第一章 病人身份[Identification]
· [Name] 姓名
· [Sex] 性别
· [Age] 年龄
· [Occupation] 职业
· [Date of birth] 出生日期
· [Marriage （Marital status）] 婚姻
· [Race] 民族
· [Place of birth (Birth place)] 籍贯
· [Identification No.(code of ID card No.)] 身份证号码
· [Department of work and TEL. No. (Unit and Business phone No.)] 工作单位及电话
· [Home address and phone No.] 家庭住址及电话
· [Post code] 邮政编码
· [Person to notify (Correspondent) and phone No.] 联系人及电话
· [Source (Complainer;offerer;supplier;provider) of history] 病史陈术者
· [Reliability of history] 病史可靠程试
· [Medical security (Type of payment)] 医疗费用
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