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<div id="_page" style="margin: 0px auto; background: rgb(255, 255, 255); width: 210mm; min-height: 297mm; transform: scale(1, 1); transform-origin: 50% 0px 0px;" pagekind="A4" direct="portrait"><div id="_header" style="min-height: 0.65cm; padding-left: 0.65cm; padding-right: 0.65cm; padding-top: 0.65cm; position: relative; outline: none;" contenteditable="false" class="">
<div style="text-align: center; ">&nbsp;</div>
<div style="text-align: center;font-size: 15px;"><span>姓名:</span>
<field tabindex="0" id="name" type="Text" contenteditable="true" class="input blank" title="姓名" value="姓名" name="name" data-code="" data-expression="" multiline="false" validate="false" format="" style="display: inline-block; min-width: 60px;">姓名</field>
<span>&nbsp;科室:</span>
<field tabindex="0" id="department" type="Text" contenteditable="true" class="input blank" title="科室" value="科室" name="department" data-code="" data-expression="" multiline="false" validate="false" format="" style="display: inline-block; min-width: 60px;">科室</field><span>&nbsp;床号:</span>
<field tabindex="0" id="bed_number" type="Text" contenteditable="true" class="input blank" title="床号" value="床号" name="bed_number" data-code="" data-expression="" multiline="false" validate="false" format="" style="display: inline-block; min-width: 60px;">床号</field><span title="" contenteditable="false">&nbsp;住院号:</span>
<field tabindex="0" id="admission_number" type="Text" contenteditable="true" class="input blank" title="住院号" value="文本输入域" name="admission_number" data-code="" data-expression="" multiline="false" validate="false" format="" style="display: inline-block; min-width: 60px;">住院号</field><span>&nbsp;病案号:</span>
<field tabindex="0" id="medical_record_number" type="Text" contenteditable="true" class="input blank" title="病案号" value="文本输入域" name="medical_record_number" data-code="" data-expression="" multiline="false" validate="false" format="" style="display: inline-block; min-width: 60px;">病案号</field>&nbsp;
</div>
</div><div id="_body" style="min-height: calc(1024.25px); padding-left: 0.65cm; padding-right: 0.65cm;" contenteditable="false" class=""><div class="Section0" style=""><p class="MsoNormal" style="margin-top:10.2500pt;margin-left:213.2000pt;mso-outline-level:1;"><span style="letter-spacing: 0.9pt; font-weight: bold; font-size: 16pt;">抑郁焦虑表</span></p><table class="16" id="" title="" data-field="" style="border-width: 1px; border-color: rgb(0, 0, 0);"><colgroup><col style="width: 421px;"><col style="width: 304px;"></colgroup><tbody style=""><tr style="height: 72.8pt"><td colspan="2" class=""><p class="15" style="margin-top: 1pt; margin-left: 26.1pt; line-height: 1.5;"><span style="letter-spacing: 0.266667px; font-size: 10.5pt;">1我对以往感兴趣的事情还是有兴趣</span></p><p class="15" style="margin-left:24.7500pt;"><group type="radio" id="radio0" style="font-size: 10.5pt;"><input type="radio" id="radio0__0" name="radio0" value="0" checked="true"><label for="radio0__0">肯定一样——0分</label><br><input type="radio" id="radio0__1" name="radio0" value="1" style=""><label for="radio0__1">不像以前那样——1分</label><br><input type="radio" id="radio0__2" name="radio0" value="2"><label for="radio0__2">只有一点——2分</label><br><input type="radio" id="radio0__3" name="radio0" value="3"><label for="radio0__3">基本上没有了——3分</label><br></group><br></p></td></tr><tr style="height:72.5000pt"><td colspan="2" class="" style="border-color: rgb(0, 0, 0)"><p class="15" style="margin-top:1.5500pt;margin-left:25.5000pt;line-height:15.6500pt;
mso-line-height-rule:exactly;"><span style="font-size: 12px; letter-spacing: 0.333333px;">2</span><span style="letter-spacing: 0.333333px; font-size: 10.5pt;">)我能够哈哈大笑,并看到事物好的一面</span></p><p class="15" style="margin-left:24.7500pt;"><group type="radio" id="radio1" style="font-size: 10.5pt;"><input type="radio" id="radio1__0" name="radio1" value="0" checked="true"><label for="radio1__0">我经常这样——0分</label><br><input type="radio" id="radio1__1" name="radio1" value="1"><label for="radio1__1">现在已经不太这样了——1分</label><br><input type="radio" id="radio1__2" name="radio1" value="2"><label for="radio1__2">现在肯定是不太多了——2分</label><br><input type="radio" id="radio1__3" name="radio1" value="3"><label for="radio1__3">根本没有——3分</label><br></group><br></p></td></tr><tr style="height: 72.55pt;"><td colspan="2" class="" style="border-color: rgb(0, 0, 0);"><p class="15" style="margin-top:2.2500pt;margin-left:25.6000pt;"><span