  3.20.transf.sangue   ( )
0113#STR0113#ALL#3.7.di�lise peritonial ( ) 3.14.paracentese          ( )  3.21.outros          ( )
0114#STR0114#ALL#Anotar (s)=sem infec��o, (a)= infec��o antes procedimento, (d) ap�s procedimento   
0115#STR0115#ALL#4- exames microbiol�gicos:  cultura( ) cultura c/antibiograma( ) bacterioscopia( )
0116#STR0116#ALL#4.1.secre��es      ( )     4.3.urina         ( )         4.5.liquor            ( )
0117#STR0117#ALL#4.2.sangue         ( )     4.4.fezes         ( )         4.6.outros            ( )
0118#STR0118#ALL#                                                         4.7.n�o realizou      ( )
0119#STR0119#ALL#5- Dados Referentes � Infec��o
0120#STR0120#ALL#5.1. cardiovascular    ( )      ( )        ( )     ( )
0121#STR0121#ALL#5.2. cir�rgica         ( )      ( )        ( )     ( )
0122#STR0122#ALL#5.3. colo umbilical    ( )      ( )        ( )     ( )
0123#STR0123#ALL#5.4. cut�nea           ( )      ( )        ( )     ( )
0124#STR0124#ALL#5.5. gastro intestinal ( )      ( )        ( )     ( )
0125#STR0125#ALL#5.6. genital           ( )      ( )        ( )     ( )
0126#STR0126#ALL#5.7. ocular            ( )      ( )        ( )     ( )
0127#STR0127#ALL#5.8. osteo-articular   ( )      ( )        ( )     ( )
0128#STR0128#ALL#5.9. ouvido            ( )      ( )        ( )     ( )
0129#STR0129#ALL#5.10.puerperal         ( )      ( )        ( )     ( )
0130#STR0130#ALL#5.11.septicetemia      ( )      ( )        ( )     ( )
0131#STR0131#ALL#5.12.trato resp.inf.   ( )      ( )        ( )     ( )
0132#STR0132#ALL#5.13.trato resp.sup.   ( )      ( )        ( )     ( )
0133#STR0133#ALL#5.14.urin�ria          ( )      ( )        ( )     ( )
0134#STR0134#ALL#5.15.outras            ( )      ( )        ( )     ( )
0135#STR0135#ALL#Localiza��o Topogr�fica
0136#STR0136#ALL#Microorganismo Isolado
0137#STR0137#ALL#No Internamento
0138#STR0138#ALL#Ap�s 72 Hs
0139#STR0139#ALL#Ap�s Alta
0140#STR0140#ALL#�poca Do Diagn�stico
0141#STR0141#ALL#6- Uso De Antibi�tico
0142#STR0142#ALL#6.1.sim  (  )     n�o (  )
0143#STR0143#ALL#6.2.antimicrobiano(s) Utilizado(s):_______________________________________________
0144#STR0144#ALL#6.3.profil�ctico cl�nico  (  )             cir�rgico  (  )
0145#STR0145#ALL#6.4.terap�utico de acordo com cultura e antibiograma (  )        emp�rico (  )
0146#STR0146#ALL#Vire A Folha E Confirme A Impress�o No Verso Da Ficha De Ccih!
