BOYTE CONG HoA xi\. HOI CHU NGHiA VIET NAM. . .DQc l~p - T\f do - H~nh phuc

S6:.2~10/QD-BYT Ha N(Ji, ngay 44 thong 6 nam 2019

QUYETDINH

V~vi~c ban hanh Huong d§n

Kham sang lQc trmrc tiem cluing oBi vrri tre em

BO TRUONG BO Y TE. .Can ctr Nghi dinh s6 75/2017/ND-CP ngay 22 thang 6 nam 2017 cua

Chinh phu quy dinh clnrc nang, nhiem vu, quyen han va co d.u t6 clurc BQY tS;Theo dS nghi cua C\lCtnrong C\lCQuan ly Kham, chua benh - BQY tS,

QUYETDINH:

Di~u 1. Ban hanh kern thea Quyet dinh nay Huang d~n kham sang loctnroc tiem chung d6i voi tre em.

Di~u 2. Quyet dinh nay co hieu hrc kS tir ngay ky ban hanh. Bai bo Quyetdinh s6 2301lQD-BYT ngay 12 thang 6 nam 2015 cua BQ tnrong BQ Y tS vSviec ban hanh Huang d~n kham sang loc tnroc tiem chung d6i voi tre em.

Di~u 3. Cac ong, ba: Chanh Van phong BQ, C\lC tnrong C\lC Qmin lyKham, chua b~nh, Chanh Thanh tra BQ, cac V\l truOng, C\lC truang cua cacV\l/C\lC thuQc BQY tS; Giam d6c cac co sa kham b~nh, chua b~nh trvc thuQc BQY tS; Giam d6c Sa Y ts cac tinh, thanh ph6 tn)'c thuQc Trung uang; Thu tnrOngy tS cac BQ, nganh; Thti truang cac dan vi co lien quan chiu trach nhi~m thihanh QuySt dinh nay./.

Noi nhtin:- Nlm Di~u 3;- BQ truang (de b/c);- C5ng TTDTBYT, Website Cl,lCQLKCB;- Luu: YT, KCB.

BOYTE eONG HoA xA HOI eHU NGHiA VIET NAM. . .DQc l~p - Tl}'do - H~nh phuc

HUONGDANKham sang IQctrmrc tiem chung d8i v6'i tre em

(Ban hanh. kern thea Quyet dinh s61.-!t1.0/QD-BYT ngay4.4thimg .6.narn 2019)

I. Muc dich cua kham sang IQc:Nh~m phat hien tnrong hop bfit thuong c~n hru y dS quyet dinh cho tre tiemchung, khong tiem chung, hoan tiem chung hoac chuyen kham sang loc tai benhvien.

II. Kham sang IQctrurrc tiem chiing cho tre em ~ 1 thang tuAi:1. Cac tnrong hop chong chi dinh:

a) Co tiSn sir s6c hoac phan irng nang sau tiem chung vAcxin l~n tnroc (co cungthanh phan): s6t cao tren 39°C kern co giat hoac dfiu hieu nao/rnang nao, tim tai,kh6 tho.

b) Suy giam miSn dich (benh suy giam miSn dich bam sinh, tre nhiem HIV giaidoan lam sang IV hoac co biSu hien suy giam miSn dich n~ng) ch6ng chi dinhtiem chung cac v~c xin s6ng giam dQc h.rc.

c) Cac trucmg hqp ch6ng chi dinh khac thea huang d~n cua nha san xufit d6i vaitUng lo~i v~c xin.

2. Cac trucmg hgp t~m hoan:

a) U6i v6i co sa tiem chung ngoai b~nh vi~n:

- Co tinh tr~ng suy chuc nang cac co quan (nhu suy ho hfip, suy tu~n hoan, suytim, suy th~n, suy gan, hon me ... ). Tiem chung khi suc khoe cua tre 6n dinh.

- M~c cac b~nh cfip Hnh, cac b~nh nhiSm trung. Tiem chung khi suc khoe cua tre6n dinh.

- S6t ~ 37,SoC ho~c h~ than nhi~t:S 3S,SoC (do nhi~t dQt~i nach).

- Tre m6i dung cac san ph&mglobulin miSn dich trong yang 3 thang (tru khanghuy~t thanh viem gan B): t~m hoan tiem chung v~c xin s6ng giam dQc h.rc.

