IHR Form
Patient Profile
last name
Name
Year of Birth
sex
male
female
Job
Country
Patient complaints and clinical symptoms
Fever
Chills
Bad public mood
Cough
Shortness of breath
Consciousness disorder
Diarrhea
Vomit
Muscle pains
History of chronic infections
HIV
HB Ag
HCVAb
HSV
Diseases of the patient
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