27.29 Registru Protocol Necropsie
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PROTOCOL DE NECROPSIE Nr………… CNP Numele…………………………………………….….Prenumele…………..…………………………… buletin de identitate seria…………nr………….……………sexul………...…………vârsta………..ani cu domiciliul în : judeţul…………………………………….localitatea……………………………….. str………………………………………….……………….nr………Decedat :
, a a a a l l z z ora………….unitatea sanitară : …………………….…………………………………………………… cu diagnosticul clinic: …………………………………………………………………………………... ……………………………………………………………………………………………………………. Foaia de observaţie nr………..internat cu diagnosticul : .……………………………………………….. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. A fost necropsiat la data :
, ora………….. a a a a
l l z z
Descrierea celor constatate la necropsie:...………………………………….……………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. Faţă 27.29 ; A4 ; t2
……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. Diagnosticul anatomo-patologic………………………………………………………………………….. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. Cauza morţii………………………………………………………………………………………………. ……………………………………………………………………………………………………………. Boala principală………..…………………………………………………………………………………. ……………………………………………………………………………………………………………. Alte boli…………………………………………………………………………..………………………. ……………………………………………………………………………………………………………. Necropsia a fost efectuată de dr………………………………………………………………………….. L.S.
Semnătura şi parafa Verso
, a a a a l l z z ora………….unitatea sanitară : …………………….…………………………………………………… cu diagnosticul clinic: …………………………………………………………………………………... ……………………………………………………………………………………………………………. Foaia de observaţie nr………..internat cu diagnosticul : .……………………………………………….. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. A fost necropsiat la data :
, ora………….. a a a a
l l z z
Descrierea celor constatate la necropsie:...………………………………….……………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. Faţă 27.29 ; A4 ; t2
……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. Diagnosticul anatomo-patologic………………………………………………………………………….. ……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………. Cauza morţii………………………………………………………………………………………………. ……………………………………………………………………………………………………………. Boala principală………..…………………………………………………………………………………. ……………………………………………………………………………………………………………. Alte boli…………………………………………………………………………..………………………. ……………………………………………………………………………………………………………. Necropsia a fost efectuată de dr………………………………………………………………………….. L.S.
Semnătura şi parafa Verso
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