B Y T - B QUC PHNG

S: 14/2006/TTLT-BYT-BQP

CNG HA X HI CH NGHA VIT NAM c lp - T do - Hnh phc H Ni, ngy 20 thng 11 nm 2006

THNG T LIN TCH Hng dn vic khm sc khe thc hin ngha v qun s Thi hnh Lut Ngha v Qun s ngy 30 thng 12 nm 1981; c sa i, b sung ngy 21 thng 12 nm 1990; sa i, b sung ngy 22 thng 6 nm 1994; sa i, b sung ngy 14 thng 6 nm 2005, lin B Y t - B Quc phng hng dn khm sc khe thc hin ngha v qun s nh sau: Chng I NHNG VN CHUNG 1. Phm vi p dng v i tng iu chnh: Thng t ny hng dn vic khm sc khe, kim tra sc khe, khm phc tra sc khe, gim nh sc khe v qun l sc khe (sau y gi chung l khm sc khe thc hin ngha v qun s) cho cng dn Vit Nam trong tui c gi lm ngha v qun s (NVQS) ti ng; qun nhn d b xp trong k hoch b sung cho lc lng thng trc ca Qun i (sau y gi l qun nhn d b) v cng dn d thi tuyn sinh qun s. 2. Khm sc khe: Thc hin vi cc i tng l cng dn c gi lm NVQS v cng dn d thi tuyn sinh qun s, tin hnh ti y t qun, huyn, th x, thnh ph thuc tnh (gi chung l huyn). 3. Kim tra sc khe: Thc hin vi cc i tng l cng dn 17 tui thuc din ng k NVQS; qun nhn d b, tin hnh ti trm y t x, phng, th trn thuc huyn (gi chung l x). 4. Khm phc tra sc khe: Thc hin vi cc i tng l chin s mi nhp ng trong thng u tin, tin hnh ti qun y trung on v tng ng. 5. Gim nh sc khe: Thc hin vi cc trng hp c khiu ni, t co lin quan n sc khe cng dn lm NVQS, tin hnh ti Hi ng gim nh y khoa tnh, thnh ph trc thuc Trung ng. 6. S tuyn sc khe S tuyn sc khe l s b nh gi, phn loi sc khe vi cc cng dn c gi lm NVQS qua vic theo di, qun l sc khe ca c quan y t. 7. H s sc kho L nhng ti liu v tnh hnh sc khe (phiu sc khe NVQS v cc ti liu lin quan n sc khe) ca cng dn c gi lm NVQS ti ng, cng dn d thi tuyn sinh qun s v qun nhn d b.

2 8. Khen thng v x l vi phm a) Khen thng: Mi t chc, c nhn c thnh tch xut sc trong khm sc khe thc hin NVQS u c khen thng theo quy nh ca Lut Thi ua khen thng v cc vn bn hng dn thi hnh Lut. b) X l vi phm: T chc, c nhn vi phm cc quy nh ca Thng t ny, ty theo tnh cht, mc vi phm m x l k lut, x pht hnh chnh hoc truy cu trch nhim hnh s theo quy nh ca php lut. Chng II CHC NNG, NHIM VCA C QUAN Y T CC CP TRONG KHM SC KHE THC HIN NGHA V QUN S Mc 1 TRM Y TX 1. Lp h s sc khe cho cng dn 17 tui thuc din ng k NVQS; qun nhn d b sau khi c kim tra sc khe. Qun l, theo di tnh hnh sc khe cng dn (thuc din qun l) trong tui lm NVQS, pht hin kp thi nhng trng hp mc bnh mn tnh, c bit l cc bnh thuc danh mc c tm min lm NVQS. 2. Phi hp vi Ban Ch huy qun s (CHQS) x t chc s tuyn sc khe cho cng dn c gi lm NVQS, lp danh sch cng dn tiu chun sc khe lm NVQS sau khi s tuyn. 3. Xc nhn v chu trch nhim v tin s bnh tt ca cng dn c gi lm NVQS. Khi a cng dn i khm sc khe, mang theo h s sc khe v phiu sc khe NVQS bn giao cho Hi ng khm sc khe NVQS. 4. Phi hp vi Ban CHQS x lp danh sch nhng cng dn mc cc bnh trong danh mc tm min lm NVQS, thng qua Hi ng NVQS x v bo co y t huyn. 5. Xc nhn vo h s sc khe v tin s bnh tt bn thn v gia nh ca cc cng dn d thi tuyn sinh qun s. 6. Thc hin s kt, tng kt, rt kinh nghim v cng tc qun l sc khe cho cng dn c gi lm NVQS v qun nhn d b sau mi t tuyn chn v gi cng dn nhp ng. Mc 2 PHNG Y THUYN 1. Ra quyt nh (hoc u quyn cho U ban nhn dn x) thnh lp t kim tra sc khe NVQS. 2. Tip nhn, hon chnh phiu sc khe NVQS ca cc cng dn c gi lm NVQS do Hi ng NVQS x chuyn ln. 3. Ch tr, phi hp vi Ban CHQS huyn lp k hoch lin ngnh khm sc khe NVQS v ch o cc c s y t thuc quyn tham gia cng tc khm sc khe cho cng dn c gi lm NVQS.

3 4. T chc Hi ng khm sc khe NVQS, trin khai cc t kim tra sc khe theo k hoch ca Hi ng NVQS huyn; ngh U ban nhn dn huyn xt duyt v ra quyt nh thnh lp Hi ng khm sc khe NVQS, bo co S Y t tnh. 5. T chc tp hun, bi dng v chuyn mn, nghip v cho cn b, nhn vin y t lm nhim v khm sc khe v kim tra sc khe NVQS. 6. T chc v ch o cng tc kim tra sc khe cho qun nhn d b theo quy nh 2 nm/mt ln. 7. Kin ngh vi S Y t tnh tng cng cc bc s chuyn khoa cho Hi ng khm sc khe NVQS ca huyn khi c nhu cu. 8. Hip ng vi cc c quan lin quan ca huyn (qun s, cng an, vn x, thng tin) bo m tt cho vic khm sc khe NVQS. 9. Tham gia hp Hi ng NVQS huyn xt duyt danh sch cng dn khng sc khe thuc din tm min lm NVQS. 10. Phi hp vi Ban CHQS huyn bn giao h s sc khe ca cng dn c gi nhp ng cho cc n v nhn qun bo m chu o, kp thi. 11. Lp d tr v tng hp thanh ton kinh ph phc v cho cng tc khm sc khe thc hin NVQS. 12. Phi hp vi Ban CHQS huyn t chc, trin khai cng tc khm sc khe cho cng dn d thi tuyn sinh qun s. 13. Ch tr v phi hp vi Ban CHQS huyn t chc gii quyt cc khiu ni, t co ca cng dn lin quan n vic khm sc khe NVQS v tuyn sinh qun s. 14. Bo co S Y t tnh v kt qu cng tc khm sc khe NVQS theo quy nh (mu s 2a; mu s 4; mu s 5 ph lc 4 Thng t ny). 15. T chc s kt, tng kt, rt kinh nghim v cng tc khm sc khe cho cng dn lm NVQS sau mi t tuyn chn v gi cng dn nhp ng. Mc 3 S Y T TNH 1. Nghin cu, qun trit v ch o cc c s y t thuc quyn thc hin nghim cc vn bn php quy ca Nh nc,Chnh ph v cc quy nh hinhnh ca U ban nhn dn tnh, hng dn ca B Y t - B Quc phng v cng tc y t trong thc hin Lut NVQS. 2. Cng vi B CHQS tnh tham mu cho Hi ng NVQS tnh lp k hoch, ch o, hng dn v gip y t huyn t chc, trin khai cng tc khm sc khe thc hin NVQS v tuyn sinh qun s. 3. C cc bc s chuyn khoa tng cng cho Hi ng khm sc khe NVQS ca cc huyn theo yu cu.

4 4. Ch o Trung tm y t d phng hoc Trung tm phng chng HIV/AIDS cp tnh trin khai vic xt nghim sng lc HIV, ma tu v cc xt nghim cn thit khc cho cng dn thuc din c gi lm NVQS theo ng quy nh ca php lut. 5. T chc kim tra, gim st vic khm sc khe NVQS ti cc a phng trong tnh. 6. Phi hp vi B CHQS tnh t chc, hip ng v y t vi cc n v nhn qun v vic giao, nhn qun. 7. Xem xt v gii quyt nhng vng mc, khiu ni, t co v cng tc khm sc khe thc hin NVQS v tuyn sinh qun s. 8. Bo co B Y t v kt qu cng tc khm sc khe thc hin NVQS theo quy nh (mu s 2b, ph lc 4 Thng t ny). 9. Thc hin s kt, tng kt, rt kinh nghim v cng tc khm sc khe thc hin NVQS sau mi t tuyn chn v gi cng dn nhp ng. Chng III CHC NNG, NHIM V CA C QUAN QUN S CC CP TRONG KHM SC KHE THC HIN NGHA V QUN S Mc 1 BAN CH HUY QUN S X 1. Ch tr, phi hp vi Trm Y t x t chc s tuyn, phn loi s b sc khe; lp danh sch nhng cng dn thuc din c gi lm NVQS, cng dn thuc din tm min lm NVQS thng qua Hi ng NVQS x v bo co ln trn theo quy nh. Hon chnh phn th tc hnh chnh phiu sc kho NVQS. 2. Kim tra, n c cng dn thuc din c gi lm NVQS i khm sc khe, kim tra sc khe theo k hoch ca Hi ng NVQS huyn. 3. Thng bo kt qu khm sc khe theo kt lun ca Hi ng khm sc khe NVQS huyn. Thu thp nhng kin thc mc v khm sc khe v kt lun sc khe bo co ln Ban CHQS huyn v Hi ng NVQS huyn. Mc 2 BAN CH HUY QUN S HUYN 1. Phi hp vi Phng Y t huyn lp k hoch khm sc khe cho cng dn thuc din c gi lm NVQS, cng dn d thi tuyn sinh qun s; k hoch kim tra sc khe i vi cng dn 17 tui ng k NVQS ln u v qun nhn d b theo k hoch ca Hi ng NVQS huyn. 2. Triu tp cc cng dn thuc din c gi lm NVQS v d thi tuyn sinh qun s i khm sc khe hoc kim tra sc khe theo k hoch ca huyn. 3. C cn b tham gia Hi ng khm sc khe NVQS huyn hoc t kim tra sc khe theo di s lng, cht lng sc khe ca cng dn cc a phng n khm. Phi hp vi cng an huyn bo m an ton khu vc khm sc khe.

5 4. Qun l phiu sc khe NVQS do Hi ng khm sc khe NVQS huyn bn giao. Thi hn lu tr cho n khi cng dn ht tui d b 2 hoc theo thi hiu Lut Khiu ni, t co hin hnh. 5. Ch tr, phi hp vi Phng Y t huyn v cc c quan chc nng khc t chc bn giao cng dn c gi nhp ng cho cc n v nhn qun; tip nhn nhng trng hp tr v a phng do khng sc khe lm NVQS theo thng bo v hip ng ca n v nhn qun. 6. Phi hp vi Phng Y t huyn v cc n v, c quan chc nng ca huyn gii quyt cc khiu ni, t co lin quan n vic khm sc khe thc hin NVQS v tuyn sinh qun s. 7. Tng hp, bo co kt qu cng tc tuyn qun v B CHQS tnh sau mi t tuyn chn v gi cng dn nhp ng (mu s 6, ph lc 4 Thng t ny). Mc 3 B CH HUY QUN S TNH 1. Ch o vic trin khai cng tc khm sc khe thc hin NVQS theo k hoch ca Hi ng NVQS tnh. 2. Phi hp vi S Y t tnh t chc, trin khai n c c quan qun s v Phng Y t huyn thc hin vic kim tra sc khe, khm sc khe v cc ni dung khc ca vic khm sc khe thc hin NVQS. 3. T chc hip ng vi tng n v nhn qun v tiu chun sc khe, s lng, thi gian, a im v phng thc giao nhn qun. 4. Ch o vic khm sc khe cho cng dn d thi tuyn sinh. 5. Phi hp vi S Y t tnh xem xt gii quyt nhng vng mc, khiu ni, t co v cng tc khm sc khe thc hin NVQS v tuyn sinh qun s. 6. Tng hp, bo co kt qu cng tc tuyn chn v gi cng dn nhp ng, tuyn sinh qun sln qun khu theo quy nh. Chng IV CHC NNG, NHIM V CA QUN Y CC CP TRONG KHM SC KHE THC HIN NGHA V QUN S Mc 1 QUN Y BAN CH HUY QUN S HUYN 1. Ch ng nm k hoch khm sc khe thc hin NVQS, tuyn sinh qun s hng nm ca a phng mnh, phi hp vi c quan y t huyn theo di cng tc khm sc khe, kim tra sc khe cng dn lm NVQS v tham gia Hi ng khm sc khe NVQS huyn. 2. Phi hp vi qun lc Ban CHQS huyn nm vng h s sc khe cc cng dn lm NVQS ca tng a phng c Hi ng khm sc khe NVQS kt lun cung cp cho Hi ng NVQS huyn pht lnh gi nhp ng.

6 3. Gip v phi hp vi qun y cc n v n nhn qun thm nhp pht hin nhng trng hp c nghi vn v sc khe, cn kim tra xc minh trc khi bn giao cho cc n v. 4. Phi hp vi cc c quan chc nng nm tnh hnh khm sc khe tuyn sinh qun s. 5. Tng hp, bo co kt qu cng tc khm sc khe thc hin NVQS v Ban Qun y tnh sau mi t tuyn chn v gi cng dn nhp ng. Mc 2 QUN Y B CH HUY QUN S TNH 1. Ch nhim qun y B CHQS tnh c trch nhim lm tham mu cho B CHQS tnh v cc ni dung cng tc khm sc khe thc hin NVQS. 2. Vi chc nng l Ph trng ban qun - dn y tnh, Ch nhim qun y B CHQS tnh lm tham mu cho Gim c S Y t tnh trong cng tc ch o, t chc phi hp gia cc c quan y t, qun s v qun y n v n nhn qun thc hin cng tc qun l sc khe, khm sc khe cng dn lm NVQS v cng tc giao, nhn qun. 3. Phi hp vi S Y t tnh xem xt v gii quyt nhng vng mc, khiu ni, t co v cng tc khm sc khe thc hin NVQS v tuyn sinh qun s. 4. Bo co kt qu cng tc khm sc khe thc hin NVQS v Phng Qun y qun khu theo quy nh. Mc 3 QUN Y QUN KHU 1. Ch nhim qun y Qun khu c trch nhim lm tham mu cho ng u, B T lnh Qun khu trong cng tc ch o khm sc khe thc hin NVQS theo k hoch hng nm ca B Quc phng v ch o cng tc qun l sc khe qun nhn d b sn sng p ng yu cu ng vin khi c lnh. 2. Ch o Ban qun y cc tnh trong cng tc khm sc khe, kim tra sc khe v gim nh sc khe thc hin NVQS. 3. Vi chc nng l Ph trng ban qun - dn y qun khu phi hp vi cc S Y t ch o cng tc khm sc khe thc hin NVQS. 4. i vi cc khu vc kh khn v lc lng y t, Ch nhim qun y Qun khu c th iu ng cn b nhn vin qun y ca Qun khu tham gia Hi ng khm sc kho NVQS theo ngh ca S Y t, Ban qun - dn y cc tnh. 5. Bo co kt qu cng tc khm sc khe thc hin NVQS v Cc Qun y sau mi t tuyn chn v gi cng dn nhp ng. Mc 4 CC QUN Y 1. Cn c vo s lng cng dn gi nhp ng trong nm do Chnh ph quyt nh, Cc Qun y phi hp vi cc c quan chc nng thuc B Quc