- Tre dang ho~c m6i k~t thuc dgt diSu tri corticoid (u6ng, tiem) liSu cao (tuangduong prednison ~ 2mg/kg/ngay), hoa tri, x~ tri trong yang 14 ngay: t~m hoantiem chung vAcxin s6ng giam dQc h.rc.

- Tre co can n~ng du6i 2000g: chuySn kham sang lQc va tiem chung t~i b~nhvi~n.

- Co tiSn su phan irng tang d~n sau cac l~n tiem chung tnroc cua cung Ioai v~cxin (vi du: l~n d~u khong s6t, l~n sau s6t cao tren 390C ...): chuyen kham sang19C va tiem chung tai benh vien.- M~c cac benh b~m sinh hoac benh man tinh a tim, phoi, h~ thong tieu hoa, tiStnieu, mau, ung thu chua 6n dinh: chuyen kham sang 19C va tiem chung tai benhvien.- Cac tnrong hop tam hoan tiem chung khac thea huang d~n cua nha san xuAtd6i voi tung loai v~c xin.

b) D6i voi co sa tiem chung tai benh vien:

- Co tinh trang suy chirc nang cac co quan (nhu suy ho hAp, suy tuan hoan, suytim, suy th~~, suy gan, hon me ... ). Tiem chung khi sire khoe cua tre 6n dinh.

- Tre mac cac benh cAp tinh, cac b~nh nhiSm trung. Tiem chung khi suc khoecua tre 6n dinh.

- Tre s6t 2:38°C ho~c h~ than nhi~t ::;35,5 °c (do nhi~t dQt~i nach).

- Tre moi dung cac san ph~m globulin miSn dich trong vong 3 thang (trir khanghuySt thanh viem gan B): t~m hoan tiem chung v~c xin s6ng giam dQc l\lc.

- Tre dang ho~c moi kSt thuc dqt diSu tri corticoid (u6ng, tiem) liSu cao (tuongduong prednison 2:2mg/kg/ngay), hoa tri, x~ tri trong vong 14 ngay: t~m hoantiem chung v~c xin s6ng giam dQc l\lc.

- Tre m~c cac b~nh tim b~m sinh ho~c m~n tinh kern thea tang ap l\lc dQngm~chph6i (2:40mmHg).

- Cac truemg hqp t~m hoan tiem chung khac thea huang d~n cua nha san xuAtd6i voi tUng lo~i v~c xin.

3. Cac truemg hqp c~n kham sang 19C va tiem chung t~i b~nh vi~n:

Cac truemg hqp t~m hoan tiem chung t~i cac ca sa tiem chung ngoai b~nh vi~nc~n chuy@ntuySn d@du<)'ckham sang 19C, tiem chung t~i b~nh vi~n:

a) Tre co can n~ng < 2000g.

b~Tre co tiSn su phan Ung tang d~n sau cac l~n tiem chung truoc cua cung lo~ivac xin.

c) Tre m~c cac b~nh b~m sinh ho~c b~nh m~n tinh a tim, ph6i, h~ th6ng tieuhoa, tiSt ni~u, mau, ung thu chua 6n dinh.

III. Kham sang IQctnr&c tiem chung cho tre sO'sinh

1. Cac truemg hqp ch6ng chi dinh:

a) Khong tiem v&c xin BCG cho tre sinh ra tir m~ nhi@mHIV rna m~ khongdu<)'cdiSu tri d\l phong t6t lay truySn tir m~ sang con.

b) Cac truemg hqp ch6ng chi dinh khac thea huang d~n cua nha san xuAt d6i voitirng lo~i v~c xin.

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2. Cac tnrong hop tam hoan:

a) D6i voi co sa tiem chung ngoai benh vien:

- Co tinh trang suy chirc nang cac co quan (nhir suy ho h~p, suy tu~n hoan, suytim, suy than, suy gan, hon me ... ). Tiem chung khi sire khoe cua tre on dinh.

I" f'OW

- Tre mac cac benh cap tinh, cac benh nhiem trung. Tiern chung khi sire khoecua tre 6n dinh,

- Tre s6t ~ 37,SoC hoac ha than nhiet ::; 3S,SoC (do nhiet dQ tai nach). Tiemchung khi than nhiet cua tre 6n dinh.

