美容皮肤科病历-门诊病历记录（出诊）2-5-16

美容皮肤科病历口力诊I门诊病历记录（初诊）就诊时间年月日时分就医者姓名性别年龄岁病历号主诉（就诊意愿）:__________________________________________________________________________________________________夕胸及手术史口无口有____________________________________________________________________________________________高血压病史口无口有糖尿病史口无口有心脏病史口无口＜肺病史口无肝病史□无□有______________________________肾病史□无□有____________________________________________________药物、食物过敏史口无口有（注明药物、食物名称）既往与本次就诊相关医疗美容史口无口有__________________________________________________________________________瘢痕体质口是口否其他___________________________________________________________________________________________________________个人史目前月照缄__________________________________________________________________________________________________婚育史月经史是否备孕专科睡体温℃脉搏处分呼欢次分血压/imilg（可寸页）________________________________________________________________________________________________辅助检$结果何附页）_______________________________________________________________________________________治疗方案:WK就医者确认签字:医师签字:主诊医^币签字:专科检杳单就资间年月S时____________________________________分脚辘加得姗颔WI估皮肤分型菲茨帕特里克口1DII口皮肤类型口中性口油性口干性口混合型皮肤质地口良好口肤质不良口敏感皮肤口毛孔粗大口凹坑、不平马影像:（编号/黏贴）I门诊病历记录（复诊）复诊就诊时间年月日时分就医者姓名性别年龄岁病历号主诉（就诊意愿）:___________________________________________________________________________________________________对上次治疗后评价n满意n一般n待改进n不满意目前月觊药______________________________________________________________________________________________________婚育史月经史是否备孕翱触体温℃W次分口搬的分血£/nniHg（可寸页）_______________________________________________________________________________________________辅助检查结果（可附页）弼_______________________________________________________________注意事项（可附页）____________________________________________________________________________________________________________________________________________________________________________________________________复诊计划2就医者确认签字医师签字主诊医师签字:母时间年月日。