7 phng tham mu cho B Quc phng v vic quy nh tiu chun sc khe cng dn nhp ng cho tng khu vc, cc qun chng, binh chng v hng dn, ch o qun y cc n v trin khai thc hin. 2. Hng nm, cn c vo yu cu xy dng qun i, Cc Qun y phi hp vi cc c quan chc nng lm tham mu cho B Quc phng ban hnh tiu chun sc khe trong tuyn sinh qun s v hng dn, ch o qun y cc n v thc hin. 3. Ch o qun y cc n v nhn qun trin khai k hoch thm nhp nm tnh hnh sc khe ca cng dn c gi nhp ng ni nhn qun, t chc khm phc tra sc khe chin s mi theo k hoch c ph duyt. 4. Ch o, t chc kim tra cng tc khm sc khe thc hin NVQS v giao, nhn qun cc a bn trng im. 5. Bo co kt qu cng tc khm sc khe thc hin NVQS, tuyn sinh qun sln trn theo quy nh. Chng V T CHC KIM TRA SC KHE, KHM SC KHE, KHM PHC TRA SC KHE, GIM NH SC KHE THC HIN NGHA V QUN S Mc 1 T CHC KIM TRA SC KHE 1. T kim tra sc khe NVQS a) T kim tra sc khe NVQS do Phng Y t huyn (hoc u quyn cho U ban nhn dn x) thnh lp trn c s lc lng y t x, khi cn thit c th c tng cng thm lc lng ca y t huyn. T kim tra sc khe gm t nht 3 ngi: 01 bc s (hoc y s) lm t trng v 02 nhn vin y t khc. b) Chc nng, nhim v: Kim tra sc khe, lp h s sc khe cho cc cng dn ng k lm NVQS ln u; kim tra sc khe cho qun nhn d b 2 nm/mt ln. 2. Ni dung kim tra sc khe (mu s 2 ph lc 2 Thng t ny) a) Kim tra v th lc. b) Pht hin nhng vn lin quan n sc khe, tin s bnh tt bn thn v gia nh. c) Phn loi s b tnh hnh sc khe. Mc 2 T CHC KHM SC KHE 1. Hi ng khm sc khe NVQS a) Hi ng khm sc khe NVQS do Phng Y t huyn ngh, Ch tch U ban nhn dn huyn ra quyt nh thnh lp. Hi ng l t chc hot ng

8 kim nhim. Ty theo a bn, s lng cn b y t c bin ch, s cng dn cn khm m mi huyn t chc mt hoc hai Hi ng khm sc khe NVQS. b) Thnh phn Hi ng khm sc khe NVQS - Hi ng khm sc kho NVQS c t 3-5 bc s; trong c 1 ch tch, 1 ph ch tch v 1 u vin thng trc kim th k hi ng. Hi ng phi c ti thiu 01 bc s ni khoa v 01 bc s ngoi khoa. - Hi ng khm sc khe c trng dng mt s cn b, nhn vin y t khc trin khai vic khm sc khe NVQS. S lng cn b, nhn vin y t tham gia khm sc khe cn c vo nhu cu thc t quyt nh, nhng phi trin khai c v cht lng cc phng khm theo cc ni dung quy nh ti khon 3, khon 4 Mc 2 Chng V Thng t ny. c) Chc nng, nhim v ca Hi ng khm sc khe NVQS Hi ng khm sc khe NVQS chu trch nhim trc Hi ng NVQS huyn v vic trin khai khm sc khe, kim tra sc khe, phn loi v kt lun sc khe cho tng cng dn c gi lm NVQS. d) Nguyn tc lm vic ca Hi ng khm sc khe NVQS - Hi ng lm vic theo nguyn tc tp th, quyt nh theo a s nhm bo m khch quan trong nh gi cht lng khm, phn loi sc khe v kt lun sc khe cho cc cng dn c gi lm NVQS. - Trng hp trong Hi ng khng thng nht v phn loi v kt lun sc khe th Ch tch Hi ng ghi vo phiu sc khe kt lun ca a s. Nhng kin khng thng nht phi c ghi y vo bin bn, gi ln Hi ng NVQS huyn. Bin bn phi c ch k ca tng u vin trong Hi ng khm sc khe. 2. Nhim v c th ca cc thnh vin trong Hi ng khm sc khe NVQS a) Ch tch Hi ng: - iu hnh v chu trch nhim v ton b hot ng ca Hi ng; - Lp k hoch, t chc trin khai cng tc khm sc khe NVQS, chu trch nhim v cht lng khm sc khe trc Hi ng NVQS huyn; - T chc tp hun, hng dn, qun trit cho cn b, nhn vin trong on khm sc khe v tiu chun sc khe, chc trch, nhim v, nguyn tc lm vic trc mi t khm sc khe NVQS; - Triu tp v ch tr hp Hi ng kt lun trong nhng trng hp c kin khng thng nht v kt lun sc khe ca cng dn c gi lm NVQS; - T chc hi chn v k giy gii thiu cho cng dn khm sc khe NVQS i kim tra cc c s y t khi cn thit; - T chc rt kinh nghim cng tc khm sc khe NVQS v lm bo co vi Phng Y t huyn sau mi t khm. b) Ph ch tch Hi ng:

9 L ngi thay th Ch tch khi vng mt v gip Ch tch lm mt s vic nh sau: - Lp d tr, tng hp v quyt ton kinh ph, thuc, vt t tiu hao phc v cho cng tc khm sc khe NVQS vi Phng Y t huyn; - Trc tip khm sc khe, tham gia hi chn khi cn thit; - Tham gia hp Hi ng khm sc khe NVQS theo quy nh. c) U vin thng trc kim th k Hi ng: - Chun b phng tin, c s vt cht, h s sc khe v cc ti liu cn thit khc Hi ng khm sc khe NVQS lm vic; - T chc ng k, thng k v lm bo co ln Phng Y t v Hi ng NVQS huyn theo quy nh (mu s 1; mu s 7 ph lc 4 Thng t ny). d) Cc u vin Hi ng: - Trc tip khm sc khe v tham gia hi chn khi cn thit; - Chu trch nhim v cht lng khm v kt lun sc khe trong phm vi c phn cng; - Tham gia hp Hi ng khm sc khe NVQS theo quy nh. 3. Ni dung khm sc kho a) Khm v th lc. b) Khm ton din cc chuyn khoa, lm sng v cn lm sng theo cc ch tiu quy nh ti Phn II, mu s 1 ph lc 2 (Phiu sc kho NVQS) Thng t ny. c) Phn loi sc kho theo quy nh ti Mc 2, Chng VI Thng t ny. d) Xt nghim sng lc HIV, ma tu v cc xt nghim khc theo quy nh ca Php lut. 4. T chc cc phng khm sc khe a) B tr cc phng khm phi theo nguyn tc mt chiu, khp kn, thun li cho ngi khm v m bo iu kin ti thiu khm i vi tng chuyn khoa. b) S lng cc phng khm cn c vo s lng nhn vin y t ca Hi ng khm sc khe v tnh hnh thc t b tr, cn c: - Phng khm th lc; - Phng khm th lc, thnh lc; - Phng khm chuyn khoa (Tai - mi - hng; Mt; Rng - hm - mt); - Phng khm ni v tm thn kinh; - Phng khm ngoi khoa, da liu;

10 - Phng xt nghim ( iu kin xt nghim theo cc ni dung khm sc kho quy nh ti im d, Khon 3, Mc 2, Chng V ca Thng t ny); - Phng kt lun. Mc 3 T CHC KHM PHC TRA SC KHE 1. Hi ng khm phc tra sc khe a) Hi ng khm phc tra sc khe chin s mi c t chc t cp trung on v tng ng tr ln do Ch nhim qun y trung on ngh, Th trng n v ra quyt nh thnh lp. Hi ng l t chc hot ng kim nhim. b) Thnh phn Hi ng khm phc tra sc khe gm cc cn b, nhn vin qun y ca trung on v tng ng tr ln. Khi cn thit, Hi ng c tng cng thm lc lng chuyn mn ca qun y tuyn trn. c) Chc nng, nhim v: Hi ng khm phc tra sc khe chu trch nhim trc Th trng n v v vic trin khai khm, phn loi v kt lun li sc khe cho ton b chin s mi theo k hoch c ph duyt. 2. Ni dung khm phc tra sc khe, t chc khm phc tra sc khe Thc hin nh khm sc khe NVQS quy nh ti khon 3, khon 4 Mc 2 Chng V Thng t ny. Mc 4 T CHC GIM NH SC KHE NGHA V QUN S 1. Gim nh sc khe NVQS do Hi ng gim nh y khoa cp tnh thc hin khi c cc khiu ni, t co n sc khe ca cng dn trong din c gi lm NVQS do Hi ng NVQS huyn yu cu. 2. Vic gim nh sc khe cn c vo tiu chun sc khe quy nh ti Bng s 1, Bng s 2, Bng s 3 ph lc 1 Thng t ny. 3. Thi gian tr li yu cu ca Hi ng NVQS huyn trong vng 7-10 ngy, k t ngy nhn c yu cu gim nh sc khe. 4. Quyt nh ca Hi ng gim nh y khoa tnh l kt lun cui cng v khiu ni sc khe ca cng dn lm NVQS. Mc 5 TRCH NHIM CA CNG DN TRONG VIC KIM TRA SC KHE, KHM SC KHE THC HIN NGHA V QUN S Nhng cng dn n khm sc khe, kim tra sc khe phi tun th y cc nguyn tc, th tc sau: 1. Phi xut trnh: a) Giy triu tp i khm sc khe hoc kim tra sc khe ca Ban CHQS huyn;

11 b) Giy chng minh nhn dn. 2. Mang theo cc giy t lin quan n sc khe c nhn (nu c) giao cho Hi ng khm sc khe hoc t kim tra sc khe. 3. Khng c ung ru, bia hoc dng cht kch thch trc khi khm sc khe hoc kim tra sc khe. 4. Chp hnh nghim tc ni quy khu vc khm sc khe, kim tra sc khe. Chng VI PHIU SC KHE NGHA V QUN S, PHN LOI SC KHE THC HIN NGHA V QUN S Mc 1 PHIU SC KHE NGHA V QUN S 1. Phiu sc khe NVQS l ti liu y khoa tng hp nhng thng tin c bn v sc khe ca cng dn, l c s tuyn chn cng dn c sc khe thc hin NVQS v d thi tuyn sinh qun s. Phiu sc khe NVQS c s dngthng nht trn ton quc, theo mu in trn giy trng kh 19 x 24cm (mu s 1ph lc 2 Thng t ny), phiu gm 2 phn: a) Phn I- S yu l lch: Do c quan qun s x ghi. b) Phn II- Khm sc kho: Do Hi ng khm sc khe NVQS huyn ghi. 2. Phiu sc khe NVQS do Hi ng NVQS x lp v phi hon thnh xong phn s yu l lch (phn I), sau bn giao cho Hi ng NVQS huyn. 3. Qun l phiu sc khe NVQS a) Khi cha nhp ng, phiu sc khe NVQS do Ban CHQS huyn qun l. b) Khi cng dn nhp ng, phiu sc khe NVQS c giao cho n v nhn qun. c) Trong qu trnh ti ng, phiu sc khe NVQS do qun y tiu on v tng ng qun l. d) Ra qun, np li Ban CHQS huyn qun l. 4. Phiu sc khe NVQS ch c gi tr khi: a) Theo ng mu qui nh; b) Vit bng bt mc hoc bt bi, khng c vit bng bt ch; c) Ch vit r rng, khng ty xo, khng vit tt, khng vit ngoy; d) Ghi y cc ni dung trong phiu sc khe NVQS; ) Kt lun ca Hi ng khm sc khe NVQS c gi tr trong 06 (su) thng k t ngy khm, nu khng c nhng din bin c bit v sc khe. Mc 2 PHN LOI SC KHE THC HIN NGHA V QUN S 1. Cn c phn loi sc khe

12 Phn loi sc khe thc hin NVQS cn c vo tiu chun sc khe quy nh ti Bng s 1, Bng s 2, Bng s 3 ph lc 1 Thng t ny. 2. Cch cho im Mi ch tiu, sau khi khm bc s cho im chn t 1 - 6 vo ct im a) im 1: Ch tnh trng sc khe rt tt. b) im 2: Ch tnh trng sc khe tt. c) im 3: Ch tnh trng sc khe kh. d) im 4: Ch tnh trng sc khe trung bnh. ) im 5: Ch tnh trng sc khe km. e) im 6: Ch tnh trng sc khe rt km. 3. Cch ghi phiu sc khe NVQS a) Mi chuyn khoa, sau khi khm xt, bc s s cho im vo ct "im"; ct "l do" phi ghi tm tt v l do g m cho s im ; ct "k" bc s no khm th phi k v ghi r h tn. b) Phn kt lun, Ch tch Hi ng khm sc khe v cc u vin ca Hi ng cn c vo im cho tng ch tiu kt lun, phn loi sc khe theo ng quy nh ( hng dn trn) ghi bng s v ch trong ngoc n. c) Ch tch, Ph ch tch v U vin thng trc Hi ng c trch nhim k vo phiu sc khe NVQS sau khi c Hi ng khm sc khe kt lun. d) Ch k ca Ch tch Hi ng khm sc khe phi c ng du ca c quan y t huyn. 4. Cch phn loi sc khe Cch phn loi sc khe c da vo s im chm cho 8 ch tiu ghi trong phiu sc khe NVQS a) Loi 1: 8 ch tiu u t im 1, c th phc v hu ht cc qun, binh chng. b) Loi 2: C t nht 1 ch tiu b im 2, c th phc v trong trong phn ln cc qun, binh chng. c) Loi 3: C t nht 1 ch tiu b im 3, c th phc v mt s qun, binh chng. d) Loi 4: C t nht 1 ch tiu b im 4, c th phc v hn ch mt s qun, binh chng. ) Loi 5: C t nht 1 ch tiu b im 5, c th lm mt s cng vic hnh chnh s v khi c lnh tng ng vin. e) Loi 6: C t nht 1 ch tiu b im 6, l loi sc khe tm min lm NVQS. 5. Mt s im cn ch

13 a) Khi ang mc bnh cp tnh, bnh c th thuyn gim hay tng ln sau mt thi gian hoc sau iu tr, th im phi km theo ch T bn cnh (ngha l tm thi). Ngi khm phi ghi tm tt bng ting Vit tn bnh bn cnh (c th ghi bng danh t quc t gia hai ngoc n). Khi kt lun, nu ch T im ln nht th cng phi vit ch T vo phn loi sc khe. b) Trng hp nghi ng cha th cho im ngay c, Hi ng khm sc khe c th gi cng dn ti khm ti mt bnh vin xc nh. c) Nu vn cha kt lun c th gi cng dn n bnh vin c chuyn khoa su gn nht khm vi tnh cht l ngoi chn v gim nh sc khe.Thi gian ti a t 7-10 ngy phi c kt lun v ch thc hin trong trng hp tht cn thit. 6. Xt li nhng trng hp phiu sc khe c ghi ch "T a) Cc phiu sc khe NVQS c ghi ch "T" th ngay sau khi khm sc khe, Trm y t x cn phi tin hnh mt t iu tr hoc gi cng dn ti bnh vin iu tr (nu cn thit). b) Sau mt thng, Hi ng khm sc khe NVQS phi tin hnh kim tra v kt lun li: - Nu bnh khi th b ch "T" v chuyn loi sc khe; - Nu khng khi hoc c chiu hng tin trin xu, cn phi xt li v c kt lun hoc khng sc khe gi nhp ng. c) Khng cng dn c tnh trng sc khe m trong phiu sc khe NVQS c ghi ch "T" bn giao cho Qun i. Chng VII GIAO, NHN PHIU SC KHE NGHA V QUN S CA CNG DN NHP NG, QUN L SC KHE QUN NHN D B Mc 1 GIAO, NHN PHIU SC KHE NGHA V QUN S CA CNG DN NHP NG 1. Trc khi Hi ng NVQS huyn pht lnh gi cng dn nhp ng, c quan y t huyn phi hon thnh vic lp danh sch nhng cng dn sc khe theo quy nh, hon chnh phiu sc khe NVQS v bn giao cho Ban CHQS huyn. C quan y t a phng chu trch nhim v kt lun sc khe ca cng dn khi giao cho cc n v qun i. 2. Ban CHQS huyn bn giao phiu sc khe NVQS ca cc cng dn c gi nhp ng cho qun y n v nhn qun t cp trung on v tng ng tr ln. Cng tc ny phi tin hnh nghim tc, ng tiu chun sc khe quy nh. 3. Qun y n v nhn qun phi c mt ti a phng nhn qun trc ngy giao qun t nht l 20 ngy nhn v xem xt cc phiu sc khe NVQS (s lng h s sc khe ca cng dn tiu chun sc khe nhn ca y t a