0147#STR0147#ALL#Esperar Para Impressao No Verso
0148#STR0148#ALL#7- Condi��es De Sa�das
0149#STR0149#ALL#7.1.curado  (  )           7.2.melhorou  (  )        7.3.inalterado  (  )
0150#STR0150#ALL#Data da alta ____/____/____
0151#STR0151#ALL#8- Tipo De Alta
0152#STR0152#ALL#       (  ) iniciativa m�dica    (  ) transfer�ncia      (  ) a pedido            
0153#STR0153#ALL#       (  ) indisciplina         (  ) abandono           (  ) �bito               
0154#STR0154#ALL#                                                         (  ) �bito por infec��o  
0155#STR0155#ALL#9- M�dico Assistente:___________________  Ass.__________________  Nr Reg Ordem M�dicos:____________
0156#STR0156#ALL#   Emfer. Assistente:___________________  Ass.__________________  Coren:__________
0157#STR0157#ALL#10- Bact�rias
0158#STR0158#ALL#10.1.acinetobacter sp                 10.24.pseudomonas sp                        
0159#STR0159#ALL#10.2.alcaligenes sp                      10.25.pseudomonas aeruginosa             
0160#STR0160#ALL#10.3.bordetella sp                       10.26.salmonella sp                      
0161#STR0161#ALL#10.4.citrobacter sp                      10.27.salmonella enteridis               
0162#STR0162#ALL#10.5.clostridium sp                      10.28.salmodella typi                    
0163#STR0163#ALL#10.6.corynebacterium difteriae           10.29.serratia sp                        
0164#STR0164#ALL#10.7.edwardsiella                        10.30.shigella sp                        
0165#STR0165#ALL#10.8.escherichia coli                    10.31.shigella dysenteriae (sub-grupo a) 
0166#STR0166#ALL#10.9.e. coli. enteroinvasora             10.32.shigella boydii (sub-grupo c)      
0167#STR0167#ALL#10.10.e.coli. enteropatog�nico           10.33.shigella flexneri (sub-grupo b)    
0168#STR0168#ALL#10.11.enterobacter sp                    10.34.shigella sonnei (sub-grupo d)      
0169#STR0169#ALL#10.12.haemophilus                     10.35.staphylococcus auraus                 
0170#STR0170#ALL#10.13.klebsiella                      10.36.staphylococcus epidemidis             
0171#STR0171#ALL#10.14.lactobacillus sp                   10.37.staphylococcus saprophyticus       
0172#STR0172#ALL#10.15.listeria monocytogenes             10.38.staphylococcus sp                  
0173#STR0173#ALL#10.16.myco bacterium sp               10.39.streptococcus sp                      
0174#STR0174#ALL#10.17.neisseria meningitidis             10.40.streptococcus - n�o hemol�tico     
0175#STR0175#ALL#10.18.neisseria gonoraheae               10.41.streptococcus virindas             
0176#STR0176#ALL#10.19.proteus sp                         10.42.streptococcus beta hemol�tico (a)  
0177#STR0177#ALL#10.20.proteus morganii                   10.43.streptococcus beta hemol�tico      
0178#STR0178#ALL#10.21.proteus rettgeri                10.44.streptococcus fecalis                 
0179#STR0179#ALL#10.22.proteus vulgaris                   10.45.streptococcus pneumoniea           
0180#STR0180#ALL#10.23.provid�ncia sp                     10.46.outros                             
0181#STR0181#ALL#11- V�rus
0182#STR0182#ALL#11.1.v�rus a da hepatite (  ) 11.3.v�rus n�o a n�o b da hepatite  11.5.outros (  )
0183#STR0183#ALL#11.2.v�rus b da hepatite (  ) 11.4.v�rus htlv 3                                   
0184#STR0184#ALL#12- Fungos
0185#STR0185#ALL#12.1.candida albicans    (  ) 12.3.criptococcus neoformans        12.5.outros (  )
0186#STR0186#ALL#12.2.candida outras      (  ) 12.4.criptococcus sp                                
0187#STR0187#ALL#13- Tipo De Infec��o
0188#STR0188#ALL#    (  ) infec��o comunit�ria      (  ) n�o houve infec��o          
0189#STR0189#ALL#    (  ) infec��o hospitalar       (  ) infec��o de outro hospital *
0190#STR0190#ALL#* Especificar O Hospital E A Topografia Da Infec��o
0191#STR0191#ALL#M�dico Ou Enfermeiro Da Ccih
0192#STR0192#ALL#Vire a folha e confirme a impress�o das observa��es m�dicas no verso
0193#STR0193#ALL#Esperar Para Impressao No Verso
0195#STR0195#ALL#   data.: 
0196#STR0196#ALL#  hora: 
0197#STR0197#ALL#      idade: 
0198#STR0198#ALL#    r.g.: 
0200#STR0200#ALL#    concelho: 
0201#STR0201#ALL#Domic�lio: 
0202#STR0202#ALL# - freguesia 
0205#STR0205#ALL#Respons�vel   pelo   paciente 
0206#STR0206#ALL#D� plena autoriza��o aos m�dicos do 
0207#STR0207#ALL#Que  o  assistem  para  levarem  a  cabo o tratamento da sua enfermidade,  a
0208#STR0208#ALL#Realizarem  as investiga��es que julguem necess�rias ao diagn�stico bem como
0209#STR0209#ALL#Se  compromete  a  submeter-se  a  todas  as  disposi��es gerais contidas no
0210#STR0210#ALL#Regulamento Da Institui��o.
