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Delibera Giunta Regionale 775/2004 - Azienda USL di Reggio Emilia

Delibera Giunta Regionale 775/2004 - Azienda USL di Reggio Emilia

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Elettrocar<strong>di</strong>ogramma a riposo:<br />

______________<br />

Referto:________________________________________________________________________________<br />

________________________________________________________________________________<br />

________________________________________________________________________________<br />

I.R.I. _______________________________________________<br />

________________________________<br />

Data _______________<br />

Esame completo urine____________________________________________________________________<br />

______________________________________________________________________________________<br />

______________________________________________________________________________________<br />

______________________________________________________________________________________<br />

ULTERIORI ESAMI SPECIALISTICI OBBLIGATORI<br />

ELETTROENCEFALOGRAMMA:____________________________________________________________<br />

______________________________________________________________________________________<br />

______________________________________________________________________________________<br />

______________________________________________________________________________________<br />

ESAME NEUROLOGICO:__________________________________________________________________<br />

______________________________________________________________________________________<br />

______________________________________________________________________________________<br />

______________________________________________________________________________________<br />

ESAME OTORINOLARINGOIATRICO: ________________________________________________________<br />

______________________________________________________________________________________<br />

______________________________________________________________________________________<br />

______________________________________________________________________________________<br />

AUDIOMETRIA: _________________________________________________________________________<br />

______________________________________________________________________________________<br />

______________________________________________________________________________________<br />

______________________________________________________________________________________<br />

EVENTUALI ESAMI INTEGRATIVI<br />

ALTRI ESAMI: __________________________________________________________________________<br />

______________________________________________________________________________________<br />

______________________________________________________________________________________<br />

______________________________________________________________________________________<br />

______________________________________________________________________________________<br />

______________________________________________________________________________________<br />

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