27.10 Registru Formulare Timbru Sec

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REGISTRUL DE EVIDENŢĂ A FOLOSIRII FORMULARELOR CU TIMBRU SEC Nr. crt.

Data eliberării

Nr. de ordine al formularului folosit

Numele şi prenumele bolnavului

Domiciliul

Diagnosticul

Reţeta prescrisă

1

2

3

4

5

6

7

Nr. fişei de consultaţie, foii de obs. sau nr. din registrul de consultaţii 8

Menţiuni speciale 9

27.10 ; A4 ; t2

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