style="letter-spacing: 0.15pt; font-size: 9pt;">3</span><span style="letter-spacing: 0.15pt; font-size: 10.5pt;">)我感到愉快</span></p><p class="15" style="margin-top: 5.2pt; margin-left: 24.75pt; line-height: 15.7pt;"><span style="letter-spacing: -0.65pt; position: relative; top: -5pt;"><group type="radio" id="radio2" style="font-size: 10.5pt;"><input type="radio" id="radio2__0" name="radio2" value="0" checked="true"><label for="radio2__0">大多数时间——0分</label><br><input type="radio" id="radio2__1" name="radio2" value="1"><label for="radio2__1">有时——1分</label><br><input type="radio" id="radio2__2" name="radio2" value="2"><label for="radio2__2">并不经常——2分</label><br><input type="radio" id="radio2__3" name="radio2" value="3"><label for="radio2__3">根本没有——3分</label><br></group><br></span></p></td></tr><tr style="height: 72.55pt;"><td colspan="2" class="" style="border-color: rgb(0, 0, 0)"><p class="15" style="margin-top: 3.1pt; margin-left: 25.35pt; line-height: 1.5;"><span style="letter-spacing: 0.25pt; font-size: 9pt;">4</span><span style="font-size: 10.5pt; line-height: 1.5;"><span style="letter-spacing: 0.25pt;">)我对自己的仪容失去兴趣</span><o:p></o:p></span></p><p class="15" style="margin-top: 5.2pt; margin-left: 24.75pt; line-height: 1.5;"><span style="letter-spacing: -0.85pt; position: relative; top: -5pt; line-height: 1.5;"><group type="radio" id="radio3" style="font-size: 10.5pt; line-height: 1.5;"><input type="radio" id="radio30" name="radio3" value="0" checked="true"><label for="radio30">我仍然像以往一样关心——0分</label><br><input type="radio" id="radio31" name="radio3" value="1"><label for="radio31">我可能不是非常关心——1分</label><br><input type="radio" id="radio32" name="radio3" value="2"><label for="radio32">并不像我应该做的那样关心我——2分</label><br><input type="radio" id="radio33" name="radio3" value="3"><label for="radio33">肯定——3分</label><br></group><span style="font-size: 10.5pt; line-height: 1.5;"><br></span></span></p></td></tr><tr style="height: 72.55pt"><td colspan="2" class="" style="border-color: rgb(0, 0, 0)"><p class="15" style="margin-top: 3.8pt; margin-left: 25.6pt; line-height: 1.5;"><span style="font-size: 10.5pt; line-height: 1.5;"><span style="letter-spacing: 0.2pt; position: relative; top: -5pt;">5我对一切都是乐观地向前看</span><o:p style=""></o:p></span></p><p class="15" style="margin-left: 24.75pt;"><span style="letter-spacing: -0.45pt;"><group type="radio" id="radio4" style="font-size: 10.5pt;"><input type="radio" id="radio40" name="radio4" value="0" checked="true"><label for="radio40">差不多是这样做——0分</label><br><input type="radio" id="radio41" name="radio4" value="1"><label for="radio41">并不完全是这样做的——1分</label><br><input type="radio" id="radio42" name="radio4" value="2"><label for="radio42">很少这样做——2分</label><br><input type="radio" id="radio43" name="radio4" value="3"><label for="radio43">几乎从不这样做——3分</label><br></group><br></span></p></td></tr><tr style="height: 108px"><td colspan="2" class="" style="border-color: rgb(0, 0, 0)"><p class="15" style="margin-top:4.5000pt;margin-left:25.5000pt;line-height:15.7500pt;
mso-line-height-rule:exactly;"><span style="font-size: 10.5pt;"><span style="letter-spacing: 0.25pt; position: relative; top: -5pt;">6我好像感到情绪在渐渐低落</span><o:p></o:p></span></p><p class="15" style="margin-left:24.7500pt;"><span style="letter-spacing: -0.75pt;"><group type="radio" id="radio5" style="font-size: 10.5pt;"><input type="radio" id="radio5__0" name="radio5" value="0" checked="true"><label for="radio5__0">根本没有——0分</label><br><input type="radio" id="radio5__1" name="radio5" value="1"><label for="radio5__1">有时——1分</label><br><input type="radio" id="radio5__2" name="radio5" value="2"><label for="radio5__2">很经常——2分</label><br><input type="radio" id="radio5__3" name="radio5" value="3"><label for="radio5__3">几乎所有时间——3分</label><br></group><br></span></p></td></tr><tr style="height: 118px"><td colspan="2" class="" style="border-color: rgb(0, 0, 0);"><p class="15" style="margin-top:3.2500pt;margin-left:25.5000pt;"><span style="font-size: 10.5pt;"><span style="letter-spacing: 0.25pt;">7)我能欣赏一本好书或意向好的广播或电视节目</span><o:p></o:p></span></p><p class="15" style="margin-top: 5.25pt; margin-left: 24.75pt; line-height: 15.7pt;"><group type="radio" id="radio6" style="font-size: 10.5pt;"><input type="radio" id="radio6__0" name="radio6" value="0"><label for="radio6__0">常常如此——0分</label><br><input type="radio" id="radio6__1" name="radio6" value="1" checked="true"><label for="radio6__1">有时——1分</label><br><input type="radio" id="radio6__2" name="radio6" value="2"><label