- Tre co can nang duoi 2000g: chuyen kham sang loc va tiem chung tai benhvien,

- Tre sinh non co tuoi thai < 34 tuan: N@ume co HBsAg (-) tam hoan tiem v~cxin viem gan B so sinh, tiem chung khi tre du 34 tufrn tu6i (tinh ca tu6i thai).N@ume co HBsAg (+) hoac me khong xet nghiem chuyen kham sang lQc vatiem chung t?i b~nh vi~n.

- Tre sinh non co tu6i thai < 34 tufrn t?m hoan tiem v~c xin BCG. Tiem chungkhi tre du 34 tuk tu6i (tinh ca tu6i thai).

- M~c cac b~nh bAm sinh ho~c b~nh m?n tinh a tim, ph6i, h~ th6ng tieu hoa, ti@tni~u, mau, thfrn kinh, ung thu chua 6n dinh: chuySn kham sang lQc va tiemchung t?i b~nh vi~n.

- Cac truOng hqp t?m hoan tiem chung khac theo huang d~n cua nha san xu~td6i v6i timg lo?i v~c xin.

b) D6i v6i co sa tiem chung t?i b~nh vi~n:

- Tre co.chi dinh c~p cUu. Tiem chung khi suc khoe cua tre 6n dinh.

- Tre s6t 2: 37,SoC ho~c h? than nhi~t ::; 3S,S °c (do nhi~t dQ t?i nach), tiemchung khi than nhi~t cua tre 6n dinh.

- Tre co tu6i thai < 28 tufrn. Tiem chung v~c xin viem gan B khi tre du 28 tufrntu6i (tinh ca tu6i thai).

- Tre co tu6i thai < 34 tuAn t?m hoan tiem v~c xin BCG. Tiem chung khi'tre du34 tufrn tu6i (tinh ca tu6i thai).

- Tre co can n~ng < 2000g rna m~ co HbsAg (-). TruOng hqp m~ co HbsAg (+)ho~c khong xet nghi~m cho m~ thi cfrn tiem v~c xin viem gan B cho tre.

- Tre m~c cac b~nh tim bAmsinh co tang ap Ivc dQng m?ch ph6i (2:40mmHg).

- Cac truOng hqp t?m hoan tiem chung khac theo huang d~n cua nha san xu~td6i v6i timg lo?i v~c xin.

3. Cac truOng hqp cfrnkham sang lQcva tiem chung t?i b~nh vi~n:

Cac truOng hqp t?m hoan tiem chung t?i cac co sa tiem chung ngoai b~nh vi~ncAnchuySn tuy@ndS duQ'ckham sang lQc, tiem chung t?i b~nh vi~n:

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a) Tre co din nang < 2000g va my co HBsAg (+) hoac my kh6ng xet nghiem,

b) Tre co tu6i thai < 34 tuan va my co HBsAg (+) hoac my kh6ng xet nghiem,

c) Tre mac cac benh b~m sinh a tim, phoi, h~ thong tieu hoa, gan, than, mau,than kinh, ung thu, chua 6n dinh.

IV. M<)t s8 hru y khi kham sang loc trmrc tiem chung t~i b~nh vi~n

1. Tre co ti@nsir di irng voi v~c xin hoac nghi ngo di irng voi v~c xin:

a) NSu tre co bang clnrng di img voi loai v~c xin tiem l~n tnroc: kh6ng tiemchung cho tre.

b) Tre co ti@nsir nghi ngo di ung voi v~c xin: Kham, danh gia nguyen nhan varmrc dQdi img,

2. Tre co yang da sa sinh:

a) Kh6ng chong chi djnh va kh6ng tarn hoan tiem chung d6i voi tnrong hopyang da sinh ly co n6ng dQ bilirubin huySt thanh :S 7mg/dL. Trong truang hgpkh6ng thvc hi~n xet nghi~m thi dVa vao phan vung yang da Krammer.

b) T~m hoan tiem chung vai truang hgp yang da b~nh ly ho~c yang da sinh ly con6ng dQbilirubin mau > 7mg/dL.

3. Tre de non ho~c nhy can so vai tu6i, suy dinh duOng, m6 de:

a) Kh6ng co ch6ng chi dinh va kh6ng t~m hoan tiem chung d6i vai tre co cann~ng ~ 2.000g ho~c m6 de. Thvc hi~n tiem chung dung lich cho tre.

b) Kh6ng co ch6ng chi dinh va kh6ng t~m hoan tiem chung v~c xin viem gan Bd6i vai tre sinh non co tU6i thai 28-36 tu~n.

c) Kh6ng co ch6ng chi dinh va kh6ng t~m hoan tiem chung v~c xin BeG d6i vaitre sinh non co tU6i thai 34-36 tu~n. Tinh tU6i cua tre dS xac dinh ngay tiemchung thea ngay thang nam sinh cua tre.

