1、礴历号:医疗美容医院上睑松弛整形术手术记录姓名me年彩Aie性别Sex男M女F病历号MRN手术日期Dateafopenticn手术暖师MamPbysician麻IIS医师Anaestbeaa助理医师Assistphysician洗手妒士HaDd-Wsshednunc遣回护士OndUtynurse手术日期：年月日Operationdate:Yymmdd开始时间，时分Startingtime:hourInUnite结束时间，时分Rnishingtime:hourmmitc手术名称t上峻检北整形术Sursoyon1.ooae88(tfUppereydid术1EExammationbeforeoper
2、ation1.科检杳Mjordck右眼Rigbteye单险血心eye1.id口是YeS否No*ttOrigina1.doub1.eeydid11m险线JtWid由ofdoub1.eeye1.id1.ine泪腺松塞1.ooeeDessafteardDCt口是Yes口否NO左眼1.efteye单险sing1.eeye1.id口是YeS口否NO原险OriSimddOUb1.eeyehdmmWtbofdouNeeydidbnemm量宣皮肤松弛Max.widthaodkenessofs1.dnmm疤痕Scar口是YeS口否NO宜皮肤松热Ma1.widthmd100eeaessfmm泡泉Scar口是YeS
3、否No泪腕松戛1.ooeenessafteardDct是YeS否NO异常项目，异常项目，异常项目，2血常康B1.oodroutiDe有（无）异常3 .凝血原时间Thneafthrombin有（无）异常4 .其他Othen有无）舁常手术过程OperationRecordsIJfWtIi麻（2%利多卡因含1，10万肾上索Awjgiakyaiado1.riinr1.ndig1：IQmf1.1.100arwa1.m)2切线距囹*Distancefromeye1.idtocuttmg1.ine,右rit1111n.左1.eftmm.3 .切皮肤)k处CuttingtewidestpomtCtfskin,右sbtInmf左1.eftmm.4除限轮匝IHCUaingoffCAicu1.armusdeafeye:口是YeS否No右fm11v左ftmm5 .去唯RIJR防WipiagouttheKXietOfeyeaDdfiQinfot口无NOWY右right(内，中,)左1.efi(内，中)其他，Otben6Jt合Sewing:方式MettKXi间断1.niervaK)皮内insideskin()缝畿，7-0隹线其他0(h7 .在催线的部位泳抗生素眼膏.手术者签名Signatureofdoctor8术后用药.记录者签名Signatureofrecixder医疗美容殿院
