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АУТОПСИОНЕН ПРОТОКОЛ
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Шифър
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№ ........ м. .............. 200....... г.
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Име ..............................................................................................................................................................................................................................................................................................................................
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М
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Ж
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...... г.
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...........................................................
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собствено, бащино, фамилно
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възраст
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Месторождение ...................... Местожителство ........................................................................................................................................................................................................................................................................................................................................
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...........................................................
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Професия ........................... вид на производството ...............................................................................................................................................................................................................................................................................................................................
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...........................................................
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клиника
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Изпратен от ................................. ----- И. З. № ...............................................................................................................................................................................................................................................................................................................................
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...........................................................
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болница
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Постъпил на лечение ....... 200.... г., починал на ... 200... г. престой в болницата .......................................................................................................................................................................................................................................................................................................
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...........................................................
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Аутопсиран на ................... 200... г. Аутопсирал д-р ................................................................................................................................................................................................................................................................................................................................
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...........................................................
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К Л И Н И Ч Н А Д И А Г Н О З А
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1. ...............................................................................................................................................................................................
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7. ...............................................................................................................................................................................................
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2. ...............................................................................................................................................................................................
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8. ...............................................................................................................................................................................................
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3. ...............................................................................................................................................................................................
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9. ...............................................................................................................................................................................................
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4. ...............................................................................................................................................................................................
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10. .........................................................................................................................................................................................
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5. ...............................................................................................................................................................................................
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11. .........................................................................................................................................................................................
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6. ...............................................................................................................................................................................................
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12. .........................................................................................................................................................................................
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Медицински интервенции (клинични сведения) ................................................................................................................................................................................................................................................................................................................................................
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1. ...............................................................................................................................................................................................
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3. ...............................................................................................................................................................................................
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2. ...............................................................................................................................................................................................
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4. ...............................................................................................................................................................................................
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П А Т О Л О Г О А Н А Т О М И Ч Н А Д И А Г Н О З А
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1. .........................................................................................................................................................................................................................................................................................................................................................................................
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Основно заб.
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Усложнения
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Прич. смъртта
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Съпътств. заб.
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Неразпоз.
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Разпоз.
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Погр. диагн
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Легенда: О - основно заболяване У - усложнения С - съпътстващи заболявания
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ИЗВЪРШИЛ АУТОПСИЯТА: ......................................................................................................................................................................................................................................
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ЗАВЕРИЛ: ..............................................................................................................................................................................................
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ЕПИКРИЗА: (А. Обосновка на патологоанатомичната диагноза. Б. Клинико-анатомичен разбор.
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В. Паралел между клинична и патологоанатомична диагноза).
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