【摘 要】 医护记载是医院主要的档案资料，又称病历，中国卫生部定名为“病案”。病案是患者就医的全部医疗、护理记录，由门诊病案和住院病案两部分构成。门诊病案包含首项、副页、各种查看报告单。

    【关键词】 主要 档案资料 病案

    【Abstract】 the medical records are major hospital archives， also known as records， the ministry of health of China as the ＼"record＼". Medical record is hospitalized， medical and nursing records consisting of outpatient medical record and hospital medical record. First， deputy page ......