14 phng xem xt nghin cu trc khng qu 120% ch tiu s nhn). Phi hp cng Ban CHQS huyn thm nhp, pht hin cc trng hp c nghi vn v sc khe, ch khai thc tin s cc bnh l mn tnh. Nu pht hin c nghi vn v sc khe, phi thng bo ngay cho Hi ng NVQS huyn kim tra v kt lun li. Khi khng thng nht c v kt lun phn loi sc khe ca cngdn lm NVQS gia n v nhn qun v Hi ng NVQS huyn, phi bo co ln Hi ng NVQS tnh t chc gim nh sc khe. Trong thi im giao, nhn qun, qun y n v nhn qun c th t chc kim tra li mt s trng hp nghi ng, nu thy cn thit, khng khm trn lan. 4. Trong vng mt thng, k t ngy nhn qun, n v nhn qun phi t chc khm phc tra sc khe cho chin s mi phn loi, kt lun li sc khe, pht hin nhng trng hp khng sc khe tr v a phng v c trch nhim thng bo cho Ban CHQS huyn bit: a) S cng dn tiu chun sc khe theo quy nh; b) S cng dn khng tiu chun sc khe theo quy nh cn tr v a phng (do sai st trong qu trnh khm cha tm ra bnh hoc bnh mi pht sinh trong qu trnh hun luyn chin s mi). 5. Quy nh v vic tr li nhng cng dn khng tiu chun sc khe v a phng a) Nhng cng dn khng tiu chun sc khe tr v a phng khi kt qu khm phc tra sc khe c Ch nhim qun y cp trung on v tng ng tr ln xc nh v cp trn trc tip ph duyt. b) Bn giao cng dn khng tiu chun sc khe tr v a phng - Phi c h s v sc khe gm: Phiu sc kho NVQS ca Hi ng khm sc khe NVQS a phng; kt qu khm phc tra sc khe ca Hi ng khm phc tra sc khe n v. - n v nhn qun phi a cng dn khng tiu chun sc khe nhp ng v bn giao ti c quan qun s huyn, ni n v nhn qun. c) Thi hn tr v a phng trong vng 01 (mt) thng k t ngy giao nhn qun. d) Y t a phng c th t chc kim tra li nu thy cn thit (thi hn t 7-10 ngy, k t khi cng dn c bn giao tr li a phng). Khi khng thng nht vi kt lun ca Hi ng khm phc tra sc khe ca n v, Hi ng NVQS huyn c th chuyn h s ca cng dn ln Hi ng NVQS tnh t chc gim nh sc khe. Mc 2 QUN L SC KHE QUN NHN D B 1. Mi qun nhn trc khi tr v a phng (xut ng, phc vin, chuyn ngnh), qun y n v c trch nhim t chc khm, phn loi sc khe, ghi vo phiu sc khe qun nhn. Khi v a phng, qun nhn cn trong tui d b phi np h s sc khe ca mnh cho c quan qun s huyn qun l.

15 2. Qun nhn d b hai nm c kim tra sc khe mt ln. Nhng qun nhn d b cn sc khe theo tiu chun th vn b tr cc n v bin ch. Trng hp khng tiu chun sc khe th Phng Y t huyn thng bo vi n v qun l a ra khi danh sch bin ch. 3. Trong cc t hun luyn v tp trung kim tra sn sng chin u qun d b, qun y n v ng vin c trch nhim theo di cht ch v mt sc khe ca qun nhn d b. 4. Khi c lnh ng vin, c quan qun s huyn c trch nhim giao ton b h s sc khe ca qun nhn d b cho n v tip nhn qun nhn d b qun l. Chng VIII T CHC THC HIN 1. B Quc phng a) Cn c vo s lng cng dn nhp ng trong nm ca Chnh ph v yu cu xy dng Qun i ban hnh quy nh c th v tiu chun sc khe cng dn gi nhp ng thc hin cho tng khu vc, tng qun chng, binh chng. b) C quan qun s cc cp c trch nhim phi hp vi c quan y t a phng trong vic lp k hoch v trin khai thc hin khm sc khe, kim tra sc khe cng dn c gi lm NVQS, cng dn d thi tuyn sinh qun s theo ng quy nh. c) Cc c quan chc nng thuc B Quc phng c trch nhim hng dn, ch o cc n v trong ton qun trin khai thc hin k hoch khm sc khe, kim tra sc khe thc hin NVQS v tuyn sinh qun s hng nm. d) Cc n v nhn qun c trch nhim phi hp vi c quan qun s cc cp v c quan y t a phng thc hin vic giao, nhn phiu sc khe NVQS i vi cng dn c gi nhp ng theo ng quy nh. 2. B Y t a) Ch o c quan y t cc cp qun trit, t chc thc hin nghim cc quy nh, hng dn hng nm ca Chnh ph, cc B, ngnh lin quan v cng tc khm sc khe thc hin NVQS. b)C quan y t cc cp c trch nhim: - Phi hp vi c quan qun s a phng trong vic lp k hoch khm sc khe thc hin NVQS v t chc trin khai thc hin theo ng quy nh; - Phi hp vi qun y n v nhn qun trong vic giao, nhn h s sc khe i vi cng dn c gi nhp ng theo ng quy nh. 3. Ch bo co, thng k Sau mi t khm sc khe thc hin NVQS, c quan y t tng hp kt qu bo co ln cp trn cho n B Y t; c quan qun y cc cp bo co theo ngnh

16 dc v Cc Qun y; cc n v qun i bo co theo quy nh ca B Quc phng. 4. Kinh ph Kinh ph bo m cho vic khm sc khe, kim tra sc khe, gim nh sc khe, xt nghim sng lc HIV, ma tu v cc xt nghim khc theo quy nh ca php lut thc hin NVQS v tuyn sinh qun s s dng t ngn sch a phng theo quy nh hin hnh. Chng IX HIU LC THI HNH Thng t ny c hiu lc thi hnh sau 15 ngy k t ngy ng cng bo v thay th cc Thng t lin B Y t - Quc phng s 13/TTLB ngy 13 thng 10 nm 1992 quy nh vic khm sc kho, kim tra sc kho, tiu chun sc kho v gim nh sc kho thc hin Lut NVQS; Thng t lin B Y t - Quc phng s 14/TTLB ngy 04 thng 12 nm 1993; Thng t lin B Y t - Quc phng s 12/TTLB ngy 20 thng 10 nm 1997 sa i b sung Thng tlin B s 13. Trong qu trnh thc hin, nu c kh khn, vng mc ngh phn nh v lin B xem xt gii quyt./. KT. B TRNG B QUC PHNG TH TRNG ( k) Thng tng Nguyn Vn Rinh KT. B TRNGB Y T TH TRNG ( k) Trn Ch Lim

17
B Y T - B QUC PHNG CNG HA X HI CH NGHA VIT NAM c lp - T do - Hnh phc PH LC (Ban hnh km theo TTLT s: 14 /2006/TTLT-BYT- BQP ngy 20 /11/ 2006) Ph lc 1

PHN LOI SC KHE THEO TH LC V BNH TT

I. Tiu chun phn loi theo th lc (Bng s 1) NAM LOI SC Cao ng Cn nng Vng ngc KHO (cm) (kg) (cm) 1 163 51 81 2 160 - 162 47 50 78 - 80 3 157 - 159 43 46 75 - 77 4 155 - 156 41 42 73 - 74 5 153 - 154 40 71 - 72 6 152 39 70 II. Tiu chun phn loi theo bnh tt (Bng s 2) 1. Cc bnh v mt TT BNH TT PHN LOI 1 Th lc: Th lc mt phi Tng th lc 2 mt 10/10 19/10 1 10/10 18/10 2 9/10 17/10 3 8/10 16/10 4 6, 7/10 13/10 -15/10 5 1, 2, 3, 4, 5/10 6/10 -12/10 6 2 Mng tht: - Mng tht 1 2 - Mng tht 2 3 - Mng tht 3 4 - Mng tht che ng t 5 - Mng tht m ti pht, gy dnh 5 - Mng tht m ti pht gy dnh che ng t 6 3 Bnh gic mc: - So gic mc n thun, mng, nh ngoi vng trung Da vo th lc h tm xung 1 bc - So gic mc c dnh mng mt 6 - ang vim gic mc 2 - 4T ty mc 4 Mt ht: - Cha bin chng: + Nu ang giai on tin trin Da vo th lc h N Cao ng (cm) 154 152 - 153 150 - 151 148 - 149 147 146 Cn nng (kg) 48 44 - 47 42 - 43 40 - 41 38 - 39 37

Cc trng hp qu bo s xem xt n ch s BMI, loi cc trng hp c BMI 30

18
TT BNH TT + Nu giai on lnh so 5 - C bin chng (mng mu, so gic mc) Lng siu (qum) mi mt: - Khng nh hng n th lc - C nh hng n th lc Vim kt mc (mng tip hp): - Cp v bn cp - Vim kt mc ma xun L o: - Vim tc l o cp tnh - Vim tc l o mn tnh hoc nhiu ln iu tr khng khi: + Nu 1 bn mt + Nu 2 bn mt Lc mt: - Khng nh hng n chc nng th gic - C nh hng n chc nng th gic Nhng bnh khc v mt: - Tng nhn p, c thy tinh th 2 mt lch th thu tinh, vim mng b o, dnh bt ng t, bong vng mc, teo gai th - Cc loi lon th n thun hoc phi hp - Cc bnh v y mt (vim vng mc do bnh tng huyt p, vim vng mc sc t) Bnh cc c vn nhn: - Lc c nng: + Khng nh hng n chc nng + C nh hng chc nng - Lc do lit 1 hay nhiu c vn nhn (lc trong, ngoi, ln, xung). Tt rung git nhn cu (tu mc rung git nhiu, t phn loi): Nhng bnh mi mt v hc mt: - Cc vt so lm h m mt, m dnh lin trng mt, m un cong vo trong v m ung cong ra ngoi r rt. - Tt sp m mt bm sinh c 2 bn khi nhn thng con ngi b che khut - Nhng bnh hc mt Cn th (phi c knh): Cn c vo th lc khi c knh xp loi theo th lc chun Vin th (phi c knh): PHN LOI xung 1 bc. Gi nguyn phn loi theo th lc. 4 Da vo th lc h xung 1 bc 4 1 - 3T ty mc 6 3T 5 6 3 4 6 6 6

6 7

8 9

10

3 4 6 4-6 6 6 6 Da vo th lc khi eo knh h xung mt bc

11 12

13

14

19
TT BNH TT Cn c vo th lc khi c knh xp loi theo th lc chun Cc loi lon th: Cn, vin n thun hoc hn hp v lon th khng u M mu (m 1 mu hoc ton b) Thoi ho biu m sc t (qung g) Thoi ho hc vng mc do cn th nng (t -3D tr ln) c thu tinh th bm sinh PHN LOI Da vo th lc khi eo knh h xung mt bc 6 6 6 6 6 PHN LOI 1 2 3 4 2T 3T 4T 1 2 3 4 5 6 1 2 3 4 5 6 2T 2

15 16 17 18 19

2. Cc bnh v rng hm mt TT BNH TT 20 Rng su: - Khng c rng su c 2 hm - Rng su 1 - 2 t 1 - 5 ci khng nh hng sc nhai - Rng su 1 - 2 t 6 - 8 ci khng nh hng sc nhai - Rng su 1 - 2 t 9 ci tr ln - C 2 rng su 3 hoc vim ty rng hoc tu rng hoi t ang cha - C 3 rng su 3 tr ln hoc vim tu rng - C 4 rng su 3 hoc vim tu rng 21 Mt rng: - Cn 28 rng (khng k rng khn) - Mt 1 - 2 rng, khng mt rng hm ln, sc nhai cn 90% tr ln - Mt 3 rng trong c 1 rng hm ln hoc rng ca, sc nhai cn 80% tr ln - Mt 4 rng trong c 1 - 2 rng hm ln: + Sc nhai cn 70% tr ln + Sc nhai cn 50% tr ln - Mt 5 - 7 rng trong c 3 rng hm ln hoc rng ca, sc nhai cn < 50% 22 Vim li: - Vim li nh 1 - 2 rng, khng c ti m su - Vim li nh 4 - 5 rng, cha c ti m su, rng cha lung lay - Vim li chy mu nhiu rng, khng c ti m 23 Vim quanh rng (nha chu vim): - Vim quanh rng 4 - 5 rng, rng lung lay 3 - 4 - Vim quanh rng t 6 rng tr ln, rng lung lay 3 - 4 - Vim quanh rng t 12 rng tr ln, rng lung lay t 2 -3 - 4 24 Vim tu, tu hoi t, vim quanh cung rng: - 1 rng b vim tu, tu hoi t hoc vim quanh cung rng ang cha - 1 rng b vim tu, tu hoi t hoc vim quanh cung rng cha, khng au trn 1 nm

20
TT BNH TT - 2 rng b vim tu, tu hoi t hoc vim quanh cung rng cha, khng au hoc khng cn l r li - 3 rng b vim tu, tu hoi t, vim quanh cung rng khng au Bin chng rng khn: - Khng c bin chng hoc c bin chng iu tr tt - Bin chng ang cha Vim lot nim mc ming, li: - Vim lot cp tnh ang iu tr - Vim lot mn tnh cha nhiu ln khng khi Vim tuyn nc bt: - Vim tuyn mang tai: + cha khi, khng ti pht t 1 nm tr ln + Vim tuyn mang tai cp ang iu tr + Vim tuyn mang tai mn tnh 1 bn n nh + Vim tuyn mang tai mn tnh 2 bn n nh + Vim tuyn mang tai mn tnh 1 hoc 2 bn cha n nh - Vim tuyn nc bt di hm: + cha khi + Vim cp ang iu tr + Vim mn, x ho, cha n nh + Si ng Wharton cha ly Vim khp thi dng hm: - Vim cp tnh - Vim mn tnh Xng hm gy: - lin tt khp cn, khng di lch, sc nhai tt - Khp cn di lch t, sc nhai cn tt - Khp cn di lch nhiu, nh hng ti sc nhai Khe h mi, khe h vm ming: - Khe h mi: + Khe h mi 1 bn, khng ton b, khng c khe h vm ming + Khe h mi 1 bn ton b to hnh nh hng t n thm m v pht m + Khe h mi 2 bn khng ton b to hnh, nh hng nh ti pht m + Khe h mi 2 bn ton b cha to hnh - Khe h vm: + Khe h vm mm + Khe h vm ton b - Khe h mi km theo khe h vm (khe h mi - vm) PHN LOI 2 4 1-2 2T 3T 5T 2 3T 3 4 4T - 5T 2-3 4T 5T 5-6 3T 4 3 4 6 3 4 5 6 3 6 6 PHN LOI 1

