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Appendix A (information)

the Questionnaire of health of the patient and a card of external survey

the Passport a series ___________ ¹ ___________ is given out __________________________________

"______" _______________________

the Home telephone number __________ the Office number __________ Mob.

Phone _____________

Number, month, year of a birth ___________________________________________________

a work Place _________________________________________________________________

the Post ___________________________________________________________________

the Subsequent information is the extremely important that we could provide you with treatment according to your general state of health. There are you now under observation of the doctor-therapist? If yes, for what reason? ________________________________________________________________________ you Accept now any medicines? If "Yes", what? you Are treated now or treated earlier concerning following diseases:

Rheumatic disease, rheumatic lesions of heart, heart hums, congenital defects _______

the Myocardial infarction, a stenocardia, an ischemic heart disease ________________________________________

Gastroenteric diseases __________________________________________

the Raised or lowered pressure, the raised staxis, an anaemia _________

the Bronchial asthma, a tuberculosis, a pollen allergy ________________

the Cancer, radiological treatment, chemotherapy _______________________________

the Diabetes _____________________________________

G epatit, an icterus, liver diseases _______________________________

Renal and mocheispuskatelnye problems _______________________________________

the Paralysis, paresises, syncopes, losses of consciousness ____________________________________

the Arthritis __________________________________

Venereal illnesses or AIDS ___________________________________

head or neck Traumas, treatment of a mandibular joint ____________ you Applied sometime:

Penicillinum __________ Erythromycin ________ Tetracyclinum or Doxycycline _______

Biseptolum ________________

If thus there were undesirable effects in what they were shown _______________ There were at you ever allergic reactions to antibiotics, soothing and other medicines

For women: you are pregnant? __________ plan pregnancy during the nearest 2

months? _________ There are for you other problems with health? Add that consider important. It was observed at you at the previous treatment:

Allergic reactions __________ long bleedings _____________

Any complications before treatment _______________________________________

As far as I know, I have answered (accurately all questions. The signature ______________

Data of objective research. External survey _____________________________

oral cavity Survey. A condition of a teeth. Symbols: is absent - About, a root-R, caries-with, a pulpitis - R, a periodontitis - Pt, sealed up - P, a parodontosis, mobility 01.2.3 (degree), a crown - To, an artificial tooth - And
8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8

oral cavity Survey. A condition of a teeth.

the Occlusion

the Condition of a mucosa of an oral cavity, gums, alveolar processes and the sky _________________

Data of x-ray and laboratory researches __________________________________________

THE BASIC DIRECTIONS OF FULL CLINICAL SURVEY

THE HEAD, THE NECK, SOFT TISSUES ___________________________________________________________

THE OCCLUSION AND THE ESTIMATION OF THE IS TEMPORAL-MANDIBULAR JOINT ____________________________

DENSITY ________________________________________________

VOLUME OF MOVEMENTS:

MOUTH OPENING ______________ THE PROTRUSION ____________ TO THE RIGHT _________ TO THE LEFT _________

PRETIME CONTACTS ___________________________________________________________________

SOUNDS AND HUM IN THE JOINT:

CLICKS __________ KRIPITATSIJA _____________

PAINS IN THE FIELD OF VNCHS:

AT THE PALPATION _______________ AT MOUTH OPENING _______________

THE PALPATION AND PAINLESSNESS IN THE FIELD OF MASSETERS _______________________

ERASABILITY OF CHEWING SURFACES (DEGREE):

GENERALIZED _____________________ LOCALIZED _______________________

CHANGE OF POSITION OF THE TEETH _________________________________________________________

THE MUCOSA AND CONDITION PARODONTA:

THE GENERAL SURVEY ________________________________________________________________________

HYGIENE OF THE ORAL CAVITY:

IT IS GOOD _______ WELL ___________ UNSATISFACTORILY _____________

SCURF AND TOOTH ADJOURNMENT: APPRECIABLE __________ MODERATED ________ EASY ______

GENERALIZED _____________________ LOCALIZED _____________________

AREAS OF JAMMING OF NUTRITION:

OPEN CONTACTS ____________ THE DISPLACED TEETH ___________

HANGING EDGES OF SEALS ___________

MOBILITY OF THE TEETH ________________________________________ COLOUR _____________________

THE BLEEDING AT PARODONTALNOM SOUNDING:

GENERALIZED _________________ LOCALIZED _______________________

THE EXUDATE AND PURULENT DISCHARGES ____________

EDGES DESNYOVYE _________ INTERDENTAL PAPILLAS __________________________

LEVEL OF THE MOTIONLESS MUCOSA _________ ZUBO-DESNEVOGO THE POCKET _______________

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Scientific source KOVALEVA MARIA SERGEEVNA. Clinico-morphological research of a condition of tissues of a tooth at treatment of caries of a dentine with application of deep fluorination and nizkointensivnogo laser radiation. The dissertation on competition of a scientific degree of the candidate of medical sciences. Great Novgorod - & 2014. 2014

Other medical related information Appendix A (information):

  1. Chapter 7. The PROGRAM CONCEPT «CHRONIC HEPATITISES At CHILDREN And TEENAGERS»
  2. THE MAINTENANCE
  3. the Appendix № 1 Informed consent to participation in psychological research
  4. the Appendix № 3 Projective technique «the Nonexistent animal»
  5. the Appendix № 4 Projective technique «the Kinetic drawing of a family»
  6. the Appendix № 7 Technique of an estimation of uneasiness on Spilbergeru in JU.L.Khanin's adaptation
  7. the Appendix № 9 Technique of diagnostics of the parent relation to the child on Varga-Stolinu
  8. Physiological bases of transfer and integration notsitseptivnoj information
  9. APPENDIX G
  10. 1.4. Information technologies in public health services
  11. the Appendix
  12. the Appendix 4 Program of Training of development of psychological readiness for innovations
  13. the Appendix 1. A questionnaire «Structure and level of professional responsibility» (for experts of a provision of pensions of the Pension fund of the Russian Federation)
  14. the Appendix 3. The training program «Development and maintenance of professional responsibility of experts of provision of pensions PFR»
  15. the Appendix 4. The training program «Stress in work of the expert of client service. Ways of management of stress»
  16. the Appendix 6. The training program «Development and maintenance of self-efficiency of the expert of provision of pensions PFR»
  17. the Appendix 7. The training program «Effective professional interaction - a basis of professional responsibility of the expert of client service»
  18. the Appendix 8. The training program «Maintenance of professional motivation of experts of provision of pensions PFR»
  19. APPENDIX A the Individually-psychological features necessary for ecologists of different specialisations