15.9 Buletin Analize Medicale Electrocardiogram A

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Judeţul…………………………. Localitatea…………………….. Unitatea sanitară……………….. BULETIN DE ANALIZE MEDICALE Nr……. ELECTROCARDIOGRAMĂ CNP Data a a a a

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continuare – Numele…………………………Prenumele…………… Sexul M ; vârsta………………………. F Domiciliul:judeţul,…………localitatea……………… ………………….Str………………..………………… Trimis de……………………………………………… Diagnostic clinic……………………………………… ……………………………………………………….. Digitală……………………chinidină……………….. ……………………………………………………….. REZULTATUL Ritm a……………………Ritm V…………………… P………………P-Q………………QRS…………….. …………QT………………… Negativare locală în: V1………..V2…………………. V5………V6…………………………………………. ……………………………………………………….. CONCLUZII: ……………………………………………………….. Lucrat de: …………………………………………………………. Semnătura şi parafa medicului, …………………………………………………………. verso

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