25 26 27

28 29

30

3. Cc bnh v Tai mi hng TT BNH TT 31 Sc nghe (o bng ting ni th tho): - Mt bn tai 5 m - tai bn kia 5 m

21
TT BNH TT - Mt bn tai 4 m - tai bn kia 2 m - Mt bn tai 3 m - tai bn kia 1 m - Mt bn tai 3 m - tai bn kia 0,3 m - Mt bn tai 2 m - tai bn kia 1 m - Mt bn tai 2 m - tai bn kia ic - Mt bn tai 1 m - tai bn kia 1 - 0,5 m - Mt bn tai 1 m - tai bn kia ic Tai ngoi: - Hp, d dng, rch, mo vnh tai v ng tai ngoi - Vim tai ngoi cp tnh - Vim tai ngoi mn tnh: + Cha nh hng sc nghe + nh hng sc nghe Tai gia: - Vim tai gia cp tnh - Vim tai gia cp tnh hay mn tnh c thng mng nh, c chy cht nhy hoc m, thng v tr : + Trc di + Sau di + Trc trn + Sau trn - Vim tai gia mn tnh c thng, c chy m thi (Cholesteatome) - Vim tai gia mn tnh c, kh hon ton tu theo sc nghe m phn loi Xng chm: - Vim tai xng chm cp tnh v mn tnh - Vim tai xng chm phu thut m hang chm thng nh c v mng nh, nu: + Lin so hon ton + Khng lin so, chy m lin tc (c triu chng ch quan) - Vim tai xng chm m tit cn, nu: + Hc m kh + Hc m cn chy m Tai trong: - tai km gim sc nghe ng tip nhn - Chng mt m nh Mi: - Mi, h mi, hng b lch vo, d dng, nu: + Khng c ri lon h hp v pht m + c ri lon h hp, pht m, nut mc nh hoc c nh hng n cu to lng ngc + C ri lon chc nng h hp quan trng, thng xuyn ri lon pht m PHN LOI 2 3 4 4 5 5 6 3 3T 3 3 - 5 ty theo sc nghe phn loi 4T -5 T 4 4 6 6 6 4-5 5 3 6 5 6 5 5 3 4-5 6

32

33

34

35 36

22
TT BNH TT PHN LOI - Vim mi mn tnh n thun (co tht qu pht hoc tit dch): + Nu khng c ri lon chc nng h hp 2 + C ri lon chc nng h hp r, tu theo th trng 4-5 + Teo t, tr mi (ozene) chy mu cam thng xuyn 6 - Polip mi (tht tha mi), thng c vim xoang: + 1 bn nh, bn kia bnh thng 4 + 1 bn to, bn kia bnh thng 5 + Polip c 2 bn 5 + Polip c 2 bn km theo thoi ho xng xon mi gia 6 Hng: - Vim hng cp tnh 1T - Vim hng mn tnh n thun th trng tt 2-3 - Vim hng mn tnh hay ho, st gy kh th nh hng 4-5 n th trng Amidan: - Vim amidan cp 2 - Vim amidan cp qu pht 2T - Vim amidan n thun khng nh hng n chc 2 nng - Amidan vim mn tnh qu pht c nhiu hc m, ti 4T pht lun - Amidan vim mn tnh c ct b 2 Chy mu cam: - Chy mu cam do nh hng khch quan 4T - Chy mu cam cha r nguyn nhn, cha nh hng 3T - 4T ty mc n th trng chy trung bnh hoc nhiu - Chy mu cam nh hng ti th trng gy thiu mu, 5 suy nhc, xanh xao Thanh qun: - Vim thanh qun cp tnh 1 - 2T - Vim thanh qun mn tnh, nu: + Khng c ri lon pht m quan trng nh ting ni cn 3 phn bit c, th trng tt + C ri lon pht m quan trng nh ting ni khng 4-5 phn bit c hoc phn bit kh, th trng km - Lit cc c khp - m dy thanh v lit dy thn kinh hi 6 qui - Khn ting n thun, khng lit dy thanh, khng c 4 tn thng thanh qun nim mc - Ni lp: + Ni 1 cu 4 - 5 ch lp 1 ln 3 + Ni 1 cu 4 - 5 ch lp 2 ln tr ln 4-5 + Ni lp c bin dng thanh qun, r thanh qun 6 Xoang mt:

37

38

39

40

41

23
TT BNH TT - Vim xoang hm mn tnh - Vim xoang trn, xoang sng mn tnh - Vim mi c phn ng xoang mt Lit mt khng hi phc do vim tai xng chm Vim nhm xoang sau (xoang sng sau, xoang bm) mn tnh, hay b chy mi xung hng v au u vng chm Amidan qu pht n thun, nh hng n h hp, c bit l khi gng sc v khi ng Khn tng do cc khi u lnh tnh dy thanh nh: plip, ht x dy thanh, u nang dy thanh...) Khn ting do u nh (papilloma) dy thanh 4. Cc bnh v Tm thn kinh BNH TT Lon thn do: - Thiu nng tm thn: + Mc nng + Mc trung bnh + Mc nh - Cc bnh lon thn c lin quan n cc bnh ca c th nh: ri lon ni tit, chuyn ho dinh dng, nhim trng, nhim c: + phc hi + Phc hi khng hon ton + Khng phc hi - Lon tm thn phn ng: + Khng hi phc + Hi phc khng hon ton + Hi phc hon ton - Cc trng thi hoang tng v lon thn khng c hiu - Cc ri lon tri gic - Cc ri lon o gic - Nhng lch lc v ri lon tnh dc : Lon dm ng gii, sc vt, tr em, ph trng, lnh m Tm thn phn lit (cc th) Lon thn do ru: - Bnh Corxacop sa st tr nng, o gic, hoang tng, say ru bnh l - Hi chng l thuc ru Nghin ma tu (opiate) Lon thn do thuc: - Hi chng cai cc thuc gy nghin, trng thi hoang tng, o gic, lon thn do ng c thuc - L thuc thuc gy nghin Lon thn cm xc: PHN LOI 5 5 2 - 3T 6 5 4T 4T 6 PHN LOI 6 5 5

42 43 44 45 46 TT 47

4 5 6 6 6 5T 6 4 5 4 6 6 6 6 6T 5

48 49

50 51

52

24
TT BNH TT - Th in hnh, cng mnh, cn ko di, mau ti pht - Th trung bnh, cn tha 1 - 3 nm /ln hoc th nh chu k cn 3 - 5 nm. Ri lon nhn cch: - Th nng, mt b thng xuyn - Cn b nhng ti pht 2 ln tr ln Lon thn c lin quan n tn thng s no do: - Vim no - mng no: + hi phc + Khng hi phc - Lao no: + hi phc + Khng hi phc - Giang mai no: + hi phc + Khng hi phc - Cc ri lon mch mu no, x cng ng mch no, u no, thoi ho h thn kinh Ri lon phn li (Hystria): - hi phc sinh hot bnh thng - ang tin trin - Hay ti pht (ti pht t 2 ln tr ln) Lon thn do chn thng: - hi phc - Khng hi phc Nhc u thnh cn: - Do cc nguyn nhn khc nhau, dai dng, ko di, nh hng n lao ng Suy nhc thn kinh: - Nh, hi phc - Nng, khng hi phc hon ton (gim tr nh, gim kh nng lao ng hoc ti pht 2 ln tr ln) ng kinh: - ht cn (lm sng v cn lm sng) - Cn cn ln hoc nh Ra m hi bn tay hoc c bn tay, bn chn: - Mc nh - Mc va - Mc nng Phn x gn xng: - Tng u 2 bn, khng km theo ri lon vn ng, cm gic, khng cn rung git bnh ch hoc bn chn - Gim u c hai bn: + C ri lon vn ng cm gic + Khng ri lon vn ng cm gic - Tng hoc gim mt bn, c ri lon vn ng cm gic PHN LOI 6 6 5-6 5 5 6 5 6 5 6 6 4 5 6 5 6 4T 4 6 5 6 3 4 5 4 6 6 3 6

53 54

55

56 57 58

59 60

61

25
TT 62 63 64 65 BNH TT + C ri lon vn ng cm gic + Khng ri lon vn ng cm gic i dm thng xuyn Di tinh nhiu, nh hng ti sc kho Chng mt c h thng: - Ri lon kiu tin nh - Ri lon kiu tiu no Lit mt ngoi vi: - Cn di chng mo mm nh khi ci, khng nh hng ti nhm mt, pht m - Cn di chng mo mm thng xuyn, c nh hng ti nhm mt - Lit dy thn kinh quay, tr, gia, hng to Lit thn kinh ngoi vi khc: - Mt hoc gim kh nng vn ng mt phn chi th: + t nh hng ti lao ng, sinh hot + nh hng nhiu n lao ng, sinh hot - Mt hon ton kh nng lao ng 1 chi Di chng tn thng s no, ty sng: - Lit dy thn kinh s no, tu sng (lit chn tay hn ch kh nng lao ng r rt) au r thn kinh v cc m ri thn kinh (m ri c, cnh tay, tht lng): - t nh hng n vn ng - Hn ch r rt kh nng vn ng Bnh c (Myopathie): - C teo c nng, nh hng r n kh nng lao ng - Teo c nh, nh hng t n vn ng Nhc c (Myasthnia): Ri lon c bit khc: - Tt my c (TIC): + Khng gy au mt + Gy au mt - Ri lon gic ng, ri lon n ung, au n, tm thn au lng do: - Thoi ho ct sng: + Mc nh + Mc va + Mc nng - Thot v a m: + Mc nh + Mc va + Mc nng au vai gy do: - Thoi ho ct sng c: + Mc nh PHN LOI 6 3 5 4-5 4-5 5 3 5 5-6 4 5 6 6

66

67 68

3-4 6 6 4-5 6 3 5 4 3 4 5 4 5 6 3

69 70 71

72

73

26
TT BNH TT + Mc va + Mc nng - Thot v a m ct sng c: + Mc nh + Mc va + Mc nng 5. Cc bnh l Ni khoa TT BNH TT 74 Bnh thc qun: - Vim thc qun cp tnh - Vim thc qun mn, lot thc qun lnh tnh (ty mc nng, nh) - Gin thc qun (ty mc nng, nh v kt qu iu tr m xp) - Hp thc qun (ty mc ) - Gin tnh mch thc qun - K thc qun 75 Bnh d dy, t trng: - Vim d dy cp - Vim d dy, t trng mn tnh - Lot d dy, t trng cha c bin chng - Lot d dy, t trng c bin chng (hp mn v, chy mu cha iu tr khi) - Lot d dy, t trng iu tr lnh bng phu thut hay iu tr ni khoa - Ti tha d dy nh hng ti sc kho t hay nhiu - K d dy 76 Bnh i trng: - Vim i trng cp (ty kt qu iu tr m xp) - Hi chng i trng kch thch: + Mc nh + Mc va + Mc nng - Vim lot trc trng do amip: + Nh + Nng - Vim lot trc, i trng xut huyt: + Nh + Va, nng 77 Bnh gan: - Vim gan cp - Vim gan cp lnh trn 12 thng, sc kho hi phc tt - Vim gan cp lnh trn 12 thng nhng hi phc cha tt, th HBsAg (+) - Ngi lnh mang vi rt vim gan B hoc C PHN LOI 4 5 4 5 6 PHN LOI 5T 4-5 4-5-6 5-6 6 6 3T 5T 5T 6 5 4-5 6 4T, 5 hoc 6 3T 4T 5T 4T 5T 5T 6 5T 3 5 3

27
TT BNH TT - Vim gan mn tnh th tn ti - Vim gan mn tnh th hot ng - Ung th gan nguyn pht hoc th pht - Sn l gan, tu mc nh hng n gan v sc kho - Gan to cha xc nh c nguyn nhn - Hi chng vng da cha r nguyn nhn - X gan giai on cn b - X gan giai on mt b Bnh lch: - Lch to do st rt - Lch to do x gan - Lch to do suy tim (thng km theo gan to) - Lch to do bnh bch cu lympho - Lch to do mt s bnh nhim trng Bnh mt, tu tng: - Si ti mt, gy vim ng mt cp hoc mn - Si ng mt trong v ngoi gan, gy vim nhim hoc tc mt - Vim tu cp th ph n: + hi phc + Ti pht - Vim tu cp th hoi t, xut huyt - Vim tu mn Hi chng v triu chng bnh h hp: - Vim ph qun mn tnh - Gin ph qun - Khi huyt khng r nguyn nhn - Khi huyt ti din ko di km theo ho khc m, au ngc - Ting c mng phi r, km theo au ngc (vim mng phi kh) - Ran m hoc ran n nhiu 1 hoc 2 y phi km theo khi huyt hoc khc m nhiu - Hi chng 3 gim (dy dnh mng phi) - G, vo ct sng, bin dng xng c v xng lng ngc nh hng n chc nng h hp - Di chng so lng ngc do m tim, phi hoc sau chn thng ngc c, nh hng dn kh phi Cc bnh ph qun: - Vim ph qun cp - Vim ph qun cp ti din km theo vim xoang hm mn tnh - Gin ph qun nh c chn on r, cha c bin chng - Vim ph qun mn tnh n thun, giai on u - Vim ph qun mn tnh bt u c bin chng tm ph mn tnh, suy h hp, kh ph thng (COPD + tm ph PHN LOI 4-5 5- 6 6 3T, 4T hoc 5T 5T 5T 6 6 4T 6 6 6 4T - 5T 5T - 6 6 3 5 6 5-6 5-6 6 4T 6 5T 5T - 6 4T 6 6 3T 5T 5 5 6

78

79

80

81

28
TT BNH TT mn) - Kh ph thng tp A - Hen ph qun: + Hen nh khng c bin chng + Hen trung bnh v nng, hen c bin chng; hen ph qun km theo vim xoang hm mn hoc polip mi Cc bnh nhu m phi: - Vim phi cp do vi khun, virus, Mycoplasma Pneumoni - Vim phi mn tnh - Sn l phi, amip phi - Kn kh phi - Hi chng Loffler - Bnh bi phi - X phi hoc x phi k lan to Cc bnh mng phi: - Ph mc vim trn dch t huyt (Sero fibrineuse): + Khng do lao, khng c di chng dy dnh mng phi + Do lao, c di chng dy dnh mng phi - Vim m mng phi khng c di chng dy dnh mng phi nhiu - Ph mc vim, trn dch mn tnh (ko di trn 2 thng) ph mc vim trn dch mu (mu ht ra khng ng), dng chp lng ngc - Vi ho mng phi: + t + Nhiu, din rng - X ho lng ngc hoc dy dnh rng ton b mt bn mng phi Bnh lao phi: - Nghi lao phi (c hi chng nhim c lao, c tin s tip xc v tin s lao) - Khi huyt do lao - Lao phi nh mi mc (lao thm nhim, lao huyt BK m tnh (-) trong m bng soi trc tip, khng c hang lao). - Lao phi mi mc nhng c BK (+) trong m bng soi trc tip, c hang lao. - Lao phi iu tr n nh v khi c trn 3 nm, nu: + Trc y c hang, c BK (+) sc kho khng b nh hng + Trc y khng c hang, khng c BK (+) sc khe khng b nh hng + Hin nay c bin chng lao, x phi, suy h hp mn tnh, tm ph mn tnh, gin ph qun PHN LOI 6 5 6 3T 6 5T 5T - 6 3T 6 6 3T 5T 6 6

