MEDICAL PASSPORT
OF RHEUMATIC PATIENT
Security and confidentiality notes
1
Surname:
2
Name, patronymic:
3
Date of birth:
4
Home tel.number:
Work tel.number:
5
Address:
6
Place of work (study):
7
Attachments for the clinical examinations:
7.1
At this institution:
(number/name of the medical station)
7.2
At another establishment:
(establishment name)
WARNING NOTES
BLOOD TYPE AND RH-FACTOR:
ALLERGY:
RESPONSE TYPE:
BLOOD TRANSFUSION (date, how much ):
VACCINATION (date, name of vaccinations):
Response:
SURGICAL INTERVENTION:
Diabetes mellitus:
INFECTIOUS DISEASES:
PHARMACOTHERAPY
OF RHEUMATIC DISEASES:
Dates and place of hospitalization (inpatient treatment)
Epicrisis from medical card
Name, surname and patronymic
Admitted to the polyclinic in year
20
Is under dispensary observation:
Yes
No
Disability group
The diagnosis of underlying disease:
Identification date
20
г.
Releated diseases with dates of their identification
THE SECURITY AND CONFIDENTIALITY OF MEDICAL PASSPORTS of RHEUMATIC PATIENT (MPRP)
Filling rheumatic passport (MPRP) does not require pre-registration.
Filling out paper forms sample MPRP guarantees complete confidentiality.
The electronic version MPRP does not save, transfer to other sites data is entered and does not maintain statistics on the treatment.
Fill in all the boxes MPRP optional. The personal information is optional by the user. The total amount of data is unlimited. Completing various choices of answers is unlimited.
Introduction MPRP in clinical practice allows the physician of any medical institution to have the most important detailed information about the patient to reduce the time to maintain medical records and increased time to communicate with the patient and objective inspection. Information MPRP can improve continuity in the work of various medical institutions, before the introduction into the daily practice of universal electronic patient records. Filling MPRP will allow the patient to organize a survey and treatment of their illness. MPRP will increase adherence to the treatment of a particular patient. The use of the medical passport will partially resolve the problem of patients’ desire to be in possession of medical documents on their health. The completed sample MPRP it is advisable to discuss with your doctor, taking into accounts its comments and suggestions.