: هﺪﻨﻨﮐ ﻪﻨﯾﺎﻌﻣ ﯽﺼﺼﺨﺗ ﺰﮐﺮﻣ...

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داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﮑﯽ و ﺧﺪﻣﺎت ﺑﻬﺪاﺷﺘﯽ درﻣﺎﻧﯽ اﺻﻔﻬﺎن ﻣﺮﮐﺰ ﺑﻬﺪاﺷﺖ اﺳﺘﺎن اﺻﻔﻬﺎن ﻃﺮح ﮐﺎﻫﺶ و ﮐﻨﺘﺮل ﺳﯿﻠﯿﮑﻮزﯾﺲ ﻓﺮم ﮔﺰارش دﻫﯽ ﻣﻌﺎﯾﻨﺎت ﮐﺎرﮔﺮان در ﻣﻌﺮض ﺳﯿﻠﯿﺲ از واﺣﺪﮐﺎري ﺑﻪ ﻣﺮﮐﺰ ﺑﻬﺪاﺷﺖ ﺷﻬﺮﺳﺘﺎن ﺗﻌﺪاد ﺷﺎﻏﻞ در ﻣﻌﺮض ﺳﯿﻠﯿﺲ ﺗﻌﺪاد ﮐﻞ ﺷﺎﻏﻠﯿﻦ ﻧﺎم ﮐﺎرﺷﻨﺎس ﺑﻬﺪاﺷﺖ ﺣﺮﻓﻪ ا ي ﻧﻮع ﺻﻨﻌﺖ ﻧﺎم ﮐﺎرﻓﺮﻣﺎ ﻧﺎم ﮐﺎرﮔﺎه: ﺗﻌﺪاد ﮐﻞ اﻓﺮاد ﻣﻌﺎﯾﻨﻪ ﺷﺪه.......... زﻣﺎن اﻧﺠﺎم ﻣﻌﺎﯾﻨﻪ: ............................. ﻧﺎم ﻣﺮﮐﺰ ﺗﺨﺼﺼﯽ ﻣﻌﺎﯾﻨﻪ ﮐﻨﻨﺪه: ............... ﺗﻌ ادCXR اﻧﺠﺎم ﺷﺪ ه............. : ﺗﻌﺪاد ﮐﻞ اﻓﺮاد ارﺟﺎع داده ﺷﺪه: ................ ﺑﺪون ﭘﺎﺳﺦ :ً ﻓﻌﻼ ﻣﻮارد ﻧﺎﻣﺸﺨﺺ : ﻋﺪم اﺑﺘﻼ ﺑﻪ ﺳﯿﻠﯿﮑﻮزﯾﺲ : اﺑﺘﻼ ﺑﻪ ﺳﯿﻠﯿﮑﻮزﯾﺲ : ﻟﯿﺴﺖ اﻓﺮاد ﻣﺒﺘﻼ ﺑﻪ ﺳﯿﻠﯿﮑﻮزﯾﺲ ﻧﺘﯿﺠﻪ ﺗﺴﺖPPD ﻧﺘﯿﺠﻪ ارﺟﺎع ﻧﻮع ﺷﻐﻞ) وﻇﯿﻔﻪ ﻣﺤﻮﻟﻪ( ﺳﺎﺑﻘﻪ ﻣﻮاﺟﻬﻪ ﺑﺎ ﺳﯿﻠﯿﺲ ﺳﻦ ﻧﺎم ﭘﺪر ﻧﺎم و ﻧﺎم ﺧﺎﻧﻮادﮔﯽ ردﯾﻒ ﻣﺘﺨﺼﺺ ﻃﺐ ﮐﺎر ﻓﻮق ﺗﺨﺼﺺ رﯾﻪ1 2 3 4 5 6 7 8 9 10 ﻧﺎم و ﻧﺎم ﺧﺎﻧﻮادﮔﯽ ﮐﺎرﺷﻨﺎس ﺑﻬﺪاﺷﺖ ﺣﺮﻓﻪ اي ﺗﮑﻤﯿﻞ ﮐﻨﻨﺪه ﻓﺮم : ﻧﺎم و ﻧﺎم ﺧﺎﻧﻮادﮔﯽ ﻣﺪﯾﺮﻋﺎﻣﻞ: ﺗﺎرﯾﺦ ﺗﮑﻤﯿﻞ ﻓﺮم :

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