27.15 Registru Mici Interventii Chirurgicale

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REGISTRUL DE MICI INTERVENŢII CHIRURGICALE a a a a l l z z Nr. Ziua Numele crt. şi prenumele 1 2 3

Vârsta 4

Domiciliul : localitatea, strada, nr. 5

Diagnosticul

Felul intervenţiei şi anestezia

6

7

Semnătura şi parafa medicului 8

27.15 ; A4 ; t2