4. Tre dang di@utri khang sinh: Kham, danh gia ly tinh tr~ng b~nh ly, nSu trekhong co ch6ng chi dinh ho~c t~m hoan: Thvc hi~n tiem chung cho tre thea Iich.

5. Tre nhiSm ho~c nghi nhiSm HIV nhung chua a trong giai do~ AIDS: NSu trekhong co cac ch6ng chi dinh ho~c t~m hoan, tiem chung cho tre thea lich kS cav~c xin s6ng giam dQc Ivc.

6. Tre co b~nh b~m sinh ho~c b~nh m~n tinh a tim, ph6i, h~ th6ng tieu hoa, gan,th~n, mau, ung thu, th~n kinh

a) NSu tinh tr~ng b~nh cua tre dang a giai do~n 6n dinh, tre kh6ng a trong tinhtr~ng c~p tinh, kh6ng co chi dinh can thi~p di@utri c~p CUu: Kh6ng ch6ng chidinh ho~c t~m hoan W~mchung. Thvc hi~n tiem chung cho tre thea Iich.

b) NSu tre thiSu ySu t6 dong mau: truy@nySu t6 dong mau bi thiSu truac khitiem chung.

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v. T8 clnrc tlnrc hi~n:

1. D6i voi co sa tiem chung ngoai benh vien

a) Ngtroi thuc hien- Bac sy, y SI: true tiSp tham kham cho tre va ghi cac thong tin cua tre, tnrc tiSpdo va ghi kSt qua nhiet dQ cua tre khi khong co diSu duong vien, hQ sinh vien.Can bQy tS kham sang loc tnroc tiem chung phai diroc t~p huan chuyen mon vStiem chung thea quy dinh tai Nghi dinh s6 155/2018/NI)-CP ngay 12 thang 11nam 2018.- DiSu duong vien, hQ sinh vien: Ghi cac thong tin cua tre, tnrc tiSp can tre, dova ghi kSt qua nhiet dQcua tre.

b) Phuong tien

- Nhiet kS, 6ng nghe.

- Bang kiem truce tiem chung cho d6i nrong tir 1 thang tu6i tro len (phu luc I)

- Bang kiem tnroc tiem chung cho tre sa sinh (ph\ll\lc II)

c) Cac buac thvc hi~n kham sang lQctruac tiem chung

Cac buac thvc hi~n va diSn thea bang kiSm truac tiem chung bao g6m:

- Hoi tiSn sir va cac thong tin co lien quan

- Danh gia tinh trC;lngsuc khoe hi~n tC;li

- KSt lu~n

d) Ghi chep vi~c kham sang IQcva luu bang kiSm

Toan bQnQi dung kham sang lQcduQ'cghi thea bang kiSm, luu tC;licac diSm tiemchung. Thai gian luu: 15 ngay.

2. D6i vai ca sa tiem chung tC;lib~nh vi~n:

a) Nguo'i thvc hi~n

- Bac sy, y SI kham sang lQc truac tiem chung: kham, danh gia, ph6i hQ'Pvai cacth~y thu6c chuyen khoa (nSu c~n), dua ra nh~n xet va kSt lu~n vS chi dinh tiemchung cho tre.

- Bac sy chuyen khoa: kham, danh gia tinh trC;lngb~nh ly cua tre thea chuyenkhoa; ph6i hQ'Pvai bac sy tu vftn tiem chung dS dua ra kSt lu~n vS chi dinh tiemchung cho tre.

- Can bQy tS co lien quan dSn tu vftn, tiem chung v~c xin va thea d5i phan ll'ngsau tiem chung.

b) PhU011gti~n

- Co du phuang ti~n dS thvc hi~n vi~c kham sang IQcva kham chuyen khoa.

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- PhiSu kham sang 19C tnroc tiem chung cho d6i nrong tir 1 thang tu6i tro len(phu luc III) va phieu kham sang IQc tnroc tiem chung cho tre sa sinh (phu lucIV).

c) Cac buoc thuc hien- Bac sy tu van, kham sang IQc tiem chung: kham danh gia toan dien cac diSukien tiem chung cho tre; tham v~n thay thuoc chuyen khoa vS tinh trang benh lytheo chuyen khoa (neu cftn). Dira ra kSt luan vS diSu kien tiem chung cho tre.

