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ОТДЕЛЕНИЕ/КЛИНИКА ПО
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МЕДИЦИНСКА ОНКОЛОГИЯ
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РЕШЕНИЕ № ....../........... 201... г.
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на ОНКОЛОГИЧНИЯ КОМИТЕТ
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по ХИМИОТЕРАПИЯ
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Пациент: .................................................................................................................................................................................................................................................................
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ЕГН: ......................................
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Диагноза - стадий: ........................................................................................................................................................................................................................................................
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Хистологичен резултат: .....................................................................................................................................................................................................................................................
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................................................................................................................................................................................................................................................................................
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ER ............ PgR ........... HER2 ........
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RAS ....... EGFR ........
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Решение
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ЩЕ СЕ ПРОВЕДЕ ЛЕКАРСТВЕНО ЛЕЧЕНИЕ ПО СХЕМА:
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НЕАДЮВАНТНА ХТ ..............................................................................................................................................................................................................................................
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АДЮВАНТНА ХТ .................................................................................................................................................................................................................................................
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ЛЕЧЕБНА ХТ .................................................................................................................................................................................................................................................
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БИФОСФОНАТИ .................................................................................................................................................................................................................................................
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ХОРМОНОТЕРАПИЯ ..............................................................................................................................................................................................................................................
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ТАРГЕТНА (БИОЛОГИЧНА) ТЕРАПИЯ ............................................................................................................................................................................................................................
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................................................................................................................................................................................................................................................................
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АНТИЕМЕТИЦИ .............................................................................................................................................................................................................................................
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КОЛОНИOСТИМУЛИРАЩИ ФАКТОРИ ...............................................................................................................................................................................................................................
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................................................................................................................................................................................................................................................................
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ИНТРАКАВИТАРНА ХТ ........................................................................................................................................................................................................................................
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Брой цикли/курсове
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Продължителност
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...................................
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.................................
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Интервал: 1 седмица; 2 седмици; 3 седмици; 4 седмици
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Контролни изследвания по преценка на лекаря:
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Задължителен набор изследвания според медицинския стандарт
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ПКК............. Биохимия............. Туморни маркери............. Ехография
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Рентгенограма на бели дробове............. КТ....................................................................................................................................................................................................
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ЕКГ............. Други
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Костна сцинтиграфия
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Мамография
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Лечебната схема и продължителност позволяват при запазено общо състояние и липса на токсичност изписване на 48-и час.
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Лечението може да бъде проведено и по клинична процедура.
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ДОКЛАДВАЛ:
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ПРЕДСЕДАТЕЛ:
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ЧЛЕНОВЕ: "
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Рецептурна бланка № .....................
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за лекарствени продукти, заплащани от НЗОК
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...............................................................................................................................................................................................................................................................................
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Наименование на лечебното заведение - Рег. №
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Лекар (име) ................................................................................................................................................................................................................................................................
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УИН на лекаря ..................................... Дата: ................................................................................................................................................................................................................
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Заболяване група № .................................................. по прил. № 1
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Протокол № ........................ Дата: ..................................................................................................................................................................................................................................
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Rp.
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1
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2
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3
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Лекар:
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(подпис и печат)
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Пациент:
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ЕГН:
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_____________________________________________________________________________________________________________________________________________________________
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Дом. адрес:
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Гр. (с.)
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Отпуснал:
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Получил:
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Маг. фарм. УИН:
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(подпис и печат)
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Дата: "
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