for="radio6__2">并非经常——2分</label><br><input type="radio" id="radio6__3" name="radio6" value="3"><label for="radio6__3">很少——3分</label><br></group><br></p></td></tr><tr style="height: 38px"><td class="" style="border-color: rgb(0, 0, 0)"><p class="15" style="margin-top:9.5000pt;margin-left:25.4000pt;"><span style="letter-spacing: 0.1pt; font-size: 10.5pt;"><font face="宋体" style="">抑郁得分(</font>0-21分</span><span style="font-size: 9pt;"><o:p></o:p></span></p></td><td class=""><p class="MsoNormal" style=""><span style="font-family: Arial; font-size: 10.5pt;"><span>&nbsp;</span><field tabindex="0" id="total1" type="Text" contenteditable="true" class="input" title="文本输入域" value="1" name="total1" data-code="" data-expression="= radio0 + radio1 + radio2 + radio3 + radio4 + radio5 + radio6" multiline="false" validate="false" format="" style="display: inline-block; min-width: 100px; text-align: left;">1</field>&nbsp;</span></p></td></tr>
<tr style="height: 72.55pt"><td colspan="2" class="" style="border-color: rgb(0, 0, 0)"><p class="15" style="margin-top:1.7500pt;margin-left:26.1000pt;"><span style="letter-spacing: 0.1pt; font-size: 10.5pt;">1我感到紧张或痛苦</span></p><p class="15" style="margin-top: 5.2pt; margin-left: 24.75pt; line-height: 15.7pt;"><span style="font-size: 10.5pt;"><group type="radio" id="radio7" style=""><input type="radio" id="radio7__0" name="radio7" value="0" checked="true"><label for="radio7__0">根本没有——0分</label><br><input type="radio" id="radio7__1" name="radio7" value="1"><label for="radio7__1">有时候——1分</label><br><input type="radio" id="radio7__2" name="radio7" value="2"><label for="radio7__2">大多时候——2分</label><br><input type="radio" id="radio7__3" name="radio7" value="3"><label for="radio7__3">几乎所有时候——3分</label><br></group><span>&nbsp;</span></span></p></td></tr><tr style="height: 138px;"><td colspan="2" class="" style="border-color: rgb(0, 0, 0);"><p class="15" style="margin-top:2.5000pt;margin-left:25.5000pt;line-height:15.7000pt;
mso-line-height-rule:exactly;"><span style="font-size: 10.5pt;"><span style="letter-spacing: 0.25pt; position: relative; top: -5pt;">2我感到有点害怕好像预感到什么可怕的事情要发生</span><o:p></o:p></span></p><p class="15" style="margin-left: 24.75pt;"><group type="radio" id="radio8" style="font-size: 10.5pt;"><input type="radio" id="radio8__0" name="radio8" value="0" checked="true"><label for="radio8__0">根本没有——0分</label><br><input type="radio" id="radio8__1" name="radio8" value="1"><label for="radio8__1">有一点但并不使我苦恼——1分</label><br><input type="radio" id="radio8__2" name="radio8" value="2"><label for="radio8__2">是有不太严重——2分</label><br><input type="radio" id="radio8__3" name="radio8" value="3"><label for="radio8__3">非常肯定和十分严重——3分</label><br></group><br></p></td></tr><tr style="height: 127px;"><td colspan="2" class="" style="border-color: rgb(0, 0, 0);"><p class="MsoNormal" style="text-indent: 30px;"><span style="font-size: 10.5pt;">3我的心中充满烦恼</span></p><p class="MsoNormal" style="margin-left: 24.75pt;"><span style="font-size: 10.5pt;"><group type="radio" id="radio9" style=""><input type="radio" id="radio90" name="radio9" value="0" checked="true"><label for="radio90">根本没有——0分</label><br><input type="radio" id="radio91" name="radio9" value="1" style=""><label for="radio91">有时候——1分</label><br><input type="radio" id="radio92" name="radio9" value="2"><label for="radio92">大多时候——2分</label><br><input type="radio" id="radio93" name="radio9" value="3"><label for="radio93">几乎所有时候——3分</label><br></group></span></p></td></tr><tr class="" style=""><td colspan="2">
<!--StartFragment--><p class="15" style="margin-top:1.9000pt;margin-left:25.3500pt;line-height:15.6500pt;
mso-line-height-rule:exactly;"><span style="font-size: 10.5pt;"><span style="letter-spacing: 0.25pt; position: relative; top: -5pt;">4我能够安闲而轻松地坐着</span><o:p></o:p></span></p><p class="15" style="margin-left: 24.75pt;"><group type="radio" id="radio10" style=""><input type="radio" id="radio100" name="radio10" value="0" checked="true"><label for="radio100">肯定--0分</label><br><input type="radio" id="radio101" name="radio10" value="1"><label for="radio101">经常--1分</label><br><input type="radio" id="radio102" name="radio10" value="2"><label for="radio102">并不经常--2分</label><br><input type="radio" id="radio103" name="radio10" value="3"><label for="radio103">更本没有--3分</label><br></group></p><!--EndFragment-->
</td></tr><tr class="" style=""><td colspan="2" style="">
