ÚÙ¯
μ—«Õ¬à“ßÀ¡“¬‡≈¢ ÚÛ μ“¡√–‡∫’¬∫¢âÕ Ú˘ (Ò) (∑.¥. Ò)
∑∫’Ë “â π
∑ Ë’ «π/‰√à
∑’Ëπ“
∑.’Ë .............
§”¢Õ®¥∑–‡∫’¬π ∑‘ ∏‘·≈–πμ‘ ‘°√√¡ πÕ°‡¢μ
„π‡¢μ
·≈–°“√ Õ∫ «π ‘∑∏‘„π∑¥’Ë π‘ ª√–‡¿∑...·..∫...ßà ..¢..“..¬....(.§..√..Õ..∫...®..”..π..Õ..ß..).......................
μ”·Àπàß∑’Ë¥‘π
√–«“ß...............................5..1..3..6..I.V....7..2..2..8..›.1....................................μ”∫≈.........................................................................................
‡≈¢∑Ë’¥‘π.....................................ı................................................ Õ”‡¿Õ........................................................................................
Àπ“â ”√«®.................................˜..ˆ...............................................®ß— À«¥— ........................................................................................
’∑Ë ‘¥π·ª≈ß Ë’∑·¬°‰ª È’π·≈–·ª≈ߧ߇À ◊≈Õ°“√®”πÕß —¬ß§ß ’¡Õ àŸ¬μ“¡ — ≠≠“®”πÕß© —∫∫≈ß —«π Ë’∑...........‡¥◊Õπ...........................æ.». ...............‚©π¥∑¥Ë’ π‘
‡®â“æπ—°ß“π ’Ë∑ ‘¥π ‡≈¢∑.’Ë ....................˜...Û..ˆ..................‡≈à¡............¯............................Àπ“â ............Û..ˆ......................
®”π«π∑’¥Ë ‘π..............ı.....................‰√à................›.................ß“π................›...................μ“√“ß«“
Ò. ¢“â 懮“â º¡Ÿâ ’π“¡μàÕ‰ªπÈ’ ¡§’ «“¡ª√– ߧå¢Õ®¥∑–‡∫¬’ π ‘∑∏·‘ ≈–π‘μ‘°√√¡‡°’ˬ«°—∫Õ ß— À“√‘¡∑√æ— ¬∑å Ë°’ ≈“à «¢â“ß∫ππ’È ·≈–
‰¥âªØ‘≠“≥μπ·≈«â ¢Õ„À∂â âÕ¬§”¥â«¬§«“¡ μ— ¬å®√‘ß ∂“â ¢â“懮ⓄÀâ∂Õâ ¬§”‰¡à‡ªì𧫓¡®√‘ß„Àâ„™∂â Õâ ¬§”π¬’È π— ¢“â 懮Ⓞπ∑“ߧ¥Õ’ “≠“‰¥â
Ú. ¢“â 懮â“..............π..“..¬....°............................ ‡≈¢ª√–®”μ—«ª√–™“™π ºâ.Ÿ ..¢..“..¬...............................
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Õ“¬ÿ..................................ªï —≠™“μ.‘ ......‰..∑..¬..............................∫‘¥“/¡“√¥“™◊ÕË .............................................................................
‚ ¥ À¡“â ¬ §Ÿ à ¡√ ™Õ◊Ë ..........................................................................................
Õ¬Ÿ∑à ’Ë∫“â π/À¡Ÿà∫â“π..........................‡≈¢∑’Ë................μ√Õ°/´Õ¬.......................................∂ππ.....................................À¡∑Ÿà Ë.’ .............
μ”∫≈/·¢«ß...................................Õ”‡¿Õ/‡¢μ...................................®ß— À«¥— .................................À¡“¬‡≈¢‚∑√»æ— ∑.å ....................
Û. ¢“â 懮“â ...............π..“..¬....ß........................... ‡≈¢ª√–®”μ—«ª√–™“™π º.Ÿâ ..´..ÕÈ◊.................................
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Õ“¬.ÿ .................................ªï ≠— ™“μ‘........‰.∑...¬.............................∫¥‘ “/¡“√¥“™◊ÕË .............................................................................
‚ ¥ À¡“â ¬ §à Ÿ ¡√ ™Ë◊Õ....................................................... —≠™“μ‘.......................
Õ¬àŸ∑Ë∫’ â“π/À¡∫Ÿà â“π..........................‡≈¢∑.’Ë ...............μ√Õ°/´Õ¬.......................................∂ππ.....................................À¡àŸ∑Ë’..............
μ”∫≈/·¢«ß...................................Õ”‡¿Õ/‡¢μ...................................®ß— À«—¥.................................À¡“¬‡≈¢‚∑√»—æ∑å.....................
Ù. ¢“â 懮“â ¢Õ· ¥ß√“§“∑√æ— ¬∑å ’¢Ë Õ∑”πμ‘ °‘ √√¡π’ȇªìπ‡ßπ‘ .............................›............................∫“∑.........›........... μ“ߧå
ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à
(Ò) ¢â“懮Ⓣ¡à‰¥√â ∫— ‚Õπ·∑πÀ√◊Õ‡æ◊ÕË ª√–‚¬™π·å °∫à ÿ§§≈μà“ߥ“â «
(Ú) √“§“∑√—æ¬å∑·Ë’ ¥ß‰«â„π Ù. ‡ªπì √“§“∑·’Ë ∑â®√ß‘
(Û) .‰.¡..à¡...’ ..ßË‘..ª...≈..Ÿ°.. ..√..â“..ß.............................................................................................................................................
(Ù) .º..¢Ÿâ..“..¬..‰..¥..∑â..’Ë¥...‘π..¡..“..‚..¥..¬.........................‡..ª..ìπ..‡..«..≈..“.......................ª..ï..‰.¡...à§..â“..ß..™..”..√..–..¿..“..…...∫’ ..”..√..ÿß..∑..âÕ..ß...∑..Ë’ ..........................................
(ı) .º..⟢..“..¬..‰..¥..√â..∫—...™..”..√.–...√..“.§...“..∑..Ë¥’..‘π...§..√..∫..∂...«â ..π..·..≈..«â...........................................................................................................
«π— ∑.Ë’ ...........‡¥Õ◊ π..............................æ.»..................
≈ß™Õ◊Ë ......................π..“..¬....°.........................ºŸâ¢Õ ¢“¬
≈ß™ËÕ◊ ......................π..“..¬....ß.........................ºŸâ¢Õ ´Õ◊È
≈ß™Õ◊Ë ......................................................º Ÿâ Õ∫ «π
(......................................................)
”À√∫— æπ°— ß“π‡®â“Àπ“â ∑’Ë
Ò) √“§“ª√–‡¡‘π∑πÿ ∑√—æ¬å.....................................................................................................∫“∑........................................ μ“ߧå
Ú) ‚©π¥∑’Ë¥π‘ „À¡√à –«“ß..........5..1.3..6..I..V....7.2..2..8..›..1............‡≈¢∑¥’Ë π‘ .................ˆ..............................Àπâ“ ”√«®........˜...˜..............................
‚©π¥∑’¥Ë ‘π‡≈¢∑Ë’.......................˜..Û...˜.......................‡≈¡à ........................¯..............................Àπâ“.................Û...˜..............................
®”π«π∑¥’Ë π‘ ...........................Ò...........................‰√.à .............................›...................ß“π.............................›.....................μ“√“ß«“
§ß‡À≈Õ◊ ................................Ù...........................‰√.à .............................›...................ß“π.............................›.....................μ“√“ß«“
Û) ‰¥®â ¥∑–‡∫¬’ π·≈â«·μ«à π— ∑Ë’.................................‡¥Õ◊ π............................................æ.»......................
≈ß™Ë◊Õ.......................................................
(......................................................)
‡®â“æπ—°ß“π∑Ë’¥‘π
μ—«Õ¬à“ßÀ¡“¬‡≈¢ Úı μ“¡√–‡∫’¬∫ ¢Õâ Ú˘ (Ò)
“√∫≠— ®¥∑–‡∫¬’ π
®¥∑–‡∫¬’ π ª√–‡¿∑°“√ ºâŸ„À â ≠— ≠“ ºâŸ√—∫ —≠≠“ ‡π◊ÈÕ∑Ë’¥‘π ‡π◊ÈÕ∑’Ë¥‘π √–«“ß ‡®â“æπ—°ß“π∑’Ë¥‘π
«—𠇥Õ◊ π ªï ®¥∑–‡∫¬’ π 𓬠°. μ“¡ ≠— ≠“ §ß‡À≈Õ◊ ‡≈¢∑Ë’¥‘π ≈ß≈“¬¡Õ◊ ™ÕË◊
π“¢ ¢. ‚©π¥∑Ë’¥‘π„À¡à ª√–∑∫— μ√“
«—π∑.Ë’ ................ ®”πÕß ºŸ√â —∫®”πÕß ‰√à ß“π μ“√“ß ‰√à ß“π μ“√“ß
‡¥Õ◊ π............... «“ «“
æ.». .................
ı››››› › (≈ß™◊ËÕ) 𓬠æ.
«—π∑.Ë’ ................ ·∫ßà ¢“¬ 𓬠°. 𓬠ß. Ò › › Ù › › 5136 IV 7228-1 (≈ß™ËÕ◊ )................
‡¥◊Õπ............... (§√Õ∫®”πÕß) ∑¥’Ë π‘ ·ª≈ß∑·Ë’ ¬°‰ªπÈ’·≈–·ª≈ߧ߇À≈◊Õ ˆ
æ.». ................. °“√®”πÕß ¬ß— §ß¡’Õ¬àμŸ “¡ —≠≠“®”πÕß ˜Û˜
©∫∫— ≈ß«—π∑’Ë............‡¥Õ◊ π...................æ.».............
à«π·ª≈ߧ߇À≈◊Õ §ß¡°’ “√®”πÕßμ“¡‡¥‘¡
ÚÙ˘
μ«— Õ¬à“ßÀ¡“¬‡≈¢ Úˆ μ“¡√–‡∫’¬∫ ¢âÕ Ú˘ (Ò) «√√§ Õß Úı
“√∫—≠®¥∑–‡∫’¬π (√“¬°“√®¥·®ßâ ∑¥’Ë ‘π·ª≈ß∑·’Ë ¬°‰ª„À¡à ‚©π¥∑Ë’ ˜Û˜)
®¥∑–‡∫’¬π ª√–‡¿∑°“√ ºŸâ„À â ≠— ≠“ ºâŸ√—∫ —≠≠“ ‡πÈ◊Õ∑Ë’¥‘π ‡π◊ÈÕ∑’Ë¥‘π √–«“ß ‡®â“æπ—°ß“π∑Ë’¥‘π
«π— ‡¥Õ◊ π ªï ®¥∑–‡∫’¬π μ“¡ ≠— ≠“ §ß‡À≈Õ◊ ‡≈¢∑Ë’¥‘π ≈ß≈“¬¡Õ◊ ™ÕË◊
‚©π¥∑’Ë¥π‘ „À¡à ª√–∑∫— μ√“
«π— ∑’Ë................. ®”πÕß ‰√à ß“π μ“√“ß ‰√à ß“π μ“√“ß
‡¥◊Õπ............... (§√Õ∫®”πÕß) «“ «“
æ.». .................
