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Приложение Б

⇐ ПредыдущаяСтр 2 из 2


Приложение Б

“СДС”            1 ФИО __________________ _______________________ _______________________ _______________________ _______________________ _______________________ _______________________ дата рожд. ____________ _______________________ дата обслед. ____________   “СДС”            1 ФИО __________________ _______________________ _______________________ _______________________ _______________________ _______________________ _______________________ дата рожд. ____________ _______________________ дата обслед. ____________   “СДС”            1 ФИО __________________ _______________________ _______________________ _______________________ _______________________ _______________________ _______________________ дата рожд. ____________ _______________________ дата обслед. ____________        
                                 3 2 1 0 1 2 3 1. (V) |___|___|___|___|_­__|___|              3 2 1 0 1 2 3 2. (I*) |___|___|___|___|_­__|___|                  3 2 1 0 1 2 3 3. (E) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 4. (V) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 5. (I) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 6. (E) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 7. (V*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 8. (I) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 9. (E*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 10. (V) |___|___|___|___|_­__|___|               3 2 1 0 1 2  3 11. (I*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 12. (E) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 13. (V) |___|___|___|___|_­__|___|               3 2 1 0     1 2 3 14. (I) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 15. (E*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 16. (V) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 17. (I) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 18. (E*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 19. (V) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 20. (I) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 21. (E) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 22. (V*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 23. (I*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 24. (E*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 25. (V*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 26. (I) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 27. (E) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 28. (V) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 29. (I) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 30. (E*) |___|___|___|___|_­__|___|                                  3    2 1 0 1 2 3 1. (V) |___|___|___|___|_­__|___|              3 2 1 0 1 2 3 2. (I*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 3. (E) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 4. (V) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 5. (I) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 6. (E) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 7. (V*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 8. (I) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 9. (E*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 10. (V) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 11. (I*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 12. (E) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 13. (V) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 14. (I) |___|___|___|___|_­__|___|               3 2 1 0 1    2 3 15. (E*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 16. (V) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 17. (I) |___|___|___|___|_­__|___|               3 2 1     0 1 2 3 18. (E*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 19. (V) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 20. (I) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 21. (E) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 22. (V*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 23. (I*) |___|___|___|___|_­__|___|                 3 2 1 0 1 2 3 24. (E*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 25. (V*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 26. (I) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 27. (E) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 28. (V) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 29. (I) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 30. (E*) |___|___|___|___|_­__|___|                                  3 2 1 0 1 2 3 1. (V) |___|___|___|___|_­__|___|              3 2 1 0 1 2 3 2. (I*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 3. (E) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 4. (V) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 5. (I) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 6. (E) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 7. (V*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 8. (I) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 9. (E*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 10. (V) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 11. (I*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 12. (E) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 13. (V) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 14. (I) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 15. (E*) |___|___|___|___|_­__|___|               3 2 1 0 1 2   3 16. (V) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 17. (I) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 18. (E*) |___|___|___|___|_­__|___|               3 2 1 0     1 2 3 19. (V) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 20. (I) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 21. (E) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 22. (V*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 23. (I*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 24. (E*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 25. (V*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 26. (I) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 27. (E) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 28. (V) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 29. (I) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 30. (E*) |___|___|___|___|_­__|___|      
                2                 2                 2      
                3 2 1 0 1 2 3 31. (V*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 32. (I) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 33. (E*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 34. (V*) |___|___|___|___|_­__|___|               3 2 1 0 1 2  3 35. (I*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 36. (E) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 37. (V) |___|___|___|___|_­__|___|               3 2 1 0     1 2 3 38. (I*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 39. (E) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 40. (V) |___|___|___|___|_­__|___|               3  2 1 0 1 2 3 41. (I) |___|___|___|___|_­__|___|              3 2 1 0 1 2 3 42. (E*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 43. (V) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 44. (I) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 45. (E*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 46. (V*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 47. (I*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 48. (E) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 49. (V*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 50. (I*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 51. (E) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 52. (V) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 53. (I*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 54. (E) |___|___|___|___|_­__|___|               3 2 1 0   1 2 3 55. (V) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 56. (I) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 57. (E) |___|___|___|___|_­__|___|               3 2   1 0 1 2 3 58. (V*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 59. (I) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 60. (E) |___|___|___|___|_­__|___|                 3 2 1 0 1 2 3 31. (V*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 32. (I) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 33. (E*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 34. (V*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 35. (I*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 36. (E) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 37. (V) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 38. (I*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 39. (E) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 40. (V) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 41. (I) |___|___|___|___|_­__|___|              3 2 1 0 1  2 3 42. (E*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 43. (V) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 44. (I) |___|___|___|___|_­__|___|               3 2 1    0 1 2 3 45. (E*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 46. (V*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 47. (I*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 48. (E) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 49. (V*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 50. (I*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 51. (E) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 52. (V) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 53. (I*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 54. (E) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 55. (V) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 56. (I) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 57. (E) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 58. (V*) |___|___|___|___|_­__|___|               3 2 1 0 1 2    3 59. (I) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 60. (E) |___|___|___|___|_­__|___|                 3 2 1 0 1 2 3 31. (V*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 32. (I) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 33. (E*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 34. (V*) |___|___|___|___|_­__|___|               3      2 1 0 1 2 3 35. (I*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 36. (E) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 37. (V) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 38. (I*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 39. (E) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 40. (V) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 41. (I) |___|___|___|___|_­__|___|              3 2 1 0 1 2 3 42. (E*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 43. (V) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 44. (I) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 45. (E*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 46. (V*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 47. (I*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 48. (E) |___|___|___|___|_­__|___|               3 2 1 0     1 2 3 49. (V*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 50. (I*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 51. (E) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 52. (V) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 53. (I*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 54. (E) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 55. (V) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 56. (I) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 57. (E) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 58. (V*) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 59. (I) |___|___|___|___|_­__|___|               3 2 1 0 1 2 3 60. (E) |___|___|___|___|_­__|___|      

 


⇐ Предыдущая12
  

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