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陸教授神經科診所 Professor Lu Neurological Clinic
病歷首頁
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病患本人是否為陸清松醫師於長庚醫院任職期間，診治的病患? Have you visited Dr. Lu previously in Chang Gung Memorial Hospital?
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姓名 First Name&Last Name
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身份證號 ID No./Passport No.
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出生日期 (西元年/月/日) Date of Birth (yyyy/mm/dd)
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MM
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DD
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YYYY
性別 Gender
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男 Male
女 Female
電話(含區域號碼) Telephone
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手機 Cell Phone
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電子信箱 E-MAIL
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住址 Address (請詳實填寫完整的地址)
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緊急聯絡人 Emergency contact
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病患與緊急聯絡人的關係 Relationship between patient and emergency contact
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緊急聯絡人電話或手機 Phone of emergency contact
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您可再補充其他人/或是其他的聯絡方式
You may add other people or alternative contact information.
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主要語言 Langue
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國語 Chinese
台語 Mandarin
客語 Hakka
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慣用手 Strong Hand
左手 Left Hand
右手 Right Hand
教育程度 Education
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未就學 Uneducated
國小 Primary school
國中 Junior high school
高中職 High school
五專、二專、三專 Juniorcollege
大學 University
碩士 Graduate school
博士 PhD
Other:
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身高(公分) Height, cm
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體重(公斤) Weight, kg
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血型 Blood type
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不清楚 Unknown
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