M U N I C I PA L H O S P I TA L 4 K U R S K R U S S I A

D E PA RT M E N T O F T R A U M ATO L O G Y & O RT H O PA E D I C S

MEDICAL CARD

Traumatology department ____; Ward ____

Date & Time of Admission: ___________; Date of Discharge: ______________

Name:________________________________________________; M/F: _____

Age: ________; Address: ____________________________________________

Clinical Diagnosis: __________________________________________________

__________________________________________________________________

Final Diagnosis: ____________________________________________________

__________________________________________________________________
__________________________________________________________________

Head of Department: M.D., Professor G.M. Dubrovin

Curator of the groupe: __________________________

Dates of observation: start _________

finish ________
Carried out: student (name)
______________________________________
Group _____; year: _______

Controlled: date - _______

Name - __________________
Mark - __________________
 Initial examination (in the first day of observation)
Complaints:________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Medical history: ____________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Life history: _______________________________________________________
__________________________________________________________________
__________________________________________________________________
General Examination: _______________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Local Examination: _________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

2
Radiodiagnostics (description) _______________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Laboratory diagnostics ______________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Other investigations, consultations ____________________________________
__________________________________________________________________
__________________________________________________________________

Clinical Diagnosis: __________________________________________________

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

3
T R E AT M E N T
Pharmacotherapy
Date of Date of drug
medicaments
prescription withdrawal

Physiotherapy, exercise therapy, massage.

Date of Date of
Prescriptions
prescription withdrawal

Orthopedic measures realizing in observation period:

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

Surgical treatment (realized or planning):

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

4
 Journals (daily or every other day recordings of observation)

Date _______.
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Signature __________

Date _______.
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Signature __________

5
 Preoperational epicrisis (if operation took place during follow-up of patient)
Date
Diagnosis
Indications to operation
Putative anesthesia and operation
Consent of the patient to operation
Signature

Operative notes (if operation took place during follow-up of patient)

Date
Name of operation
Who operated?
Kind of anesthesia
Description of operation

Signature

6
 Epicrisis (if the patient discharges from the hospital)
Name, age of the patient
Period of hospital stay
Final diagnosis
Methods of treatment realized in the hospital
Condition of the patient at discharge
Recommendations

Recommendations (if the patient remains in the hospital)

Planning operations (if there is indications)
Orthopedic measures (if necessary)
Medications
Approximate periods of discharge from the hospital
Where it is recommended to continue treatment?
Program of rehabilitation
Prognosis
Approximate periods of disability

Abstract (if you chose this kind of the independent work)

Title of the abstract: Modern methods of treatment of pathology which had your
patient.
Modern methods of treatment of present pathology from modern literature and
internet. Their description, advantages and disadvantages.
List of literature (sources of information).