1. Information about a doctor-subscriber
- First name, Surname :
- Speciality :
- Experience of work :
- Scientific degree :
2. Questions to a consultant *
3. The type of consultation *
Make up your choice
Elective
Emergency
Make up your choice
Primary
Secondary
4. Consultations are performed *
5. Demands to a consultant:(First name, surname, speciality, qualification, scientific degree)
6. Identification of the patient (nickname, conditional code) *
Make up your choice
Male
Female
- Country :
- Land, region :
- Populated area :
- No street :
11. Diagnosis (provisional, clinical, final) *
12. Complaints ( maximum detailed) at the moment when teleconsultation is performed *
13. How long has the patient been feeling sick *
14. When did the disease start. What is its beginning connected with (mechanism of trauma) *
15. How has the disease passed (periods of deterioration and improvement)
16. Was the treatment performed (if yes what kind of , where was it performed)
17. What is effectiveness of that treatment
18. What kinds of diseases has the patient suffered from earlier (angina, pneumonia, tuberculosis, dermatoses, diseases lead by sexual tracts)
19. Has the patient got any other diseases at this moment (heart diseases, diseases of liver and stomach) ; if he has then it should be pointed if he undergoes a cure (and mention what kind of treatment) *
20. Has the patient occupational hazard; if he has what kind of
21. The general state (mood, working ability, appetite, sleep, stool, urination)
22. The detailed local status *
23. The list of the medical documents and examinations *
24. The electronic data *
- the digital photograph of the place of the disease (graphic file (jpg, gif), the size of vision up to 900 for 900 picsiles, the size of a file up to 300kB)цифровая фотография места болезни )
- the electronic text ( a case record, consultant's conclusions ) or the graphic information on the paper or the other carrier (electrocardiogram, scintigram, photograph, termogram and so on) the simple planshet scanner is used ( 150-250 points per inch is allowed, graphic file (jpg, gif) or text (rft), the size of vision to 900 for 900 picsiles, the size of a file up to 200 kB)
- the digital carrier ( X-ray, tomogram, magnetic resonance image and so on 150-250points per inch is allowed, graphic file (jpg, gif) or text (rft), the size of vision to 900 for 900 picsiles, the size of a file up to 300 kB)
25. Additional information ( mention any additional peculiarities of the disease which are important )