𓬠°. π“¢ ¢. Ò››››› › (≈ß™ËÕ◊ ) 𓬠æ.
ºŸâ√∫— ®”πÕß °“√®”πÕ߬—ߧߡՒ ¬àμŸ “¡ ≠— ≠“®”πÕß©∫∫— «—π∑Ë’.............................
≈ß«—π∑.Ë’ .........‡¥◊Õπ.............................æ.»................ ‡¥Õ◊ π...........................
æ.». .............................
(≈ß™ÕË◊ ).......................
ÚıÒ
μ—«Õ¬à“ßÀ¡“¬‡≈¢ Ú˜ μ“¡√–‡∫’¬∫¢âÕ Ú˘ (Ú) (∑.¥. Ò)
∑∫’Ë “â π
∑’Ë «π/‰√à
∑’Ëπ“
∑.Ë’ .............
§”¢Õ®¥∑–‡∫¬’ π ‘∑∏·‘ ≈–π‘μ‘°√√¡ πÕ°‡¢μ
„π‡¢μ
·≈–°“√ Õ∫ «π ∑‘ ∏‘„π∑Ë’¥‘π ª√–‡¿∑...·..∫...àß..·..¬..°...„.π..π...“.¡...‡.¥..¡‘....(.§...√..Õ..∫...›.ª...≈..Õ..¥...®..”..π.Õß)
μ”·Àπàß∑Ë’¥‘π ·¬°‹ Ò
√–«“ß...............................5..1..3..6..I.V....7..2..2..8..›.1....................................μ”∫≈.........................................................................................
‡≈¢∑Ë’¥‘π....................................Ú..Û............................................... Õ”‡¿Õ........................................................................................
Àπ“â ”√«®...............................Ù...Ù..Ù..............................................®—ßÀ«¥— ........................................................................................
Ë’∑¥‘π·ª≈ß∑’Ë·¬°‰ªπÈ’æâπ®“°°“√®”πÕßμ“¡ —≠≠“®”πÕß ©∫—∫≈ß«—π∑Ë’...........‡ ◊¥Õπ...........................æ.». ...............‚©π¥∑Ë’¥π‘
μ“¡∫—π∑÷° â¢Õμ°≈ߪ≈Õ¥®”πÕß ≈ß«—π∑Ë’...........‡¥◊Õπ...........................æ.». ............... ‡≈¢∑.Ë’ ....................ı..Û..˘...Ò................‡≈à¡............ı..Ù..........................Àπâ“............˘..Ò......................
‡ ⮓æπ—°ß“π Ë’∑ ‘¥π ®”π«π∑¥Ë’ π‘ ..............Ú.....................‰√.à ...............Û.................ß“π................ı...................μ“√“ß«“
Ò. ¢“â 懮“â ºŸâ¡’π“¡μàÕ‰ªπÈ’ ¡§’ «“¡ª√– ߧ¢å Õ®¥∑–‡∫¬’ π ‘∑∏·‘ ≈–π‘μ‘°√√¡‡°Ë¬’ «°—∫Õ ß— À“√¡‘ ∑√æ— ¬∑å ’Ë°≈à“«¢â“ß∫ππ’È ·≈–
‰¥âªØ≠‘ “≥μπ·≈«â ¢Õ„Àâ∂âÕ¬§”¥â«¬§«“¡ —쬮å √ß‘ ∂â“¢â“懮ⓄÀ∂â âÕ¬§”‰¡‡à ªì𧫓¡®√ß‘ „Àâ„™â∂Õâ ¬§”π’Ȭ—π¢â“懮“â „π∑“ߧ¥Õ’ “≠“‰¥â
Ú. ¢â“懮“â ..............π..“..¬....°............................ ‡≈¢ª√–®”μ—«ª√–™“™π ºâŸ...¢..Õ.................................
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Õ“¬ÿ............ı......................ªï ≠— ™“μ‘.......‰..∑..¬..............................∫‘¥“/¡“√¥“™ËÕ◊ .............................................................................
‚ ¥ À¡“â ¬ § Ÿà ¡√ ™ÕË◊ ..........................................................................................
Õ¬àŸ∑∫’Ë “â π/À¡à∫Ÿ “â π..........................‡≈¢∑.Ë’ ...............μ√Õ°/´Õ¬.......................................∂ππ.....................................À¡Ÿà∑’.Ë .............
μ”∫≈/·¢«ß...................................Õ”‡¿Õ/‡¢μ...................................®ß— À«—¥.................................À¡“¬‡≈¢‚∑√»—æ∑å.....................
Û. ¢â“懮“â ...............π..“..¬....°........................... ‡≈¢ª√–®”μ—«ª√–™“™π ºŸ.â ..¢..Õ.................................
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Õ“¬.ÿ ............ı.....................ªï —≠™“μ‘........‰.∑...¬.............................∫‘¥“/¡“√¥“™◊ËÕ.............................................................................
‚ ¥ À¡“â ¬ §Ÿà ¡√ ™◊ÕË ....................................................... ≠— ™“μ‘.......................
Õ¬∑àŸ ∫’Ë â“π/À¡Ÿà∫â“π..........................‡≈¢∑’Ë................μ√Õ°/´Õ¬.......................................∂ππ.....................................À¡∑Ÿà Ë’..............
μ”∫≈/·¢«ß...................................Õ”‡¿Õ/‡¢μ...................................®ß— À«—¥.................................À¡“¬‡≈¢‚∑√»æ— ∑.å ....................
Ù. ¢“â 懮ⓢշ ¥ß√“§“∑√æ— ¬å∑’Ë¢Õ∑”π‘μ°‘ √√¡π’‡È ªìπ‡ßπ‘ .............................›............................∫“∑.........›........... μ“ߧå
ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à
(Ò) ¢â“懮Ⓣ¡à‰¥â√∫— ‚Õπ·∑πÀ√◊Õ‡æÕË◊ ª√–‚¬™π·å °∫à ÿ§§≈μ“à ߥ⓫
(Ú) √“§“∑√—æ¬∑å ·’Ë ¥ß‰«â„π Ù. ‡ªìπ√“§“∑Ë’·∑®â √ß‘
(Û) .....................................................................................................................................................................
(Ù) .....................................................................................................................................................................
(ı) .....................................................................................................................................................................
«π— ∑.Ë’ ...........‡¥Õ◊ π..............................æ.»..................
≈ß™◊ÕË ......................π..“..¬....°.........................ºŸâ¢Õ ¢“¬
≈ß™Õ◊Ë ......................π..“..¬....°.........................ºŸâ¢Õ ´È◊Õ
≈ß™◊ËÕ......................................................º ⟠Õ∫ «π
(......................................................)
”À√—∫æπ—°ß“π‡®“â Àπâ“∑’Ë
Ò) √“§“ª√–‡¡‘π∑πÿ ∑√—æ¬å.....................................................................................................∫“∑........................................ μ“ߧå
Ú) ‚©π¥∑¥Ë’ ‘π„À¡√à –«“ß..........5..1.3..6..I..V....7.2..2..8..›..1............‡≈¢∑Ë’¥‘π.................Ú..Ù............................Àπâ“ ”√«®...........Ù..Ù...ı.........................
‚©π¥∑Ë¥’ π‘ ‡≈¢∑.’Ë ......................ı..Û..˘...Ú.....................‡≈à¡........................ı..Ù............................Àπ“â .................˘...Ú..............................
®”π«π∑¥Ë’ π‘ ...........................›...........................‰√.à .............................Û...................ß“π.............................ı.....................μ“√“ß«“
§ß‡À≈Õ◊ ................................Ú...........................‰√.à .............................›...................ß“π.............................›.....................μ“√“ß«“
Û) ‰¥â®¥∑–‡∫¬’ π·≈â«·μà«—π∑’.Ë ................................‡¥Õ◊ π............................................æ.»......................
≈ß™ÕË◊ .......................................................
(......................................................)
‡®â“æπ—°ß“π∑Ë’¥‘π
ÚıÚ
μ«— Õ¬“à ßÀ¡“¬‡≈¢ Ú˜ μ“¡√–‡∫¬’ ∫¢Õâ Ú˘ (Ú) (∑.¥. Ò)
∑∫Ë’ “â π
∑Ë’ «π/‰√à
∑’Ëπ“
∑’Ë..............
§”¢Õ®¥∑–‡∫¬’ π ∑‘ ∏·‘ ≈–π‘μ°‘ √√¡ πÕ°‡¢μ
„π‡¢μ
·≈–°“√ Õ∫ «π ‘∑∏‘„π∑’¥Ë π‘ ª√–‡¿∑...·..∫...ßà ..·..¬..°...„.π..π...“.¡...‡.¥..¡‘.................. ·¬°‹ Ú ·≈–
μ”·Àπàß∑’Ë¥‘π (§√Õ∫›ª≈Õ¥®”πÕß) ·ª≈ߧ߇À≈Õ◊
√–«“ß...............................5..1..3..6...I.V....7..2..2..8..›..1..................................μ”∫≈.........................................................................................
‡≈¢∑¥’Ë π‘ ....................................Ú..Û...............................................Õ”‡¿Õ........................................................................................
Àπ“â ”√«®...............................Ù...Ù..Ù..............................................®ß— À«¥— ........................................................................................
’∑Ë¥‘π·ª≈ß∑’Ë·¬°‰ªπ’È·≈–·ª≈ߧ߇À≈◊Õ°“√®”πÕ߬—ߧߡ’Õ àŸ¬μ“¡ —≠≠“®”πÕß ©∫—∫≈ß«—π∑Ë’...........‡ ◊¥Õπ...........................æ.». ...............‚©π¥∑’¥Ë π‘
‡®â“æπ—°ß“π ’Ë∑ ‘¥π ‡≈¢∑’.Ë ....................ı..Û..˘...Ò................‡≈à¡............ı..Ù..........................Àπ“â ............˘..Ò......................
®”π«π∑Ë’¥‘π..............Ú.....................‰√.à ...............›.................ß“π................›...................μ“√“ß«“
Ò. ¢â“懮“â ºŸâ¡’π“¡μàÕ‰ªπ’È ¡’§«“¡ª√– ߧå¢Õ®¥∑–‡∫’¬π ∑‘ ∏‘·≈–πμ‘ °‘ √√¡‡°Ë¬’ «°∫— Õ ß— À“√¡‘ ∑√æ— ¬å∑Ë°’ ≈à“«¢â“ß∫ππÈ’ ·≈–
‰¥âªØ≠‘ “≥μπ·≈«â ¢Õ„Àâ∂Õâ ¬§”¥«â ¬§«“¡ μ— ¬å®√‘ß ∂â“¢“â 懮“â „Àâ∂Õâ ¬§”‰¡à‡ªπì §«“¡®√‘ß„Àâ„™â∂âÕ¬§”π’¬È —π¢â“懮“â „π∑“ߧ¥Õ’ “≠“‰¥â
Ú. ¢â“懮“â ..............π..“..¬...°............................. ‡≈¢ª√–®”μ—«ª√–™“™π ºŸâ...¢..Õ.................................
