REFERRAL

Document Sample
REFERRAL Powered By Docstoc
					OSPITAL NG MAYNILA MEDICAL CENTER CITY OF MANILA Interdepartmental Referral Sheet Patient’s Name: ROSALES, MERRY CHRIST Hospital Number: # 1713814 Age/Sex: 23/F Ward/Room: IM-427 Date referred: July 16, 2007 Attending Physician: Drs. Aguila/Receno/Dimaandal Diagnosis: Chronic Kidney Disease stage V probably secondary to Chronic Glomerular Nephritis; HCVD, RAA, ST, IIB

Referred to: Department of Surgery Reason/s for Referral: IJ catheter insertion

______Co-management ______Opinion and suggestion only ______Pre-operative evaluation (with pre-op form) ______Transfer of service ______Others

Opinion and suggestion:

Stat ____ Routine____

__________________________ Signature of Referring Physician

__________________________ Signature of Receiving Physician


				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:112
posted:7/3/2009
language:English
pages:1