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Aftale ark Afdeling for Hjertesygdomme Til patienter og pårørende Vælg farve Har været til undersøgelse/ambulant kontrol den __________ /_______ - 20______ Undersøgelsen viser: ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Medicinændring: ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Yderligere undersøgelser/kontroller: ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Andet : ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Sign. ______________________________________________________________________________________ Afdeling for Hjertesygdomme Kresten Philipsens Vej 15 6200 Aabenraa Tlf. 7997 2600 x 1/1 Materiale nr: 148911 30.01.2020