<!--StartFragment--><p class="15" style="margin-top:2.9500pt;margin-left:25.6000pt;"><span style="font-size: 10.5pt;"><span style="letter-spacing: 0.25pt;">5我有点坐立不安好像感到非要活动不可</span><o:p></o:p></span></p><p class="15" style="margin-top: 5.2pt; margin-left: 24.75pt; line-height: 15.75pt;"><group type="radio" id="radio11" style=""><input type="radio" id="radio11__0" name="radio11" value="0" checked="true"><label for="radio11__0">根本没有——0分</label><br><input type="radio" id="radio11__1" name="radio11" value="1"><label for="radio11__1">并不很少——1分</label><br><input type="radio" id="radio11__2" name="radio11" value="2"><label for="radio11__2">是不少——2分</label><br><input type="radio" id="radio11__3" name="radio11" value="3"><label for="radio11__3">确实非常多——3分</label><br></group></p><!--EndFragment-->
</td></tr><tr class=""><td colspan="2" style=""><span>
</span><!--StartFragment--><p class="15" style="margin-top:3.9500pt;margin-left:25.5000pt;"><span style="letter-spacing: 0.2pt; font-size: 9pt;">6</span><span style="font-size: 10.5pt;"><span style="letter-spacing: 0.2pt;">我突然发现有恐慌感</span><o:p></o:p></span></p><p class="15" style="margin-top:5.2000pt;margin-left:24.7500pt;line-height:15.7500pt;
mso-line-height-rule:exactly;"><group type="radio" id="radio12" style=""><input type="radio" id="radio12__0" name="radio12" value="0" checked="true"><label for="radio12__0">根本没有——0分</label><br><input type="radio" id="radio12__1" name="radio12" value="1"><label for="radio12__1">并非经常——1分</label><br><input type="radio" id="radio12__2" name="radio12" value="2"><label for="radio12__2">非常肯定十分严重——2分</label><br><input type="radio" id="radio12__3" name="radio12" value="3"><label for="radio12__3">确实很经常——3分</label><br></group></p><!--EndFragment--><span>
</span></td></tr><tr class="" style=""><td colspan="2" style=""><span>
</span><!--StartFragment--><p class="15" style="margin-top:2.9500pt;margin-left:25.6500pt;line-height:15.7500pt;
mso-line-height-rule:exactly;"><span style="font-size: 10.5pt;"><span style="letter-spacing: 0.25pt; position: relative; top: -5pt;">7我感到有点害怕好像某个内脏器官变化了</span><o:p></o:p></span></p><p class="15" style="margin-left: 24.75pt;"><group type="radio" id="radio13" style=""><input type="radio" id="radio13__0" name="radio13" value="0" checked="true"><label for="radio13__0">根本没有——0分</label><br><input type="radio" id="radio13__1" name="radio13" value="1"><label for="radio13__1">有时——1分</label><br><input type="radio" id="radio13__2" name="radio13" value="2"><label for="radio13__2">很经常——2分</label><br><input type="radio" id="radio13__3" name="radio13" value="3"><label for="radio13__3">非常经常——3分</label><br></group></p><!--EndFragment--><span>
</span></td></tr><tr style="height: 35px"><td class="" id="" title="" style="border-color: rgb(0, 0, 0); background-color: rgb(255, 255, 255); vertical-align: middle; text-align: center"><p class="15" style="text-align: center; margin-top: 0pt; margin-left: 0pt;"><span style="letter-spacing: 0.1pt; font-size: 10.5pt;"><font face="宋体" style=""></font>
<!--StartFragment-->焦虑得分</span></p></td><td class="" style="border-width: 1pt; border-color: rgb(0, 0, 0)"><field tabindex="0" id="total2" name="total2" type="Text" contenteditable="true" class="input" title="文本输入域" value="0" data-code="" data-expression="= radio7 + radio8 + radio9 + radio10 + radio11 + radio12 + radio13" multiline="false" validate="false" format="" style="display: inline-block; min-width: 100px; text-align: left;">0</field><span>&nbsp;</span></td></tr><tr class=""><td colspan="1"><span>
</span><!--StartFragment--><p class="15" style="margin-top:1.7500pt;margin-left:129.0500pt;"><span style="font-size: 10.5pt;"><span>结果</span><o:p></o:p></span></p><p class="15" style="margin-top:0.0500pt;margin-right:0.6500pt;margin-left:124.2000pt;
text-indent:-97.2500pt;"><span style="font-size: 10.5pt;"><span style="letter-spacing: 0.2pt;"><font face="宋体"></font>0-7分为阴性;8-10为轻度;11-14分为</span><span style="letter-spacing: 0.15pt;"><font face="宋体">中度</font>;15-21分为</span>&nbsp;<span style="letter-spacing: -0.1pt;"></span><span style="letter-spacing: -0.1pt;">度)</span></span></p><!--EndFragment--><span>
</span></td><td colspan="1" class=""><field tabindex="0" id="field_4" name="field_4" type="Text" contenteditable="true" class="input" title="文本输入域" value="1" data-code="" data-expression="=total1 + total2" multiline="false" validate="false" format="" style="display: inline-block; min-width: 100px; text-align: left;">1</field>&nbsp;<br></td></tr></tbody></table></div><p class="MsoNormal" style="margin-left:90.0500pt;"><span style="position:absolute;z-index:1;margin-left:75.5000px;