82

83

3 4-5 6 3T - 5T 5T 5T 6

84

5 - 6T 4T 6

29
TT 85 BNH TT Lao ngoi phi: - Lao hch ngoi vi khi - Lao hch c mn tnh hoc r m - Lao thanh qun khi - Lao mng bng, lao xng - Lao tinh hon m, khi Huyt p: tnh trng HA khi ngh, thng xuyn, tnh bng mmHg: - 90 - < 130/60 - < 85 - 130 - 139/85 - 89 - < 90/60 - 140 - 159/90 - 99 - 160/100 Mch: tnh trng mch khi ngh, thng xuyn u: - 60 - 80 ln/pht - 81 - 89 ln/pht - 90 ln/pht - 50 - 59 ln/pht - < 50 ln/pht Ri lon dn truyn v nhp tim: - Bloc nh tht I - Bloc nh tht II - Bloc nh tht III - Bloc nhnh phi: + Khng hon ton + Hon ton - Bloc nhnh tri: + Khng hon ton + Hon ton - Bloc nhnh phi + bloc nhnh tri - Lon nhp ngoi tm thu (ch yu ngoi tm thu tht): + Cc NTT mt hoc gim i sau vn ng + NTT tht tha (1 - 9 nhp/gi) + NTT tht trung bnh (10 - 29 nhp/gi) + NTT tht dy ( 30 nhp/gi) + NTT tht a + NTT tht tng chm hoc R/T + NTT tht trong cc bnh tim thc th - Rung cung nh, lon nhp hon ton - Cn nhp nhanh kch pht Bnh h thng mch mu: - Vim tc ng mch cc loi - Ri lon vn mch (bnh Raynaud) - Gin tnh mch - Vim tc tnh mch nng hoc su chi di PHN LOI 4 6T 4-5 6 4 1-2-3 4 5 - 6T 4 - 5T 5 - 6T 1-2-3 4 5, 6T 2 - 4 (Da vo nghim php Lian) 5, 6T 4 5 6 2 4 5 6 6 2-3 2-3 4 5 - 6T 5 - 6T 5 - 6T 5-6 5- 6 5- 6 6 6 5 5T - 6

86

87

88

89

30
TT 90 BNH TT Bnh tim: - Bnh tim bm sinh: + Cha gy ri lon huyt ng ng k + C ri lon v huyt ng + c can thip hoc phu thut trc 16 tui - Bnh van tim do thp v bm sinh - Vim ni tm mc nhim khun - Suy tim - Vim c tim v cc bnh c tim - Thp tim (thp khp cp) v bnh tim do thp - Cc bnh mng ngoi tim - Tng p lc ng mch nguyn pht - Cc khi u tim Bnh tng huyt p: - Giai on I - Giai on II - Giai on III Bnh khp: - Cc bnh khp nhim khun, lao khp, lao ct sng - Vim khp nhim khun, hi chng Reiter, vim khp Lyme, cc bnh ny mi khi cha qu 6 thng. - Cc bnh vim khp do thp, vim khp dng thp, vim ct sng dnh khp (Bechterew): + Nu cha gy teo hoc bin dng khp, cng khp, chc nng khp cha hn ch, sc kho ton thn tt + Nu gy teo c, cng khp, bin dng khp, hn ch chc nng khp, nh hng ti sc kho ton thn: Mc nh v va Mc nng - Gai i ct sng - Hi chng tht lng hng Cc bnh ni tit v chuyn ho: - Bnh Basedow - Bnh l tuyn thng thn - Bnh l tuyn yn - Bnh i tho ng - Bnh Goutte mn tnh Cc bnh ni khoa khc: - Bnh u ht lympho c tnh (Hodgkin) - Thiu mu nng thng xuyn do cc nguyn nhn Bnh thn: - i ra mu cha r nguyn nhn - Bnh thn cp tnh nh: vim cu thn cp, vim b thn cp, vim ng thn cp do cc nguyn nhn mi khi bnh cha qu 6 thng - Bnh thn mn tnh: vim cu thn mn tnh c hi PHN LOI 5 6 4 6 6 6 6 6 6 6 6 4 5 6 5T 5T

91

92

5 6 4-5 3T - 4T 6 6 6 5-6 6 6 5-6 5T 5T 6

93

94 95

31
TT 96 BNH TT chng thn h, suy thn mn tnh do cc nguyn nhn o ngc ph tng PHN LOI 5-6 PHN LOI 1T - 2T 2T - 3T 2T 4T 2T - 3T 4T

6. Cc bnh l Da liu - hoa liu TT BNH TT 97 Nm da, nm bn (hc lo): - Th gin n, cha c bin chng, din tch cha qu lng bn tay ca i tng khm - Nm da c bin chng: chm ho, nhim khun khc..., din tch ln hn lng bn tay ca i tng khm 98 Nm mng: - C t 1-2 mng b nm, khng c nm da kt hp - C t 3 mng tr ln b nm 99 Nm k: - B nm k ch bt trng t 1 - 2 k - B nm k bt trng, c mn nc t 3 k tr ln v c th km theo nm mng 10 Lang ben: 0 - Th khu tr (mt hoc vai hoc lng...) - Th lan to chim trn 1/3 din tch c th 10 Nm tc, rng tc do cc nguyn nhn: 1 - Mc nh - Mc va - Mc nng 10 Gh: 2 - Th gin n, khu tr, cha c bin chng: vim da nhim khun, chm ho... - Th c bin chng: vim da nhim khun, chm ho... 10 Eczema: 3 - Eczema tip xc - Eczema vi khun - Eczema mn tnh: + Khu tr + Nhiu ni Eczema c a 10 Duhring, Pemphigus, Pemphigoide: 4 10 Bnh t chc lin kt: 5 - Luput : + Luput khu tr + Luput h thng - X cng b:

1 - 2T 3T 3T 4T 6 2T - 3T 4T 3T 3T 3 6 6 6

4 6

32
TT BNH TT + Khu tr + Lan to - Vim b c - Vim nt quanh ng mch Bnh vy nn v bnh da c vy: - Bnh vy nn cc th - sng lin cu vng u - Lichen phng - Vim da da u Bnh ri lon sc t: - Bnh bch bin: + Th khu tr + Th lan to - Xm da + Khu tr vng m + Ri rc Cc tt bm sinh da, bt cc loi: - Din tch nh di 3 cm2, khng vng h - Din tch t 3 cm2 tr ln vng mt hoc c ri rc nhiu ni Bnh phong tt c cc th: Bnh ly theo ng tnh dc: - Giang mai: + Giang mai giai on 1 v 2 sm, iu tr ng, phc v xt nghim TPHA m tnh + Giang mai giai on 2 mun, iu tr ng, phc v xt nghim TPHA m tnh. + Giang mai giai on 3 + Giang mai cha iu tr n nh - Lu: + Lu cp iu tr khi + Lu cp cha iu tr + Lu mn c tn thng b phn tit niu, sinh dc - Bnh h cam (Chancremou): + iu tr khi + Cha iu tr - Bnh Nicolas-Favre - Nhim HIV/AIDS T a, vim da thn kinh: - T a r nguyn nhn (nm, tip xc...) 4T 5 6 5T - 6 2-3 4T 5T - 6 3 4T 6T 6 4T PHN LOI 5 6 6 5-6 4-6 2T 5 3T

10 6

10 7

3 4 3 5-6 1-2 4 6

10 8

10 9 11 0

11 1

33
TT BNH TT - Bnh t a: bnh dai dng, hay ti pht - Vim da thn kinh: + Khu tr + Lan to (nhiu ni) Trng c v mt s bnh khc: - Trng c thng: + Nh: < 100 sn + Va: t 100 - 200 sn; < 5 mn m + Nng: > 200 sn; > 5 mn m - Trng c hoi t, trng c mch ln, trng c so li - Trng c - Sn cc do cn trng: rui vng, b ch, dn... t: + S lng di 10 nt + Di 20 nt + T 20 - 30 nt + Trn 30 nt - My ay mn tnh do th a Lao da cc loi: iu tr di ngy, hay ti pht Cc bnh u da: - U x thn kinh (bnh di truyn) - Cc loi u khc Xm da cc loi: - Xm phn kn, khng nh hng thm m v din tch di 5 cm2 - Xm phn h, nh hng thm m v din tch trn 5 cm2 Cy d vt vo dng vt 5 4-5 2 - 3T 4T 5T - 6T PHN LOI 5 4T - 5T 5-6

11 2

2T 2 - 3T 4T 4 4-5 3T 4T 4T - 5T 5 6 5

11 3 11 4 11 5

11 6

7. Cc bnh l ngoi khoa TT BNH TT Ngoi khoa 117 Bnh tuyn gip: - Vim tuyn gip cp tnh - Bu lnh tnh nh, s thy, cha nh hng ti h hp - Bu lnh tnh to, c nh hng ti h hp, ni , nut - Basedow, ung th tuyn gip 118 Bnh gan: - ng gip gan c iu tr bo tn, kt qu tt - p xe (abcs) gan do a-mip t 1 - 2 , m trn 1 nm - p xe gan v gy bin chng tuy iu tr khi 119 Mt, ti mt: - p xe ng mt - Si ti mt n c, cha m

PHN LOI 3T 3 5 6 4 5 6 5T 5T

34
TT BNH TT - Si ti mt m n nh trn 1 nm: + Khng nh hng ti sinh hot + C nh hng ti sinh hot - Vim ti mt, vim ng mt, vim ti mt cp do si n c m trn 1 nm, n nh - Vim ng mt do si hoc do nguyn nhn khc - Si ng mt ch Ty tng: - Vim ty cp iu tr bo tn khi - Vim ty cp iu tr ngoi khoa - Si ty Lch: - Lch to, x (mn tnh) - Cng lch - p xe lch - V lch do chn thng phi phu thut nu m ct lch D dy t trng: Lot d dy t trng iu tr ngoi khoa Tiu trng: - Thng tiu trng do cc nguyn nhn phi m: + Kt qu khng nh hng ti tiu ho + C nh hng ti tiu ho v sinh hot - Tc rut c gii m: + Kt qu tt + Nu vn cn ri lon tiu ho Vim rut tha: - Vim rut tha m, kt qu tt - C bin chng, bn tc, s thnh bng i trng, hu mn: - Cc bnh lnh tnh ca i trng phi can thip phu thut - Ung th i trng - Polip trc, i trng (Polypose Rectocolique) - Polip trc trng (Polype rectal) c cung nh iu tr ht c: + ct b + Cha ct b - Nhiu polip trc trng chy mu Bnh hu mn - trc trng: - R hu mn (Fistule anale): + n gin iu tr khi + n gin cha iu tr + R hu mn phc tp - Sa trc trng (Prolapsusrectal) - Nt hu mn (Fissure anale): PHN LOI 4 5 4 5T 6 3 5 6 6 6 6 5 5 4 5 5 6 2 5 5 6 6 2 5T 6 3 3T 5T 5T

120

121

122 123

124 125

126

35
TT 127 BNH TT + iu tr tt + Nhim trng nhiu ln Tr: - Tr ngoi: + 1 bi nh 0,5 cm + 1 bi va di 1 cm - Tr ni hoc tr kt hp 1 bi nh di 0,5 cm - Tr ni, ngoi, tr kt hp nhiu bi (2 bi tr ln, kch thc 0,5 -1 cm) - Tr m tt - Tr nhiu bi, c bi to trn 1cm, bi tr li ra khng t co ln c - Tr tht, nay c bi tr ti pht Cc loi U: - Cc loi u lnh tnh (u m, nang nhy, u xng lnh tnh) + Nu v tr khng nh hng ti sc kho, lao ng, luyn tp, sinh hot + Nu nh hng ti sinh hot, lao ng, luyn tp - Cc loi u c tnh cc v tr Thot v bn cc loi: - c phu thut tt, n nh trn 1 nm. - Cha c phu thut Cc ng m bng thm d (khng can thip vo ni tng): - Lin so tt v trn 1 nm, khng c triu chng dnh tc - Nu so rn rm hoc s thnh bng - C du hiu dnh tc hoc bn tc Thn tit niu: - Si thn (c chn on bng hnh nh): + m (tu theo v tr, kch thc, tnh cht ca si, suy thn...) + Cha m + Si thn c bin chng phi ct 01 bn thn - U thn m - Nang thn: + Kch thc nh, khng chn p i b thn + Kch thc ln, chn p i b thn - Si niu qun m ly si - Si niu qun m c bin chng (r nc tiu, cht hp gy gin thn hoc vim thn) - Si bng quang, niu o: + Cha m + m ly si tt + M li nhiu ln Cc hi chng tit niu: - Cn au qun thn hay ti din i ra mu, i rt, i but, PHN LOI 3 5T 3 4 4 3 3 5T 5T 1-3 4 - 5T 6 2-3 5T 4 5 6 4-5 5T 6 6 4 6 4-5 6 5T 4 5 5T

128

129 130

131

132

36
TT 133 BNH TT i kh, i c, i ra m, dng chp, nhiu cn lng. Vim ng tit niu: - Vim b thn - thn cp, vim bng quang, vim niu o do lu, vim tuyn tin lit - Vim niu o thng Cc bnh thn bm sinh: - Sa thn (1 hoc 2 bn) - Thn mng nga - Thn kp 1 bn c bin chng - Thn kp c 2 bn - Thn lc ch (1 - 2 bn) hoc 1 thn Khi u sau phc mc: - U thn m hoc cha m - U tuyn thng thn (huyt p cao) - U m, u qui, u thn kinh, u hch Lao ng tit niu, sinh dc: - Lao thn m hoc cha m - Lao thn li di chng hp niu qun - Lao bng quang, lao tuyn tin lit - Lao mo tinh hon (u cc hoc r) Cc d tt niu qun: - Niu qun nm sau tnh mch ch - Niu qun nm sau ng mch chu - Niu qun kp 1 bn - Niu qun kp 2 bn - Niu qun lc ch Cc bnh bng quang: - U nh bng quang - U nh bng quang m, hi phc tt - U c tnh bng quang - Ti tha bng quang, hp c bng quang Sinh dc: - Hp bao hnh khng nh hng tiu tin, m tt - Hp bao hnh nh hng tiu tin - Hp niu o do di chng lu, chn thng r v hp niu o khc Cc d tt dng vt: - L i lch thp (hypospadias) - L i lch cao - Ct dng vt - Vo dng vt - Niu o kp D tt bu: - Tinh hon thiu, n hoc lc ch 1 bn - Thiu hoc n c 2 bn tinh hon - i nam, i n PHN LOI 5T 3T 5T 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 5-6 4-5 6 5T 1 2 - 3T ty mc 5T 5T 6 6 5T 6 3T 6 6

134

135

136

137

138

139

140

141

37
TT BNH TT - U tinh hon n thun (thng l K) - U mo tinh hon (khng phi lao) - Trn dch mng tinh hon m tt - Trn dch mng tinh hon cha m - Vim dy da tinh hon (di voi) - Trn mu mng tinh hon - Vim lot da bu. - U nang thng tinh: + Cha m. + m trn 6 thng, din bin tt. - Teo tinh hon: + Teo c 2 bn do quai b. + Teo 1 bn do bnh khc, nu bnh n nh. - Teo mo tinh hon 1 - 2 bn. - U nh qui u v rnh qui u. K dng vt: - K dng vt sm, mun, K niu o. Vim tinh hon, vim mo tinh hon Gin tnh mch thng tinh (Varicocel): - Nh - Nng Gin tnh mch chn (Varice): - Cha thnh bi - thnh bi, chy nhy i li nhiu th cng, tc Bn chn bt: - i li khng gy au nhi - i li au nhi, nh hng mang vc, chy nhy Chai chn, mt c, r chn: - Chai chn (Durillon) dy sng nhng nn cn mm, i li khng nh hng - Chai dy sng gy cm cng, i li nh hng - Mt c lng bn chn (Corpolantaire): + Nu ng knh di 1cm, s lng t t 1 - 2 ci, i li khng nh hng + Nu ng knh trn 1cm, s lng t 3 ci tr ln, i li nh hng - R chn (Porokratose): + ng knh cc im lm di 2 mm, trong 1cm2 ch c 1- 2 im, i li khng nh hng + ng knh cc im lm trn 2 mm, trong 1 cm 2 c trn 2 im lm, i li khng nh hng + ng knh cc im lm trn 2 mm, trong 1cm2 c trn 2 im lm, i li nh hng Dnh k ngn tay, ngn chn: - Cha x tr phu thut: + t nh hng n hot ng PHN LOI 6 3T 4 5T 6 5T 5T 5T 4 6 4 5T 5T 6 5T 2-3 5T 2-3 4 2-3 4 2-3 5 2-3 4 2 3 5

