附件18 醫(yī)療處理表（船長醫(yī)療報(bào)告表） ship master report form for medical info

1、附件18（MEDICALTREATMENTFM醫(yī)療處理表）ShipMaster’sReptFm1船長報(bào)告表船長報(bào)告表DateofRept:報(bào)告日期Ship’sIdentity&NavigationStatus船舶特性和航行狀況船舶特性和航行狀況VesselName船名VesselOwner船東JIYANGName&Addressofonsheagent岸上代理地址Position(LatitudeLongitude)atonsetofi

2、llness生病時(shí)位置（經(jīng)緯度）Destination&ETA(expectedtimeofarrival)目的港和預(yù)計(jì)到達(dá)時(shí)間Thepatientthemedicalproblem患者及其醫(yī)患者及其醫(yī)療問題療問題Name(FamilyNameGivenNames)姓名（姓，名）DateofBirth(ddmmyyyy)出生日期（日月年）Gender性別Nationality國籍Male男Female女ShipboardJobTitle

3、船上工作職務(wù)SeafarerRegistrationNumber海員證號(hào)碼Hour&Datewhentakenoffwk休假時(shí)間和日期Hour&Datewhenreturnedtowk重返工作的時(shí)間日期1Attachallrelevantmedicalreptstothisreptfm本報(bào)告表附有所有相關(guān)的醫(yī)療報(bào)告InjuryIllness受傷或患病受傷或患病Hour&dateofinjuryonsetofillness受傷或生病的時(shí)間

4、日期Hour&dateoffirstexaminationtreatment首次檢查或處理時(shí)間日期Locationofshipwheninjuryoccurred受傷發(fā)生時(shí)船位Circumstancesofinjury受傷情況Symptoms癥狀Findingsofphysicalexamination體檢結(jié)果FindingsofXraylabatytestsX射線或?qū)嶒?yàn)室檢查結(jié)果Overallclinicalimpressionbef

5、etreatment治療前總體臨床印象Treatmentgivenonboard治療前總體臨床印象Overallclinicalimpressionaftertreatment治療后總體臨床印象Telemedicalconsultation遠(yuǎn)程醫(yī)療會(huì)診Hour&dateofinitialcontact初始聯(lián)系時(shí)間和日期Modeofcommunication(telephoneradiofaxother)通訊方式（無線電、電話、傳真、其它