PSYCHIATRIC DISEASE PEPORT(병력신고서)

1. PSYCHIATRIC_DISEASE_PEPORT(병력신고.hwp
2. PSYCHIATRIC_DISEASE_PEPORT(병력신고.doc
3. PSYCHIATRIC_DISEASE_PEPORT(병력신고.pdf
PSYCHIATRIC DISEASE PEPORT(병력신고서)
[별지 제 44호의2서식]<신설 94. 9. 10> (제28조의2)

PSYCHIATRIC DISEASE PEPORT

(병력신고서)

1) Have you received any treatment for schizophrenia affective disorder. severe personality disorder or the equivalent psychological problems
Yes
(있음)
No
(없음)

(귀하는 정신분열증, 정통장애, 고도의 성격장애 및 이에 준하는 증세로 인하여 치료받
은 사실이 있습니까)
beginning date of treatment :,,
<있는 (치료개시일)
겨우> end date of treatment :,,
(치료종료일)
name of disease :,,
(별명)
name of hospital :,,
(치료병원)

2) Have you received any treatment for epilepsy or other convulsive disorder
Yes
(있음)
No
(없음)

(귀하는 경련성질환(간질)으로 치료받은 사실이 있습니까)
beginning date of treatment :,,
<있는 (치료개시일)
겨우> end date of treatment :,,
(치료종료일)
name of disease :,,
(별명)
name of hospital :,,
(치료병원)