margin-top:112.3333px;width:680.0000px;height:0.0000px;"><br></span><span style="position:absolute;z-index:1;margin-left:75.5000px;
margin-top:112.3333px;width:680.0000px;height:0.0000px;"><br></span><span style="position:absolute;z-index:1;margin-left:75.5000px;
margin-top:112.3333px;width:680.0000px;height:0.0000px;"><br></span></p><br></div><div id="_footer" style="position: relative; min-height: 0.65cm; padding-left: 0.65cm; padding-right: 0.65cm; padding-bottom: 0.65cm; outline: none;" contenteditable="false" class=""></div>
</div>

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<div id="_page"
style="margin: 0px auto; background: rgb(255, 255, 255); width: 209.5mm; min-height: 148mm; transform: scale(1, 1); transform-origin: 50% 0px 0px;"
pagekind="A5" direct="landscape">
<div id="_header"
style="outline: none; min-height: 0.5cm; padding-left: 1cm; padding-right: 1cm; padding-top: 0.65cm; position: relative;"
contenteditable="false" class="">
<div style="text-align: center; line-height: 1.5;"><span
style="font-size: x-large; font-weight: 700;">成都中医药大学附属医院</span></div>
<div style="text-align: center; line-height: 1;"><span
style="font-weight: bold; font-size: large;">电子病历</span></div>
<div style="text-align: center;"><span
style="font-weight: bold; font-family: 楷体; line-height: 1; color: rgb(255, 255, 255); font-size: 5pt;">.</span>
</div>
</div>
<div id="_body" style="min-height: calc(472.441px); padding-left: 1cm; padding-right: 1cm;"
contenteditable="false" class="">
<div style="text-align: left;" domain="" code="" title="" contenteditable="false"><span
style="font-size: small; text-align: justify; font-weight: bold;" domain="" code="" title=""
contenteditable="false">姓名:</span>
<field tabindex="0" id="pat_name" type="Text" contenteditable="false" class="input" title="姓名"
name="pat_name" data-code="" data-expression="" multiline="false" validate="false" format=""
style="font-size: small; text-align: justify;" value=""></field><span
style="font-size: small; text-align: justify;">&nbsp; &nbsp;</span><span
style="font-size: small; text-align: justify; font-weight: bold;" domain="" code="" title=""
contenteditable="false">性别:</span>
<field tabindex="0" id="pat_sex" type="Text" contenteditable="false" class="input" title="性别" value="男"
name="pat_sex" data-code="" data-expression="" multiline="false" validate="false" format=""
style="font-size: small; text-align: justify;"></field><span
style="font-size: small; text-align: justify;">&nbsp; &nbsp;</span><span
style="font-size: small; text-align: justify; font-weight: bold;" domain="" code="" title=""
contenteditable="false">年龄:</span>
<field tabindex="0" id="pat_age" type="Text" contenteditable="false" class="input" title="年龄"
name="pat_age" data-code="" data-expression="" multiline="false" validate="false" format=""
style="font-size: small; text-align: justify;" value=""></field><span
style="font-size: small; text-align: justify;">&nbsp; &nbsp;</span><span
style="font-size: small; text-align: justify; font-weight: bold;" domain="" code="" title=""
contenteditable="false">就诊科室:</span>
<field tabindex="0" id="visit_dept" type="Text" contenteditable="false" class="input" title="就诊科室"
name="visit_dept" data-code="" data-expression="" multiline="false" validate="false" format=""
style="font-size: small; text-align: justify;" value="风湿免疫科">风湿免疫科</field><span
style="font-size: small; text-align: justify; font-weight: bold;" domain="" code="" title=""
contenteditable="false">&nbsp; &nbsp;就诊号:</span>
<field tabindex="0" type="Text" contenteditable="false" class="input" title="就诊号" data-code=""
data-expression="" multiline="false" validate="false" format="" style="font-size: small;" domain=""
code="" required="false" inputmode="" id="pat_id" name="pat_id" value="MZ07882405098">
MZ07882405098</field><span style="font-size: small; text-align: justify;">&nbsp;</span>
</div>
<div style="text-align: justify; line-height: 2;"><span style="line-height: 2;"><span
style="font-weight: 700; line-height: 2;">
<hr style="font-size: small;"><span style="font-size: 9pt;">就诊时间:</span>
</span>
<field tabindex="0" id="visit_time" type="Text" class="input" title="就诊时间" name="visit_time"
data-code="" data-expression="" multiline="false" validate="false" format=""
style="font-size: 9pt;" value="2024-05-09 14:21:52">2024-05-09 14:21:52</field>