142 143 144 145 146 147

148

2-3

38
TT 149 BNH TT + nh hng n hot ng ca bn tay, bn chn Tha ngn tay, ngn chn: - Cha ct b, khng nh hng n hot ng ca bn tay, bn chn - ct b, khng nh hng n hot ng ca bn tay, bn chn Mt ngn tay, ngn chn: - Mt 1 t: + Ca 1 ngn tay ci + Ca ngn tr bn tay phi + Ca 1 ngn chn ci + Ca 1 ngn khc ca bn tay hoc bn chn - Mt 2 t: + Ca ngn tay tr ca bn tay phi. + Ca 1 ngn khc ca bn tay hoc bn chn + Ca 2 ngn khc ca bn tay hoc bn chn - Mt 1 ngn: + Mt 1 ngn ci ca bn tay + Mt 1 ngn ci ca bn chn + Mt 1 ngn tr ca bn tay phi + Mt 1 ngn khc ca bn tay hoc bn chn - Mt 2 ngn: + Mt 2 ngn trong khng mt ngn tay ci, ngn chn ci v ngn tr bn tay phi + Mt 2 ngn trong c mt ngn tay ci, ngn chn ci, ngn tr bn tay phi - Mt 3 ngn tr ln Co rt ngn tay, ngn chn: - Co rt t 1 - 2 ngn tay hoc ngn chn c nh hng ti chc nng vn ng, sinh hot, lao ng - Co rt t 3 - 4 ngn tay hoc ngn chn tr ln Lch vo ngn chn ci vo trong (Hallux varus) hay ra ngoi (Hallux valgus): - Nu khng nh hng ti i giy, dp v mang vc, chy, nhy - Nu nh hng ti mang vc, chy, nhy Sai khp xng: - nn chnh khng li di chng (nu li di chng ngn tay, ngn chn th tnh theo mt ngn tay, ngn chn xp loi) - Sai khp ln khng nn chnh thnh c tt cn tr n lao ng v sinh hot - Sai khp ln: + nn chnh khng li di chng + nn chnh li di chng + c phu thut nn chnh: PHN LOI 4 2-3 1

150

4 4 4 3 5 4 4-5 6 4-5 5-6 4-5 5 6 6 5-6 6 4 5 2-3 6 4 5

151

152

153

39
TT BNH TT Nu khng li di chng, c theo di 1 nm tr ln, lao ng sinh hot bnh thng li di chng nh li di chng au, hn ch vn ng, thoi ho bin dng hoc cng khp. - Sai khp bnh l cc khp ln - Sai khp ti pht nhiu ln Gy xng (va v ln): - lin xng vng t th bnh thng, khng li di chng au mi hoc hn ch vn ng (thi gian t khi gy xng n khi kim tra 1 nm tr ln) - lin xng vng, cong lch trc khng quan trng, hn ch vn ng khp, khng gy au mi, khng gy thoi ho bin dng khp, khng nh hng ng k ti sinh hot, hot ng ca chi - C au mi hn ch vn ng nhiu. - C au mi, thoi ho bin dng khp nhiu - Cha lin xng, hoc xng lin nhng trc lch vo, hn ch vn ng - Gy xng phu thut cn phng tin kt xng Khp gi xng di t chi: - Km theo mt on xng ln, ngn chi t 5 cm tr ln - Khng km theo ngn chi D dng bm sinh: - Sai khp ln, mt on xng, mt u xng. Cng, dnh cc khp ln: - Cng, dnh cc khp vai, khuu, gi, hng Cng, dnh khp c tay, c chn: - t th c nng - Khng t th c nng Chnh lch chiu di chi: - T 2 cm tr xung, khng gy au mi trong sinh hot, lao ng - 3 - 4 cm, t nhiu nh hng ti thm m v au mi khi lao ng, sinh hot - Trn 5 cm, nh hng ti thm m v au mi khi lao ng, sinh hot Hai chn vng king hnh ch O, ch X: - Nh, khng nh hng ti i li, chy nhy (5 -10 ) hoc nh hng khng ng k. - Va (di 15 ) i li, chy nhy t nh hng - Nng (trn 15 ) thng km theo bin dng cng chn, bn chn, nh hng n chc nng vn ng Cong g ct sng: - n nh (khng tin trin, khng gy vim r, au mi) PHN LOI 4 5 6 6 6 3 4

154

5 6 4 - 5T 5T 6 5 6 6 5 6 4 5 6 4 5 6 4

155 156 157 158 159

160

161

40
TT BNH TT - nh hng ti mang vc, vn ng, chy nhy - Nng: do di chng bi lit, di chng chn thng hoc do lao ct sng ph hy t sng R xng: - n gin, c xng vim khu tr, khng ph hu xng rng - R cc xng ln, r lin tc, hay ti pht Bnh u xng, sn lnh tnh nhiu xng: - m c b u, khng nh hng ti chc phn - m c b 1 - 3 u ln - Cha m khuyt xng xng di: - nh hng n vng ca xng - Khng nh hng n vng ca xng Hoi t v khun chm xng i Hoi t v khun mo xng chy: - m c xng, kt qu tt - Cha m, au ti pht nhiu ln Hoi t v khun li cu xng cnh tay Bn chn thung: - Khng ngn chi hoc c ngn chi t 1 - 3 cm - C ngn chi trn 3 cm D tt bn chn kho: - C 2 bn chn - 1 bn chn Di chng bi lit, lit mm chi th: - Mc nng - Mc va Di chng bi no, lit cng chi th Bn tay kho D tt bm sinh thiu xng chi th (xng quay, xng chy...) So bng v cc loi so do cc nguyn nhn khc: - Nh, lnh, khng nh hng n vn ng, sinh hot v lao ng - Nh, lnh, c nh hng n thm m ( mt, c, ngc): + t + Nhiu - Co ko gy bin dng: + nh hng t n chc phn, sinh hot v lao ng + nh hng nhiu n thm m, lao ng, sinh hot S no: - Chn thng s no nh, vt thng c khng thu no li di chng suy nhc thn kinh nh: + Nu in no khng bin i PHN LOI 5 6 5T 6 4 4-5 5-6 6 4-5 5-6 4 4T - 5T 4T 5 6 6 5-6 6 5-6 6 6 6 1- 2-3

162

163

164 165 166 167 168 169 170 171 172 173 174

3 4 4 - 5T 6

175

41
TT BNH TT + Nu in no c bin i - Chn thng s no c, vt thng thu no c cn li di chng r rt v thn kinh hoc tm thn Ph khoa Kinh nguyt: - c kinh nguyt di 2 nm, vng kinh u, kinh tht thng ko di 6 - 7 ngy tr ln hoc ngn di 2 ngy - a kinh, rong kinh, b kinh, v kinh, bng kinh - Chm kinh nghi c thai - Rong huyt cha r nguyn nhn Ngoi hnh: - Cc d tt bm sinh, b phn sinh dc ngoi pht trin khng bnh thng - Lon dng v (sa v) v ph i, v teo, v lch - U x v cha m Khi u: - C u cc vng bng di, c so m - U x t cung cha m - U x t cung m ly u hoc ct t cung cn bo tn phn ph - U x t cung m ct b c phn ph - U nang bung trng hoc u th c ca bung trng cha m hoc m 1 bn - U nang bung trng, u th c bung trng ct c 2 bn Vim nhim ph khoa: - Cc vim nhim cp tnh c quan sinh dc (m h, m o, t cung) - Vim mn tnh c quan sinh dc - Vim phn ph cp hoc mn d cha khi hoc cha khi Vim l tuyn t cung Polipe c t cung Condyloma m h, m o, c t cung Papyloma m h D tt m h (ph i m vt) Vch ngn m o Vim nang tuyn Bartholine D tt mng trinh khng thng PHN LOI 5-6 6

176

4-5 5 5T 5T 4-5 4-5 5T 4 5T 5 6 5T 6 3T 4-5 4-5 4T 4T 4T 4T 4-6 4T 4T 3T - 5

177

178

179

180 181 182 183 184 185 186 187

III. Danh mc cc bnh tm min lm ngha v qun s (Bng s 3) L nhng bnh thuc din tm min lm NVQS khng nhn vo qun thng trc. y l nhng trng hp d dng pht hin, phn loi s b c qua theo di, qun l sc khe ca a phng v thuc din c min pht lnh gi i khm sc khe hoc kim tra sc khe y t cp huyn, gm 22 bnh theo danh mc di y: 1. ng kinh thnh thong ln cn;

42
2. Tm thn: in r, mt tr, cung di (bnh tm thn c th c iu tr nhiu ln khng khi); 3. Ph thng lu ngy do b cc bnh nh: suy tim, vim thn, thn h, suy thn mn tnh; 4. Chn voi (do giun ch) khng lao ng c; 5. Chn tay tn tt, bin dng, mt chc phn chi do mi nguyn nhn; 6. Lao xng khp, lao hch ang tin trin; 7. Phong cc th cha n nh (c lot, si, ct ngn tay, ngn chn); 8. Cm hay ngng lu li t b; 9. ic t b; 10. M hoc cht mt; 11. Run tay chn quanh nm, i li kh khn, khng lao ng c (nh bnh Parkinson) hoc chn tay c nhng ng tc bt thng ma git (Chore), ma vn (Athtose); 12. Lit na ngi tri hoc phi, lit hai chi di; 13. Gy cm, hc hc, yu ui, c th suy kit kh c th hi phc c do mc cc bnh mn tnh nh lao x hang, hen dai dng, c bin chng tm ph mn hoc kh ph thng, x gan c trng; 14. C b c tt, ngoo r rt t nhiu nm; 15. Ln qu kh (chiu cao ng di 140 cm); 16. G c bu lng do di chng lao ct sng, chn thng c lm ct sng tn thng li di chng; 17. Tt sp mi mt bm sinh; 18. St mi km theo khe h vm ming cha v; 19. Tr mi (Ozne) c ri lon pht m; 20. Bnh khp c bin dng teo c, cng khp; 21. Cc bnh l c tnh; 22. Ngi nhim HIV. IV. Ch dn khm tuyn 1. Khm th lc a) Cch quy trn s liu : Chiu cao, vng ngc, cn nng t 0,5 tr ln ghi l 1 n v; t 0,49 tr xung th khng ly phn l. V d: - Cao: + 152,50 cm ghi l 153 cm + 158,49 cm ghi l 158 cm - Cn nng:

43
+ 46,50 kg ghi l 47 kg + 51,49 kg ghi l 51 kg - Vng ngc: + 82,50cm th ghi l 83cm + 79,49cm th ghi l 79cm b) Khm th lc: Khi khm th lc, ngi c khm phi b m, nn, khng i giy hoc dp (chn t, u trn): Nu l nam gii phi ci ht qun o di, o lt, ch mc 1 qun i. Nu l n gii mc qun di, o mng. - o chiu cao: Ngi c o phi ng t th thng, 2 gt chn chm vo nhau, 2 tay bung thng t nhin, mt nhn ngang, tm nhn l 1 ng thng nm ngang song song vi mt t. + Thc o: Nu o chiu cao bng thc bn cn th phi ch ko phn trn cho ht c, sau iu chnh ly kt qu phn di ca thc. + Nu dng tng, ct k thc o th tng hoc ct phi thng ng, nn ng khng g gh, phi vung gc vi tng hoc ct lm thc o. + Ngi ng vo v tr o, gt chn, mng, xng b vai chm tng. Thc t ly kt qu o chm nh u phi vung gc vi tng. - o vng ngc: Vng o qua ngc vung gc vi trc thn i qua nm v i vi nam, mp trn tuyn v i vi n pha trc, qua 2 b di xng b vai pha sau. Dng thc dy o, ngi c o ht th bnh thng. chnh xc ta o khi ht vo ti a v th ra ti a, ly 2 gi tr cng li chia trung bnh, tnh nh sau: Ht vo ti a + th ra ti a 2 = Vng ngc trung bnh

- Ch s BMI (Body Mass Index) l ch s khi c th nh gi mi tng quan gia chiu cao v cn nng: BMI 2. Khm mt S 1: Th lc: Th lc l tiu chun c bn nh gi sc nhn ca tng mt, mun o th lc chnh xc, yu cu: - Nhn vin chuyn mn: Phi trc tip hng dn cch c v tin hnh ng k thut quy nh. Ch pht hin nhng trng hp ngi c khng trung thc hoc khng bit c theo hng dn. - Bng th lc phi: + Ch en, nn trng, giy khng b hoen , phng, khng nhu nt, hng 7/10 n 8/10 phi treo ngang tm mt nhn. + nh sng cn thit c (khong 400 - 700 lux) trnh mi hin tng gy lo mt, qu sng hoc sng di vo mt ngi c hoc ti qu nh hng ti sc nhn ca ngi c. + C ly gia bng ti ch ng ca ngi c l 5m. = Cn nng (kg) {Chiu cao (m)}2

44
+ Ngi c phi che mt 1 bn bng 1 ming ba cng (khng che bng tay) v khi c c 2 mt u m (1 mt m sau ba che). + Ngi o dng que ch vo di tng ch, ngi c phi c xong ch trong khong di 10 giy. Hng 8/10, 9/10, 10/10 mi hng ch c c sai 1 ch mi tnh kt qu hng . - Cch tnh tng th lc 2 mt: nu th lc cao hn 10/10 vn ch tnh l 10/10 V d: Mt phi 12/10, mt tri 5/10 th tng th lc 2 mt l 15/10. Khi tnh tng th lc phn loi th ch th lc ca mt phi. Th lc ca mt tri khng th b cho mt phi c m th lc ca mt phi vn phi nh tiu chun quy nh. 3. Khm rng S 21: Mt rng. a) Quy nh v k hiu rng: Mi rng u c k hiu bng hai ch s: - Ch s u l k hiu ca phn na hm ca i tng: Pha Phi Tri Trn 1 2 Di 4 3 + Nhng rng hm trn bn phi c k hiu s 1. + Nhng rng hm trn bn tri c k hiu s 2. + Nhng rng hm di bn tri c k hiu s 3. + Nhng rng hm di bn phi c k hiu s 4. - Ch s th hai k hiu ca tng rng: + Rng ca gia: S 1 + Rng khn trong cng: S 8 V d: + Rng nanh hm trn tri k hiu 23 + Rng hm s 5 di phi k hiu 45 - Rng hm ci nh (cn gi l rng hm ln): Gm cc rng hm trn v di k c rng khn, rng hm gm rng s 6, 7, 8. b) Cch tnh sc nhai: - Rng b vim ty hoc ty b hoi t; hoc lung lay n mc khng iu tr c cn phi nh; hoc mt ht thn rng cn chn th coi nh mt rng. - Nu mt 1 rng th coi nh mt c rng cng s i din vi mt nhai. Vd: Mt rng 16 th coi nh mt c rng 46 v tnh mt 10% sc nhai. - Nu mt 4 rng khn hm trn v di th khng tnh l mt sc nhai (v c nhiu ngi khng c rng khn). Cch tnh sc nhai:

