15.12 Buletin Analize Med Teste Efort

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Judeţul…………………………. Localitatea…………………….. Unitatea sanitară……………….. BULETIN DE ANALIZE MEDICALE Nr……. TESTE DE EFORT CNP

Data a a a a

l l z z

Numele…………………………Prenumele…………… Sexul M ; vârsta………………………. F Domiciliul:judeţul ,…………localitatea ……………… Str………………..……………Nr ……………………. Trimis de……………………………………………….. REZULTATUL Presiunea atm .………………………………………... Temperatura atm……………………………………….. Greutatea……………………………………………….. Înălţimea……………………………………………….. Suprafaţa corporală…………………………………….. Tipul de efort…………………….…………………….. Durata efortului………………………………………… Debitul pompă…………………………………………. …………………………………………………………. Faţă 15..12 A6;t2

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Efort

Revenire

VO2 VCO2 Di PR VO2/V Oximetrie Cardiotatahimetrie frecvenţa TA ERG Pneumotahografie frecvenţa V CONCLUZII Lucrat de: Semnătura şi parafa medicului, …………………………………………………………. verso

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