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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