_____________________________________________________腹壁及四肢:腹壁形态:¨臌隆¨凹陷¨扁平,异常形态部位:¨全腹¨上腹¨下腹¨腰,妊娠纹:¨有¨无,脐位置:¨正常¨偏上¨偏下¨偏左¨偏右,脐类型:¨凸¨平¨凹¨深凹,局部脂肪堆积部位:¨上腹¨下腹¨脐周¨髂腰¨大腿外侧¨大腿内侧¨臀外侧¨臀上¨腰背部¨小腿¨上臂,挟捏厚度______cm其他:_______________________________________________________________________________辅助检查:_________________________________________________________________________________________________________________________________________________________________________________初步诊断:______________________________________________________________________________________________________________________拟行治疗方式:___________________________________________________________预约时间:______________________________________________以上内容属实。就诊者签字:________________医生签字:______________日期:______年____月____日病案续页姓名:病案号:_____________年月日时科别:
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