Приложение N 2. Форма N 03-ТБ/у "Журнал регистрации больных туберкулезом"

Приложение N 2

 

Утверждено

приказом Минздрава РФ

от 13 февраля 2004 г. N 50

 

Медицинская документация

учетная форма N 03-ТБ/у

 

Утверждена приказом Минздрава РФ

от 13 февраля 2004 г. N 50

 

__________________________________

__________________________________

     наименование учреждения

 

                                 Журнал

                    регистрации больных туберкулезом

 

Начат "__"_________ 20__ г.    Окончен "__"________ 20__ г.

 

+-------+-------+---------+--------------+------+-----+--------+----------+------+------------+--------------------------------------------------+

|Поряд- | Дата  |Региона- |     ФИО      | Пол  |Воз- | Адрес  | Учрежде- | Дата |Диагноз: 1 -|                  Группы больных                  |

| ковый |регист-|  льный  | (полностью)  |(М/Ж) |раст |(полнос-|  ние, в  |начала| легочный,  |                                                  |

| номер | рации |регистра-|              |      |     |  тью)  | котором  |лече- |    2 -     |                                                  |

|       |       | ционный |              |      |     |        | больной  | ния  | туберкулез |                                                  |

|       |       |  номер  |              |      |     |        |состоит на+------+    ВДП,    +------------+------+-------+-------+-------+------+

|       |       |         |              |      |     |        |диспансер-|Режим |  бронхов,  |  Впервые   |Реци- |Лечение|Переве-|Лечение|Прочие|

|       |       |         |              |      |     |        |ном учете |химио-|  плевры и  | выявленный | див  | после |денные | после |      |

|       |       |         |              |      |     |        |          |тера- |   ВГЛУ,    |  больной   |      |неэффе-| (для  |преры- |      |

|       |       |         |              |      |     |        |          | пии  |    3 -     |туберкулезом|      |ктивно-|продол-| вания |      |

|       |       |         |              |      |     |        |          |      |внелегочный |   (новый   |      |  го   | жения | курса |      |

|       |       |         |              |      |     |        |          |      |            |  случай)   |      | курса | лече- |химио- |      |

|       |       |         |              |      |     |        |          |      |            |            |      |химио- |  ния) |терапии|      |

|       |       |         |              |      |     |        |          |      |            |            |      |терапии|       |       |      |

+-------+-------+---------+--------------+------+-----+--------+----------+------+------------+------------+------+-------+-------+-------+------+

|   1   |   2   |    3    |      4       |  5   |  6  |   7    |    8     |  9   |     10     |     11     |  12  |  13   |  14   |  15   |  16  |

+-------+-------+---------+--------------+------+-----+--------+----------+------+------------+------------+------+-------+-------+-------+------+

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|       |       |         +--------------+      |     +--------+          +------+            |            |      |       |       |       |      |

|       |       |         |              |      |     |        |          |      |            |            |      |       |       |       |      |

+-------+-------+---------+--------------+------+-----+--------+----------+------+------------+------------+------+-------+-------+-------+------+

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|       |       |         +--------------+      |     +--------+          +------+            |            |      |       |       |       |      |

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|       |       |         +--------------+      |     +--------+          +------+            |            |      |       |       |       |      |

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|       |       |         +--------------+      |     +--------+          +------+            |            |      |       |       |       |      |

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+-------+-------+---------+--------------+------+-----+--------+----------+------+------------+------------+------+-------+-------+-------+------+

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|       |       |         +--------------+      |     +--------+          +------+            |            |      |       |       |       |      |

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+-------+-------+---------+--------------+------+-----+--------+----------+------+------------+------------+------+-------+-------+-------+------+

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|       |       |         +--------------+      |     +--------+          +------+            |            |      |       |       |       |      |

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|       |       |         +--------------+      |     +--------+          +------+            |            |      |       |       |       |      |

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+-------+-------+---------+--------------+------+-----+--------+----------+------+------------+------------+------+-------+-------+-------+------+

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|       |       |         +--------------+      |     +--------+          +------+            |            |      |       |       |       |      |

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+-------+-------+---------+--------------+------+-----+--------+----------+------+------------+------------+------+-------+-------+-------+------+

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|       |       |         +--------------+      |     +--------+          +------+            |            |      |       |       |       |      |

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+-------+-------+---------+--------------+------+-----+--------+----------+------+------------+------------+------+-------+-------+-------+------+

 

+-----------------------------------------------------------------------------------------------+------------------------------------------+-----+

|Результаты исследований: для микроскопии мокроты ввести результат в верхнюю часть клетки, дату |        Исходы курса химиотерапии         |При- |

|    исследования в нижнюю часть клетки, для остальных исследований ввести только результат     |                                          |меча-|

+-------------------------+------------+-------------+-------------+-------------+--------------+------------+-----------+------+-----+----+ ния |

|       До лечения        | 2/3 месяц  |  3/4 месяц  |5 месяц фаза |             |   В конце    | Эфф. курс  |Неэфф. курс| Умер |Пре- |Вы- |     |

|                         |интенсивная |  продление  | продолжения |             |   лечения    |х/т, подтв. |х/т, подтв.|  от  |рыва-|был |     |

|                         |    фаза    | интенсивной |             |             |              +-----+------+----+------+тубер-| ние |    |     |

|                         |            |    фазы     |             |             |              |мик- |клини-|мик-|клини-|кулеза|курса|    |     |

|                         |            |             |             |             |              |рос- |ко-ре-|рос-|ко-ре-|      |хими-|    |     |

|                         |            |             |             |             |              |копи-|нтге- |ко- |нтге- |      |оте- |    |     |

|                         |            |             |             |             |              | ей  |нолог.|пией|нолог.|      |рапии|    |     |

|                         |            |             |             |             |              |мок- |      |мок-|      |      |     |    |     |

|                         |            |             |             |             |              |роты |      |роты|      |      |     |    |     |

+-----+----+----+---+-----+----+---+---+-----+---+---+----+---+----+----+---+----+-----+---+----+-----+      +----+      +------+     |    |     |

|Мик- |Мик-|По- |ЛУ |Рент-|Мик-|По-|Ре-|Микро|По-|Рен|Мик-|По-|Рент|Мик-|По-|Рент|Микро|По-|Рент|посев|      |по- |      |не от |     |    |     |

|рос- | ро |сев |   |ген* | ро |сев|нтг|ско- |сев| т | ро |сев|ген | ро |сев|ген |ско- |сев|ген |     |      |сев |      |тубер-|     |    |     |

|копия|ско-|    |   |     |ско-|   |ен | пия |   |ген|ско-|   |    |ско-|   |    | пия |   |    |     |      |    |      |кулеза|     |    |     |

| ОЛС |пия |    |   |     |пия |   |   |     |   |   |пия |   |    |пия |   |    |     |   |    |     |      |    |      |      |     |    |     |

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| 17  | 18 | 19 |20 | 21  | 22 |23 |24 | 25  |26 |27 | 28 |29 | 30 | 31 |32 | 33 | 34  |35 | 36 | 37  |  38  | 39 |  40  |  41  | 42  | 43 | 44  |

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* Деструкция легочной ткани