-----------,-------

l_J I-IU'ONG DAN VIET D~)NHANG KY(Dlnh kent phu luc (2)

***

Ngay dip: 12/2/2012II ].fi).f6(io Noi ccip: Cong un'll' Illl

NQi

11() kllflu t11Lrlrn(~ [I'Ll:

Num Can nang: 56 Kg

Thon ....Xii ... Huy?I1 .... TP Ha NN

Than: ....Xu: .... Huyen .... TP !-lei N{Ji

O.f3Y7.fxxx 0967721 xxx

Sf) tl1(' l3iio l1i011 Y 10 (n0u co):

Loui bcnh (theo chc1n dO{lI1):

Hoan cunh bi b nh:

Tell Benh viOnl '0' so Y to ti~p nhan (neu ten & dia chi):

Ti~u sCI'benh d5 tung dieu tri, cac thuoc dal dang SLI'

dung:

Tinh trang benh hien nay:

HNxxxxxxxxx

!-I(j' van 2 lei nang ...

B6m sinh

B? th vien Da khoa QU6c td Vinmec Times City( .f5RMinh Khai, Vinh Tuy, Hai Bel Trung, Hel

noi)

Dc7 tung m6 tai Benh vien ....Bi di totg voi thuoc ...

C chi dinh phdu thudt nhung chua co lienad lam .

Hoan canh kinh t~I: (5 ngheo, lam nghi: nang. thu nhdp thdp 3

trieu/ thang, nuoi 5 khdu.

Nguui lam don(l(y & ghi ro Iu; ten)

(U?I Ot/ (J.t 1t/8 ;y if)[)uop LU~I !.Q.n~N

9lLi I!>I ljU1}J L1~OI-1

:A13L1LI~!L! L! I?q 'i1111;'.1lL!L1!1

Q .:.oLlI1pns 'all13p IEP J?nLll J\1J '!.I1 n~!p i1L1.1~l11. qLl?q ,1,lS1l9!.L

:(Itj:ll!!p 1? Uiil11lgU) ?1 A .os .oJI 10!/\ 111101111O.l.

:l[L1~C !q ljUI1;') lIl,lOII

:(u1}op LlVlI;')0 til) ljll;)q !I'lO'1

:(9;') 119u) ?lA UI. !1I Ollll ·''11 VS1t':o'l 1 11011)(;lS

:11,1 lI0! I[ 11[., l:i( I

: 1,1.11'fil .(,1IHI1 Il~llj)1 <)11

:'flll0u u\iJ : l[ "!1 1.<,)I !i

:df) !.oN:1l?!L!" (111 ;')0Oll (I N 11\1.) <}S

:d!_lJ A~'flN

:'i111(1111! (;1[11.:'1

:uuis lU~lI RU1]lll Ar:llN :1I01 1.:/\ () II

--------- *** ---------

~)I ~~NYG NOH (1 ylAl ( 'J

----

STT

( II iU[';C l'HiNII T(i'TlllfN 110 TI{V 1'11'\11TIIII,~TI,~IIIt: TIIONC IIfNIl VlfN IlA !.:1I0A IJII()(' 11\ \'INMEC

II

QUY DINI-I VE 116 SO B~;NH NilAN vA C UiNH SACI-II-16TIUj

HV nghcoil'~n nghco/ hV cbho;\n canh u~c ui~1 Idlb khi\1IHi) tl"l,l'100% vi~1I phi buog6111Thu6c VI\ V~I hr y I~

Ngu'o'i b dillg vb'i each 1II\111gJllIlr., 100% vi~1I phi UUO 1,16111

Th~6c VI\ VOl ur y t~

-----'-----+-------,----------.---+--------r---------,

Yilu cI1u Khach hUllg IIVI'cho Vimuee khi U~II Idlllm

r---------~----------,_------------------_+----~--------------~----------------~1),nl d;illb ky Illco 11I!l1I (gi'ri11;"111 1;_l11'1\1 I\IL' 1)2) l Iuu g0c

11;"111 scan B;"1I1scan

--------r---------r------------------r-----+-------------4----------------l

--------~---------~-----------------+---~------------~------------~

5

13,111 scan Ball SCUll Bun sao cOlig clurng

Ban scan the I3HYT h(l ngheo., "',' , Nvp ban photocopy V,\Ban scan I he bao 11Iell1 y ie cho I' I' I d' I"

v: 6 mang ran C 11111 C (01ngum C c ng chi~lI

Ban scan 'I Ie ho~c gidy la clnrngnh(ln h\ tlnrimg binh.bcnh binh,nguoi hu(l'If chinh such nhu l3;.\nsao cong clUIngtinrO'ngbini, Lilo lh.\nh cachnwng, 13,\n I( Vi~l nal11Anh hung

Ban scan Ban scan

Th0 1311 Y' , cun b~lIh nhfln

Ui,\y chLfI16nhdn,gi.1yxac B" , I' I' / r._ , ["., , I' I' an scan so I\) ng leo e,1I1IIh:111 hI) n hco, can IIg 11;:0, I\) I... I' I r. I'.' , , _', _ , ng 1<:;0, cnung n 1\111 I\)co Iwall c; nh d;,IC Im;t kho nghco/e(ln ngheo/ hO e6 ho.\nkhell]' IIgll'i'i C,')ClIng v6i

eimh d~e bi~t kh6 khilnddll11;,1I1g

11(\ sO'b~nl {Ill bao gem1:I, Thong t n ve tien su b$nh,2, Thong t'n b~nh sCr,l, K,h qllil thum kil{lIl1,ch§n

6 lio{1ll (1-16 Sp'b~llh (Ill),

4, K01 qll~10n Iflill s;\ng (XCIIIg,hi~lll,CI ;1n dO;"1I1 iJillh;"Illil),

116 so' gii'i v~ qU! Email: vctt@quythientam,com hoi}c qua uU'Ui1i~n theo ilia -hi: Dl}' an Quy Thi~n T;im, S6 7- Du'o'ng BiingLiing- I(hll uu tl[i sinh thai Vinhomes RivCI'siuc- Phu'o'ng Vi~t Hu'ng- Qu~n Lpng Bicn- Ha NQiS6 i1i~n lilo',1i hotlinc ci'la cllU'o'ng tdnh: 0938889639L(l'll "I': 116 so' gu'i v~ clllJ"O'ngtrlnh sc oU'Q'e th~rn uinh hoiln canh va th~rn din I chuycn 1I10n, sau do c1lu'o'ng trlnh sc thung tind~n ngu'(ri u~nh ,~t411:i xu' Iy h& so',

Ban photocopy