45
H m trn H m di % sc nhai Rng % sc nhai Rng 2 1 8 3 4 8 5 1 7 5 4 7 5 1 6 5 4 6 3 1 5 3 4 5 3 1 4 3 4 4 4 1 3 4 4 3 1 1 2 1 4 2 2 1 1 1 3 1 2 2 1 1 3 1 1 2 2 1 3 2 4 2 3 4 3 3 3 2 4 3 3 4 3 2 5 3 3 5 5 2 6 5 3 6 5 2 7 5 3 7 2 2 8 3 3 8

Rng gi: Mt rng lm rng gi tt c tnh 50% sc nhai ca rng. S 22, 23: Phn bit gia vim li v vim quanh rng: Vim li Vim quanh rng - Li cng , c th vim 2 - 3 rng n - Li c th vim , chy mu tch khi ton b 2 hm rng c th khng - Khng c ti m su - C ti m su nhiu rng n ton b 2 hm, m chy thng xuyn - Rng lung lay t hoc khng lung lay - Rng lung lay c khi n 4 - Hi th hi - Hi th rt hi - C cao rng - Nhiu cao rng trn li v di li - Xng rng tiu dc hoc ngang S 24: Vim quanh cung rng: Khc vim quanh rng l vim dy chng quanh rng, tiu xng rng, vim li. - Vim cung rng: L vim vng tn cng ca rng ni cc mch mu v thn kinh i vo nui dng rng (thng do ty hoi t) au m, rng c cm gic tri ln, g dc au, hai hm chm vo au, li vng cung hi n. - Vim ty: Rng t nhin au, au nhiu v m, au m, g ngang au hn dc. - Vim ty hoi t: Rng khng au, thng rng i mu xm hoc vng c. S 27: Vim tuyn mang tai: Biu hin sng vng tuyn mang tai. Nu cha n nh, khi khm, nn vo vng tuyn mang tai s thy chy m ra ng Stnon. S 29: Khp cn bnh thng: Ngi c khm ngm ming t th tnh, nut nc bt, hai hm rng kht li, khng b h, khng di lch sang phi hoc tri. Khp cn di lch l khi t th trn m hai hm b h hoc lch sang mt bn. 4. Khm tai mi hng S 31: o sc nghe. a) Ni thm: - Ngi khm th ra ht ri ni thm th. Phi th tng tai ring bit (tai khng th phi c bt kn bng cch ngn tay ln np l tai do ngi c th lm). - Ting ni pht ra thng gc vi tai th. Ngi c th cm ming ba cng che mt khng nhn c ming ngi th.

46
- Trong iu kin khm ng ngi, khng c ni yn tnh, c th dng ting ni thng. Trng hp tai b gim sc nghe phi dng cch th ting ni thm vi iu kin cho php. Nu nghi ng cn cho kim tra k ti c s chuyn khoa. o bng m sch: m n thun trm (128) m cao (2096). b) Ni thng: Sc nghe tt hn ni thm 10 ln khong cch o. S 35: Chng mt m nh, biu hin. a) Cm gic ch quan t quay theo cc chiu khng gian khc nhau hoc mi vt xung quanh mnh. b) Cc ri lon thc vt km theo (xanh ti, tot m hi, nn, mch nhanh hoc chm li). Cc ri lon khch quan mt thng bng. c) Thng c ng mt t pht. S 37: Vim hng mn tnh. - Nu thnh sau hng ch c t chc lympho tng sinh, dy ln, th trng tt th vn xp loi 2 hoc loi 3. - Nu t chc lympho dy ln lm hp khoang sau hng, hoc trn m t chc lymho tng sinh c nhng chm nc hoc m gy ho, st lun hoc lm th trng suy nhc th xp loi 4 hoc 5. 5. Khm tm thn v thn kinh S 60: Ra m hi tay, chn: Chia lm cc mc . - Nh: S vo bn tay ch hi m, nhn vo k ng ch bn tay thy lm tm, ng nh m hi khng thnh vt di. Lau kh, trn 10 pht mi xut hin tr li nh c hoc sau thi gian vn ng m hi bn tay khng thnh vt di hoc thnh git. - Va: Biu hin nng hn cc du hiu trn v thng c c m hi chn. - Nng: Ma h cng nh ma ng, bn tay lun nhp nhp m hi, s vo u ngn tay thy lnh, cc k ng ch bn tay ng nh m hi thnh vt di v thnh git. Sau khi lau m hi, 5 - 6 pht m hi li tit ra gn nh c. Loi ny cng thng km theo ra m hi ton thn, nht l khi cm xc. S 69: Bnh c (Myopathie): Biu hin teo c gc chi. Bnh nhn ang ngi xm m t ng ng dy khng c hoc rt kh khn. S 70: Bnh nhc c (Myasthenia): Thng biu hin bng sp m mt, bui sng mt cn m c, v chiu sp cng r. Cc c khc lc u vn ng cn kh, sau 1 thi gian vn ng v cng v chiu th c yu dn. S 71: Tt my c (TIC): Biu hin nhy mt, nhy mm, nhy mp. 6. Khm ni khoa S 76: a) Hi chng i trng kch thch: L ri lon v vn ng v xut tit ca i trng. Thng au bng dc theo khung i trng, ri lon i tin, khng c vim hoc vim rt nh, phn khng c a mip. Chia lm cc mc : - Nh: Mi nm ch 1 - 2 t ngn, au t v nh. Ri lon i tin nh, t nh hng ti sinh hot v sc kho chung.

47
- Va: Mi nm 3 - 4 t, cng au ng k hn, ri lon tiu ho ko di c nh hng ti sinh hot v sc kho chung. - Nng: Mi nm trn 4 t, hoc au ko di hng thng, cng au ng k, nh hng nhiu n sc kho chung v sinh hot, tm thn kinh. b) Vim lot trc, i trng xut huyt : Thng c nhiu lot to, chy mu ri rc trc trng, i trng. S 77: a) Vim gan mn tnh tn ti: L loi vim gan mn tnh th nh v khng tin trin, t nh hng ti sc kho chung v cc chc nng ca gan, do khng tr thnh x gan. Tuy nhin cn gi gn v theo di. b) Vim gan mn tnh hot ng: L loi vim gan mn tnh th nng, tin trin thnh nhiu t, cc chc nng gan b nh hng r, sc kho chung b nh hng d tin n x gan. S 78: Tnh s l lch: K 1 ng thng t nh nch ti rn, ly on thng t b sn tri ti rn ca on thng trn chia lm 3 phn u nhau. Phn st sn l s 1, phn st rn l s 3, t rn tr xung l s 4. S 81: Hen ph qun. - Mc nh: Cn kh th nh, thnh thong xut hin nhiu v ma rt, v ban m, cha nh hng ti th trng, lao ng bnh thng, khng phi i nm vin. - Mc trung bnh: Thi gian mc 10 - 15 nm, cn hen xut hin v m v sng. Ti pht t, ph thuc vo thi tit, sc kho ton thn cn tt. - Mc nng: Mc bnh 15 - 20 nm, cn hen xut hin c ngy v m, ko di dai dng, c bin chng kh ph thng, tm ph mn, vim ph qun mn, trong 3 nm gn y, nm no cng c cn hen xut hin lin tc phi i nm vin. S 86: Thng nht cch o huyt p (HA): Theo phng php chun ca Koroskoff (5 pha). a) My o HA: - Bao qun: B rng phi ln hn ng knh ca chi c o 20%, tc l rng 12 - 14cm i vi cnh tay ngi ln. Vi ngi bo ph hoc o HA i th cn bao qun c chiu rng l 20cm. o HA cnh tay th t bao qun trn np khuu 2 3cm. - Thc o: + Huyt p k thu ngn: Mc thu ngn phi mc 0 khi trong h thng khng c p lc no. Ct thu ngn khng c bn v phi thng ng, vch trn ngang mt ngi o. + Huyt p k ng h: Phi c kim tra mi nm 2 ln. Kiu my o ny c th mi mc so vi mt ngi o. b) K thut o HA: - Ngi c o HA c ngh ngi t th thoi mi 15 pht trc khi o. Trc khng c hot ng mnh, khng ung ru, khng ht thuc l, khng n ung qu nhiu.

48
- Khi o, i tng c th ngi hoc nm nga, chn dui thng thoi mi trong mi trng yn tnh, tay t ngang mc tim, khng cng cng. Ngi o bt u tin hnh k thut o HA. - Huyt p tm thu (HATTh): Mt tay bm hi t t lm cng bng cun cho n khi tay kia khng bt c mch quay tay c qun bao (o HA p bng phng php bt mch quay). X hi t t, ng thi c s tng ng trn ng h ng lc mch quay xut hin tr li v ghi nhn bc u v HATTh. X ht hi trong bng cun. Sau ng nghe vo np khuu v tr ng mch (khng p mnh) ri bm nhanh bao cun ti mt p sut cao hn 30 mmHg so vi mc o c bng phng php bt mch quay. Khi t ti , bt u x hi t t (2 - 3 mmHg/giy). p sut tm thu tng ng vi lc xut hin ting u tin c nghe thy (pha I). Nu tip tc x hi trong bao t t th ting s nh dn v tr thnh ting thi (pha II). C tip tc x hi trong bao th cc ting ngy cng r hn v to hn (Pha III). Cc tc gi u thng nht ly pha I ghi nhn kt qu ca HATTh. Ch : L hng khi nghe l nhm pha III vi pha I, nht l khi pha II hon ton khng c ting no. y l hin tng thng gp ngi b cao HA. L hng ny c th ti 40 mmHg. V vy, bao gi ngi ta cng phi tin hnh o HA bng phng php bt mch quay trc trnh sai lm v nhn nh con s HA. - Huyt p tm trng (HATTr): Tip tc x hi trong bao, cc ting bng nhin thay i, tr nn nh v m hn (pha IV), cui cng s mt (pha V). Thng thng pha IV v pha V hay trng nhau. c bit mt s ngi pha V nghe c thm ch khi kim ng h ch ti 0 mmHg. Hu ht cc tc gi u ly pha IV ghi nhn kt qu HATTr. - Khi thy kt qu o HA 140/90, cn o li t nht 3 ln, mi ln cch nhau t nht 2 - 3 pht. Nu sau 3 ln o vn ghi nhn c mc HA nh trn cn cho khm chuyn khoa ti bnh vin. S 87: Mch. - Khm mch: Ch yu bt mch quay, phi bt 2 bn ng thi. Khi thy mch sinh i, mch sinh ba (ngoi tm thu) th phi nghe tim v m s ngoi tm thu trong 1 pht. Ngi khng mc bnh tim km theo cho vn ng ti ch (ng ln ngi xung nhanh 20 - 30 ln hoc chy cao chn ti ch trong 5 pht). Nu ngoi tm thu gim hoc mt i th ghi nhn l ngoi tm thu c nng, nu ngoi tm thu tng ln th cn a n khm chuyn khoa ti bnh vin. - Nu bt mch thy lon nhp hon ton th phi nghe tim v m nhp. - Mch thng xuyn khi ngh 90 ln/pht cn khm chuyn khoa tim mch v ni tit ti bnh vin. - Mch thng xuyn khi ngh 50 - 59 ln/pht, nu nhng ngi c rn luyn th dc th thao thng xuyn th xp loi 1 - 2. Nu nhng ngi khng c hot ng th lc nhiu th cn tin hnh nghim php Lian. - Cch lm nghim php Lian: + Ngi c th t th ng ly mch trc khi chy. + Chy ti ch vi tc 10-12 bc trong 5 giy, chy trong 5 pht. Khi chy, cng chn gp thng gc vi i. Sau khi chy 1 pht ly mch 15 giy u ca tng

49
pht 1, 2, 3, 4, 5. Trong khi , ngi c th phi ng im, khng c ng, khng ni. - Kt qu: + Nu u pht th nht mch ln ti 140 ln /pht hoc cao hn l xu khng xp t loi 1 - 3 c. + Nu u pht th 2 - 3 tr li nh c hoc gn nh c th coi nh bnh thng. + Nu u pht th 4 - 5 mch mi tr li nh c l xu khng xp t loi 1 n loi 3 c m phi xp t loi 4 tr i. + Nu tn u pht th 6 mch mi tr li nh c l xu, xp loi 4. - Mch thng xuyn khi ngh < 50 ln/pht, cn c tin hnh nghim php Atropin: + Tim tnh mch Atropin 1/4 mg x 04 ng (nu hm lng 1/2mg th dng 02 ng). Trc ghi in tim o trnh DII, sau tip tc ghi tng on DII ngay sau tim, sau 1-3-5-7 pht. + nh gi: Nu nhp tim t 90 ln/pht th mch chm do cng ph giao cm. Nu nhp tim < 90 ln/ pht th mch chm c th do bnh l nt xoang, cn a n khm chuyn khoa tim mch ti bnh vin. S 90: Bnh tim. - Khi nghe tim cn m t r ting th nht (T1) v ting th hai (T2) cc v tr mm tim, lin sn II v III cnh c tri, mi c. Khi pht hin ting thi tm thu cn m t cng , thi gian v m sc; phn bit r ting thi tm thu c nng hay thc th. Ting thi tm thu c nng thng nh, ngn v khng th rp, mt i khi vn ng hoc thay i t th. Ting th nht v th hai phn i xy ra ngi tr tui (hay xc ng), khng mc bnh tim mch l sinh l. S 92: Bnh khp. - Bnh khp nhim khun: y l trng hp vim khp sau 1 bnh nhim khun nh lin cu khun v khng sinh m. V lm sng c vim r rt mt vi khp va v nh nh: gi, c chn, ngn chn, khuu tay, ngn tay... thng vim khng i xng, khng di chuyn, khng gy teo c nhiu v khng c biu hin tim km theo. - Hi chng Reiter: Cng l mt loi thp khp nhim khun xut hin sau khi bnh nhn b mt hi chng l hoc b i lng. c im ca bnh l ngoi triu chng vim khp cn c cc triu chng vim kt mc v vim niu o. Tuy cc triu chng c mt v niu o c th ch mc nh v thong qua. 93. Bnh Addison (suy tuyn thng thn): - Xm da v nim mc xut hin nhng ngi tip xc vi nh sng nhiu. - ng ch lng bn tay, nim mc li cng en. - HA h thng xuyn, mch chm, yu. - Hay ri lon tiu ho, ngi lun mt mi. S 94: Mt s bnh ni khoa khc: a) Bnh u ht lympho (Hodgkin): C cc triu chng sau:

50
- Xut hin tng m hch c, bn (t 4 hch tr ln) rn chc, khng r m. - Gan lch c th to. - Thnh thong c st. - Nga. - Tnh trng ton thn suy sp dn. b) Thiu mu nng thng xuyn: - Hng cu 2.500.000/mm3 huyt sc t 50% xp loi 6. - Hng cu 2.500.000 - 3.000.000/mm3 mu, huyt sc t 50 - 60% xp loi 5. 7. Khm ngoi da - hoa liu S 97: Nm da. Th gin n l th ch c nn da hi , c vin b r, nn khng cm, cha b bin chng vim da ( nhiu, c mn nc lm tm, trt) hoc nhim khun (sng ty, c m, xut tit). S 98: Nm mng: Mng b si mu vng c, l ch, c khi c mn nh li sy. S 104: a) Bnh Durinh: Tng t ni mn nc cng thnh cm, c triu chng bo trc khi tn thng, khng c tn thng nim mc, sc kho ton thn n nh. b) Bnh Pemphigut: Ni nhng bng nc nho, khi v li trt rng au rt, km tn thng nim mc, ton thn suy sp dn, tin lng d dt. S 105: Bnh Luput ban . - Th khu tr thng ni mt thnh m , ranh gii r, c vy sng gn cht, xen k so, teo da. - Th ri rc, bn cp, h thng tin trin nng hn, nhiu khi km theo tn thng ni tng, tin lng d dt. S 106: Bnh vy nn. Biu hin bng cc m hi cm, c vy trng nh x c, d bong, c khi thnh chm, git, c khi thnh vt nh ng tin hoc thnh mng mn tnh. i vi th da, vim a khp c th dn ti tn ph, t vong. S 108: Tt bm sinh ca da: Gm nhng loi nh: - Bt sc t (vt en, mu nu, xanh l). - Bt sc t c lng. - U gin mch. - Bt ht cm sn si, bt tuyn b... S 110: Giang mai: Chia cc giai on: - Giang mai I: Ch c vt trt nng trn hoc bu dc, ranh gii r, nn cm cng nh m ba km theo hch bn, khng vim, xt nghim trc tip tm T.P (Trponma pallidum) dng tnh (+)

