FICHA DE ANAMNESE Intradermoterapia

 

IECBN HL NANGALSL - EAXPNHLPGKXLPN]EN ]PLSS\PEVNHN  ]PLSS\PEVNHN 

AKGL6 PD6

ANSC6 EHNHL6

C]I6

Lahlrläk6 @nerrk6 ]rkiessãk6 Lgnej6 Xlj.6 ( )

Cehnhl6

\I6

Lstnhk Cevej6 Cljujnr6 (

)

BESXÓPECK SEG   AÃK

^\NJ/^\NES;

Ilztrntnglatklståtecknatlrekr; @ktkxaksöjtegks3glsls; Bestóreckhlnjlrdennnjdugnjeglatk, cksgåteckkuglhecnglatk; ]rntecnntevehnhliçsecn; Åiugnatl; Ådlstnatl;Åjnctnatl; Inznjdugtrntnglatkgåheck; Njdugnhklaänntevn; Xrntnglatkckgnate`eóteck; Inznjdugtrntnglatkkutkgn glhecnäãkpnrnhlprlssãk; Ckstugntkgnrskj; \snprktltkrskjnrirlqulatlglatl; Lstîlgtrntnglatkkufîtlvlcàaclr; Cuehnhksheîrekslprkhutkslgusk; ^uljóehl; Blrpls;

Beplrtlasãk(prlssãknjtn); Bepktlasãk(prlssãk`nexn); Hen`ltls; ]rk`jlgnscnrhçncks; Jöpuskunjdugnhklaännutk-egual; Blpntetl; Gnrcn-pnssk;

Lpejlpsen(ckavujsãk);

Xlrgk hl Plspkasn`ejehnhl Lstkucelatllhlnckrhkckgtkhnsnseaikrgnäülsncegnrljncekanhnslhlcjnrkaãktlrkgetehkalabugneaikrgnäãkhlsnöhlqulpkssn prlfuhecnrnnvnjenäãkhkprkiessekanj. Cehnhl\IHntn//

NsseanturnCjelatl

soeacnhlgy

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IECBN HL NYNJENÄÃK CKP]KPNJ EAXPNHLPGKXLPN]EN ]PLSS\PEVNHN  AKGL HK ]NCELAXL6 Glhehns Nprkxegnhns

Pldeãk

Eaçcek

 

/

@rnäk @ustk/Xórnx Lstøgndk Ceaturn @nrredn ^unhrej Cujktl

Ckxnsuplrekr Ckxneailrekr

• Hestre`ueäãk hn dkrhurn ckrpkrnj6   Deaóehl(pærn) • Cljujetl6

  Drnu>

  Drnu0

 

 

  Drnu3

 

  Nahróehl(gnän)  

 Drnu8

Pldeãk6 • Lst Lstren rens6 s6

  Nuslatls     Pu`rns(vlrgljbns)  

  Nj`ns(`rnacns)

Pldeãk6 • Ijncehlz Guscujnr6

 

• Ijncehlz Xessujnr (pljl)6

  Nuslatl

 

  ]rlslatl

  Nuslatl

 

  ]rlslatl

Pldeãk6 • Lhl Lhlgn6 gn6

  Nuslatl

 

  ]rlslatl

* Ie` Ie`rks rksl6 l6

  Nuslatl

 

  ]rlslatl

Pldeãk6 • Dkrhurn Jkcnjeznhn6

    Ckgpnctn

 

  Ijîcehn

Pldeüls6

soeacnhlgy

0

 

Ieanj /

 

IECBN HL NYNJENÄÃK INCENJ - EAXPNHLPGKXLPN]EN ]PLSS\PEVNHN  AKGL HK ]NCELAXL6

]PLSLAÄN Gnacbns]edglatnrl Gnacbns ]edglatnrlsrljncekanhn srljncekanhnsí sígljnaea gljnaeann   Ncrkgen Gljnsgn

Liåjehls

Bepkcrkgen

Beplrcrkgen

Nuslatl

Gnacbnspkrnjtlrnäülsvnscujn   Pksîcln

Lretlgn

]ltåquens

Xljlnadlctnsens

Nuslatl

Ylrrudns

Alcrksl

Gejjeug

]îpujn

Aóhujk

Nuslatl

Blgntkgn

Ikrgnäüls sójehns6   Clrntksl Ckglhãk Ikrgnäüls ckg ckatlöhk jçquehk6   @kjbn

 

]östujn

Jlsüls hl pljl6   Iessurn

 

Nuslatl

Hlscngnäãk

Nuslatl

\jclrnäãk

 

Crkstn

 

Akrgnj Akrgnj

Beplrqulrntksl

Slquljns6   Ntrkien

 

]ljks6   Besurtesgk

 

Cecntrez

 

Nuslatl

Akrgnj

 

Nuslatl

Kutrks6

CJNSSEIECNÄÃK HK XE]K C\XÀALK ^unatk í behrntnäãk6   Hlsehrntnhn

^unatk nk drnu hl kjlksehnhl6   Njçpecn ^unatk í lsplssurn6   Lsplssn Iktktepk6    E

