Anastasia Zherlitsyna — timeline

Ministry of health of Ukraine

Name and location of the health care institution from which the statement was sent

MEDICAL DOCUMENTATION

Form of primary accounting documentation N 027-1/o

The order of the Ministry of Health of Ukraine was approved 10.10.2007 № 629

National

Cancer Institute

03022, Kyiv, 33/43 Lomonosova st,

EDRPOU CODE 02011976

AN EXTRACT

an extract from the medical card of an inpatient with a malignant neoplasm

November "15th” 2022

To: Zhytomyr region. , Malynsky district

Identifier: С212964 N: 14809/2022

1. Surname, first name, patronymic: ZHERLITSYNA ANASTASTYA STANISLAVIVNA

2. Sex: female

3. Date of birth (DD/MM/YYYY): 25/04/1976

4. The patient's registration address: (713 ;0 ) 30 Heroiv Krut st., Zhytomyr Region , Malynskyi District, Malyn city, 

5. Type: town

6. The place of work (specialty): unknown

7. Group of primary accounting:

8. Date of hospitalization (DD/MM/YYYY): 27/09/2022

9. Date of discharge(DD/MM/YYYY): 28/09/2022

CODE ICD-10: C55 (34 unspecified part of the uterus)
Clinical group: 2

FINAL DIAGNOSIS

1. Clinical diagnosis: malignant neoplasm (ICD-10 code C55)

(48901) uterus

(3254) Leiomyosarcoma

Date of diagnosis: 8 /2022

Indices (p) TNM according to the 6th revision:

Т2 NO M1

The diagnosis is confirmed: histologically

Morphological conclusion № 48278 from 31/08/2022 (DD/MM/YYYY)

Transferred and accompanying diseases:

(code ICD-10)

(code ICD-10)

Chronic gastritis

01/09/2022: distant metastasis 19805-omentum

01/09/2022: distant metastasis 16001-liver

HOSPITAL

Hospitalization:

from 01/09/2022 until 02/09/2022 (DD/MM/YYYY) about:

- malignant neoplasm of of an unspecified part of the uterus (ICD-10 code C55)

Hospitalization: from 08/09/2022 until 09/09/2022 about:

- malignant neoplasm of of an unspecified part of the uterus (ICD-10 code C56)

Hospitalization: from 27/09/2022 until 28/09/2022 about: (ICD-10 code C55)

- malignant neoplasm of of an unspecified part of the uterus

CHRONOLOGY OF TREATMENT (DD/MM/YYYY)

Chemo-, hormone-, immunotherapy

NI hosp.	Drug	Dose (Total)	Method of drug administration
0.	from 04/10/2022 until 04/10/2022 Type:Chemotherapy Character: according to a radical program
	- Gemzar	2000.0	intravenously
1.	from 01/09/2022 until 01/09/2022 Type:Chemotherapy Character: according to a radical program
	- Taxotere - Gemzar	160.0 2000.0	intravenously intravenously
2.	from 08/09/2022 until 08/09/2022 Type:Chemotherapy Character: according to a radical program
	- Gemzar	2000.0	intravenously
3.	from 27/09/2022 until 27/09/2022 Type:Chemotherapy Character: according to a radical program
	- Taxotere - Gemzar	160.0 2000.0	intravenously intravenously

20. Special examination methods:

21. Recommendations at discharge:

The doctor who filled out the discharge: L A Proskurnya

Chief department: U V Ostapenko