 

HSPAHR82_RU.TRES

 0001#STR0001#ALL#REPORT OF PRODUCT CONSUMPTION BY PATIENT
0002#STR0002#ALL#The purpose of this program is to generate reports 
0003#STR0003#ALL#� �����. � �����������, ���������� �����.   
0004#STR0004#ALL#Attend. Dt.
0005#STR0005#ALL#Attend.
0006#STR0006#ALL#��� 
0007#STR0007#ALL#ICD
0008#STR0008#ALL#ICD Description
0009#STR0009#ALL#Grand Patient Total
0010#STR0010#ALL#Prod. Code
0011#STR0011#ALL#��������   
0012#STR0012#ALL#Total Qty
0013#STR0013#ALL#Total Sales Vl.
0014#STR0014#ALL#Grand Total of Day 
0015#STR0015#ALL#Grand Total of Period 
0016#STR0016#ALL#Service Grand Total
0017#STR0017#ALL#Exp. Date
0018#STR0018#ALL#Service Reg.
0019#STR0019#ALL#Gen. Reg.
0020#STR0020#ALL# Place of Work:___________________________
0021#STR0021#ALL#Section:__________________________________  Secretary:___________________________   Phone:___________________
0022#STR0022#ALL#Class:           Employee (   )                  Beneficiary (   )                   Private (   )
0023#STR0023#ALL#Father Name: 
0024#STR0024#ALL#Mother Name: 
0025#STR0025#ALL#                    Reg. No.___________________
0026#STR0026#ALL#Person Responsible: 
0027#STR0027#ALL#                     Phone:_________________
0028#STR0028#ALL#Responsible Address:_______________________________________________________________   Phone:_________________
0029#STR0029#ALL#Place of Work:_____________________________________________________________________   Phone:_________________
0030#STR0030#ALL#Notify:______________________________________________________________   Kinship degree: _____________________
0031#STR0031#ALL#Admission Diagnosis:____
0032#STR0032#ALL#Doctor that authorized admission:
0033#STR0033#ALL#����:
0034#STR0034#ALL#Clinic: 
0035#STR0035#ALL#ICD:
0036#STR0036#ALL#DISCHARGE SUMMARY:
0037#STR0037#ALL#Discharge Diagnosis:
0038#STR0038#ALL#Days of Hospitalization:   
0039#STR0039#ALL#DISCHARGE TYPE
0040#STR0040#ALL#Doctor Request
0041#STR0041#ALL#��������
0042#STR0042#ALL#By request       
0043#STR0043#ALL#�����. 
0044#STR0044#ALL#Indiscipline     
0045#STR0045#ALL#Death            
0046#STR0046#ALL#TREATMENT RESULT       
0047#STR0047#ALL#Cure       
0048#STR0048#ALL#Bettered   
0049#STR0049#ALL#Unchanged  
0050#STR0050#ALL#Worsened   
0051#STR0051#ALL#DOCTOR NOTES
0052#STR0052#ALL#Main Complaint
0053#STR0053#ALL#Current Illness History
0054#STR0054#ALL#Family and Personal History
0055#STR0055#ALL#Nutrition and Development
0056#STR0056#ALL#Special Physical Exams
0057#STR0057#ALL#Positive data from other equipments or systems
0058#STR0058#ALL#Diagnosis
0059#STR0059#ALL# -Phone: 
0060#STR0060#ALL#-ZipC: 
0061#STR0061#ALL#���: 
0062#STR0062#ALL#    Record:    
0063#STR0063#ALL#    Bed:   
0064#STR0064#ALL#INFIRMARY NOTES        
0065#STR0065#ALL#����
0066#STR0066#ALL#TIME
0067#STR0067#ALL#PATIENT DEVELOPMENT 
0068#STR0068#ALL# - CNPJ: 
0069#STR0069#ALL#Philantropy Purposes Certificate - Process 44006.002144/97-02 - UPUB.-FED.DEC. 64.412-280469
0070#STR0070#ALL#Liability statement      
0071#STR0071#ALL#The undersigned,       
0072#STR0072#ALL#responsible for the patient 
0073#STR0073#ALL#authorizes the doctors that treat 
0074#STR0074#ALL#him, to end the treatment related to his illness to carry out 
0075#STR0075#ALL#investigations which will be necessary in his diagnoses, 
0076#STR0076#ALL#as well as, compromise him/herself to all general dispostions which 
0077#STR0077#ALL#are part of the Institution Regulation.
