JPH03129474U - - Google Patents
Info
- Publication number
- JPH03129474U JPH03129474U JP3874190U JP3874190U JPH03129474U JP H03129474 U JPH03129474 U JP H03129474U JP 3874190 U JP3874190 U JP 3874190U JP 3874190 U JP3874190 U JP 3874190U JP H03129474 U JPH03129474 U JP H03129474U
- Authority
- JP
- Japan
- Prior art keywords
- sheet
- leaf
- displayed
- symptoms
- column
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Pending
Links
- 208000024891 symptom Diseases 0.000 claims description 7
- 201000010099 disease Diseases 0.000 claims description 2
- 208000037265 diseases, disorders, signs and symptoms Diseases 0.000 claims description 2
- 208000035473 Communicable disease Diseases 0.000 claims 1
- LFQSCWFLJHTTHZ-UHFFFAOYSA-N Ethanol Chemical compound CCO LFQSCWFLJHTTHZ-UHFFFAOYSA-N 0.000 claims 1
- 241000208125 Nicotiana Species 0.000 claims 1
- 235000002637 Nicotiana tabacum Nutrition 0.000 claims 1
- 230000035622 drinking Effects 0.000 claims 1
- 239000003814 drug Substances 0.000 claims 1
- 229940079593 drug Drugs 0.000 claims 1
- 230000000391 smoking effect Effects 0.000 claims 1
- 206010060891 General symptom Diseases 0.000 description 2
- 238000010586 diagram Methods 0.000 description 1
Landscapes
- Accommodation For Nursing Or Treatment Tables (AREA)
Description
図面は本考案に係る受診用チエツクシートの一
実施例を示すもので、第１図Ａは病歴等チエツク
シートの第一葉シートの平面図、第１図Ｂはその
第二葉シートの平面図、第２図Ａは概括症状チエ
ツクシートの第一葉シートの平面図、第２図Ｂは
その第二葉シートの平面図、第３図〜第７図はそ
れぞれ具体的症状チエツクシートの第一葉シート
を示す平面図である。
主要図中符号の説明、１は病歴等チエツクシー
ト、１ａはその第一葉シート、１ｂはその第二葉
シート、１０は個人識別表示欄、１１は家族病歴
表示欄、１２は既往症表示欄、１３は習慣等表示
欄、１５はチエツク印の表示枠である。２は概括
症状チエツクシート、２ａはその第一葉シート、
２ｂはその第二葉シートである。３〜７は具体的
症状チエツクシート、３１〜３４，４１，５２，
５３，６２，６３，７１〜７８は具体的予想症状
である。
The drawings show an embodiment of the check sheet for medical examinations according to the present invention, and FIG. 1A is a plan view of the first sheet of the medical history check sheet, and FIG. 1B is a plan view of the second sheet. , FIG. 2A is a plan view of the first sheet of the general symptom check sheet, FIG. 2B is a plan view of the second sheet, and FIGS. 3 to 7 are the first sheets of the specific symptom check sheet. It is a top view showing a leaf sheet. Explanation of the symbols in the main diagrams: 1 is a medical history check sheet, 1a is the first sheet, 1b is the second sheet, 10 is the personal identification display column, 11 is the family medical history display column, 12 is the past disease display column, 13 is a display column for habits, etc., and 15 is a display frame for checkmarks. 2 is the general symptoms check sheet, 2a is the first leaf sheet,
2b is the second leaf sheet. 3-7 are specific symptom check sheets, 31-34, 41, 52,
53, 62, 63, 71-78 are specific expected symptoms.
Claims (1)
へ複写されるように重ねて綴じられた複数葉のシ
ートからなり、シートの各葉には、病気のときに
生じ得る種々の症状が各葉においてそれぞれ異な
る言語でかつそれぞれ同位置で同症状が重なるよ
うに表示されていることを特徴とする、受診用チ
エツクシート。 (2) 上位のシートへの筆記事項が下位のシート
へ複写されるように重ねて綴じられた複数葉のシ
ートからなり、シートの各葉にはそれぞれ各葉に
おいて重なる位置に、個人識別表示欄を設けると
ともに、家族病歴表示欄又は既往症表示欄若しく
は習慣等表示欄を設け、前記家族病歴表示欄には
各種続柄及び人の死因や持病となり易い各種病名
が、前記既往症表示欄には人がかかり易い各種伝
染病や経験し易い手術場所が、前記習慣等表示欄
には酒やタバコの種類とともに飲酒や喫煙の諸傾
向及び一般に常用され易い薬品名が、それぞれ各
葉において異なる言語でかつそれぞれ同位置で同
一の表示が重なるように表示されていることを特
徴とする、診断葉チエツクシート。 (3) 請求項２のチエツクシートと請求項１のチ
エツクシートとからなる、診断用チエツクシート
。 (4) 最上位のシートの言語が、受診する者の母
国語で表示されている請求項１又は２に記載の受
診用チエツクシート。 (5) 症状が科毎に区分されて表示され、当該症
状が表示されている先端部に表示枠が印刷されて
いることを特徴とする、請求項１に記載の受診用
チエツクシート。[Claims for Utility Model Registration] (1) Consisting of multiple sheets bound together so that written notes on the upper sheet are copied to the lower sheet, and each leaf of the sheet contains a message that indicates when an illness occurs. 1. A check sheet for medical examinations, characterized in that various symptoms that may occur in patients are displayed on each leaf in different languages and in the same position so that the same symptoms overlap. (2) Consists of multiple sheets bound one on top of the other so that written notes on the upper sheet are copied onto the lower sheet, and each leaf of the sheet has a personal identification display field at the overlapping position of each leaf. In addition, a column for displaying family medical history, a column for displaying past diseases, or a column for displaying habits, etc. is provided. The various infectious diseases that people are likely to experience and the surgical locations that they are likely to experience are listed in the habit display column, as well as types of alcohol and tobacco, as well as trends in drinking and smoking, and the names of drugs that are commonly used. A diagnostic leaf check sheet characterized in that identical displays are displayed so as to overlap at different positions. (3) A diagnostic check sheet comprising the check sheet according to claim 2 and the check sheet according to claim 1. (4) The medical examination check sheet according to claim 1 or 2, wherein the language of the topmost sheet is displayed in the native language of the patient. (5) The medical examination check sheet according to claim 1, wherein the symptoms are displayed categorized by department, and a display frame is printed at the tip of the sheet where the symptoms are displayed.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP3874190U JPH03129474U (en) | 1990-04-11 | 1990-04-11 |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP3874190U JPH03129474U (en) | 1990-04-11 | 1990-04-11 |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| JPH03129474U true JPH03129474U (en) | 1991-12-26 |
Family
ID=31547024
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| JP3874190U Pending JPH03129474U (en) | 1990-04-11 | 1990-04-11 |
Country Status (1)
| Country | Link |
|---|---|
| JP (1) | JPH03129474U (en) |
Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| JP2001080245A (en) * | 1999-09-14 | 2001-03-27 | Of Base Medica:Kk | Diagnosis written in english for travel and medical certificate written in english |
-
1990
- 1990-04-11 JP JP3874190U patent/JPH03129474U/ja active Pending
Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| JP2001080245A (en) * | 1999-09-14 | 2001-03-27 | Of Base Medica:Kk | Diagnosis written in english for travel and medical certificate written in english |
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