外科手術Ⅰ全身麻酔同意書

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䊕䉾䊃䈱⒳㘃䋺㩷
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㫆㩷෰൓ᚻⴚ䋨䉥䉴䋩
㫆㩷⁤Ὺ䋨›䋯೨⿷䉁䈢䈲ᓟ䉐⿷䋩䈱㒰෰
㫆㩷䊧䊮䊃䉭䊮౮⌀䋨䌘✢䋩㩷
㫆㩷ㆱᅧᚻⴚ䋨䊜䉴䋩
㫆㩷⡊ᵞᵺ䋯⡊䈱ᬌᩏ
㫆㩷ౝⷞ㏜ᬌᩏ㩷
㫆㩷ᱤ䈱䉴䉬䊷䊥䊮䉫䋯⎇⏴
㫆㩷⿥㖸ᵄᬌᩏ
䈠䈱ઁ䋺㩷
䈅䈭䈢䈱䊕䉾䊃䈲⃻࿷䇮ਅ⸥䈱䈇䈝䉏䈎䈱ஜᐽਇ቟䉕ᛴ䈋䈩䈇䉁䈜䈎䋿
㫆㩷ຕ
㫆㩷ཌྷฯ
㫆㩷ਅ∯
㫆㩷㘩᰼䉁䈢䈲᳓ಽ៨ข㊂䈱ᄌൻ㩷
㫆㩷䈠䈱ઁ
ᧄᣣ䇮ઁ䈮ᔅⷐ䈫䈘䉏䈩䈇䉎ಣ⟎䈲䈅䉍䉁䈜䈎䋿㩷
㫆㩷䊪䉪䉼䊮ធ⒳
㫆㩷⢂㐷⣼⛉䉍
㫆㩷䊙䉟䉪䊨䉼䉾䊒䈱ၒ䉄ㄟ䉂
㫆㩷䊐䉞䊤䊥䉝ᬌᩏ
㫆㩷Ὺಾ䉍
㫆㩷䉫䊦䊷䊚䊮䉫
䈠䈱ઁ䋺㩷
ᚻⴚ䋯ಣ⟎⾌↪䈱⷗Ⓧ㊄㗵㩷
䋨䈗Ꮧᦸ䈱႐ว䈲㤗㈮೨䈱ⴊᶧᬌᩏ䉅฽䉁䉏䉁䈜䋭⹦䈚䈒䈲ⵣ㕙䉕䈗ⷩਅ䈘䈇䋩䋺㩷
౞㩷
⑳䈲䈖䈖䈮䇮ోり㤗㈮䉕ᔅⷐ䈫䈜䉎ಣ⟎䉕਄ㅀ䈱േ‛䈮ታᣉ䈜䉎⸵น䉕
䈮ਈ䈋䉁䈜䇯⑳䈲䇮䈠䈱䊥䉴䉪䉕⹺⼂䈚䇮ᜂᒰ₞
කᏧ䈭䉌䈶䈮േ‛∛㒮䉕䇮㤗㈮ว૬∝䈎䉌⊒↢䈜䉎䈅䉌䉉䉎ᴺᓞ⊛䊶⚻ᷣ⊛⽿છ䈎䉌఺㒰䈚䉁䈜䇯⑳䈲䇮䈇䈎䈭䉎ಣ⟎ਛ䈮䉅⿠
䈖䉍䈉䉎ਇ᷹䈱੐ᘒ䈮䉋䈦䈩ಣ⟎䈱⷗Ⓧ㊄㗵䈮ᄌᦝ䈏↢䈛䈉䉎䈖䈫䉕ℂ⸃䈚䇮䈠䈱⾌↪䉕ᡰᛄ䈉䈖䈫䈮หᗧ䈚䉁䈜䇯㩷
㘺䈇ਥ䉁䈢䈲⽿છ䉕⽶䈉ઍℂੱ䈱⟑ฬ䇮䉁䈢䈲ᝲශ㩷
Copyright © 2009 Intervet/Schering-Plough Animal Health.䇭ήᢿォ౮䊶ⶄ⵾⑌ᱛ䇯㩷
ᣣઃ㩷
㤗㈮೨䈱ⴊᶧᬌᩏ
ਅ⸥䈱ౝኈ䉕䉋䈒䈍⺒䉂䈱䈉䈋䇮⟑ฬ䇮䉁䈢䈲ᝲශ䉕䈍㗿䈇䈚䉁䈜䇯㩷
䈅䈭䈢䈱䊕䉾䊃䈲ᧄᣣ䇮㤗㈮䋯ᚻⴚ䈱䈢䉄䈮േ‛∛㒮䈮᧪㒮䈘䉏䈩䈇䉁䈜䇯ᒰ㒮䈪䈲㤗㈮䉕ⴕ䈉೨䈮䇮䈅䈭䈢䈱䊕䉾䊃䈮ኻ䈚䈩
౉ᔨ䈭り૕ᬌᩏ䉕ⴕ䈇䉁䈜䇯䈚䈎䈚䇮ᚻⴚ䈮䈲࿕᦭䈱䊥䉴䉪䈏䈅䉍䉁䈜䈱䈪䇮ᒰ㒮䈪䈲㤗㈮೨䈱ⴊᶧᬌᩏ䈱ታᣉ䉕ᒝ䈒䈍൘䉄䈚
䈩䈍䉍䉁䈜䇯ⴊᶧᬌᩏ䉕ታᣉ䈜䉎䈖䈫䈪䇮䊥䉴䉪䉕ૐਅ䈘䈞䇮り૕ᬌᩏ䈪䈲᣿䉌䈎䈮䈭䉌䈭䈇䇮ᷓೞ䈭ว૬∝䉕ᒁ䈐⿠䈖䈜䈍䈠䉏
䈱䈅䉎ౝ⊛∔ᖚ䈱ሽ࿷䈮᳇䈨䈒䈖䈫䈏䈪䈐䉁䈜䇯㩷
䊕䉾䊃䈮ᚻⴚ䉕ታᣉ䈜䉎೨䈮䇮ផᅑ䈜䉎ⴊᶧᬌᩏ䉕
ⴕ䈦䈩䈒䈣䈘䈇䇯㩷
⇣Ᏹ䈏䉂䈧䈎䈦䈢႐ว䈲䇮⴫㕙䈮⸥タ䈚䈩䈅䉎ㅪ
⛊వ䈮䈗ㅪ⛊䈒䈣䈘䈇䇯㩷
⑳䈲䇮⃻ᤨὐ䈪䈲䇮㤗㈮೨䈱ⴊᶧᬌᩏ䉕ⴕ䈇䉁䈞
䉖䇯ᄖ⑼ᚻⴚ䈲ᒁ䈐⛯䈐䈍㗿䈇䈇䈢䈚䉁䈜䇯㩷
㘺䈇ਥ䉁䈢䈲⽿છ䉕⽶䈉ઍℂੱ䈱⟑ฬ䇮䉁䈢䈲ᝲශ㩷
㘺䈇ਥ䉁䈢䈲⽿છ䉕⽶䈉ઍℂੱ䈱⟑ฬ䇮䉁䈢䈲ᝲශ㩷
Copyright © 2009 Intervet/Schering-Plough Animal Health.䇭ήᢿォ౮䊶ⶄ⵾⑌ᱛ䇯㩷