TASDIQLANGAN
1-ILOVA
2-ILOVA
O‘zbekiston Respublikasi IIV maxsus tibbiy komissiyasi | |||
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XULOSA | |||
Familiyasi ________________________________________________________ | |||
Ismi, sharifi ______________________________________________________ | |||
Tug‘ilgan yili va joyi ______________________________________________ ___________________________________________________________________ | |||
Kim tomondan va qachon hukm qilingan _________________________________ ___________________________________________________________________ | |||
O‘zR JK _________ moddasi Jazo muddati ____________________________________ | |||
Muddat boshlangan vaqti ___________________________ Muddatning tugash vaqti ___________________________ | |||
Shaxsiy hujjatlarning yig‘ma jildi № _______________________________ | |||
Sudlanguncha kim bo‘lib ishlagan ______________________________________ | |||
(ishlamagan bo‘lsa sababi ko‘rsatilsin) | |||
Jazo muddatini o‘tash davrida kasal bo‘lguncha kim bo‘lib ishlagan __________________________________________________________________ | |||
(ishlamagan bo‘lsa sababi ko‘rsatilsin) | |||
Hozirgi kunda saqlanayotgan (davolanayotgan) muassasaning nomi ___________ ___________________________________________________________________ | |||
Sog‘lig‘iga shikoyatlar ________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ | |||
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Hayoti davomida qanday kasalliklarga chalingan va qayerda davolangan ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ | |||
Qanday jarohatlar olgan va operatsiya bo‘lgan ___________________________ ___________________________________________________________________ ___________________________________________________________________ | |||
Asosiy kasallikning boshlanishi va kechishi, asosiy kasalliklari bo‘yicha qayerda va qancha vaqt davolangan, o‘tkazilgan davolanish muolajalari ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ | |||
Obyektiv tekshirish ma’lumotlari: | |||
1. Bo‘yi _______sm. Vazni ______kg. | |||
2. Tana terisi va shilliq pardalari holati _____________________________ ___________________________________________________________________ ___________________________________________________________________ | |||
3. Muskul va suyak tizimi, bo‘g‘inlar holati ______________________________ ___________________________________________________________________ ___________________________________________________________________ | |||
4. Nafas olish a’zolari ______________________________________________ ___________________________________________________________________ ___________________________________________________________________ | |||
5. Yurak, qon-tomir a’zolari _________________________________________ ___________________________________________________________________ ___________________________________________________________________ | |||
6. Ovqat hazm qilish a’zolari _________________________________________ ___________________________________________________________________ ___________________________________________________________________ | |||
7. Siydik yo‘llari va jinsiy a’zolar tizimi ___________________________ ___________________________________________________________________ ___________________________________________________________________ | |||
8. Asab tizimi va ruhiy holati _______________________________________ ___________________________________________________________________ ___________________________________________________________________ | |||
9. Ko‘rish holati ____________________________________________________ ___________________________________________________________________ ___________________________________________________________________ | |||
10. Quloq, tomoq va burun a’zolari h�lati ______________________________ ___________________________________________________________________ ___________________________________________________________________ | |||
11. Rentgen tekshiruvi natijalari ____________________________________ ___________________________________________________________________ ___________________________________________________________________ | |||
12. Laboratoriya tekshiruvlari natijalari _____________________________ ___________________________________________________________________ ___________________________________________________________________ | |||
Yakuniy tashxis: _____________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ | |||
O‘zbekiston Respublikasi Ichki ishlar vazirligi va O‘zbekiston Respublikasi Sog‘liqni saqlash vazirligining 2008-yil 13-avgustdagi 12 va 9-sonli hamkorlikdagi qarori bilan tasdiqlangan “Mahkumlarni kasalligi tufayli jazoni o‘tashdan ozod qilishga taqdim etish uchun asos bo‘ladigan kasalliklar Ro‘yxati”ning _______bandiga asosan mahkum_____________________________________________________________ | |||
(familiyasi, ismi, sharifi) | |||
jazo muddatini o‘tashdan ozod qilishga tavsiya etiladi. | |||
Komissiya raisi O‘zR IIV | |||
Tibbiyot boshqarmasi boshlig‘i o‘rinbosari ____________________________ | |||
(imzosi, familiyasi) | |||
Komissiya a’zolari: ________________________________________________ | |||
(lavozimi, imzosi, familiyasi) | |||
__________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ | |||
Davolovchi shifokor ________________________________________________ | |||
M.O‘. | 200____yil “____” ________________ |
3-ILOVA
O‘zbekiston Respublikasi IIV Maxsus tibbiy komissiyasi | ||||||||
Tibbiy ko‘rikdan o‘tgan mahkumlarni qayd etish | ||||||||
DAFTARI | ||||||||
Tartib soni | Bemor mahkumning familiyasi, ismi-sharifi, tug‘ilgan yili | Bemor mahkumni jo‘natgan muassasa | Bemor mahkumni kasalxonaga kelgan kuni | O‘zR JK moddasi, jazo muddati va boshlangan kuni | Bemor kasalxonaga kelgandagi tashxis | Maxsus tibbiy komissiya ko‘rigiga taqdim etilgan tashxis | Maxsus tibbiy komissiya majlisi o‘tgan kun va chiqarilgan qaror | Sud majlisi o‘tgan kun va chiqarilgan qaror |
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