姓名： 居住地址： 过敏史： 系统病史： 备注： 日期
现病史：
既往史：
检查：
诊断 性别： 电话： 年龄： 复诊 时间 医生 签名 缴费 情况 处理 费用 主诉：
辅助检查：
诊断
治疗方案：
处理：
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口腔门诊空白病历页
