| 疾病名称 | 持续时间 | 是否住院 | 服药情况(用药、口服药、肌肉注射、静脉注射) | 所用药品名称 | |
| 1 | ____________ | ____________ | ____________ | ____________ | ____________ | 
| 2 | ____________ | ____________ | ____________ | ____________ | ____________ | 
| 3 | ____________ | ____________ | ____________ | ____________ | ____________ | 
| 4 | ____________ | ____________ | ____________ | ____________ | ____________ | 
| 5 | ____________ | ____________ | ____________ | ____________ | ____________ | 
6题 | 被引用3次