Latent sil yoki ximioprofilaktika davosi olayotgan bemorlar nazorat varog`I

Davolash so`nggida:
Diaskintest sinamasi qo`yilgan sana: ____/____/_______ seriya raqami_____/_____/_________ natijasi___________ Obzor rentgenografiya, flyuorografiya yoki MSKT □ xa □yo`q sana: _____/_____/__________ natijasi___________
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Dorilarni berilish dozalari

	N-Izoniazid	R.Rifampisin	P-Rifapentina
1 kunlik dozasi (grammda)

Dorilarni berilish kunlari
Belgilash tartibi: “ ” dorilarni ichganligi “-” dori qabul qilmagan kun “Ya” yakshanba kuni “B” bayram kunlari

Kun oylar	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	17	18	19	20	21	22	23	24	25	26	27	28	29	30	31	Re- ja	Ich- di	Ich- madi
Jami

Davo natijasi davolash tugatilgan sana: _____/_____/_______

1. Davolandi □ 2. O`ldi □ o`lgan kuni _____/_____/______ 3.Samarasiz davo □ 4.bemorni davolovchi vrach yo`qotib qo`ydi □

Izohlar: ___________________________________________________________________________________________________

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Davolovchi vrach : __________________________________________ imzo:______________