| Name: |
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Sex: |
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Age: |
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| Address: |
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Zipcode: |
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| The receiver'sname: |
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Telephone: |
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Cellular phone: |
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| Mail |
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| Cause of disease:Child |
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premature delivery |
dystocia |
asphyxiation |
high fever |
twitch |
trauma |
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Frighten |
coma |
toxicosis |
kernicterus |
brain paralysis |
waterhead |
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cerebrovascular abnormality |
brain infarct |
brain blooding |
brain atrophy |
brain hypogenesis |
braitumourn |
| Other: |
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| Medium-old age |
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The high fever |
trauma |
frighten |
twitch |
coma |
toxicosis |
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high blood pressure |
low blood pressure |
arteriosclerosis |
brain infarct |
brain blooding |
brain atrophy |
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waterhead |
encephalomalacia |
brain liquescence |
brain cirrhosis |
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| comnbinedsymptom: |
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| Now symptom |
| low intelligence(
light
medium
heavy) |
expression(
pure
not pure) |
flabby emotion |
descended memory |
| thinking(
good
medium
bad) |
impatience
irascibility
willful |
scatterbrained |
cowardice frighten |
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incognize relative |
surface dementia |
sluggish action |
more active and unease |
little movement |
less talking |
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Talk not pure or only a word |
informless |
hearing and sight |
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choked when drinking and eating |
difficulty to swallow |
drivel |
dizzy and pain of head |
unconsc
iousness |
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Beat the head |
chest with stuffy air |
atony body |
joint(
flabbiness
ankylosis
convulsion
twitch paralysis) |
| stiff muscle
weak
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atony body |
can't raise head |
can't turn over the body |
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Will not sit or sit unsteady |
will not stand |
will not run |
unsteady fast walking andfall down |
| (
Single
double)he feet can't set levelt |
toe(
single
double)touch ground |
malformated walking gesture or scissors step |
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hemiplegy |
oneside leg paralysis |
paraplegia |
twitch |
blended paralysis |
hyperkinesia |
| Assistance check |
Electroencep
halogram: |
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| Electrocardiogram: |
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| B ultrasonic: |
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| E.M.G.: |
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| Hearing check: |
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| CT:MRI: |
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| Examination |
| Early Examination: |
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| Clinical diagnosis: |
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| Processing: |
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