- Bac sy chuyen khoa: khi duoc yeu cftu, danh gia dfty du vS tinh trang benh lytheo chuyen khoa cftn tham van; dua ra nhan xet, dS nghi lien quan dSn tiemchung vS tinh trang benh ly cua tre, Ph6i hQ'Pvoi can bQ tiem chung thirc hientiem chung va theo d6i sau tiem chung cho tre khi cftn.

d) Ghi chep vi~c kham sang IQcva luu hi) sa

- Thvc hi~n vi~c ghi chep, luu gifr ca sa dfr li~u tiem chung theo quy dinh hi~nhanh va cac quy dinh vS ghi chep s6 kham b~nh, hi) sa b~nh an nhu d6i vai tredSn kham, diSu tri ngo~i tru, nQi tru t~i b~nh vi~n.

- Truang hQ'Pco hi) sa b~nh an t~i b~nh vi~n: toan bQ nQi dung kham sang IQctrong bang kiSm va y l~nh chi dinh tiem phai duQ'cghi trong hi) sa b~nh an ho~cphiSu kham sang IQc truac tiem chung duQ'c luu cung hi) sa b~nh an theo quidinh.

TrU'ftng SO'n

6

PHULUCI(Ban hanh kern thea Quyet atnh s6 ..~... iQD-BYTngay ...thang.... ndm 2019)

TTYTDP /TYT IPKlNHS CONG HoA xA HOI CHU NGHiA VIET NAM. . .DQc l~p - TV do - H~nh phuc

BANG KIEM TRUdc TIEM CHUNG DOl v6'I DOl TUQNG 2: 1THANG TUOITAl cAc CO Sa TIEM CHUNG NGoAI BENH VIEN. . .

HQva ten tre: Nam 0 NfrD

Tu6i: sinh ngay thang nam ..

Dia chi: .

HQten bo/me: Dien thoai: ..

Can nang: kg Than nhiet: °cI. Kham sang loc:

l. S6c, phan img nang sau l~n tiem chung tnroc Khong 0 CoO

2. Dang mac benh cfrPtinh hoac benh man tinh ti~n trien" Khong 0 Co 03. Dang hoac moi k~t thuc dot dieu tri corticoid li~u cao (tuong Khong 0 Co 0duong prednison >Zmg/kg/ngay), hoa tri, xa tri, gammaglobulin **4. S6t/H~ than nhiet ( S6t: nhiet d9 2: 37,5 o, H~ than nhiet: nhiet d9 Khong 0 CoO::;35,50C )

5. Nghe tim bfrt thuOng*** Khong 0 CoO

6. Nhip tho, nghe phoi bfrt thuong Khong 0 I CoO7. iii giac bfrt thuong (li bi hoac kich thich) Khong 0 CoO

8. Can nang < 2000g ong 0 CoO...........................................................................................................................................................................................................................................~......,...... . ........................_

9. Cac chong chi dinh/tam hoan khac, neu co ghi ra:Khong 0 CoO...............................................................................

.......... ...................................................................................................................................._ ........

*: Khong hoiin tiem v6c xin a6i voi tre co benh nhe (ho, .'1'6mUi, lieu chay muc ap nhr;:... va khOng s6t),bu t6t, {m t6t**: Tru khang huydt thanh viem gan B. Tieu chudn nay chi ap d1:lngv6'i v6c xin s6ng giam ape hrc.II. K~t lu~n:- Du di~u ki~n tiem chung ngay (Tfrt cft d~u KHONG co di€m bftt thuOng)

L . :, . t' A h' 1~ ,O~lvac xm lem c ung an nay: .

- Ch6ng chi dinh tiern chung (Khi CO di€rn bfrt thuOng t~i m\lc 1,9)

- T~m hoan tiem chung (Khi CO bfrtkY m(>tdi€m bfrtthuOng t~i cac m\lc 2,3,4,5,6,7,8)

D~ nghi kharn sang lQc t~i b~nh vi~n: Khong 0 Co 0+ Ly do: .

DDGJ

lJ).· • , h ' , th ' ~n01 gUY p ut, ngay.... ang nam .Nguai th\fc hi~n sang lQc(k)', ghi ra hQva ten)

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PHULUCII. .(Ban hanh kern thea Quyit dinh s6 IQfJ-BYT ngay .)