<field tabindex="0" type="Text" class="blank input" title="就诊时间" name="visit_time" data-code=""
data-expression="" multiline="false" validate="false" format=""
style="font-weight: 700; font-size: 9pt;">&nbsp;</field>
</span><span style="font-size: 9pt; line-height: 2;">&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;
<group type="radio" id="firstcall" domain="" code="" style=""><input type="radio" id="firstcall__0"
name="firstcall" value="1" checked><label for="firstcall__0">初诊</label><input type="radio"
id="firstcall__1" name="firstcall" value="2"><label for="firstcall__1">复诊</label></group>
</span></div>
<div style="text-align: justify; line-height: 2;"><span style="font-size: 9pt; line-height: 2;"><span
style="font-weight: bold;">联系电话:</span>
<field tabindex="0" id="pat_phone" type="Text" class="input" title="联系电话" name="pat_phone"
data-code="" data-expression="" multiline="false" validate="false" format=""
contenteditable="true" style="" value=""></field><span style="" domain=""
code="" title=" "><span style="font-weight: bold;">&nbsp; 家庭住址:</span>
<field tabindex="0" id="pat_address" name="pat_address" type="Text" contenteditable="true"
class="blank input" title="地址" domain="" code="" multiline="true" required="false" format=""
inputmode="" data-expression="" value="">地址</field>
</span>
</span></div>
<div style="text-align: justify; line-height: 2;"><span style="font-size: 9pt; line-height: 2;"><span
style="font-weight: bold;">主诉:</span>
<field tabindex="0" id="pat_appeal" name="pat_appeal" type="Text" contenteditable="true"
class="input" title="主诉" domain="" code="" multiline="true" required="false" format=""
inputmode="" data-expression="" style="" value=""></field><span
style="font-weight: bold;">&nbsp;</span>
</span></div>
<div style="text-align: justify; line-height: 2;"><span style="font-size: 9pt; line-height: 2;"><span
style="" title="" domain="" code=""><span style="font-weight: bold;">现病史:</span>
<field tabindex="0" id="pat_now_history" name="pat_now_history" type="Text"
contenteditable="true" class="input" title="病史" domain="" code="" multiline="true"
required="false" format="" inputmode="" data-expression="" style=""
value=""></field><span
style="font-weight: bold;">&nbsp;</span>
</span></span></div>
<div style="text-align: justify; line-height: 2;"><span style="font-size: 9pt; line-height: 2;"><span
style="font-weight: bold;">既往史:</span>
<field tabindex="0" id="pat_past_history" name="pat_past_history" type="Text" contenteditable="true"
class="blank input" title="既往史" domain="" code="" multiline="true" required="false" format=""
inputmode="" data-expression="" style="">既往史</field><span
style="font-weight: bold;">&nbsp;</span>
</span></div>
<div style="text-align: justify; line-height: 2;" domain="" code="" title=" "><span
style="font-size: 9pt; line-height: 2;"><span style="font-weight: bold;">过敏史:</span>
<field tabindex="0" id="pat_allergy_history" name="pat_allergy_history" type="Text"
contenteditable="true" class="blank input" title="过敏史" domain="" code="" multiline="true"
required="false" format="" inputmode="" data-expression="" style="">过敏史</field><span
style="font-weight: bold;">&nbsp;</span>
</span></div>
<div style="text-align: justify; line-height: 2;"><span style="font-size: 9pt; line-height: 2;"><span
style="font-weight: bold;">诊断:</span>
<field tabindex="0" id="diagnosis" name="diagnosis" type="Text" contenteditable="true" class="input"
title="诊断" domain="" code="" multiline="true" required="false" format="" inputmode=""
data-expression="" style="" value=""></field>
</span></div>
<div style="text-align: justify; line-height: 2;"><span style="font-size: 12px;"><span
style="font-weight: 700;">处方:</span>
<field tabindex="0" id="presc" name="presc" type="Text" contenteditable="false" class="input"
title="处方" domain="" code="" multiline="true" required="false" format="" inputmode=""
data-expression="" style="" value=""></field><span style="font-weight: 700;">&nbsp;</span>
</span></div>
<div style="text-align: justify; line-height: 2;"><span style="font-size: 9pt; line-height: 2;"><span
style="font-weight: bold;">建议:</span>
<field tabindex="0" id="advice" type="Text" contenteditable="true" class="input" title="建议" domain="" code=""
multiline="true" required="false" format="" inputmode="" data-expression="" style=""
value="在用药过程中有任何身体不适,请及时前往实体医院就诊">在用药过程中有任何身体不适,请及时前往实体医院就诊</field><span
style="font-weight: bold;">&nbsp;</span>
</span></div>