51
- Giang mai II: Biu hin thnh o ban, sn ht, sn si mng nim mc vim, hch ri rc... Xt nghim huyt thanh, phn ng BW, VDRL dng tnh. Xt nghim trc tip T.P dng tnh mnh. - Giang mai III: Biu hin bng gm, c, mng, bch sn... c khi km theo tn thng ph tng hoc thn kinh. - Giang mai bm sinh mun, vim gic mc kh, trn , mi tt, rng Hutchinson hoc c tn thng nh trong giai on III. 8. Khm ngoi S 127: Tr. - Cch khm: Khm tng ngi mt ni nh sng, ngi c khm chng mng, t banh rng hu mn v rn mnh. - Phn loi: Ly ng lc ca hu mn lm chun (c tht hu mn): + Nu bi tr trong c tht l tr ni + Nu bi tr ngoi c tht l tr ngoi + Nu bi tr ng lc l tr hn hp. - Triu chng: a ra mu ti (c th r tng git sau khi i tin chi mi thy mu ti): + Tr li ra ngoi t co c hay khng t co c (phi y ln). + Bi tr lot rm mu. + c tc tnh mch tr. - Cch ghi v tr bi tr: V d: Tr ni 5 gi 0,8 cm; tr ngoi 7 gi 0,5 cm (pha xng cng l 6 gi, i din l 12 gi). S 144: Gin tnh mch thng tinh (Varicocel). - ng v phng din gii phu, gin tnh mch thng tinh thng v bn tri. Nu s thy to hn bn phi cht t th cha gi l bnh l. - Nh: S thy tnh mch to, thng, cha qun vo nhau thnh bi. - Nng: S thy tnh mch to, qun vo nhau thnh bi nh bi giun v thng lm sa bu. Khi khm khng cn cho chy m khm lc bnh thng. S 146: Bn chn bt. Bnh thng bn chn in trn nn gch, du chn b khuyt vng vm bn chn. Bn chn bt du in khng thy khuyt t vng vm. 9. Khm ph khoa - Phng khm phi kn o, nghim tc. - Khi khm ph khoa c gng b tr cn b chuyn mn l n. i vi n thanh nin, mng trinh cha rch th ch khm nn bng, khng khm m vt, khng thm m o, ch khm qua hu mn nhng trng hp cn thit. i vi ngi mng trinh rch c, khi c nghi ng bnh ph khoa th khm bng dng c qua m o xc nh chn on.

52
- Nu khng c cn b chuyn khoa ph sn th ch nh bc s ngoi khoa thay th, nhng phi c nhn vin n tham d. Khng s dng y s khm, phn loi bnh tt.

53
Ph lc 2

MU PHIU SC KHE V PHIU KIM TRA SC KHE NGHA V QUN S

1. Mu s 1 TNH. HUYN. X. CNG HO X HI CH NGHA VIT NAM c lp - T do - Hnh phc

PHIU SC KHE NGHA V QUN S I. S yu l lch H v tn: H v tn b: H v tn m: Nguyn qun: Sinh qun: Tr qun: Giy chng minh nhn dn s: Tin s bnh: Gia nh: Bn thn: Ti xin cam oan khai ng l lch v tin s bnh ca ti.
XC NHN L LCH CA A PHNG XC NHN TIN S BNH CA Y T C S Ngy thng nm NGI KHAI K TN

Sinh ngy: Nm sinh: Nm sinh:

II. Khm sc khe Cao : Th lc: Thnh lc: Huyt p : cm. Nng: Mt phi: Tai phi: mmHg. Mch: Y, bc s khm k tn kg. Vng ngc trung bnh: Mt tri: Tai tri: ln/pht. Kt qu xt li sc khe BS xt li sc khe k tn cm.

Ch tiu Th lc Mt Tai mi hng Rng hm mt Ngoi khoa

im

L do

54
Ni khoa Thn kinh - tm thn Da liu - Hoa liu Kt lun (phn loi sc khe) Kt lun sau khi xt li sc khe

U vin 1

U vin 2

Ngy thng nm Ch tch Hi ng KSK

2. Mu s 2 TNH. HUYN. X.

CNG HO X HI CH NGHA VIT NAM c lp - T do - Hnh phc

PHIU KIM TRA SC KHE NGHA V QUN S I. S yu l lch H v tn: H v tn b: H v tn m: Nguyn qun: Sinh qun: Tr qun: Giy chng minh nhn dn s: Tin s bnh: Gia nh: Bn thn: Ti xin cam oan khai ng l lch v tin s bnh ca ti.
XC NHN L LCH CA A PHNG XC NHN TIN S BNH CA Y T C S Ngy / /

Sinh ngy: Nm sinh: Nm sinh:

NGI KHAI K TN

II. Kim tra sc khe ln 1 (hoc nm 17 tui) Cao : cm. Nng: kg. Vng ngc trung bnh: cm. Tnh hnh bnh tt:

55
Phn loi sc khe s b: Ngy T TRNG T KIM TRA SC KHE III. Kim tra sc khe ln 2 Cao : cm. Nng: kg. Vng ngc trung bnh: cm. Tnh hnh bnh tt: Phn loi sc khe s b: Ngy T TRNG T KIM TRA SC KHE / / / /

56
Ph lc 3

NH MC VT T TIU HAO V KINH PH

CHO HOT NG KIM TRA SC KHE, KHM SC KHE THC HIN NGHA V QUN S

I. NH MC MT S VT T TIU HAO 1. nh mc vt t tiu hao cho hot ng kim tra sc khe/100 ngi: - Cn 70 - Bng ht - Pin n 1,5 V - X phng git - Khn mt lau tay - Giy trng A4 - Bt bi - Cht t - Vt t khc (nu c) - Cn 70 - Bng ht nc - Pin n 1,5V - X phng git - Khn mt lau tay - Giy trng A4 - Bt bi - Cht t - Vt t khc (nu c) : 300 - 500ml : 200gr : 02 i : 200 -300gr : 02 chic : 0,25gr : 05 chic : theo thc dng : theo thc dng : 500 - 1000ml : 500 - 1000gr : 09 i : 500 - 1000gr : 10 chic : 01gr : 20 chic : theo thc dng : theo thc dng

- X phng thm ra tay : 01 bnh

2. nh mc vt t tiu hao cho hot ng khm sc khe/1000 ngi:

- X phng thm ra tay : 03 bnh - Gng tay cao su (ngn) : 10 i

3. Gi vt t tiu hao: c tnh theo mt bng gi ca a phng ti thi im . II. NH MC KINH PH 1. Kinh ph bi dng cho mt ngy lm vic ca mi thnh vin trong on khm sc khe hoc t kim tra sc khe (gm: khm sc khe, tp hun, s kt, tng kt v.v...):

57 a) c tnh bng mt ngy cng tc ph trong tnh ca cn b cng nhn vin chc theo quy nh hin hnh ca Nh nc. b) Ring thnh vin Hi ng khm sc khe NVQS, ngoi tiu chun nh thnh vin on khm sc khe ni trn cn c bi dng thm khon tin bng ph cp trc ca bc s ti bnh vin huyn (theo ch hin hnh ca Lin B Y t - Ti chnh). 2. Kinh ph chi cho vic gi cng dn i khm chuyn khoa, chiu, chp Xquang v lm cc xt nghim cn thit khc 3. Kinh ph chi cho vn chuyn dng c, phng tin phc v cho on khm sc khe.

58
Ph lc 4 CC LOI MU BO CO V MU S THNG K 1. Mu s 1 TNH. HUYN. S: / CNG HO X HI CH NGHA VIT NAM c lp - T do - Hnh phc .............(a danh), ngy thng nm

BO CO KT QU KHM SC KHE NGHA V QUN S

TT 1 2 3

Ni dung S lng khm theo k hoch S lng khm Phn loi sc khe: Loi 1 Loi 2 Loi 3 Loi 4 Loi 5 Loi 6

Kt qu

Ghi ch

TM.HI NG KHM SC KHE NVQS CH TCH (K tn v ng du) Ghi ch: Bo co lm thnh 2 bn - 01 bn gi v Hi ng NVQS huyn - 01 bn gi v Phng Y t huyn

59
2. Mu s 2a S Y T ................... PHNG Y T ......... S: /

CNG HO X HI CH NGHA VIT NAM c lp - T do - Hnh phc .............. (a danh), ngy thng nm

BO CO KT QU KHM SC KHE NGHA V QUN S t......... nm ........ TT 1 2 3 Ni dung S lng khm theo k hoch S lng khm Phn loi sc khe: Loi 1 Loi 2 Loi 3 Loi 4 Loi 5 Loi 6 Kt qu Ghi ch

TRNG PHNG (K tn v ng du) Ghi ch: Bo co lm thnh 4 bn - 01 bn gi v Hi ng NVQS huyn - 01 bn gi Ban CHQS huyn - 01 bn gi v S Y t - 01 bn lu

60
3. Mu s 2b UBND ........................ S Y T S: / CNG HO X HI CH NGHA VIT NAM c lp - T do - Hnh phc .............. (a danh), ngy thng nm

BO CO KT QU KHM SC KHE NGHA V QUN S t......... nm ........ TT 1 2 3 Ni dung S lng khm theo k hoch S lng khm Phn loi sc khe: Loi 1 Loi 2 Loi 3 Loi 4 Loi 5 Loi 6 Kt qu Ghi ch

GIM C (K tn v ng du) Ghi ch: Bo co lm thnh 3 bn - 01 bn gi v UBND tnh - 01 bn gi B Y t - 01 bn lu

61
4. Mu s 3 TNH......................... HUYN. S: / CNG HO X HI CH NGHA VIT NAM c lp - T do - Hnh phc ..........(a danh), ngy thng nm BO CO KT QU KIM TRA SC KHE NGHA V QUN S TT 1 2 3 Ni dung S lng theo k hoch S lng kim tra Phn loi sc khe: Loi 1 Loi 2 Loi 3 Loi 4 Loi 5 Loi 6 T TRNG T KIM TRA SC KHE (K tn) Ghi ch: Bo co lm thnh 2 bn - 01 bn gi Hi ng NVQS huyn - 01 bn gi Phng Y t huyn Kim tra sc khe nm 17 tui Kim tra sc khe qun nhn d b Cng

62
5. Mu s 4 S Y T ........................ PHNG Y T ......... S: / CNG HO X HI CH NGHA VIT NAM c lp - T do - Hnh phc .............( a danh), ngy thng nm t ....... . nm ........ TT 1 2 3 Ni dung S lng khm theo k hoch S lng khm Phn loi sc khe: Loi 1 Loi 2 Loi 3 Loi 4 Loi 5 Loi 6 TRNG PHNG (K tn v ng du) Ghi ch: Bo co lm thnh 4 bn - 01 bn gi v Hi ng NVQS huyn - 01 bn gi v S Y t tnh - 01 bn Ban CHQS huyn - 01 bn lu Kim tra sc kho nm 17 tui Kim tra sc kho qun nhn d b Cng

BO CO KT QU KIM TRA SC KHE

63
6. Mu s 5 S Y T ........................ PHNG Y T ......... S: / CNG HO X HI CH NGHA VIT NAM c lp - T do - Hnh phc .............( a danh), ngy thng nm t.......nm........ Knh gi: .................................................................................... 1. Tng s cng dn giao: Sc khe loi 1: Sc khe loi 2: Sc khe loi 3: Sc khe loi 4: 2. Tng s cng dn vo qun i : Sc khe loi 1: Sc khe loi 2: Sc khe loi 3: Sc khe loi 4: 3. Tng s cng dn tr li do sc khe: Nguyn nhn tr li Loi bnh Thn kinh - tm thn Ngoi khoa Ni khoa Da liu - Hoa liu Mt Tai - mi - hng Rng hm mt Th lc S ngi

BO CO TNH HNH GIAO NHN TN BINH

TRNG PHNG (K tn v ng du) Ghi ch: Bo co lm thnh 03 bn: - 01 bn gi v HNVQS huyn; - 01 bn gi v S Y t tnh v 01 bn lu

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7. Mu s 6 B CHQS TNH BAN CHQS HUYN S: / CNG HO X HI CH NGHA VIT NAM c lp - T do - Hnh phc .............( a danh), ngy thng nm t.......nm........ Knh gi: ....................................................................................... 1. Tng s cng dn giao: Sc khe loi 1: Sc khe loi 2: Sc khe loi 3: Sc khe loi 4: 2. Tng s cng dn vo qun i : Sc khe loi 1: Sc khe loi 2: Sc khe loi 3: Sc khe loi 4: 3. Tng s cng dn tr li do sc khe: Nguyn nhn tr li Loi bnh Thn kinh - tm thn Ngoi khoa Ni khoa Da liu - Hoa liu Mt Tai - mi - hng Rng - hm - mt Th lc S ngi

BO CO TNH HNH GIAO NHN TN BINH

CH HUY TRNG (K tn ng du) Ghi ch: Gi v B CHQS tnh 2 bn (Ban Qun y v Ban Qun lc)

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8. Mu s 7 (T ba v ni dung thng k khm sc khe ngha v qun s) Tnh:.............................. Hi ng KSK NVQS Huyn:........................... Quyn s:....................... S THNG K KHM SC KHO NGHA V QUN S Nm............. S THNG K KHM SC KHE NGHA V QUN S NM........ Th lc Cn Vng nng ngc TB (kg) (cm) CNG HO X HI CH NGHA VIT NAM c lp - T do - Hnh phc

TT

H v tn

Ngy sinh

a ch

Cao (cm)

Tnh trng sc khe v bnh tt

L1

L2

Phn loi sc khe L3 L4 L5

L6

Ghi ch: - Thng k khm sc khe NVQS sau mi ngy cng dn cc ct phn loi sc khe - Sau mi t c tng kt vic phn loi sc khe v c cu bnh tt cng dn sc khe loi 4, 5 v 6

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9. Mu s 8 (T ba v ni dung thng k kim tra sc khe ngha v qun s) Tnh:.............................. Hi ng KSK NVQS Huyn:........................... Quyn s:....................... S THNG K KIM TRA SC KHO NGHA V QUN S Nm............. S THNG K KIM TRA SC KHE NGHA V QUN S NM........ Th lc Cn Vng nng ngc TB (kg) (cm) CNG HO X HI CH NGHA VIT NAM c lp - T do - Hnh phc

TT

H v tn

Ngy sinh

a ch

Cao (cm)

Tnh trng sc khe v bnh tt

L1

L2

Phn loi sc khe L3 L4

L5

L6

Ghi ch: - Thng k khm sc khe NVQS sau mi ngy cng dn cc ct phn loi sc khe. - Sau mi t c tng kt vic phn loi sc khe