編號No. | 項目Qestion | 說明Answer | 備註Reserve |
01 |
name? |
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02 |
sexuality? |
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03 |
stature? |
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04 |
weight? |
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05 |
blood pressure, blood type? |
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06 |
age? |
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07 |
ancestral home? |
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08 |
education school? |
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09 |
headache? |
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10 |
dandruff? |
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11 |
any kind of allergy? |
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12 |
eyeball: is there black spots on white part, on up down right or left? |
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13 |
white part: white, yellow, red, clear or turbid? |
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14 |
nose: inner dry, moist, hot or cool? |
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15 |
tongue: fur white, yellow or red? |
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16 |
gums: status? nail? |
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17 |
ear: internal and external status? ? |
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18 |
regular diet habit: rice, noodle, fish? meat? |
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19 |
vegetation? fruit? Have cold drink often?regular drink? |
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20 |
digestive system is normal? BM solid? loose? |
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21 |
urine clear? turbid? yellow? red? |
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22 |
sleeping time? biological clock reversed? |
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23 |
occupation? mental stress? |
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24 |
exercise habit? |
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25 |
Lower abdomen circumference and waist circumference? |
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26 |
ultrasonic check? ever had surgery? |
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27 |
menstruation blood color? quantity? any clot? |
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28 |
Pregnancy? married? have close friends? |
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29 |
grandparents are alive? age? any inheritance symptom? occupation? |
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30 |
Self introduction , photo without cosmetic in order to watch, hear, ask and touch(望)? |
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31 |
other hospital treatment? medication? |
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32 |
address? telephone? religion ? |
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