<html><head><meta name="qrichtext" content="charset=utf-8" /></head><body text="#000000" style="font-size:9pt;font-family:MS Shell Dlg">
<p><span style="font-weight:600;text-decoration:underline;color:#0000ff">Date</span>:  {{DATE TIRET}}  {{AGE PATIENT}}<br /><span style="font-weight:600;color:#0000ff">Motif</span> : <br /><span style="font-family:Arial;font-size:10pt;color:#0000ff">Circonstances</span> :  	<span style="font-family:Arial;font-size:10pt;font-weight:600;text-decoration:underline;color:#0000ff">Heure </span><span style="font-family:Arial;font-size:10pt">:   {{DT=hh|mm}}  	</span><br />_______________________________________ <span style="font-style:italic;font-size:6pt;font-weight:600;color:#0000ff">Constantes_____________________________________________________</span><br /><span style="color:#0000ff">Pouls</span> :  		<span style="color:#0000ff">TA</span> :  		<span style="color:#0000ff">T°</span>:   	<span style="color:#0000ff">Poids</span>:   	Peak Flow :	<span style="font-weight:600;text-decoration:underline;color:#0000ff">BMI</span> {{BMI PATIENT}}<br />____________________________________________________________________________________________________<br /><br /><span style="font-weight:600;text-decoration:underline;color:#0000ff">OBSERVATION</span>:	<br /><br /><span style="font-weight:600">Subjectif </span>: <br />	<span style="font-weight:600;color:#0000ff">Symptômes</span> : <br />	<span style="font-weight:600;color:#0000ff">Depuis</span> : <br />	<span style="font-weight:600;color:#0000ff">Contexte</span> : <br />	<span style="font-weight:600;color:#0000ff">Traitements essayés</span> : <br /><br /><span style="font-weight:600;color:#0000ff">Examen physique</span> : <br /><br /><span style="font-weight:600;text-decoration:underline;color:#0000ff">PARACLINIQUE</span> : <br /><br /><span style="font-weight:600;color:#0000ff">Hypothèses diagnostiques</span> : <br /><br /><span style="font-weight:600;text-decoration:underline;color:#0000ff">TRAITEMENT</span>: <br /><br /><span style="font-weight:600;text-decoration:underline;color:#0000ff">CONCLUSION</span>: <br />Certificat             	: ~&quot;       &quot;~<br /><span style="color:#0000ff">Arrêt Travail</span> (ou scolaire) :    <br />Soins                               : <br />Arrêt Sport     		:    <br />ITT                 		: <br /><span style="font-family:Arial;font-size:10pt;color:#0000ff">Sera revu en consultation</span> :  <br /><br /><span style="color:#0000ff">Fact agravants</span>	:     <br /><span style="text-decoration:underline;color:#0000ff">Codage CCAM</span>: <br /><br /></p>
</body></html>