0078#STR0078#ALL# ��  
0079#STR0079#ALL#Reponsible Signature
0080#STR0080#ALL#Witness:________________________________________
0081#STR0081#ALL#The undersigned,        
0082#STR0082#ALL#,   person
0083#STR0083#ALL#responsible for the patient 
0084#STR0084#ALL#Certifies that he/she has left the Installa- 
0085#STR0085#ALL#tions against the doctors opinion in this Institution, assuming the entire 
0086#STR0086#ALL#responsibility for his/her acts.
0087#STR0087#ALL#HOSPITAL INFECTION CONTROL GROUP
0088#STR0088#ALL#INFECTION CONTROL FORM
0089#STR0089#ALL#1- IDENTIFICATION
0090#STR0090#ALL#���.
0091#STR0091#ALL#Fem.
0092#STR0092#ALL#   BthD.: 
0093#STR0093#ALL#������:
0094#STR0094#ALL#            Bed:   
0095#STR0095#ALL#          Hospitalization date:
0096#STR0096#ALL#N.B. Weight              (  ) < 1.500g      (  ) 1.501g to2.500g     (  ) > 2.500g
0097#STR0097#ALL#2- HOSPITALIZATION INFO         Prev. Hospitalization in this Hospital Yes( ) No( )
0098#STR0098#ALL#2.1.MAIN DIAGNOSIS:_______________________________________________________________
0099#STR0099#ALL#2.2.SECONDARY DIAGNOSIS:__________________________________________________________
0100#STR0100#ALL#2.3.SURGERY:______________________________________________________________________
0101#STR0101#ALL#Surgery Importan.   Surgery Type                            Status                
0102#STR0102#ALL#2.3.1.HIGH    ( )   2.3.4 CLEAN                       ( )   2.3.8  ELECTIVE    ( )
0103#STR0103#ALL#2.3.2.MEDIUM  ( )   2.3.5 POTENTIALLY CONTAMINATED    ( )   2.3.9  URGENCY     ( )
0104#STR0104#ALL#2.3.3.LOW     ( )   2.3.6 CONTAMINATED                ( )   2.3.10 EMERGENCY   ( )
0105#STR0105#ALL#                    2.3.7 INFECTED                    ( )                         
0106#STR0106#ALL#3- DIAGNOSTIC/THERAPEUTIC PROCEDURES      
0107#STR0107#ALL#3.1.ANTIMICROBIAL      ( ) 3.8. DRAINS               ( )  3.15.LUMBAR PUNCTION ( )
0108#STR0108#ALL#3.2.ASPIRATION         ( ) 3.9. ENDOSCOPY            ( )  3.16.PLEURAL FUNCTION( )
0109#STR0109#ALL#3.3.BIOPSY             ( ) 3.10.ENDOTRACHEO TUBE     ( )  3.17.ARTF. BREATHING ( )
0110#STR0110#ALL#3.4.VENOUS CATHETER    ( ) 3.11.HEMODIALYSIS         ( )  3.18.VENOUS THERAPY  ( )
0111#STR0111#ALL#3.5.VESICAL CATHETER   ( ) 3.12.NEBULIZATION         ( )  3.19.TRACHEOTOMY     ( )
0112#STR0112#ALL#3.6.CORTICOID          ( ) 3.13.PARENTERAL NUTR.     ( )  3.20.BLOOD TRANSFUS. ( )
0113#STR0113#ALL#3.7.PERITONIAL DIALYSIS( ) 3.14.PARACENTESIS         ( )  3.21.OTHERS          ( )
0114#STR0114#ALL#Note   (S)=no infection,(A)= infection before procedure,  (D) after procedure     
0115#STR0115#ALL#4- MICROBIOLOGY EXAMS:      CULTURE( ) CULTURE w/ANTIBIOGRAM ( ) BACTERIOSCOPY ( )
0116#STR0116#ALL#4.1.SECRETION      ( )     4.3.URINE         ( )         4.5.LIQUOR            ( )
0117#STR0117#ALL#4.2.BLOOD          ( )     4.4.FECAL         ( )         4.6.OTHERS            ( )
0118#STR0118#ALL#                                                         4.7.NOT ACCOMPLISHED  ( )
0119#STR0119#ALL#5- DATA REFERENT TO INFECTION
0120#STR0120#ALL#5.1. CARDIOVASCULAR    ( )      ( )        ( )     ( )
0121#STR0121#ALL#5.2. SURGICAL          ( )      ( )        ( )     ( )