TTYTDP ITYT IPKlNHS CONG HoA xA HOI CHU NGHiA VIET NAM. . .DQc l~p - T1}.'do - H~nh phuc

.........................BANG KIEM TRUaC TIEM CHUNG DOl VOl TRE SO SINH

TAl cAc CO Sa TIEM CHUNG NGoAI BENH VIEN. . .HQva ten tre: Nam D NfrD

Sinh: gio ngay thang nam Tu6i thai khi sinh: ..

Dia chi: .

HQ ten bo/me: Di~n thoai: .

Can nang: g Than nhiet: °cM~ da xet nghiem HbsAg: Kh6ng D C6 0 K€t qua: Duong tinh D Am tinh 0I. KhalD sang IQc:

l. Tinh trang sire khoe chua 6n dinh Kh6ng 0 C60

2. S6t/H~ than nhiet (S6t: nhiet d<) ~ ,5°C; H~ thanKh6ng 0 C60

nhiet: nhiet d<)::;35,50C)

6c be hoac kh6ng kh6c duoc Kh6ng 0 C60

4. Da, m6i kh6ng hong Kh6ng 0 C60

5. Bu kern hoac bo bu Kh6ng 0 C60

6. Tu6i thai < 34 tu~n Kh6ng 0 C60

7. Tre < 2000 g Kh6ng 0 C60

8. Cac chong chi dinh khac, neu c6 ghi ra: Kh6ng 0 C60...................................................................II. K~tlu~n:- Du di~u ki~n tiem chung ngay (Titt ca d~u KHONG co diem bitt thuong) DLoai a:'c xi n ti ~ h ' 1" ,~I V eITI c ung an nay: .

- Chong chi dinh tiem chung (Khi Co diem bitt thuong tai muc 8) D- Tarn hoan tiem chung (Khi CO bitt icy m<)tdi6m bitt thuang t~i cac mvc 1,2,3,4,5,6,7) D- D€ nghi kham sang iQc t~i b~nh vi~n: Kh6ng D Co D+ IJY do: .

lJ).· • , h ' , th ' ~nOl ........ glO' ..... put, ngay.... ang .....nam.....Nguai th\fChi~n sang iQC(ky, ghi ra hQva ten)

8

PHULUC III(Ban hanh kern thea Quyet dinh s6 .......";QD-BYT ngay ... thang .... ndm 2019)

BV CONG HoA xA HOI CHU NGHiA vrsr NAMDQc l~p - T1}.'do - Hanh phuc

BANG KIEM TRUaC TIEM CHUNG DOl VOl DOl TU<}NG~ 1THANG TUOITAl cAc CO sa TIEM CHUNG THUOC BENH VIEN. .. .

HQva ten tre: Nam 0

T z . . h ' tha namUOl: sln ngay............. ang.. . .Dia chi: .HQten b6/m~: Dien thoai: .Can nang: kg Than nhiet: °cI. Kham1. S6c, phan img nang sau Ifin tiem chung truce ng 0 C60

. ... ...... ............................... ~............ ...............................~........ ...............~.....................-.....ng mac benh cfrPtinh hoac benh man tinh tien trien" Khong 0 C60

Dang hoac moi kSt thuc dot di€u tri corticoid li€u cao (nrong Khong 0 C60dirong prednison >2mg/kg/ngay), h6a tri, xa tri, gammagiobulin**S6t/H;;t than nhiet ( S6t: nhiet d{)~ 3soC; Ha than nhiet: nhiet d{) Khong 0 C60:s 35,50C)Nghe tim bfrt thuong"?" Khong 0 C60

Nhip tho, nghe phoi bfrt thuemg*** Khong 0 C6

Tri giac bfrt thuong (li bi hoac kich thich) Khong 0 C60

s. Cac chong chi dinh khac, neu co ghi ra: Khong 0 C60...............................................................................*: Chi dinh tiem tre co b?nh nh? (ho, mui, lieu chily muc d(5nh? ... va khOng**: Tn} khtmg huyit thanh viem gan B***: Niu khCtmchuyen khoa khOng cdn xu trEclip cUu thi chi dinh liem chimg

- Kham sang IQctheo chuyen khoa: Khong 0 C6 0, chuyen khoa: ..+ Ly do: .

+Ket qua: .

+KSt lu~n: .

