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医学英语阅读:英文病历

zongxujian 于2008-05-16发布 l 已有人浏览
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  A Sample of Complete History  PATIENT'S NAME: Mary Swan  CHART NUMBER: 660518  DATE OF B

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  a sample of complete history

  patient's name: mary swan

  chart number: 660518

  date of birth:10-5-1993

  sex: female

  date of admission: 10-12-2000

  date of discharge: 10-15-2000

  final discharge summary

  chief complaint:

  coughing, wheezing with difficult respirations.

  present illness:

  this is the first john hopkins hospital admission for this seven-year-old female with a history of asthma since the age of 3 who had never been hospitalized for asthma before and had been perfectly well until three days prior to admission when the patient development shortness of breath and was unresponsive to tedral or cough medicine.

  the wheezing progressed and the child was taken to john hopkins hospital emergency room where the child was given epinephrine and oxygen. she was sent home. the patient was brought back to the er three hours later was admitted.

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