DOM ZA PSIHIČKI BOLESNE ODRASLE OSOBE ZEMUNIK UL 1

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Ime I prezime korisnika

MIŠLJENJE LIJEČNIKA O ZDRAVSTVENOM STANJU KORISNIKA

1. IME I PREZIME (i djevojačko prezime): _____________________________________________

2. DATUM I MJESTO ROĐENJA: ___________________________________________________

3. ADRESA STANOVANJA: ________________________________________________________

PODATCI O ZDRAVSTVENOM STANJU KORISNIKA:

1. Dijagnoza/e: ___________________________________________________________________

____________________________________________________________________________________________________________________________________________________________

2. Pokretljivost korisnika:

a) potpuno pokretan b) djelomično pokretan c) nepokretan

3. Orijentiranost korisnika u prostoru i vremenu: a) u potpunosti b) djelomično c) nije orijentiran Obrazloži: ____________________________________________________________________________

4. Kontinentnost: a) kontinentan b) inkontinentan

5. Psihičko oštećenje: a) da b) ne

Ako da, navesti koje: ___________________________________________________________________

6. Zarazno oboljenje a) da b) ne

Ako da, navesti koje: ____________________________________________________________________

7. Potreba za njegom i podrškom druge osobe:

a) nije potrebna b) potrebna je– kod obavljanja osobne higijene (npr. tuširanje, pranje zubi)

- kod oblačenja i svlačenja

-kod hranjenja

Obrazložiti: ___________________________________________________________________________

8. Dijetalna prehrana: a) potrebna je b) nije potrebna

Obrazložiti: ___________________________________________________________________________

9. Trenutna medikamentozna terapija korisnika: ____________________________________________

__________________________________________________________________________________________________________________________________________________________________________

10. Razlog traženja smještaja u Dom: _____________________________________________________

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

11. Druge važne napomene po pitanju zdravstvenog stanja korisnika: _____________________________

__________________________________________________________________________________________________________________________________________________________________________

Datum i mjesto: Potpis liječnika

____________________ ____________________

Tags: bolesne odrasle, bolesne, psihički, zemunik, odrasle, osobe

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