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Õ“¬.ÿ ...........ı......................ªï —≠™“μ‘.......‰..∑..¬..............................∫‘¥“/¡“√¥“™◊ËÕ.............................................................................
‚ ¥ À¡“â ¬ §Ÿà ¡√ ™◊ÕË ..........................................................................................
Õ¬Ÿà∑∫Ë’ “â π/À¡à∫Ÿ “â π..........................‡≈¢∑’.Ë ...............μ√Õ°/´Õ¬.......................................∂ππ.....................................À¡à∑Ÿ ’.Ë .............
μ”∫≈/·¢«ß...................................Õ”‡¿Õ/‡¢μ...................................®ß— À«—¥.................................À¡“¬‡≈¢‚∑√»—æ∑å.....................
Û. ¢â“懮â“...............π..“..¬....°........................... ‡≈¢ª√–®”μ—«ª√–™“™π ºŸâ...¢..Õ.................................
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Õ“¬.ÿ ............ı.....................ªï ≠— ™“μ‘........‰.∑...¬.............................∫‘¥“/¡“√¥“™ÕË◊ .............................................................................
‚ ¥ À¡“â ¬ §àŸ ¡√ ™ÕË◊ ....................................................... ≠— ™“μ.‘ ......................
Õ¬∑àŸ ∫Ë’ “â π/À¡àŸ∫“â π..........................‡≈¢∑’Ë................μ√Õ°/´Õ¬.......................................∂ππ.....................................À¡∑Ÿà Ë.’ .............
μ”∫≈/·¢«ß...................................Õ”‡¿Õ/‡¢μ...................................®ß— À«—¥.................................À¡“¬‡≈¢‚∑√»—æ∑.å ....................
Ù. ¢“â 懮“â ¢Õ· ¥ß√“§“∑√æ— ¬å∑Ë¢’ Õ∑”π‘μ‘°√√¡πȇ’ ªπì ‡ß‘π.............................›............................∫“∑.........›........... μ“ߧå
ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à
(Ò) ¢“â 懮Ⓣ¡à‰¥â√—∫‚Õπ·∑πÀ√◊Õ‡æË◊Õª√–‚¬™πå·°∫à §ÿ §≈μ“à ߥ⓫
(Ú) √“§“∑√—æ¬å∑·’Ë ¥ß‰«â„π Ù. ‡ªìπ√“§“∑·’Ë ∑â®√‘ß
(Û) ·...∫..ßà..·..¬...°..„.π..π...“..¡..‡.¥...¡‘ ...μ...“..¡..§..”..¢..Õ...©..∫..∫—...≈..ß..«..—π..∑...Ë’ ............‡..¥..Õ◊..π...........................æ...».................................................................
(Ù) .....................................................................................................................................................................
(ı) .....................................................................................................................................................................
«π— ∑.Ë’ ...........‡¥Õ◊ π..............................æ.»..................
≈ß™ÕË◊ ......................π..“..¬....°.........................ºŸâ¢Õ ¢“¬
≈ß™ËÕ◊ ......................π..“..¬....°.........................ºâŸ¢Õ ´ÈÕ◊
≈ß™ÕË◊ ......................................................º Ÿâ Õ∫ «π
(......................................................)
”À√∫— æπ°— ß“π‡®â“Àπ“â ∑’Ë
Ò) √“§“ª√–‡¡‘π∑πÿ ∑√æ— ¬å.....................................................................................................∫“∑........................................ μ“ߧå
Ú) ‚©π¥∑’Ë¥‘π„À¡√à –«“ß..........5..1..3.6....I.V....7..2..2..8..›..1..........‡≈¢∑’¥Ë ‘π.................Ú..ı............................Àπâ“ ”√«®...........Ù..Ù...ˆ.........................
‚©π¥∑Ë’¥‘π‡≈¢∑Ë’.......................ı..Û..˘...Û.....................‡≈¡à ........................ı..Ù............................Àπâ“..................˘..Û..............................
®”π«π∑¥Ë’ π‘ ............................Ò..........................‰√.à .............................›...................ß“π..............................›....................μ“√“ß«“
§ß‡À≈Õ◊ ................................Ò...........................‰√.à .............................›...................ß“π.............................›.....................μ“√“ß«“
Û) ‰¥®â ¥∑–‡∫¬’ π·≈«â ·μ«à π— ∑Ë’.................................‡¥Õ◊ π............................................æ.»......................
≈ß™◊ÕË .......................................................
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‡®â“æπ—°ß“π∑Ë’¥‘π
μ«— Õ¬à“ßÀ¡“¬‡≈¢ Ú˜ μ“¡√–‡∫’¬∫¢âÕ Ú˘ (Ú) ÚıÛ
(∑.¥. Òˆ)
∫—π∑°÷ ¢âÕμ°≈߇√ÕË◊ ߪ≈Õ¥®”πÕß
∑Ë’¥‘π
√–«“ß.............5..1..3.6....I.V....7..2..2..8..›..1..........................................μ”∫≈........................................................................
‡≈¢∑¥Ë’ ‘π..................Ú..Û...........Àπâ“ ”√«®........Ù...Ù..Ù...............Õ”‡¿Õ.......................................................................
‚©π¥À¡“¬‡≈¢∑Ë.’ ..............ı..Û...˘..Ò.........................................®—ßÀ«—¥.......................................................................
∑«’Ë à“°“√.....................................................................
«—π∑Ë.’ ...............‡¥◊Õπ........................................æ.».....................
¢“â 懮“â .....................π..“..¬....¢......º..√âŸ..∫—..®..”..π...Õ..ß................................................ ‡≈¢ª√–®”μ—«ª√–™“™π
.....................π..“..¬....°.......º..⮟ ..”..π..Õ...ß....................................................
Õ“¬ÿ...ı.....,...ı........ªï ‡™È◊Õ™“μ.‘ ........‰.∑...¬.................. —≠™“μ‘........‰..∑..¬...................∫‘¥“/¡“√¥“™Ë◊Õ............................................................
Õ¬∑Ÿà ∫Ë’ â“π/À¡à∫Ÿ “â π......................................‡≈¢∑’.Ë .............μ√Õ°/´Õ¬.....................................∂ππ.................................À¡à∑Ÿ .Ë’ .........
μ”∫≈/·¢«ß...............................Õ”‡¿Õ/‡¢μ...............................®ß— À«—¥................................À¡“¬‡≈¢‚∑√»—æ∑.å .............................
¢//Õ//ª//Ø//‘≠//“/≥///μ//π//·/≈//–//„/À//â∂//âÕ//¬/§//”//μ/Õà//.....‰..¥..∑â...”.∫...—π..∑..°÷...¢..âÕ..μ...°..≈..ß..μ..àÕ...‡.®..“â..æ..π...°— ..ß..“..π..∑...’Ë¥..π‘.....................................................................................
¥//«â//¬//§//«/“/¡// //μ—//¬//®å /√//ß‘ / ¥ß— μÕà ‰ªπ’È :›
......................¢..Õâ....Ò.......μ..“..¡...∑..’Ë¢..“â..æ...‡.®...“â .∑...Èß—.. ...Õ..ß..Ω...É“..¬..‰.¥...â®..¥...∑..–..‡..∫..¬’...π..®..”..π...Õ..ß..∑...¥Ë’ ..‘π...·..ª...≈..ß..‡..§..√..◊ËÕ...ß..À..¡...“..¬..¢...â“..ß..∫..π...π..È’‰..«..μâ..Õà...°..—π....μ...“..¡..À...π..—ß.. ...◊Õ.. ...≠— ...≠....“.......
.®..”..π..Õ...ß..©..∫...—∫..≈...ß..«..π—..∑...Ë’.....................‡..¥..◊Õ...π.........................................æ.....»............................∫..¥—...π..¢È’...â“..æ..‡..®..â“...π...“..¬....°.....‰..¥..¢â...Õ..√..—ß..«..¥—...·..∫...ßà ..·..¬...°..„..π..π..“..¡...‡.¥...‘¡..‡.. ..√..Á®..‡..√..¬’ ..∫...√..Õâ..¬....æ...√..âÕ...¡..∑...’®Ë ..–..
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.ı..Û..˘...Ú....æ...πâ..®...“..°..°..“..√..®...”..π..Õ...ß...§...ß..¡..°’...“..√..®..”..π..Õ...ß..§...√..Õ..∫...μ..‘¥...Õ..¬...Ÿà‡.©..æ...“..–..∑...’Ë¥..π‘...·..ª...≈..ß..·...¬..°..‚..©..π...¥..‡..≈..¢..∑...’Ë .ı...Û..˘...Û....·..≈..–...·..ª...≈..ß..§...ß..‡.À...≈..◊Õ....‚..©..π..¥...‡.≈...¢..∑...Ë’ .......
.ı..Û..˘...Ò....μ...“.¡...À..π...ß—.. ..Õ◊... ..—≠....≠...“..®..”..π...Õ..ß..©...∫..—∫...≈..ß...«..—π..∑...’Ë.....................‡.¥...Õ◊ ..π.....................................................æ....».....................................‰.ª...μ..“..¡...‡.¥..¡‘...........................................................
......................¢..âÕ....Ú.......¢..â“..æ..‡..®..â“..∑..È—ß... ..Õ...ß..Ω..É“..¬...μ..°..≈...ß..°..—π...¬..‘π...¬..Õ...¡..°..—π...„.À...â‡.®..â“..æ...π..—°...ß..“..π..∑...’¥Ë ..π‘...®..¥...∑..–..‡..∫..’¬...π..„..À..â¢..â“..æ...‡.®..“â..μ...“..¡..§...«..“..¡..ª...√..–.. ...ß..§..å¥...—ß..°..≈...à“..«......
¢...â“..ß..μ..âπ........................................................................................................................................................................................................
......................∫...—π..∑...÷°..¢..Õâ...μ..°...≈..ß..π...’È∑..”..‰..«..Àâ ..π...÷Ëß..©..∫...∫— ....‡.°...Á∫..‰..«..â .≥..... ...”.π...—°..ß..“..π...∑..’Ë¥...π‘....∑..—Èß... ..Õ..ß...Ω..“É..¬..‰..¥..μâ...√..«..®..¥...∫Ÿ ..—π...∑..°÷...¢..Õâ..μ...°..≈...ß...·...≈..–..‡..¢..“â..„.®...¢..Õâ..§...«..“..¡........