 

Akrgnj Jepçhecn Iean

     

 EE

Cnrnctlrçstecn hn pljl6   Slgrudns

 

Sl`krråecn Iean  

   

 EEE

PudnsHeaàgecns

Ijncehlz

Iktklavljblceglatk

S\DLSXÃK HL XPNXNGLAXK

soeacnhlgy

3

 

 EY

PudnsLstîtecns  

  Sujcks

 Y

 

XLPGK HL CKASLAXEGLAXK ]NPN EAXPNHLPGKXLPN]EN ]PLSS\PEVNHN 

  Lu,                      ,  pkrtnhkr (n)hk (n)h k P.D. P.D.a¶ a¶    ,  C.]. ,C. ].I. I. a¶ a¶                , tlj tljlik likal al rlsehl rls ehlace acenj nj ( (  ) )  , cljujnr () ), tl tljl jlik ikal al ckglrcenj (  ),l-gnej ),l-gnej                          .

Hlcjnr Hlc jnrk k qul qulk k prk prkies iessek sekanj anj rl rlspk spkasî asîvlj vljgl gl lxp lxpjec jecku ku ks `la `laliç liçcek ceks s qul qul tlr tlrle le ckg ckg ks trn trntng tnglat latks ks l sun sunss pkssç-vlesckgpjecnäüls. Ckasehlrnäüls Dlrnes

>.

NEatrnhlrgktlrnpenprlssureznhnåugprkclheglatkqulckasestlannpjecnäãkhlglhecnglatksan

pljlkusu`cutàalkherltnglatlanrldeãknslrtrntnhn.Åugntåcaecnhlkredlgirnaclsn,qul tlgckgkeatuetkprkpkrcekanrugnnjtnckaclatrnäãkhkiîrgnckakjkcnjhlnäãklckgpkucks liletksckjntlrnes,vestkqulnn`skräãklckaclatrnäãkhlstlaksnadulsãkguetkglakrlshkqul sliksslhnhkpkrvenkrnj. 0.

Neatrnhlrgktlrnpenånplansugngnalernhlnhgeaestrnäãkhlglhecnglatks.Åhlplahlatlhn tåcaecn,hktepkhlglhecnglatknpjecnhk,hkprk`jlgnnslrtrntnhklhkórdãknjvkkahlikeiletn nnpjecnäãk.Ks`kasrlsujtnhksckggåtkhkglsktlrîpecklstãkrljncekanhksnugnnjtnckaclatrnäãklugplrçkhkprkjkadnhkhlglhe trnäãklugplrçkhkprk jkadnhkhlglhecnglatksanîrlnhn cnglatksanîrlnhnjlsãk. jlsãk.

3.

Ns vnatndlas hlssn tåcaecn sãk6 rlprlslatn ugn njtlrantevn tlrnpæutecn í cerurden pjîstecn (custk,

tlgpkhlckavnjlsclaän tlgpkhlckavnjl sclaän,ckatrneahecn ,ckatrneahecnäülscjçaec äülscjçaecns),nprl ns),nprlslatnugngljbkr slatnugngljbkrnrîpehnlgneshurnnrîpehnlgneshurnhkurnqulkstrntnglatkstópecks,njåghlprkhuzerliletkssestægeckshlsprlzçvles,`nexkaçvljhl gkr`ehnhllliletksrnzkîvles. 8.

]rkclh ]rk clheg eglat latk6 k6

]rkclhl-slnnatesslpsenhnpljlnslrtrntnhn(ckgîjckkj4=¶ldnzl)lanslquæaceneafltn-sl herltnglatlkprkhutkansrldeülsprlvenglatlgnrcnhns.N npjecnäãk å iletn pkr ug lquepnglatk qul eafltn ks ntevks ntrnvås hk glcnaesgk hl prkpujsãk n fntk hl njtn prlssãk hlscnrtnahk n

sehnhl nhl hl ndujbns. ndujbns. Nglscjnhksglhecnglatksårlnjeznhnnirlsck.Nhurnäãkhk alcls- seh

trntnglatkhlplahlrîhnsntesinäãklrlspkstnhlcnhnpncelatl. soeacnhlgy

8

 

. Plckglahn-sl nk pncelatl aãk gnssndlnr n rldeãk trntnhn hurnatl ns  preglerns 08 bkrns npós n npjecnäãk? 0. Lvetl rlnjeznr lxlrcçceks içsecks hurnatl ns preglerns 08 bkrns npós n npjecnäãk? 3. Lvetnr rkupns fustns l sufns an rldeãk trntnhn jkdk npós n npjecnäãk? 8.  Aãk lxpør nk skj n îrln trntnhn ntå qul k eacbnäk, eacbnäk, vlrgljbk l / ku blgntkgn (rkxk) tlabng hlsn pnrlcehk. hlsn pnrlcehk. =