Plastische-wesseling.de

DREIFALTIGKEITS-KRANKENHAUS WESSELINGAbteilung für Plastische Chirurgie Chefarzt: Dr. med. Dirk F. Richter Anmelde- / Anamnesebogen
Name / Vorname:_____________________________________________________________ Straße: _____________________________________________________________________ PLZ: ____________ Ort: ______________________________________________________ Telefon (Privat) : ___________________________ (Mobil): ___________________________ Telefon tagsüber:___________________________ Email-Adresse: _______________________________________________________________ Beruf: _____________________________________________________________________ Hausarzt: Name: __________________________ Ort: ______________________________ Überweisende Arzt: Name: __________________ Empfohlen durch: _____________________________________________________________ Versicherung: ________________________________________________________________ Vorerkrankungen:
Medikamente:___________________________________ Medikamente:___________________________________ welche:________________________________________ Medikamente:___________________________________ welche:________________________________________ welche:________________________________________ welcher:_________________________________ welche:________________________________________ welche:__________________________________ welche:__________________________________ Medikamente:_____________________________ Allergien :
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Plavix, Aspirin ( ASS): nein: € ja : € Welche: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Körpergröße ( in cm ): ______________ Gewicht ( in Kg. ): _________________
Ich trage Kontaktlinsen:
Operationen in letzten zehn Jahren:
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Plastisch-Chirurgische Vorbehandlungen:
Botox oder Unterspritzungen: nein: € ja : € wann zuletzt:______________________________ welche + wann:___________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Seit wann beschäftigen Sie sich mit dem Thema? __________________________________________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Source: http://www.plastische-wesseling.de/relaunch/wp-content/uploads/2009/01/anamneseboge.pdf

Pjr#9-103aug20

3 Drawing fire without acartoonist’s flak jacketHOW would I like to be an embedded cartoonist? Not one little bit. I believepassionately in the idea of cartoon reportage, but not at my age, andcertainly not in the present circumstances with the military breathing down myneck. Don’t get me wrong — I would love to hurl myself into foxholes and I reallyenjoyed the only time I have been pai

Microsoft word - 4 questions

St. Judes Anglican Church London, Ontario A coalition of personal thoughts about our faith brought forward by addressing Four Questions: 1. What Is The Character Of Your GOD? 2. What is the Content of my Faith? 3. What is the Purpose of My Worship? 4. What is the function of your Community? Introduction The accompanying report is the final collation of the answe

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