<div style="text-align: justify; line-height: 2;"><span style="font-size: 9pt; line-height: 2;"><span
style="font-weight: bold;"><br></span></span></div>
<div style="text-align: justify; line-height: 2;" domain="" code="" title="" contenteditable="false"><span
style="font-weight: bold; line-height: 2; font-size: 9pt;">医师签字:</span>
<field tabindex="0" id="doctor_name" type="Text" contenteditable="false" class="input" title="医师签字"
name="doctor_name" data-code="" data-expression="" multiline="false" validate="false" format=""
style="line-height: 2; font-size: 9pt;" domain="" code="" required="false" inputmode="" value="贾连荣">
张某某</field><span style="line-height: 2; font-size: 9pt;">&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;
&nbsp; <span style="font-weight: bold; line-height: 2;">手签:</span></span>
</div>
</div>
<div id="_footer"
style="outline: none; position: relative; min-height: 0.5cm; padding-left: 1cm; padding-right: 1cm; padding-bottom: 0.65cm;"
contenteditable="false" class="">
<div style="text-align: center;"><span style="font-size: small;"><field page="pageNum" style="">#</field>
页,共<field page="pageTotal" style="">#</field></span></div>
</div>
</div>

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<div id="_page" style="margin: 0px auto; background: rgb(255, 255, 255); width: 210mm; min-height: 297mm; transform: scale(1, 1); transform-origin: 50% 0px 0px;" pagekind="A4" direct="portrait">
<div id="_header" style="outline: none; min-height: 0.99cm; padding-left: 1.5cm; padding-right: 1.5cm; padding-top: 0.99cm; position: relative;" contenteditable="false" class="">
<p style=" font-family: 宋体; font-size: 15.75pt; text-align: Center;">
<label style=" font-family: 宋体; font-size: 15.75pt; font-weight: bold; text-align: Center;">云南城投昆明妇女儿童医院</label>
</p><p style=" font-family: 宋体; font-size: 14.25pt; text-align: Center;">
<label style=" font-family: 宋体; font-size: 15.75pt; font-weight: bold;">麻醉知情同意书</label>
</p></div>
<div id="_body" style="outline:none;min-height: calc(297mm - 0.99cm - 0.48cm - 0.99cm - 1.5cm);padding-left:1.5cm;padding-right:1.5cm;" contenteditable="false" class="">
<p style=" font-family: 宋体; font-size: 14.25pt;">
<label style=" font-family: 仿宋; font-size: 14.25pt;">姓名:</label>
<field tabindex="0" id="姓名" name="姓名" class="blank" style=" font-family: 仿宋; font-size: 14.25pt;" contenteditable="true" type="Text" value="" title="姓名">姓名</field>
<label style=" font-family: 仿宋; font-size: 14.25pt;"> 性别:</label>
<field tabindex="0" id="性别" name="性别" class="blank" style=" font-family: 仿宋; font-size: 14.25pt;" contenteditable="true" type="Text" value="" title="性别">性别</field>
<label style=" font-family: 仿宋; font-size: 14.25pt;"> 年龄:</label>
<field tabindex="0" id="年龄" name="年龄" class="blank" style=" font-family: 仿宋; font-size: 14.25pt;" contenteditable="true" type="Text" value="" title="年龄">年龄</field>
<label style=" font-family: 仿宋; font-size: 14.25pt;"> 门诊号:</label>
<field tabindex="0" id="病历号" name="病历号" class="blank" style=" font-family: 仿宋; font-size: 14.25pt;" contenteditable="true" type="Text" value="" title="病历号" data-code="" validate="false" format="">病历号</field>&nbsp;<label style=" font-family: 仿宋; font-size: 14.25pt;">科室:</label>
<field tabindex="0" id="科室" name="科室" class="blank" style=" font-family: 仿宋; font-size: 14.25pt;" contenteditable="true" type="Text" value="" title="{科室}">科室</field>&nbsp;<label style=" font-family: 仿宋; font-size: 14.25pt;"> 床号:</label>
<field tabindex="0" id="日期" name="日期" class="blank" style=" font-family: 仿宋; font-size: 14.25pt;" contenteditable="true" type="Text" value="" title="床号">床号</field>
</p><p style=" font-family: 仿宋; font-size: 14.25pt;">
<label style=" font-family: 仿宋; font-size: 14.25pt;">诊断:</label>
<field tabindex="0" id="诊断" name="诊断" class="blank" style=" font-family: 仿宋; font-size: 14.25pt;" contenteditable="true" type="Text" value="" title="诊断" data-code="" validate="false" format="">诊断</field>&nbsp;<label style=" font-family: 仿宋; font-size: 14.25pt;">执行检查手术:</label>
<field tabindex="0" class="blank" style=" font-family: 仿宋; font-size: 14.25pt;" contenteditable="true" type="Text" value="" title="执行手术">执行手术</field>
<label style=" font-family: 仿宋; font-size: 14.25pt;"> 体重:</label>
<field tabindex="0" id="体重" name="体重" class="blank" style=" font-family: 仿宋; font-size: 14.25pt;" contenteditable="true" type="Text" value="" title="体重" data-code="" validate="false" format="alpha">{体重}</field>
<label style=" font-family: 仿宋; font-size: 14.25pt;">k</label>