μ...≈..Õ...¥..·...≈..â«....®..ß÷..≈...ß..≈..“..¬...¡..Õ◊...™..Õ◊Ë ..À...√..◊Õ..≈...ß..≈..“..¬...æ..¡‘...æ...åπ..«È‘..¡...◊Õ..‰.«...‡â .ª..πì...À..≈...°— ..∞..“..π...μ..àÕ...À..π...“â ..æ..¬...“..π..·...≈..–..‡..®..“â ..æ..π...°— ..ß..“..π...∑..Ë¥’...‘π....................................................
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............................................................................................≈..ß...™..Ë◊Õ...........................................................π......“....¬.........¢......................................................º..√Ÿâ..—∫...®..”..π...Õ..ß..................................
............................................................................................≈..ß...™..Ë◊Õ...........................................................π......“....¬.........°......................................................º..⟮...”..π..Õ..ß.......................................
............................................................................................≈..ß...™..◊ËÕ....................................................................................................................................æ...¬..“..π...........................................
............................................................................................≈..ß...™..Ë◊Õ.....................................................................................................................................æ...¬..“..π...........................................
.............................∫...—π..∑...÷°..¢..Õâ...μ..°...≈..ß..π...È’‰..¥..∑â...”..μ..Õà...À..π...“â ......................................................................................................................................
............................................................................................≈..ß...™..◊ËÕ.....................................................................................................................................‡.®..“â..æ...π...°— ..ß..“..π..∑...¥Ë’..π‘..........................
..........................................................................................................ª..√..–..∑...—∫..μ...√..“..μ...”.·...À..π...àß..‡.ª...πì .. ...”..§..—≠..........................................................
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μ—«Õ¬“à ßÀ¡“¬‡≈¢ Ú˜ μ“¡√–‡∫¬’ ∫ ¢âÕ Ú˘ (Ú) ÚıÙ
“√∫≠— ®¥∑–‡∫’¬π (√“¬°“√®¥∑–‡∫¬’ π ·ª≈߇¥¡‘ ‚©π¥∑Ë’ ıÛ˘Ò)
®¥∑–‡∫¬’ π ª√–‡¿∑°“√ ºŸâ„À â ≠— ≠“ ºâŸ√—∫ —≠≠“ ‡π◊ÈÕ∑Ë’¥‘π ‡π◊ÈÕ∑’Ë¥‘π √–«“ß ‡®â“æπ—°ß“π∑’Ë¥‘π
«—𠇥◊Õπ ªï ®¥∑–‡∫¬’ π μ“¡ ≠— ≠“ §ß‡À≈Õ◊ ‡≈¢∑Ë’¥‘π ≈ß≈“¬¡Õ◊ ™ÕË◊
‚©π¥∑’Ë¥‘π„À¡à ª√–∑∫— μ√“
‰√à ß“π μ“√“ß ‰√à ß“π μ“√“ß
«“ «“
«—π∑’.Ë ................ ®”πÕß π“¬ °. 𓬠™. Ú Û ı › › › › (≈ß™Õ◊Ë ) 𓬠æ.
‡¥Õ◊ π............... ºâŸ√∫— ®”πÕß
æ.». ................. ·∫àß·¬°„ππ“¡‡¥¡‘ 𓬠°.
«—π∑.’Ë ................ (§√Õ∫›ª≈Õ¥ 𓬠°. › Û ı Ú › › 5136IV7228-1 (≈ß™ËÕ◊ ).......................
‡¥◊Õπ............... ®”πÕß)
æ.». ................. ∑’¥Ë ‘π·ª≈ß∑·Ë’ ¬°‰ªπÈæ’ πâ ®“°°“√®”πÕß ÚÙ
μ“¡ ≠— ≠“®”πÕß©∫∫— ≈ß«π— ∑Ë’.......‡¥◊Õπ......... ıÛ˘Ú
æ.».............μ“¡∫—π∑°÷ ¢âÕμ°≈ߪ≈Õ¥®”πÕß
≈ß«π— ∑’.Ë ..........‡¥Õ◊ π................æ.».............
Ò››Ò›› 5136IV7228-1 (≈ß™◊ÕË )........................
∑¥’Ë ‘π·ª≈ß∑·Ë’ ¬°‰ªπ·’È ≈–·ª≈ߧ߇À≈◊Õ ÚÙ
°“√®”πÕ߬ߗ §ß¡Õ’ ¬Ÿàμ“¡ ≠— ≠“®”πÕß ıÛ˘Û
©∫∫— ≈ß«—π∑Ë’...........‡¥Õ◊ π................æ.».............
À¡“¬‡Àμÿ “√∫≠— ®¥∑–‡∫¬’ π·ª≈ß·¬°‚©π¥∑’Ë ıÚ˘Ú ª≈Õ¥®”πÕ߉¡μà âÕ߬°√“¬°“√®¥·®ßâ ·μÕà ¬“à ß„¥
μ«— Õ¬“à ßÀ¡“¬‡≈¢ Ú˜ μ“¡√–‡∫’¬∫ ¢âÕ Ú˘ (Ú)
“√∫≠— ®¥∑–‡∫¬’ π (√“¬°“√®¥·®ßâ ∑¥Ë’ π‘ ·ª≈ß·¬°‰ª„À¡à‚©π¥∑’Ë ıÛ˘Û)
®¥∑–‡∫’¬π ª√–‡¿∑°“√ ºâŸ„À â ≠— ≠“ ºâŸ√—∫ —≠≠“ ‡πÈ◊Õ∑’Ë¥‘π ‡π◊ÈÕ∑Ë’¥‘π √–«“ß ‡®â“æπ—°ß“π∑Ë’¥‘π
«π— ‡¥◊Õπ ªï ®¥∑–‡∫’¬π μ“¡ —≠≠“ §ß‡À≈Õ◊ ‡≈¢∑Ë’¥‘π ≈ß≈“¬¡Õ◊ ™Õ◊Ë
‚©π¥∑’¥Ë ‘π„À¡à ª√–∑∫— μ√“
«—π∑’Ë................. ®”πÕß ‰√à ß“π μ“√“ß ‰√à ß“π μ“√“ß
‡¥Õ◊ π............... (§√Õ∫®”πÕß) «“ «“
æ.». .................
𓬠°. 𓬠™. Ò››››› › (≈ß™ËÕ◊ ) 𓬠æ.
ºâŸ√—∫®”πÕß °“√®”πÕ߬ߗ §ß¡’Õ¬Ÿμà “¡ ≠— ≠“®”πÕß©∫∫— «π— ∑.’Ë ...........................
≈ß«—π∑’.Ë ............‡¥Õ◊ π...........................æ.».............. ‡¥◊Õπ.........................
æ.». ...........................
(≈ß™Ë◊Õ).....................
Úıı
Úıˆ
μ—«Õ¬à“ßÀ¡“¬‡≈¢ Ú¯ μ“¡√–‡∫’¬∫¢âÕ Ú˘ (Ú) (∑.¥. Ò)
∑∫Ë’ “â π
∑’ Ë «π/‰√à
∑Ë’π“
∑’Ë..............
§”¢Õ®¥∑–‡∫’¬π ∑‘ ∏‘·≈–π‘μ°‘ √√¡ πÕ°‡¢μ
„π‡¢μ
·≈–°“√ Õ∫ «π ∑‘ ∏‘„π∑¥Ë’ π‘ ª√–‡¿∑...·..∫...ßà ..¢..“..¬...(..§..√..Õ..∫...›..ª..≈..Õ...¥..®..”..π..Õ...ß)
μ”·Àπàß∑Ë’¥‘π
√–«“ß...............................5..1..3..6...I.V....7..2..2..8..›..1.................................. μ”∫≈.........................................................................................
’Ë∑ ‘¥π·ª≈ß∑Ë’·¬°‰ªπÈ’æâπ®“°°“√®”πÕßμ“¡ —≠≠“®”πÕß ©∫—∫≈ß«—π∑Ë’...........‡ ◊¥Õπ...........................æ.». ............... ‡≈¢∑Ë¥’ ‘π....................................˘................................................. Õ”‡¿Õ........................................................................................
μ“¡∫—π∑÷°¢âÕμ°≈ߪ≈Õ¥®”πÕß ≈ß«—π∑’Ë...........‡ ◊¥Õπ...........................æ.». ............... à «π·ª≈ߧ߇À≈◊Õ°“√®”πÕ߬—ߧߡ’Õ Ÿà¬μ“¡‡¥‘¡
Àπ“â ”√«®...............................Ú...¯................................................®—ßÀ«¥— ........................................................................................
‡®â“æπ—°ß“π Ë’∑ ‘¥π
‚©π¥∑¥’Ë ‘π
‡≈¢∑’Ë.....................Ò..Û..ı...................‡≈à¡............Ò..Ù..........................Àπâ“............ı........................
®”π«π∑Ë¥’ π‘ ..............Ú.....................‰√.à ...............›.................ß“π................›...................μ“√“ß«“
Ò. ¢â“懮“â ºŸâ¡π’ “¡μÕà ‰ªπ’È ¡§’ «“¡ª√– ߧå¢Õ®¥∑–‡∫’¬π ‘∑∏‘·≈–πμ‘ °‘ √√¡‡°’¬Ë «°—∫Õ —ßÀ“√¡‘ ∑√—æ¬å∑Ë’°≈à“«¢“â ß∫ππ’È ·≈–
‰¥âªØ‘≠“≥μπ·≈«â ¢Õ„À∂â âÕ¬§”¥«â ¬§«“¡ —μ¬å®√ß‘ ∂“â ¢“â 懮ⓄÀ∂â Õâ ¬§”‰¡à‡ªπì §«“¡®√ß‘ „Àâ„™∂â Õâ ¬§”π¬È’ —π¢“â 懮“â „π∑“ߧ¥Õ’ “≠“‰¥â
Ú. ¢“â 懮“â ..............π..“..¬....°............................ ‡≈¢ª√–®”μ—«ª√–™“™π ºŸ.â ..¢..“..¬...............................
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Õ“¬.ÿ ...........ı......................ªï ≠— ™“μ‘.......‰..∑..¬..............................∫¥‘ “/¡“√¥“™ËÕ◊ .............................................................................
‚ ¥ À¡“â ¬ §àŸ ¡√ ™◊ËÕ..........................................................................................
Õ¬à∑Ÿ ∫’Ë â“π/À¡∫àŸ “â π..........................‡≈¢∑’.Ë ...............μ√Õ°/´Õ¬.......................................∂ππ.....................................À¡àŸ∑’Ë..............
μ”∫≈/·¢«ß...................................Õ”‡¿Õ/‡¢μ...................................®ß— À«¥— .................................À¡“¬‡≈¢‚∑√»—æ∑.å ....................
Û. ¢â“懮â“...............π..“..¬....§........................... ‡≈¢ª√–®”μ—«ª√–™“™π ºâ.Ÿ ..´..Õ◊È.................................
