Държавен вестник, бр. 50, 2022 г., стр. 148

СТР.  148	
Д Ъ Р Ж А В Е Н  В Е С Т Н И К 	
БРОЙ  50
 
 
Диагнози на придружаващите заболявания  
 
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Анамнеза 
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Обективно състояние 
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Медицински изделия, помощни средства, приспособления и съоръжения 
 
 
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Мнение относно временната неработоспособност или трайно намалената работоспособност/вид и степен на 
увреждане на лицето:  
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Болничен лист № ......................  дни, МКБ . от .................до ................  първичен   продължение 
ТЕЛК №, ЕР на ТЕЛК/НЕЛК №  от заседание №  дата    (д/м/г)  
 
 Освидетелстване за снабдяване с медицински изделия, помощни средства, приспособления и съоръжения 
(попълва се при избрани медицински изделия, помощни средства, приспособления и съоръжения)