Name 姓名
Sex 性别
Age 年龄
Occupation 职业
Date of birth 出生日期
Marriage (Marital status) 婚姻
Race 民族
Place of birth (Birth place) 籍贯
Identification No.(code of ID card No.) 身份证号码
Post code 邮政编码
Person to notify (Correspondent) and phone No. 联系人及电话
Source (Complainer;offerer;supplier;provider) of history 病史陈术者
Reliability of history 病史可靠程试
Medical security (Type of payment) 医疗费用
Type of admission (Patient condition) 住院类别(入院时病情)
Medical record No. 病历号
Clinic diagnosis 门诊诊断
Date of admission (admission date) 入院日期
皓歌云
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