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Õ“¬.ÿ ............ı.....................ªï ≠— ™“μ.‘ .......‰.∑...¬.............................∫¥‘ “/¡“√¥“™Ë◊Õ.............................................................................
‚ ¥ À¡“â ¬ § àŸ ¡√ ™Ë◊Õ....................................................... —≠™“μ‘.......................
Õ¬Ÿà∑Ë∫’ â“π/À¡∫Ÿà â“π..........................‡≈¢∑Ë.’ ...............μ√Õ°/´Õ¬.......................................∂ππ.....................................À¡∑àŸ Ë.’ .............
μ”∫≈/·¢«ß...................................Õ”‡¿Õ/‡¢μ...................................®—ßÀ«—¥.................................À¡“¬‡≈¢‚∑√»æ— ∑.å ....................
Ù. ¢â“懮ⓢշ ¥ß√“§“∑√—æ¬∑å ¢Ë’ Õ∑”π‘μ‘°√√¡π’ȇªìπ‡ß‘π.............................›............................∫“∑.........›........... μ“ߧå
ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à
(Ò) ¢â“懮“â ‰¡à‰¥√â ∫— ‚Õπ·∑πÀ√◊Õ‡æÕ◊Ë ª√–‚¬™πå·°à∫§ÿ §≈μ“à ߥ“â «
(Ú) √“§“∑√—æ¬∑å Ë·’ ¥ß‰«â„π Ù. ‡ªìπ√“§“∑’·Ë ∑â®√‘ß
(Û) .....................................................................................................................................................................
(Ù) .....................................................................................................................................................................
(ı) .....................................................................................................................................................................
«π— ∑.Ë’ ...........‡¥Õ◊ π..............................æ.»..................
≈ß™◊ËÕ......................π..“..¬....°.........................ºŸâ¢Õ ¢“¬
≈ß™Õ◊Ë ......................π..“..¬...§..........................ºâŸ¢Õ ´ÕÈ◊
≈ß™ËÕ◊ ......................................................º Ÿâ Õ∫ «π
(......................................................)
”À√∫— æπ—°ß“π‡®â“Àπ“â ∑’Ë
Ò) √“§“ª√–‡¡‘π∑ÿπ∑√æ— ¬.å ....................................................................................................∫“∑........................................ μ“ߧå
Ú) ‚©π¥∑’Ë¥‘π„À¡√à –«“ß..........5..1.3..6....I.V....7..2..2..8..›.1...........‡≈¢∑’Ë¥‘π.................Ò..............................Àπ“â ”√«®...........Ú..˘............................
‚©π¥∑¥Ë’ π‘ ‡≈¢∑.’Ë ......................Ò..Û..ı..Ò......................‡≈à¡........................Ò..Ù............................Àπâ“.................ı...Ò..............................
®”π«π∑¥’Ë π‘ ...........................Ò...........................‰√.à .............................›...................ß“π.............................›.....................μ“√“ß«“
§ß‡À≈Õ◊ ................................Ò...........................‰√.à .............................›...................ß“π.............................›.....................μ“√“ß«“
Û) ‰¥â®¥∑–‡∫¬’ π·≈«â ·μà«—π∑Ë’.................................‡¥◊Õπ............................................æ.»......................
≈ß™ËÕ◊ .......................................................
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‡®â“æπ—°ß“π∑Ë’¥‘π
μ«— Õ¬à“ßÀ¡“¬‡≈¢ Ú¯ μ“¡√–‡∫¬’ ∫¢Õâ Ú˘ (Ú) Úı˜
(∑.¥. Òˆ)
∫—π∑÷°¢Õâ μ°≈߇√ÕË◊ ߪ≈Õ¥®”πÕß
∑Ë’¥‘π
√–«“ß.............5..1..3.6....I.V....7..2..2..8..›..1..........................................μ”∫≈........................................................................
‡≈¢∑¥’Ë π‘ ..................˘.............Àπ“â ”√«®......Ú...¯...................Õ”‡¿Õ.......................................................................
‚©π¥À¡“¬‡≈¢∑Ë’...............Ò..Û...ı...........................................®—ßÀ«¥— .......................................................................
∑’«Ë à“°“√.....................................................................
«π— ∑Ë.’ ...............‡¥Õ◊ π........................................æ.».....................
¢“â 懮“â .....................π..“..¬....¢......º..√Ÿâ..—∫..®..”..π...Õ..ß................................................ ‡≈¢ª√–®”μ—«ª√–™“™π
.....................π..“..¬....°.......º..®âŸ ..”..π..Õ...ß....................................................
Õ“¬ÿ...ı.....,...ı........ªï ‡™Õ◊È ™“μ‘.........‰.∑...¬.................. —≠™“μ.‘ .......‰..∑..¬...................∫‘¥“/¡“√¥“™ËÕ◊ ............................................................
Õ¬∑àŸ ∫’Ë “â π/À¡∫Ÿà â“π......................................‡≈¢∑.’Ë .............μ√Õ°/´Õ¬.....................................∂ππ.................................À¡∑àŸ .’Ë .........
μ”∫≈/·¢«ß...............................Õ”‡¿Õ/‡¢μ...............................®ß— À«—¥................................À¡“¬‡≈¢‚∑√»æ— ∑.å .............................
¢//Õ//ª//Ø//‘≠//“/≥///μ//π//·/≈//–//„/À//â∂//Õâ //¬/§//”//μ/Õà//.....‰..¥..∑â...”.∫...π— ..∑..÷°...¢..Õâ ..μ...°..≈..ß..μ..àÕ...‡.®..â“..æ..π...°— ..ß..“..π..∑...’¥Ë ..‘π.....................................................................................
¥//â«//¬//§//«/“/¡// //μ—//¬//®å /√//ß‘ / ¥—ßμÕà ‰ªπ’È :›
......................∑...¥’Ë ..π‘...·..ª..≈...ß..‡.§...√..Ë◊Õ...ß..À..¡...“..¬..¢..â“..ß..∫...π..π...’È.¢...“â ..æ..‡..®..“â ...π...“..¬....°.....º...⟮..”..π..Õ...ß..‰..¥..®â..”..π...Õ..ß..‰..«..°â ..—∫....π...“..¬....¢.....º...Ÿâ√..∫— ..®..”..π...Õ..ß...‚.¥..¬...‰.¥...â®..”..π..Õ...ß..μ...“..¡.. ..≠—....≠...“
.®..”..π..Õ...ß..≈..ß..«..—π...∑..Ë.’...................‡.¥...◊Õ..π..........................................æ.....»..........................‡.æ...ÕË◊ ..‡..ª..πì...ª..√..–..°...π— ..À...π..°’È...Ÿ¬â ..◊¡...‡.ß..‘π...´..÷ßË ..º..Ÿâ®...”..π..Õ...ß..°..¬âŸ..¡◊...‰.ª...®..“..°..º...√Ÿâ..—∫...®..”..π..Õ...ß..‡.ª...πì ..®..”..π...«..π..................................∫...“..∑.
(.........................................................................)...∫...¥— ..π...È’ .π...“..¬....°.....‰..¥..·â...∫..àß..¢...“..¬..∑..¥Ë’...‘π..·...ª..≈...ß..π..’È.„.À..·â...°..à..π..“..¬....§......‚.¥...¬..∑...Ë’¥..‘π... ..«à..π...·..∫...ßà ..·..¬...°..‰.ª...‡.ª...ìπ..‚..©..π...¥..∑...¥Ë’ ..‘π...„.À...¡..‡à.≈...¢..∑...’Ë...............................
¢...â“..æ..‡..®..“â..∑..—Èß... ..Õ..ß...Ω..“É..¬..μ...°..≈...ß..°..π—...„.À...∑â ..¥’Ë...‘π..‚..©..π..¥...∑...¥Ë’ ..‘π..·...ª..≈...ß..·..¬...°..„..À..¡...à .‡.≈...¢..∑...Ë.’ ........................æ..âπ...®..“..°..°...“..√..®..”..π..Õ...ß..‰.ª....‚..¥..¬...∑..Ë’¬...ß— ..¡..‘‰..¥..¡â...’°..“..√..™...”.√...–..À..π...’È∑..®’Ë..”..π...Õ..ß...
‡..ª..ìπ...ª..√...–..°..π—...·..μ..àÕ...¬..à“..ß..„..¥.... ..à«..π...‚.©...π..¥...∑..¥’Ë...π‘ ..·...ª..≈...ß..§..ß..‡..À..≈...Õ◊ ..¬...ß— ..§..ß..®...”..π..Õ...ß..‡.ª...πì ..ª...√..–..°..π—...À..π...’È„.π...«..ß..‡.ß..π‘...‡.¥...¡‘ ..Õ...¬..àŸμ...“..¡..‡.¥...‘¡....‡.ß...◊ÕË ..π..‰..¢..·...≈..–..¢..Õâ...μ..°...≈..ß..Õ...◊Ëπ..Ê...
„..À..â‡..ª..ìπ...‰.ª...μ..“..¡... ..≠—....≠...“..®..”..π...Õ..ß..‡..¥..‘¡...∑..ÿ°..ª...√..–..°...“..√..............................................................................................................................................
......................∫...—π..∑...÷°..¢..âÕ...μ..°...≈..ß..π...È’∑..”..‰..«..Àâ ..π...Ëß÷ ..©..∫...—∫....‡.°...Á∫..‰..«..â .≥..... ...”.π...—°..ß..“..π...∑..’¥Ë...‘π....∑..—Èß... ..Õ..ß...Ω..É“..¬..‰..¥..μâ...√..«..®..¥...Ÿ∫..—π...∑..°÷...¢..âÕ..μ...°..≈...ß...·...≈..–..‡..¢..“â..„.®...¢..âÕ..§...«..“..¡........
μ...≈..Õ...¥..·...≈..â«....®..ß÷..≈...ß..≈..“..¬...¡..◊Õ...™..ÕË◊ ..À...√..◊Õ..≈...ß..≈..“..¬...æ..‘¡...æ...πå ..‘È«..¡...◊Õ..‰.«...‡â .ª..ìπ...À..≈...—°..∞..“..π...μ..àÕ...À..π...“â ..æ..¬...“..π..·...≈..–..‡..®..â“..æ..π...°— ..ß..“..π...∑..¥Ë’...‘π....................................................
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............................................................................................≈..ß...™..◊ËÕ...........................................................π......“....¬.........¢......................................................º..Ÿ√â..—∫...®..”..π...Õ..ß..................................
............................................................................................≈..ß...™..◊ËÕ...........................................................π......“....¬.........°......................................................º..⟮...”..π..Õ..ß.......................................
............................................................................................≈..ß...™..Ë◊Õ....................................................................................................................................æ...¬..“..π...........................................
............................................................................................≈..ß...™..Ë◊Õ.....................................................................................................................................æ...¬..“..π...........................................
.............................∫...π— ..∑...°÷ ..¢..Õâ...μ..°...≈..ß..π...È’‰..¥..∑â...”..μ..Õà...À..π...“â ......................................................................................................................................
