Държавен вестник, бр. 82, 2002 г., стр. 21

Б Р О Й  82
Д Ъ Р Ж А В Е Н   В Е С Т Н И К
С Т Р .  21
Приложение № 5
към раздел VIII
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АУТОПСИОНЕН ПРОТОКОЛ
Шифър
.........................................................................................
№ ........ м. .................... 200....... г.
Име...........................................................................................................................................
М  Ж ............... г.
......................
собствено, бащино,  фамилно
възраст
Месторождение ...................................................... Местожителство .................................................................
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Професия .................................................................вид на производството ......................................................
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клиника
Изпратен от .................................................................................... ––––– И. З. № .....................................
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болница
Постъпил  на лечение ........................200...…г., починал на .. 200... г. престой в болницата.....................
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Аутопсиран на ......................................200... г. Аутопсирал   д-р .....................................................................
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К Л И Н И Ч Н А  Д И А Г Н О З А
1. ............................................................................................
7. .............................................................................
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2. ............................................................................................
8. .............................................................................
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3. ............................................................................................
9. .............................................................................
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4. ............................................................................................
10. .............................................................................
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5. ............................................................................................
11. .............................................................................
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6. ............................................................................................
12. .............................................................................
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Медицински интервенции (клинични сведения) .......................................................................................
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1. ............................................................................................
3. .............................................................................
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2. ............................................................................................
4. .............................................................................
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П А Т О Л О Г О А Н А Т О М И Ч Н А  Д И А Г Н О З А
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2. ..................................................................................................................................................................................
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3. ..................................................................................................................................................................................
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7. ..................................................................................................................................................................................
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8. ..................................................................................................................................................................................
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9. ..................................................................................................................................................................................
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10...................................................................................................................................................................................
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11...................................................................................................................................................................................
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12...................................................................................................................................................................................
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13...................................................................................................................................................................................
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14...................................................................................................................................................................................
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15...................................................................................................................................................................................
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18...................................................................................................................................................................................
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Основно заб.
Усложнения
Прич. смъртта
Съпътств. заб.
Неразпоз.
Разпоз.
Погр. диагн.
Легенда:
О—основно заболяване
У—усложнения
С—съпътстващи заболявания
ИЗВЪРШИЛ АУТОПСИЯТА: .............................................
ЗАВЕРИЛ: ............................................................
ЕПИКРИЗА: (А. Обосновка на патологоанатомичната диагноза. Б. Клинико-анатомичен разбор. В. Паралел между
клинична и патологоанатомична диагноза).