O‘zbekiston Respublikasi IIV maxsus tibbiy komissiyasi |
Mahkumni tibbiy ko‘rikdan o‘tkazilganligi haqida
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| XULOSA | |
Familiyasi ________________________________________________________ |
Ismi, sharifi ______________________________________________________ |
Tug‘ilgan yili va joyi ______________________________________________ ___________________________________________________________________ |
Kim tomondan va qachon hukm qilingan _________________________________ ___________________________________________________________________ |
O‘zR JK _________ moddasi Jazo muddati ____________________________________ |
Muddat boshlangan vaqti ___________________________ Muddatning tugash vaqti ___________________________ |
Shaxsiy hujjatlarning yig‘ma jildi № _______________________________ |
Sudlanguncha kim bo‘lib ishlagan ______________________________________ |
| (ishlamagan bo‘lsa sababi ko‘rsatilsin) |
Jazo muddatini o‘tash davrida kasal bo‘lguncha kim bo‘lib ishlagan __________________________________________________________________ |
(ishlamagan bo‘lsa sababi ko‘rsatilsin) |
Hozirgi kunda saqlanayotgan (davolanayotgan) muassasaning nomi ___________ ___________________________________________________________________ |
Sog‘lig‘iga shikoyatlar ________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ |
| Anamnez
| |
Hayoti davomida qanday kasalliklarga chalingan va qayerda davolangan ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ |
Qanday jarohatlar olgan va operatsiya bo‘lgan ___________________________ ___________________________________________________________________ ___________________________________________________________________
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Asosiy kasallikning boshlanishi va kechishi, asosiy kasalliklari bo‘yicha qayerda va qancha vaqt davolangan, o‘tkazilgan davolanish muolajalari ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ |
Obyektiv tekshirish ma’lumotlari: |
1. Bo‘yi _______sm. Vazni ______kg. | | |
2. Tana terisi va shilliq pardalari holati _____________________________ ___________________________________________________________________ ___________________________________________________________________ |
3. Muskul va suyak tizimi, bo‘g‘inlar holati ______________________________ ___________________________________________________________________ ___________________________________________________________________ |
4. Nafas olish a’zolari ______________________________________________ ___________________________________________________________________ ___________________________________________________________________ |
5. Yurak, qon-tomir a’zolari _________________________________________ ___________________________________________________________________ ___________________________________________________________________ |
6. Ovqat hazm qilish a’zolari _________________________________________ ___________________________________________________________________ ___________________________________________________________________ |
7. Siydik yo‘llari va jinsiy a’zolar tizimi ___________________________ ___________________________________________________________________ ___________________________________________________________________ |
8. Asab tizimi va ruhiy holati _______________________________________ ___________________________________________________________________ ___________________________________________________________________ |
9. Ko‘rish holati ____________________________________________________ ___________________________________________________________________ ___________________________________________________________________ |
10. Quloq, tomoq va burun a’zolari h�lati ______________________________ ___________________________________________________________________ ___________________________________________________________________ |
11. Rentgen tekshiruvi natijalari ____________________________________ ___________________________________________________________________ ___________________________________________________________________ |
12. Laboratoriya tekshiruvlari natijalari _____________________________ ___________________________________________________________________ ___________________________________________________________________ |
Yakuniy tashxis: _____________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ |
O‘zbekiston Respublikasi Ichki ishlar vazirligi va O‘zbekiston Respublikasi Sog‘liqni saqlash vazirligining 2008-yil 13-avgustdagi 12 va 9-sonli hamkorlikdagi qarori bilan tasdiqlangan “Mahkumlarni kasalligi tufayli jazoni o‘tashdan ozod qilishga taqdim etish uchun asos bo‘ladigan kasalliklar Ro‘yxati”ning _______bandiga asosan mahkum_____________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ |
| (familiyasi, ismi, sharifi) | |
jazo muddatini o‘tashdan ozod qilishga tavsiya etiladi. |
Komissiya raisi O‘zR IIV | | |
Tibbiyot boshqarmasi boshlig‘i o‘rinbosari ____________________________ |
| | (imzosi, familiyasi) |
Komissiya a’zolari: ________________________________________________ |
| (lavozimi, imzosi, familiyasi) |
| __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ |
Davolovchi shifokor ________________________________________________ |
M.O‘. | 200____yil “____” ________________ |