............................................................................................≈..ß...™..Ë◊Õ.....................................................................................................................................‡.®..“â..æ...π...°— ..ß..“..π..∑...¥Ë’..π‘..........................
..........................................................................................................ª..√..–..∑...—∫..μ...√..“..μ...”.·...À..π...ßà ..‡.ª...ìπ.. ...”..§..≠—..........................................................
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μ«— Õ¬“à ßÀ¡“¬‡≈¢ Ú¯ μ“¡√–‡∫’¬∫ ¢Õâ Ú˘ (Ú) Úı¯
“√∫—≠®¥∑–‡∫¬’ π (√“¬°“√®¥∑–‡∫¬’ π·ª≈߇¥‘¡ ‚©π¥∑’Ë ÒÛı)
®¥∑–‡∫¬’ π ª√–‡¿∑°“√ ºŸâ„À â ≠— ≠“ ºŸâ√—∫ —≠≠“ ‡πÈ◊Õ∑’Ë¥‘π ‡πÈ◊Õ∑’Ë¥‘π √–«“ß ‡®â“æπ—°ß“π∑Ë’¥‘π
«—𠇥Õ◊ π ªï ®¥∑–‡∫¬’ π μ“¡ ≠— ≠“ §ß‡À≈Õ◊ ‡≈¢∑’Ë¥‘π ≈ß≈“¬¡Õ◊ ™Õ◊Ë
‚©π¥∑¥Ë’ ‘π„À¡à ª√–∑∫— μ√“
‰√à ß“π μ“√“ß ‰√à ß“π μ“√“ß
«“ «“
«π— ∑Ë’................. ®”πÕß π“¬ °. 𓬠¢. Ú››››› › (≈ß™ËÕ◊ ) 𓬠æ.
‡¥◊Õπ...............
æ.». ................. ·∫ßà ¢“¬ º√⟠—∫®”πÕß
«π— ∑.Ë’ ................ (§√Õ∫›ª≈Õ¥
‡¥Õ◊ π............... ®”πÕß) 𓬠°. 𓬠§. Ò › › Ò › › 5136IV7228-1 (≈ß™◊ÕË ).......................
æ.». .................
∑¥Ë’ ‘π·ª≈ß∑’·Ë ¬°‰ªπÈæ’ πâ ®“°°“√®”πÕß Ò
μ“¡ —≠≠“®”πÕß ©∫—∫≈ß«π— ∑Ë.’ .......... ÒÛıÒ
‡¥Õ◊ π................æ.»...........μ“¡∫π— ∑÷°¢Õâ μ°≈ß
ª≈Õ¥®”πÕß ≈ß«—π∑.Ë’ .........‡¥Õ◊ π.....................
æ.»............. à«π·ª≈ߧ߇À≈Õ◊ °“√®”πÕß
¬—ߧߡ’μ“¡‡¥¡‘
À¡“¬‡Àμÿ “√∫—≠®¥∑–‡∫¬’ π·ª≈ß·¬°‚©π¥∑’Ë ÒÛıÒ ª≈Õ¥®”πÕß ‰¡μà âÕ߬°√“¬°“√®¥·®âß·μÕà ¬à“ß„¥
μ«— Õ¬à“ßÀ¡“¬‡≈¢ Ú˘ μ“¡√–‡∫¬’ ∫¢âÕ Ú˘ (Û) Úı˘
(∑.¥. Ò)
∑∫Ë’ “â π
°√≥’ à«π¢Õߺ⟮”πÕ߇ªìπ·ª≈ߧ߇À≈◊Õ ∑ ’Ë «π/‰√à
∑’Ëπ“
∑.Ë’ .............
§”¢Õ®¥∑–‡∫¬’ π ∑‘ ∏‘·≈–πμ‘ ‘°√√¡ πÕ°‡¢μ
„π‡¢μ
·≈–°“√ Õ∫ «π ∑‘ ∏‘„π∑’¥Ë π‘ ª√–‡¿∑.·..∫...àß..°..√..√..¡.. ...‘∑..∏..√Ï‘..«..¡....(.§...√..Õ..∫..›..ª...≈..Õ..¥...®..”.πÕß)
μ”·Àπàß∑’Ë¥‘π ·¬°‹ Ò
√–«“ß...............................5..1..3..6...I.V....7..2..2..8..›..1..................................μ”∫≈.........................................................................................
‡≈¢∑Ë¥’ ‘π....................................˘.................................................Õ”‡¿Õ........................................................................................
’Ë∑¥‘π·ª≈ß∑Ë’·¬°‰ªπÈ’æâπ®“°°“√®”πÕßμ“¡ —≠≠“®”πÕ߇©æ“– à«π ©∫—∫≈ß«—π∑Ë’...........‡ ◊¥Õπ...........................æ.». ...............Àπâ“ ”√«®...............................Ò...˘................................................®—ßÀ«—¥........................................................................................
μ“¡∫—π∑÷° â¢Õμ°≈ߪ≈Õ¥®”πÕß ≈ß«—π∑Ë’...........‡¥◊Õπ...........................æ.». ...............
‚©π¥∑¥Ë’ π‘
‡ ⮓æπ—°ß“π Ë’∑¥‘π ‡≈¢∑Ë.’ ....................Ò..Ú...Û..................‡≈¡à ............Ò..Û..........................Àπâ“............Û........................
®”π«π∑¥’Ë ‘π..............Ú.....................‰√à................›.................ß“π................›...................μ“√“ß«“
Ò. ¢â“æ‡®â“ºâŸ¡π’ “¡μÕà ‰ªπÈ’ ¡’§«“¡ª√– ߧå¢Õ®¥∑–‡∫’¬π ‘∑∏‘·≈–π‘μ‘°√√¡‡°¬’Ë «°∫— Õ ß— À“√‘¡∑√—æ¬∑å Ë°’ ≈à“«¢â“ß∫ππÈ’ ·≈–
‰¥ªâ Ø≠‘ “≥μπ·≈«â ¢Õ„À∂â Õâ ¬§”¥«â ¬§«“¡ —쬮å √ß‘ ∂“â ¢“â 懮ⓄÀâ∂âÕ¬§”‰¡à‡ªì𧫓¡®√‘ß„Àâ„™â∂âÕ¬§”πȬ’ π— ¢â“懮“â „π∑“ߧ¥Õ’ “≠“‰¥â
Ú. ¢“â 懮â“..............Ò.....π..“..¬....°........................ ‡≈¢ª√–®”μ—«ª√–™“™π ºâŸ...∂..Õ◊..°...√..√..¡.. ..∑‘...∏..Ï‘ ...............
.............Ú......π..“..ß....¢........................
Õ“¬ÿ............ı.....,..Ù..ı.............ªï ≠— ™“μ.‘ ......‰..∑..¬..............................∫¥‘ “/¡“√¥“™Ë◊Õ.............................................................................
‚ ¥ À¡“â ¬ §Ÿ à ¡√ ™◊ËÕ..........................................................................................
Õ¬Ÿà∑’∫Ë â“π/À¡Ÿà∫“â π..........................‡≈¢∑Ë’................μ√Õ°/´Õ¬.......................................∂ππ.....................................À¡Ÿ∑à Ë’..............
μ”∫≈/·¢«ß...................................Õ”‡¿Õ/‡¢μ...................................®—ßÀ«—¥.................................À¡“¬‡≈¢‚∑√»æ— ∑å.....................
Û. ¢“â 懮â“...............π..“..ß...¢............................ ‡≈¢ª√–®”μ—«ª√–™“™π ºŸâ...∂...Õ◊ ..°..√..√..¡.. ...∑‘ ..∏..‘Ï...............
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Õ“¬.ÿ ............ı.....................ªï ≠— ™“μ.‘ .......‰.∑...¬.............................∫‘¥“/¡“√¥“™ËÕ◊ .............................................................................
‚ ¥ À¡“â ¬ §Ÿ à ¡√ ™◊ËÕ....................................................... —≠™“μ.‘ ......................
Õ¬Ÿà∑’Ë∫â“π/À¡∫àŸ “â π..........................‡≈¢∑’.Ë ...............μ√Õ°/´Õ¬.......................................∂ππ.....................................À¡Ÿ∑à ’Ë..............
μ”∫≈/·¢«ß...................................Õ”‡¿Õ/‡¢μ...................................®ß— À«—¥.................................À¡“¬‡≈¢‚∑√»—æ∑å.....................
Ù. ¢â“懮“â ¢Õ· ¥ß√“§“∑√—æ¬å∑Ë¢’ Õ∑”πμ‘ °‘ √√¡π‡È’ ªìπ‡ßπ‘ .............................›............................∫“∑.........›........... μ“ߧå
ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à
(Ò) ¢â“懮“â ‰¡à‰¥â√—∫‚Õπ·∑πÀ√Õ◊ ‡æË◊Õª√–‚¬™πå·°à∫§ÿ §≈μ“à ߥ⓫
(Ú) √“§“∑√æ— ¬å∑·’Ë ¥ß‰«â„π Ù. ‡ªìπ√“§“∑Ë·’ ∑®â √‘ß
(Û) .·..∫..àß..°..√..√..¡... ..‘∑..∏...√‘Ï ..«.¡....μ...“.¡...§..”..¢..Õ...©..∫..∫—...≈..ß..«..—π..∑...Ë’........................‡.¥...◊Õ..π............................................æ....».............................................................................
(Ù) .....................................................................................................................................................................
(ı) .....................................................................................................................................................................
«π— ∑.’Ë ...........‡¥Õ◊ π..............................æ.»..................
≈ß™◊ËÕ......................π..“..¬....°.........................ºŸâ¢Õ ∂◊Õ°√√¡ ∑‘ ∏Ï‘
≈ß™Õ◊Ë ......................π..“..ß...¢..........................ºŸâ¢Õ ∂◊Õ°√√¡ ‘∑∏‘Ï
≈ß™Õ◊Ë ......................................................º Ÿâ Õ∫ «π
(......................................................)
”À√—∫æπ°— ß“π‡®â“Àπ“â ∑’Ë
Ò) √“§“ª√–‡¡π‘ ∑πÿ ∑√æ— ¬å.....................................................................................................∫“∑........................................ μ“ߧå
Ú) ‚©π¥∑’¥Ë π‘ „À¡√à –«“ß..........5..1..3.6....I.V....7..2..2..8..›..1..........‡≈¢∑Ë¥’ π‘ .................Ò..............................Àπ“â ”√«®...........Ú..............................
‚©π¥∑¥Ë’ ‘π‡≈¢∑’Ë.......................Ò..Ú...Û..Ò.....................‡≈¡à ........................Ò..Û............................Àπâ“..................Û..Ò..............................