0122#STR0122#ALL#5.3. UMBILICAL WALL    ( )      ( )        ( )     ( )
0123#STR0123#ALL#5.4. CUTANEOUS         ( )      ( )        ( )     ( )
0124#STR0124#ALL#5.5. GASTROINTESTINAL  ( )      ( )        ( )     ( )
0125#STR0125#ALL#5.6. GENITAL           ( )      ( )        ( )     ( )
0126#STR0126#ALL#5.7. OPTICAL           ( )      ( )        ( )     ( )
0127#STR0127#ALL#5.8. OSTEOARTICULAR    ( )      ( )        ( )     ( )
0128#STR0128#ALL#5.9. AUDITION          ( )      ( )        ( )     ( )
0129#STR0129#ALL#5.10.PUERPERAL         ( )      ( )        ( )     ( )
0130#STR0130#ALL#5.11.SEPTICEMIA        ( )      ( )        ( )     ( )
0131#STR0131#ALL#5.12.INF.BREATH TREAT. ( )      ( )        ( )     ( )
0132#STR0132#ALL#5.13.SUP.BREATH TREAT. ( )      ( )        ( )     ( )
0133#STR0133#ALL#5.14.URINARY           ( )      ( )        ( )     ( )
0134#STR0134#ALL#5.15.OTHERS            ( )      ( )        ( )     ( )
0135#STR0135#ALL#TOPOGRAPHIC LOCALIZATION
0136#STR0136#ALL#ISOLATED MICROORGANISM
0137#STR0137#ALL#IN HOSPITALIZ.
0138#STR0138#ALL#AFTER 72 Hs
0139#STR0139#ALL#AFTER DISCHARGE
0140#STR0140#ALL#DIAGNOSIS PERIOD
0141#STR0141#ALL#6- USE OF ANTIBIOTICS
0142#STR0142#ALL#6.1.YES  (  )      NO (  )
0143#STR0143#ALL#6.2.ANTIMICROBIAL(S) USED:________________________________________________________
0144#STR0144#ALL#6.3.CLINICAL PROPHYLATIC (  )             SURGICAL   (  )
0145#STR0145#ALL#6.4.THERAPIST ACCORDING TO CULTURE AND ANTIBIOGRAM   (  )        EMPIRIC  (  )
0146#STR0146#ALL#Turn the sheet and confirm printing at the back of the CCIH form!
0147#STR0147#ALL#Wait for printing on the back of the sheet
0148#STR0148#ALL#7- DISCHARGE CONDITIONS
0149#STR0149#ALL#7.1.CURED   (  )           7.2.BETTERED   (  )        7.3.UNALTERED   (  )
0150#STR0150#ALL#Disch. Date  ____/____/____
0151#STR0151#ALL#8- DISCHARGE TP
0152#STR0152#ALL#       (  ) DOCTOR REQUEST       (  ) TRANSFERENCE       (  ) BY REQUEST          
0153#STR0153#ALL#       (  ) UNDISCIPLINE         (  ) ABANDON            (  ) DEATH               
0154#STR0154#ALL#                                                         (  ) DEATH BY INFECTION  
0155#STR0155#ALL#9- DOCTOR RESPONS.:_____________________  SIG.__________________  CRM:____________
0156#STR0156#ALL#   NURSE RESPONSIBLE:___________________  SIG.__________________  COREN:__________
0157#STR0157#ALL#10- BACTERIAS
0158#STR0158#ALL#10.1.Acinetobacter SP                 10.24.Pseudomonas SP                        
0159#STR0159#ALL#10.2.Alcaligenes SP                      10.25.Pseudomonas Aeruginosa             
0160#STR0160#ALL#10.3.Bordetella SP                       10.26.Salmonella SP                      
0161#STR0161#ALL#10.4.Citrobacter SP                      10.27.Salmonella Enteridis               
0162#STR0162#ALL#10.5.Clostridium SP                      10.28.Salmodella Typi                    
0163#STR0163#ALL#10.6.Corynebacterium Difteriae           10.29.Serratia SP                        
0164#STR0164#ALL#10.7.Edwardsiella                        10.30.Shigella SP                        
0165#STR0165#ALL#10.8.Escherichia Coli                    10.31.Shigella Dysenteriae (Subgroup A)  