</p><p style=" font-family: 宋体; font-size: 14.25pt;">
<label style=" font-family: 仿宋; font-size: 14.25pt;">任何麻醉均有风险性,在根据患者病情,切实做好麻醉前准备并按操作规范认真做好麻醉工 作及范防范措施情况下,仍有可能发生以下难以避免的麻醉意外及并发症:</label>
</p><p style=" font-family: 宋体; font-size: 14.25pt;">
<label style=" font-family: 仿宋; font-size: 14.25pt;">1、根据麻醉需要及操作规范遵照《中华人民共和国药典》要求使用各种麻醉药物和输液用液体由于患者体制原因出现输液反应过敏、高敏反应致热源反应等甚至导致过敏性休克、呼吸心跳停止</label>
</p><p style=" font-family: 宋体; font-size: 14.25pt;">
<label style=" font-family: 仿宋; font-size: 14.25pt;">2、麻醉期间可能发生恶心、呕吐、返流误吸、喉水肿、喉痉挛导致气道梗阻窒息</label>
<label style=" font-family: 宋体; font-size: 14.25pt;"></label>
</p><p style=" font-family: 宋体; font-size: 14.25pt;">
<label style=" font-family: 仿宋; font-size: 14.25pt;">3、呼吸抑制甚至短暂呼吸暂停血压下降心率减慢严重者可能发生心跳呼吸骤停</label>
</p><p style=" font-family: 宋体; font-size: 14.25pt;">
<label style=" font-family: 仿宋; font-size: 14.25pt;">4、因麻醉诱发原有隐患匿性疾病发作如哮喘、癫痫、心脑血管意外等</label>
</p><p style=" font-family: 宋体; font-size: 14.25pt;">
<label style=" font-family: 仿宋; font-size: 14.25pt;">5、因抢救需要气管插管可能损伤患者口唇、牙齿、引起反流误吸、气道痉挛、窒息</label>
</p><p style=" font-family: 宋体; font-size: 14.25pt;">
<label style=" font-family: 仿宋; font-size: 14.25pt;">6、其他难以预料的并发症及意外。</label>
</p><p style=" font-family: 宋体; font-size: 14.25pt;">
<label style=" font-family: 仿宋; font-size: 14.25pt;">麻醉后注意事项 </label>
</p><p style=" font-family: 宋体; font-size: 14.25pt;">
<label style=" font-family: 仿宋; font-size: 14.25pt;">1、麻醉结束后2小时内不要饮水、进食</label>
</p><p style=" font-family: 宋体; font-size: 14.25pt;">
<label style=" font-family: 仿宋; font-size: 14.25pt;">2、接受麻醉后当天不能驾驶机动车骑自行车及电动车不能经行精细操作工作和高空作业</label>
</p><p style=" font-family: 宋体; font-size: 14.25pt;">
<label style=" font-family: 仿宋; font-size: 14.25pt;">3、麻醉结束后请在医院观察休息一段时间待麻醉医生认可后方能离开</label>
</p><p style=" font-family: 宋体; font-size: 14.25pt;">
<label style=" font-family: 仿宋; font-size: 14.25pt;">我们将以良好的医德医术为患者实行麻醉,力争将麻醉风险降低到最低程度,保障患者安全。上 述情况以对患者及家属说明,并对患者方提出的问题作了详细的解答,经慎重考虑,患者及家属 对麻醉可能出现的风险表示充分的理解,同意要求实行麻醉,签字为证:</label>
</p><p style="undefined" id="" title="患者签名">
<label style=" font-family: 仿宋; font-size: 14.25pt;">患者本人签字</label><img type="sign" alt="双击手写签名" style="width: 120px; height: 40px;" draggable="false" id="patient-sign" name="patient-sign" title=""><span style="font-size: 14.25pt;">签字时间_____年___月___日___时____分</span></p><p style=" font-family: 仿宋; font-size: 14.25pt;">
<label style=" font-family: 仿宋; font-size: 14.25pt;">患者家属签字</label><img type="sign" alt="双击手写签名" style="width: 120px; height: 40px;" draggable="false" id="patient-family-sign" name="patient-family-sign" title="家属签名"><span style="font-size: 14.25pt;">与患者关系_____</span></p><p style=" font-family: 仿宋; font-size: 14.25pt; text-align: Center;"><br></p><p style=" font-family: 宋体; font-size: 12pt; text-align: Right;">
<label style=" font-family: 仿宋; font-size: 14.25pt;">麻醉医师签名: <img readonly style="width: 120px; height: 80px;" type="sign" alt="医生签名" id="doctor-sign" name="doctor-sign" title="医生签名"></label>
</p><p style=" font-family: 宋体; font-size: 12pt; text-align: Right;">
<field tabindex="0" class="blank" style=" font-family: 仿宋; font-size: 14.25pt;" contenteditable="true" type="Text" value="" title=""></field>
<label style=" font-family: 仿宋; font-size: 14.25pt;"></label>
<field tabindex="0" class="blank" style=" font-family: 仿宋; font-size: 14.25pt;" contenteditable="true" type="Text" value="" title=""></field>
<label style=" font-family: 仿宋; font-size: 14.25pt;"></label>
<field tabindex="0" class="blank" style=" font-family: 仿宋; font-size: 14.25pt;" contenteditable="true" type="Text" value="" title=""></field>
<label style=" font-family: 仿宋; font-size: 14.25pt;"></label>
<field tabindex="0" class="blank" style=" font-family: 仿宋; font-size: 14.25pt;" contenteditable="true" type="Text" value="" title=""></field>
<label style=" font-family: 仿宋; font-size: 14.25pt;"></label>
<field tabindex="0" class="blank" style=" font-family: 仿宋; font-size: 14.25pt;" contenteditable="true" type="Text" value="" title=""></field>
<label style=" font-family: 仿宋; font-size: 14.25pt;"></label>
<label style=" font-family: 仿宋; font-size: 14.25pt; text-align: Right;"></label>
</p></div>
<div id="_footer" style="outline:none; position:relative;min-height:1.5cm;padding-left:1.5cm;padding-right:1.5cm;padding-bottom:0.48cm;" contenteditable="false" class="">
<p style=""><label style=" font-family: 宋体; font-size: 10.5pt; color: #323232;"></label>&nbsp;</p></div>
</div>

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