®”π«π∑¥Ë’ π‘ ...........................Ò...........................‰√.à .............................›...................ß“π..............................›....................μ“√“ß«“
§ß‡À≈Õ◊ ................................Ò...........................‰√.à .............................›...................ß“π.............................›.....................μ“√“ß«“
Û) ‰¥®â ¥∑–‡∫’¬π·≈â«·μà«—π∑Ë.’ ................................‡¥Õ◊ π............................................æ.»......................
≈ß™Õ◊Ë .......................................................
(......................................................)
‡®â“æπ—°ß“π∑’Ë¥‘π
Úˆ
μ«— Õ¬“à ßÀ¡“¬‡≈¢ Ú˘ μ“¡√–‡∫¬’ ∫¢Õâ Ú˘ (Û) (∑.¥. Ò)
∑∫’Ë “â π
∑Ë ’ «π/‰√à
∑Ë’π“
∑’Ë..............
§”¢Õ®¥∑–‡∫’¬π ‘∑∏·‘ ≈–πμ‘ ‘°√√¡ πÕ°‡¢μ
„π‡¢μ
·≈–°“√ Õ∫ «π ∑‘ ∏‘„π∑Ë¥’ π‘ ª√–‡¿∑.·..∫...ßà ..°..√..√..¡.. ...∑‘ ..∏..Ï√‘..«..¡....(.§...√..Õ..∫..›..ª...≈..Õ..¥...®..”.πÕß)
μ”·Àπàß∑Ë’¥‘π ·ª≈ߧ߇À≈Õ◊
√–«“ß...............................5..1..3..6...I.V....7..2..2..8..›..1.................................. μ”∫≈.........................................................................................
‡≈¢∑’Ë¥π‘ ....................................˘................................................. Õ”‡¿Õ........................................................................................
Àπ“â ”√«®...............................Ò...˘................................................®—ßÀ«¥— ........................................................................................
∑’Ë ‘¥π·ª≈ߧ߇À≈◊Õ°“√®”πÕ߬—ߧߡ’Õ àŸ¬μ“¡ —≠≠“®”πÕ߇©æ“– à«π ©∫—∫≈ß«—π∑Ë’...........‡¥◊Õπ...........................æ.». ...............‚©π¥∑¥’Ë π‘
‡®â“æπ—°ß“π ’Ë∑¥‘π ‡≈¢∑’.Ë ....................Ò..Ú...Û..................‡≈¡à ............Ò..Û..........................Àπâ“............Û........................
®”π«π∑Ë¥’ π‘ ..............Ò.....................‰√.à ...............›.................ß“π................›...................μ“√“ß«“
Ò. ¢“â 懮⓺Ÿ¡â π’ “¡μÕà ‰ªπ’È ¡§’ «“¡ª√– ߧ¢å Õ®¥∑–‡∫’¬π ‘∑∏·‘ ≈–π‘μ‘°√√¡‡°¬Ë’ «°—∫Õ —ßÀ“√¡‘ ∑√—æ¬∑å ’Ë°≈à“«¢â“ß∫ππÈ’ ·≈–
‰¥âªØ≠‘ “≥μπ·≈â« ¢Õ„À∂â Õâ ¬§”¥â«¬§«“¡ —쬮å √ß‘ ∂“â ¢â“懮ⓄÀâ∂âÕ¬§”‰¡‡à ªì𧫓¡®√‘ß„Àâ„™∂â âÕ¬§”π’È¬π— ¢â“懮Ⓞπ∑“ߧ¥Õ’ “≠“‰¥â
Ú. ¢â“懮â“..............Ò.....π..“..¬....°........................ ‡≈¢ª√–®”μ—«ª√–™“™π ºŸ.â ..∂..◊Õ..°...√..√..¡.. ..‘∑...∏..‘Ï ...............
.............Ú......π..“..ß....¢........................
Õ“¬.ÿ ...........ı.....,..Ù..ı.............ªï ≠— ™“μ.‘ ......‰..∑..¬..............................∫‘¥“/¡“√¥“™◊ÕË .............................................................................
‚ ¥ À¡“â ¬ §àŸ ¡√ ™Õ◊Ë ..........................................................................................
Õ¬∑àŸ ’Ë∫“â π/À¡Ÿà∫“â π..........................‡≈¢∑Ë’................μ√Õ°/´Õ¬.......................................∂ππ.....................................À¡àŸ∑.’Ë .............
μ”∫≈/·¢«ß...................................Õ”‡¿Õ/‡¢μ...................................®ß— À«—¥.................................À¡“¬‡≈¢‚∑√»—æ∑.å ....................
Û. ¢“â 懮â“...............π..“..¬....°........................... ‡≈¢ª√–®”μ—«ª√–™“™π ºâŸ...∂..Õ◊...°..√..√..¡.. ...‘∑..∏..Ï‘...............
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Õ“¬.ÿ ............ı.....................ªï ≠— ™“μ.‘ .......‰.∑...¬.............................∫‘¥“/¡“√¥“™◊ÕË .............................................................................
‚ ¥ À¡“â ¬ §Ÿ à ¡√ ™Ë◊Õ....................................................... ≠— ™“μ.‘ ......................
Õ¬∑Ÿà ’∫Ë â“π/À¡Ÿ∫à â“π..........................‡≈¢∑.’Ë ...............μ√Õ°/´Õ¬.......................................∂ππ.....................................À¡à∑Ÿ Ë.’ .............
μ”∫≈/·¢«ß...................................Õ”‡¿Õ/‡¢μ...................................®—ßÀ«—¥.................................À¡“¬‡≈¢‚∑√»—æ∑å.....................
Ù. ¢“â 懮ⓢշ ¥ß√“§“∑√—æ¬∑å ’Ë¢Õ∑”π‘μ‘°√√¡π’‡È ªπì ‡ß‘π.............................›............................∫“∑.........›........... μ“ߧå
ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à
(Ò) ¢“â 懮“â ‰¡à‰¥â√—∫‚Õπ·∑πÀ√Õ◊ ‡æÕ◊Ë ª√–‚¬™π·å °à∫§ÿ §≈μà“ߥ“â «
(Ú) √“§“∑√æ— ¬å∑·Ë’ ¥ß‰«â„π Ù. ‡ªπì √“§“∑’·Ë ∑â®√‘ß
(Û) ·..∫...àß..°..√..√..¡.. ...∑‘ ..∏..√‘Ï..«..¡....μ..“..¡..§...”..¢..Õ..©..∫...∫— ..≈...ß..«..—π..∑..’Ë...............‡.¥..Õ◊...π..........................æ....»..................................................................
(Ù) .....................................................................................................................................................................
(ı) .....................................................................................................................................................................
«π— ∑.’Ë ...........‡¥Õ◊ π..............................æ.»..................
≈ß™ËÕ◊ ......................π..“..¬....°.........................ºâŸ¢Õ ∂◊Õ°√√¡ ∑‘ ∏Ï‘
≈ß™Õ◊Ë ......................π..“..ß...¢..........................ºâŸ¢Õ ∂Õ◊ °√√¡ ∑‘ ∏‘Ï
≈ß™◊ÕË ......................................................º Ÿâ Õ∫ «π
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”À√∫— æπ°— ß“π‡®“â Àπ“â ∑Ë’
Ò) √“§“ª√–‡¡π‘ ∑πÿ ∑√æ— ¬.å ....................................................................................................∫“∑........................................ μ“ߧå
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®”π«π∑¥’Ë π‘ ...........................Ò...........................‰√.à .............................›...................ß“π.............................›.....................μ“√“ß«“
§ß‡À≈Õ◊ ................................Ò...........................‰√.à .............................›...................ß“π.............................›.....................μ“√“ß«“
Û) ‰¥â®¥∑–‡∫’¬π·≈â«·μà«—π∑Ë.’ ................................‡¥Õ◊ π............................................æ.»......................
≈ß™Õ◊Ë .......................................................
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‡®â“æπ—°ß“π∑’Ë¥‘π
μ—«Õ¬à“ßÀ¡“¬‡≈¢ Ú˘ μ“¡√–‡∫¬’ ∫¢Õâ Ú˘ (Û) ÚˆÒ
(∑.¥. Òˆ)
∫—π∑°÷ ¢âÕμ°≈߇√◊ËÕߪ≈Õ¥®”πÕß
∑’Ë¥‘π
√–«“ß.............5..1..3.6....I.V....7..2..2..8..›..1..........................................μ”∫≈........................................................................
‡≈¢∑¥’Ë ‘π..................˘.............Àπâ“ ”√«®......Ò..˘....................Õ”‡¿Õ.......................................................................
‚©π¥À¡“¬‡≈¢∑.Ë’ ..............Ò..Ú...Û...........................................®ß— À«—¥.......................................................................
∑Ë«’ “à °“√.....................................................................
«π— ∑’Ë................‡¥Õ◊ π........................................æ.».....................
¢“â 懮“â .....................π..“..¬....™......º..âŸ√..∫—..®..”..π...Õ..ß................................................ ‡≈¢ª√–®”μ—«ª√–™“™π
.....................π..“..¬....°.......º..®âŸ ..”..π..Õ...ß....................................................
Õ“¬ÿ...ı.....,...Ù...ı.....ªï ‡™◊ÈÕ™“μ‘.........‰.∑...¬.................. ≠— ™“μ‘........‰..∑..¬...................∫‘¥“/¡“√¥“™ËÕ◊ ............................................................
Õ¬à∑Ÿ ∫’Ë “â π/À¡Ÿà∫â“π......................................‡≈¢∑’Ë..............μ√Õ°/´Õ¬.....................................∂ππ.................................À¡∑àŸ ’.Ë .........
μ”∫≈/·¢«ß...............................Õ”‡¿Õ/‡¢μ...............................®—ßÀ«¥— ................................À¡“¬‡≈¢‚∑√»—æ∑.å .............................
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......................∫...π— ..∑...÷°..¢..âÕ...μ..°...≈..ß..π...∑È’ ..”..‰..«..âÀ..π...Ë÷ß..©..∫...—∫....‡.°...Á∫..‰..«..â .≥..... ...”.π...°—..ß..“..π...∑..’Ë¥...π‘....∑..—Èß... ..Õ..ß...Ω..É“..¬..‰..¥..âμ...√..«..®..¥...∫Ÿ ..—π...∑..°÷...¢..âÕ..μ...°..≈...ß...·...≈..–..‡..¢..â“..„..®..¢..âÕ..§...«..“..¡........
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............................................................................................≈..ß...™..◊ËÕ...........................................................π......“....¬.........°......................................................º..Ÿâ®...”..π..Õ..ß.......................................
............................................................................................≈..ß...™..Ë◊Õ....................................................................................................................................æ...¬..“..π...........................................
............................................................................................≈..ß...™..Ë◊Õ.....................................................................................................................................æ...¬..“..π...........................................
.............................∫...—π..∑...°÷ ..¢..Õâ...μ..°...≈..ß..π...È’‰..¥..∑â...”..μ..Õà...À..π...“â ......................................................................................................................................
