Medical card

MEDICAL KAPTA

FULL NAME ___________________________________________________________________

Date of Birth ___________________________________________________________

The address ____________________________________________________________

Mother ___________________________________________________________________

(Name, phone)

________________________________________________________________________

Father ___________________________________________________________________

(Name, phone)

________________________________________________________________________

INFORMATION ABOUT THE CONDITION OF THE CHILD

_______________________________________________________________________

HEALTH ASSESSMENT

Physical development: Weight _____ Height _____

Neuropsychic development:

Health group I II III (circle required)

Medical group for physical education:

Basic, Preparatory, Special (underline as appropriate)

Mode - general, gentle (underline the necessary)

Date of examination "" 20 Doctor (

CONTRAINDICATIONS FOR SENDING CHILDREN

1. Somatic diseases in the acute and sub-acute stages, chronic diseases in the acute stage, in the stage of decompensation.

2. Infectious and parasitic diseases, including those with damage to the eyes and skin, infestations (head lice, scabies) - in the period until the end of the isolation period.

3. The established diagnosis of "bacterial carriers of pathogens of intestinal infections, diphtheria."

4. Active tuberculosis of any localization.

5. Malignant neoplasms requiring treatment, including chemotherapy.

6. Epilepsy with ongoing seizures, including those resistant to treatment.

7. Epilepsy with drug remission less than 1 year.

8. Cachexia.

9. Mental and behavioral disorders in a state of exacerbation and (or) posing a danger to the patient and others.

10. Mental and behavioral disorders caused by the use of psychoactive substances.

11. Diabetes mellitus.

• Children should be vaccinated by age and taking into account the epidemiological situation in the territory.

• Children who were injured before leaving must have a certificate from a specialist with recommendations.

Children who do not have a medical card or have contraindications for health reasons return back with an accompanying person at their own expense.

MEDICAL OCMOTPA DATA (TO BE FILLED IN ON ARRIVAL)

DATE, OCMOTPA TIME ______________________________

PEDICULOSIS

LEATHER

MACCA BODY

COMPLAINTS:

Doctor (_________________)