0166#STR0166#ALL#10.9.E. Coli. Enteroinvasora             10.32.Shigella Boydii (Subgroup C)       
0167#STR0167#ALL#10.10.E.Coli. EnteroPatog�nico           10.33.Shigella Flexneri (Subgroup B)     
0168#STR0168#ALL#10.11.EnteroBacter SP                    10.34.Shigella Sonnei (Subgroup D)       
0169#STR0169#ALL#10.12.Haemophilus                     10.35.Staphylococcus Auraus                 
0170#STR0170#ALL#10.13.Klebsiella                      10.36.Staphylococcus Epidemidis             
0171#STR0171#ALL#10.14.Lactobacillus SP                   10.37.Staphylococcus SaproPhyticus       
0172#STR0172#ALL#10.15.Listeria Monocytogenes             10.38.Staphylococcus SP                  
0173#STR0173#ALL#10.16.Myco Bacterium SP               10.39.Streptococcus SP                      
0174#STR0174#ALL#10.17.Neisseria Meningitidis             10.40.Streptococcus - not Hemolytic      
0175#STR0175#ALL#10.18.Neisseria Gonoraheae               10.41.Streptococcus Virindas             
0176#STR0176#ALL#10.19.Proteus SP                         10.42.Streptococcus Beta Hemolytic (A)   
0177#STR0177#ALL#10.20.Proteus Morganii                   10.43.Streptococcus Beta Hemolytic       
0178#STR0178#ALL#10.21.Proteus Rettgeri                10.44.Streptococcus Fecalis                 
0179#STR0179#ALL#10.22.Proteus Vulgaris                   10.45.Streptococcus Pneumoniea           
0180#STR0180#ALL#10.23.Provid�ncia SP                     10.46.Others                             
0181#STR0181#ALL#11- VIRUS
0182#STR0182#ALL#11.1.Hepatitis A Virus   (  ) 11.3.non-A non-B Hepatitis Virus    11.5.Others (  )
0183#STR0183#ALL#11.2.Hepatitis B Virus   (  ) 11.4.HTLV 3 Virus                                   
0184#STR0184#ALL#12- FUNGUS
0185#STR0185#ALL#12.1.Candida Albicans    (  ) 12.3.Criptococcus Neoformans        12.5.Others (  )
0186#STR0186#ALL#12.2.Candida Others      (  ) 12.4.Criptococcus SP                                
0187#STR0187#ALL#13- INFECTION TYPE
0188#STR0188#ALL#    (  ) Community Infection       (  ) No Infection                
0189#STR0189#ALL#    (  ) Hospital Infection        (  ) Infection in other Hospital*
0190#STR0190#ALL#* SPECIFY THE HOSPITAL AND TOPOGRAPHY ABOUT INFECTION
0191#STR0191#ALL#CCIH DOCTOR OR NURSE
0192#STR0192#ALL#Turn the sheet and confirm Doctor�s Notes printing on the back
0193#STR0193#ALL#Wait for printing on back page
0194#STR0194#ALL#�������
0195#STR0195#ALL#   Date:  
0196#STR0196#ALL#  Time: 
0197#STR0197#ALL#      Age:   
0198#STR0198#ALL#    I.D.: 
0199#STR0199#ALL#Phone no.:
0200#STR0200#ALL#    City:      
0201#STR0201#ALL#�����:  
0202#STR0202#ALL# -District:
0203#STR0203#ALL#The undersigned,       
0204#STR0204#ALL#, person
0205#STR0205#ALL#responsible for the patient   
0206#STR0206#ALL#fully authorizes the doctors of     
0207#STR0207#ALL#that assist him/her to treat his/her disease,                               
0208#STR0208#ALL#to conduct the researches they deem necessary for diagnosis and      
0209#STR0209#ALL#and agrees to be subject to all the general regulations of the              
0210#STR0210#ALL#Institution's Regulations.