II. K~t lu~n:-Du di~u ki~n tiem chung ngay CTfrtca d€u KHONG c6 di~m bfrt thuemg) DL .,:_ . t' A ch' I~ ,O;;tlvac Xln lem ung an nay: .- Ch6ng chi dinh tiem chung (Khi CO di~m bfrt thuemg t;;tim\1c 1,S) D- T;;tmhoan tiem chung (Khi CO b~t ky m{)tdi~m b~t thuemg t;;ticac m\1C2,3,4,5,6,7) D

,lJ~ • • , h " th ' ~110l ......... guy ..... put, ngay ... ..... ang ..... nam .....

Nguai tht;rchi~n sang IQc(k'), ghi ra hQva ten)

9

PHVLVCIV(Ban hanh kern thea Quyit dinh s6 IQD-BYT ngay .)

BV CONG HoA xA HOI CHU NGHiA VI~T NAMDQc l~p - Tl}'do - H~nh phuc

BANGKIEM TRUaC TIEM CHUNGDOl VOl TRE SO SINHT~I cAc CO sa TIEM CHUNGTHUOC B~NH VI~N

HQva ten tre: Nam 0 Nit 0Sinh gio ngay thang nam Tu6i thai khi sinh: .Dia chi: .HQten bo/rn«: Dien thoai: ..Can nang: g Than nhiet: °cM~ da xet nghiern HbsAg: Khong 0 C6 0 K~t qua: Duong tinh 0 Am tinh 0I. Kham sang lee:Cac d§.uhieu hien tai:

······l.···Tirili··t;~ng sire kh6~'~h~~6~···di~···_........ . ················_··1······ Kh6~~······D-························(:6-0!.................................., - - ································u····················· ,

2. SotlH~ than nhiet (Sot: nhiet dQ ~ 37,5 C; H~ than I 0 C6 0

!3~~i~~9~~~~ --_ - f~-D c6D, ....•...••••••.•••••••••••••••••••••••••••••••••• _............................................................................................................................................................................................................................................................... j' .••. _ ••• _ ••••••••••••• _ ••••.•••.•••.•.....•..• _ .•.•.•.••••••••••••••• + _..___..___ .

i Khong 0 C60_ + _ 1

I Khong 0

4. Da, moi khong hong

6. Tu6i thai < 28 tu~n Khong C60

8. Tre < 2000 g, me c6 HBsAg (-)

oC605. Btl kern hoac bo btl

7. Tre < 34 tuan tu6i * Khong o C60

Khong 0 C609. Cac chong chi dinh khac, neu c6 ghi r5

Khong 0 C60

* Chi ap dung voi vdc xin song giam d(jc luc- Kham sang loc theo chuyen khoa: Khong 0 C60, chuyen khoa: ..

+ Ly do: .

+ Ket qua: ..

+ .K~tluan: .II. K~t lu~n:- Du di~,uki~n tiem chung, ngay (T§.tca d~u KHONG c6 di8m b§.tthuang) DL . ~ . t'~ h' l~ ,- O~lvac xm lem c ung an nay: .

- Ch6ng chi dinh tiem chung (Khi Co di8m b§.tthuang t~i m\lc 9) D- T~m hoan tiem chung (Khi CO b§.tky mot di8m b§.tthuang t~i mvc 1,2,3,4,5,6,7,8)D

H6i.. gia phiLt,ngay thang namNguai thlJc hi~n sang lQc(ky, ghi r5 hQva ten)

10

PHULUCV. .(Ban hanh kern thea QuyJt dinh s6 IQIJ-BYT ngay .)

TAn sB thO' binh thuimg hie nghi 0' tre theo cac nhom tu8i

Tu8i (nam) Nhjp thO' (tAn sB thO' theo phut)

So sinh 40 -50

<1 30 - 40

1-2 25 -35

2-5 25 - 30

5 -12 20 -25

>12 15 - 20

(Hirong dfin dieu tri - Tap III - Xu tri c§.pciru nhi khoa)

11

PHl) Ll)C VI(B ~nhanh kern thea Quyet dinh s6 ....... IQD-BYT ngay .......... )

Nhjp tim binh thuong theo tu3i

Tu3i (nam) Nhjp tim (tin sa tim/phut)

So sinh 140 -160

<1 110 - 160

I1-2 100 - 150

2-5 95 -140

5 -12 80 -120

>12 60 - 100

(Hu6ng d~n diSu tri - Tap III - Xu tri e&pelm nhi khoa)

12