KARTA PACJENTA
IMIE I NAZWISKOPACJENTA:…………………………………………………………
ADRES:……………………………………………………………………………………. TELEFON:…………………………………………………………………………………
RODZAJ SCHORZENIA:……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………...
ILOŚĆ ZABIEGÓW:………………………………………………………………………….
WYKONYWANE ZABIEGI:………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
TERMIN WYKONANIA ZABIEGÓW:…………………………………………………
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CZAS ZABIEGU:…………………………………………………………………………….
TECHNIKA ZABIEGU:…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
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