QUESTIONNAIRE STAMP

• US 20180126762A1
• Filed: 06/01/2017
• Published: 05/10/2018
• Est. Priority Date: 11/10/2016
• Status: Abandoned Application

• Current Assignee: Institute for Neuropsychiatry
• Original Assignee: Institute for Neuropsychiatry
• Inventors: TSUIKI, Satoru, INOUE, Yuichi, NARAHARA-ENO, Yukiko
• Application Number:
  US15/611,758
• Publication Number:
  US 20180126762A1
• Time in Patent Office: Days
• CPC Class Codes: A61B 90/90 Identification means for patients or instruments, e.g. tags
• CPC Class Codes: A61B 90/94 coded with symbols, e.g. text
• CPC Class Codes: B41K 1/38 Inking devices; Stamping surfaces
• CPC Class Codes: B41K 1/50 Stamping surfaces impregnated with ink, or made of material leaving a mark after stamping contact

Abstract

A questionnaire stamp is disclosed which has: a question item indicating section that indicates at least one question item concerning a predetermined symptom that a patient may have; a check result entry section in which a check result as to whether the question item is applicable to the patient can be recorded; and an applicable item counting section in which the total number of applicable question items is entered, wherein the questionnaire stamp is affixed to a given location of the patient'"'"'s medical record or an auxiliary record form of the medical record.

Claims

1. A questionnaire stamp comprising:

a question item indicating section that indicates at least one question item concerning a predetermined symptom that a patient may have;

a check result entry section in which a check result as to whether the question item is applicable to the patient can be recorded; and

an applicable item counting section in which a total number of applicable question items is entered,

wherein the questionnaire stamp is affixed to a given location of a medical record of the patient or an auxiliary record form of the medical record.

2. The questionnaire stamp according to claim 1, wherein the question item indicating section indicates the question item in a simplified manner by using a character contained in a word that represents the question item.

3. The questionnaire stamp according to claim 2, wherein the question item indicating section indicates four question items in a simplified manner such that each question item is indicated by a character that represents the question item.

4. The questionnaire stamp according to claim 3, wherein the question item indicating section indicates four letters of S, T, O and P, in this order.

5. The questionnaire stamp according to claim 4, wherein the check result entry section is provided adjacent to each item in the question item indicating section.

6. A medical record to which a questionnaire stamp according to claim 1 is affixed.

7. A stamper having a rubber stamp formed as a questionnaire stamp according to claim 1.

8. The questionnaire stamp according to claim 1 which is electronically provided at a given location of an electronic medical record of the patient or an auxiliary electronic record form of the electronic medical record.