护理会诊记录申请单

 □常诊 □急诊

患者姓名：         住院号：           性别：     年龄：      初步诊断：                               

申请护理会诊的目的：                                                                                                 

被邀请科室：                                                                             

会诊需解决的护理问题：___________________________________________________________________

                                                                                       _

简要病历及护理措施                                                   年   月   日    时

      兹邀请      　　护长、组长及高责护士           前来协助解决护理难题，谢谢！

请求会诊科室：              护士长：          

会诊意见（汇总）                                                    年   月   日    时

                                                       科  会诊者签名：                        

注：（1）护理会诊分科间、院内、院外三级。（2）科间会诊，由科室完成，需院内多科会诊或需请院外专家时，科室提出申请，由护理部完成。