O‘zbekiston Respublikasi
Sog‘liqni saqlash vaziri
F.G. Nazirov
2000-yil 18-oktabr
Ichki ishlar vazirligining
2000-yil 18-dekabrdagi
260-sonli buyrug‘iga
2-ilova
KELIShILGAN
O‘zbekiston Respublikasi
Bosh prokurori 2-darajali davlat adliya
maslahatchi R.X. Qodirov 2000-yil 5-dekabr
KELIShILGAN
O‘zbekiston Respublikasi Oliy sudi Raisi
U.Q. Mingboyev
2000-yil 13-dekabr
035-1-U-I shakldagi tibbiy hujjat
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Mahkumlarning tibbiy tekshiruvdan o‘tganligi haqida Maxsus tibbiy komissiya | |
| Ismi, sharifi ____________________________________________________________________________________________ | |
| Tug‘ilgan yili va joyi ___________________________________________________________________________ | |
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| Kim tomonidan va qachon hukm qilingan _______________________________________________________________ | |
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| O‘zR JK ____________________ moddasi Jazo muddati __________________________________ Muddat boshlangan vaqt _______________________ Muddatning tugash vaqti _________________ Shaxsiy hujjatlarning yig‘ma jildi__________________________________________________ Sudlanguncha kim bo‘lib ishlagan _____________________________________________________ | |
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(ishlamagan bo‘lsa sababi ko‘rsatilsin) | |
| Jazo muddatini o‘tash davrida kasal bo‘lguncha kim bo‘lib ishlagan _____________________________________________ | |
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(ishlamagan bo‘lsa sababi ko‘rsatilsin) | |
| Sog‘ligiga shikoyatlar ____________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ | |
| Anamnez | |
| Hayoti davomida qanday kasalliklarga chalingan va qayerda davolangan _________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ | |
| Qanday jarohatlar olgan va operatsiya bo‘lgan ____________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ | |
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Asosiy kasalliklarning boshlanishi va kechishi, asosiy kasalliklari bo‘yicha qayerda va qancha vaqt davolangan, o‘tkazilgan davolash muolajalari _________________________________________________________________________________ | |
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Obyektiv tekshirish ma’lumotlari | |
| 1. Bo‘yi________sm. Vazni___________kg. | |
| 2. Tana terisi va shilliq pard�si holati _______________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ | |
| 3. Muskul va suyak tizimi, bo‘g‘inlar holati _____________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ | |
| 4. Nafas olish a’zolari __________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ | |
| 5. Yurak, qon-tomir a’zolari_______________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ | |
| 6. Ovqat xazm 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 holati ____________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ | |
| 11. Rentgen tekshiruvi natijalari ___________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ | |
| 12. Laboratoriya tekshiruvlari natijalari ____________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ | |
| 13. Yakuniy tashxis ________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ | |
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O‘zbekiston Respublikasi Sog‘liqni saqlash va Ichki ishlar vazirligi tomonidan tasdiqlangan va O‘zbekiston Respublikasi Ichki ishlar vazirligining 2000-yil “18” dekabr dagi 260 —sonli buyrug‘i bilan e’lon qilingan, Mahkumlarni kasalligi tufayli jazo muddati o‘tashdan ozod qilish uchun asos bo‘ladigan Kasalliklar Ro‘yxatining ____________bandiga asosan Mahkum________________________________________________________________________ | |
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(familiyasi, ismi, sharifi) | |
| jazo muddatini o‘tashdan ozod qilishga tavsiya etilishi mumkin. | |
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_______________(F.I.Sh.) _______________(F.I.Sh.) _______________(F.I.Sh.) _______________(F.I.Sh.) 200_yil “___” __________ ___________ (F.I.Sh.) 200_yil “___”____________ |
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Tartib |
Familiyasi, ismi sharifi, tug‘ilgan yili, O‘zR JK moddasi, jazo muddati va boshlangan sana |
Bemor kasalxonaga kelgan sana va qanday tashxis bilan yuborilgan |
Bemor kasalxonada tekshirilgandan so‘ng qo‘yilgan va maxsus tibbiy komissiya ko‘rigiga taqdim etilgan tashxis, sana |
Maxsus tibbiy Komissiya majlisi o‘tgan sana va qabul qilingan qaror |
Muassasa ma’muriyati hujjatlarni sudga yuborgan sana |
Sud majlisi bo‘lgan sana, sud chiqargan qaror |
Izoh (sud ozod etgan sana, sud kunigacha yetmay vafot etgan sana, sud rad etgandai so‘ng vafot etgan sana, hujjatlari qaytadan sudga taqdim etilgan sana) tagiga chizilsin. |
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Ichki ishlar vazirligining 2000-yil
18-dekabrdagi 260-sonli
buyrug‘iga 5-ilova
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| Muassasa turining kodi _____________________ IIV,IIBB,IIB,JIEBB |
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_________________________________________ muassasa Tibbiyot bo‘limi (maxfiylik belgisi) xizmati kodi______________________________ _________________________________________ |
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| (hisobotni qabul qiluvchi idora nomi) | |
Kim tomonidan taqdim etiladi ______________ ________________________________________ |
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| (IIV.JIEBB, IIBB,IIB nomi) ________________________________________ (hisobotni yuboruvchi muassasa nomi) |
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