............................................................................................≈..ß...™..◊ËÕ.....................................................................................................................................‡.®..“â..æ...π...°— ..ß..“..π..∑...¥’Ë..π‘..........................
..........................................................................................................ª..√..–..∑...—∫..μ...√..“..μ...”.·...À..π...àß..‡.ª...πì .. ...”..§..≠—..........................................................
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μ—«Õ¬“à ßÀ¡“¬‡≈¢ Ú˘ μ“¡√–‡∫’¬∫ ¢Õâ Ú˘ (Û) ÚˆÚ
“√∫≠— ®¥∑–‡∫¬’ π (√“¬°“√®¥∑–‡∫’¬π ·ª≈߇¥‘¡ ‚©π¥∑Ë’ ÒÚÛ)
®¥∑–‡∫’¬π ª√–‡¿∑°“√ ºâŸ„À â ≠— ≠“ ºŸâ√—∫ —≠≠“ ‡πÈ◊Õ∑Ë’¥‘π ‡π◊ÈÕ∑’Ë¥‘π √–«“ß ‡®â“æπ—°ß“π∑Ë’¥‘π
«—𠇥◊Õπ ªï ®¥∑–‡∫¬’ π μ“¡ —≠≠“ §ß‡À≈Õ◊ ‡≈¢∑Ë’¥‘π ≈ß≈“¬¡Õ◊ ™Õ◊Ë
‚©π¥∑’¥Ë ‘π„À¡à ª√–∑∫— μ√“
‰√à ß“π μ“√“ß ‰√à ß“π μ“√“ß
«“ «“
«—π∑’.Ë ................ ®”πÕ߇©æ“– «à π Ò. 𓬠°. 𓬠™. Ú››››› › (≈ß™ËÕ◊ ) 𓬠æ.
‡¥Õ◊ π............... Ú. π“ß ¢. ºŸ√â ∫— ®”πÕß π“¬ °. ®”πÕ߇©æ“– à«π¢Õßμπ·°à 𓬠™. (≈ß™◊ËÕ).......................
æ.». ................. ·∫ßà °√√¡ ∑‘ ∏‘Ï√«¡ à«π¢Õß π“ß ¢. §ß‡¥¡‘
«—π∑’Ë................. (§√Õ∫›ª≈Õ¥ Ò. 𓬠°. π“ß ¢. (≈ß™◊ÕË )........................
‡¥Õ◊ π............... ®”πÕß) Ú. π“ß ¢. Ò››Ò›› 5136IV7228-1
æ.». ................. 𓬠°. ∑Ë’¥‘π·ª≈ß∑·’Ë ¬°‰ªπ’Èæπâ ®“°°“√®”πÕßμ“¡ Ò
≠— ≠“®”πÕ߇©æ“– «à π©∫—∫≈ß«π— ∑’.Ë ............ ÒÚÛÒ
‡¥Õ◊ π....................æ.»..........μ“¡∫—π∑÷°¢âÕμ°≈ß
ª≈Õ¥®”πÕß ≈ß«π— ∑’Ë.......‡¥◊Õπ...........æ.»........
Ò››››› ›
∑’¥Ë π‘ ·ª≈ߧ߇À≈Õ◊ °“√®”πÕ߬ߗ §ß¡Õ’ ¬μàŸ “¡
—≠≠“®”πÕ߇©æ“– à«π ©∫—∫≈ß«—π∑Ë’..............
‡¥◊Õπ..........................æ.». ............
À¡“¬‡Àμÿ “√∫—≠®¥∑–‡∫’¬π·ª≈ß·¬°‚©π¥∑’Ë ÒÚÛÒ ª≈Õ¥®”πÕ߉¡μà âÕ߬°√“¬°“√®¥·®ßâ ·μàÕ¬à“ß„¥
ÚˆÛ
μ—«Õ¬“à ßÀ¡“¬‡≈¢ Û μ“¡√–‡∫’¬∫¢Õâ Ú˘ (Û) «√√§ Õß (∑.¥. Ò)
∑∫’Ë “â π
∑ Ë’ «π/‰√à
∑’Ëπ“
∑.Ë’ .............
§”¢Õ®¥∑–‡∫’¬π ‘∑∏·‘ ≈–π‘μ°‘ √√¡ πÕ°‡¢μ
„π‡¢μ
·≈–°“√ Õ∫ «π ∑‘ ∏‘„π∑¥Ë’ ‘π ª√–‡¿∑.·..∫...àß..°..√..√..¡.. ...∑‘ ..∏..Ï‘√..«..¡....(.§...√..Õ..∫..›..ª...≈..Õ..¥...®..”.πÕß)
μ”·Àπàß∑’Ë¥‘π ·¬°‹ Ò
√–«“ß...............................5..1..3..6...I.V....7..2..2..8..›..1.................................. μ”∫≈.........................................................................................
‡≈¢∑Ë¥’ ‘π....................................Ú..Û............................................... Õ”‡¿Õ........................................................................................
Àπâ“ ”√«®...............................Ù...Ù..Ù..............................................®ß— À«—¥........................................................................................
∑’Ë ‘¥π·ª≈ß∑Ë’·¬°‰ªπÈ’°“√®”πÕ߬—ߧߡ’Õ Ÿ¬àμ“¡ —≠≠“®”πÕ߇©æ“– à«π ©∫—∫≈ß«—π∑’Ë...........‡¥◊Õπ...........................æ.». ...............‚©π¥∑¥’Ë ‘π
‡ ⮓æπ—°ß“π ’Ë∑¥‘π ‡≈¢∑’.Ë ....................ı..Û..˘...Ò................‡≈à¡............ı..Ù..........................Àπ“â ............˘..Ò......................
®”π«π∑Ë¥’ ‘π..............Ú.....................‰√.à ...............Û.................ß“π................ı...................μ“√“ß«“
Ò. ¢â“懮⓺¡âŸ ’π“¡μàÕ‰ªπÈ’ ¡§’ «“¡ª√– ߧå¢Õ®¥∑–‡∫¬’ π ∑‘ ∏·‘ ≈–πμ‘ ‘°√√¡‡°Ë’¬«°∫— Õ —ßÀ“√¡‘ ∑√—æ¬∑å ’Ë°≈à“«¢“â ß∫ππ’È ·≈–
‰¥ªâ Ø≠‘ “≥μπ·≈â« ¢Õ„À∂â âÕ¬§”¥â«¬§«“¡ μ— ¬®å √‘ß ∂“â ¢â“懮“â „Àâ∂Õâ ¬§”‰¡‡à ªì𧫓¡®√‘ß„Àâ„™∂â Õâ ¬§”π’È¬π— ¢“â 懮Ⓞπ∑“ߧ¥’Õ“≠“‰¥â
‡≈¢ª√–®”μ—«ª√–™“™π
Ú. ¢“â 懮“â ................Ò.....π...“.¬....°...................... ºâŸ...∂..◊Õ..°...√..√..¡.. ..‘∑...∏..Ï‘ ...............
................Ú......π..“..ß...¢......................
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Õ“¬ÿ........ı.....,..Ù..ı.................ªï —≠™“μ.‘ .............‰.∑..¬........................∫‘¥“/¡“√¥“™◊ËÕ.............................................................................
‚ ¥ À¡“â ¬ § Ÿà ¡√ ™◊ËÕ..........................................................................................
Õ¬Ÿ∑à ∫Ë’ â“π/À¡∫àŸ “â π..........................‡≈¢∑Ë’................μ√Õ°/´Õ¬.......................................∂ππ.....................................À¡∑Ÿà .Ë’ .............
μ”∫≈/·¢«ß...................................Õ”‡¿Õ/‡¢μ...................................®—ßÀ«—¥.................................À¡“¬‡≈¢‚∑√»—æ∑.å ....................
Û. ¢â“懮â“..............π..“..¬....°........................... ‡≈¢ª√–®”μ—«ª√–™“™π ºŸâ...∂...Õ◊ ..°..√..√..¡.. ...∑‘ ..∏..Ï‘...............
Õ“¬ÿ.............ı.....................ªï ≠— ™“μ‘........‰.∑...¬.............................∫‘¥“/¡“√¥“™Õ◊Ë .............................................................................
‚ ¥ À¡“â ¬ §Ÿà ¡√ ™Ë◊Õ....................................................... —≠™“μ‘.......................
Õ¬Ÿ∑à Ë∫’ â“π/À¡àŸ∫“â π..........................‡≈¢∑.’Ë ...............μ√Õ°/´Õ¬.......................................∂ππ.....................................À¡∑Ÿà .Ë’ .............
μ”∫≈/·¢«ß...................................Õ”‡¿Õ/‡¢μ...................................®ß— À«¥— .................................À¡“¬‡≈¢‚∑√»—æ∑å.....................
Ù. ¢“â 懮ⓢշ ¥ß√“§“∑√æ— ¬∑å ’¢Ë Õ∑”πμ‘ ‘°√√¡π‡’È ªìπ‡ß‘π.............................›............................∫“∑.........›........... μ“ߧå
ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à
(Ò) ¢â“懮Ⓣ¡à‰¥â√—∫‚Õπ·∑πÀ√◊Õ‡æÕ◊Ë ª√–‚¬™πå·°à∫ÿ§§≈μ“à ߥ“â «
(Ú) √“§“∑√æ— ¬å∑Ë’· ¥ß‰«â„π Ù. ‡ªìπ√“§“∑Ë’·∑â®√‘ß
(Û) ·..∫...àß..°..√..√..¡.. ...∑‘ ..∏..√‘Ï..«..¡....μ..“..¡...§..”..¢..Õ..©...∫..—∫..≈...ß..«..—π..∑..Ë’...............‡.¥..◊Õ...π..........................æ...»..................................................................
(Ù) .....................................................................................................................................................................
(ı) .....................................................................................................................................................................
«π— ∑.’Ë ...........‡¥Õ◊ π..............................æ.»..................
≈ß™ÕË◊ ...............π..“..ß...¢.....,..π..“..¬....§.................ºŸâ¢Õ∂Õ◊ °√√¡ ∑‘ ∏Ï‘
≈ß™Ë◊Õ......................π..“..¬....°.........................ºŸâ¢Õ∂Õ◊ °√√¡ ‘∑∏Ï‘
≈ß™Õ◊Ë ......................................................º ⟠Õ∫ «π
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”À√—∫æπ°— ß“π‡®â“Àπâ“∑’Ë
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®”π«π∑¥’Ë π‘ ...........................›...........................‰√.à .............................Û...................ß“π.............................ı.....................μ“√“ß«“
§ß‡À≈Õ◊ ................................Ú...........................‰√.à .............................›...................ß“π.............................›.....................μ“√“ß«“
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≈ß™Õ◊Ë .......................................................
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ÚˆÙ
μ«— Õ¬à“ßÀ¡“¬‡≈¢ Û μ“¡√–‡∫’¬∫¢Õâ Ú˘ (Û) «√√§ Õß (∑.¥. Ò)
∑∫’Ë “â π
°√≥ ’ à«π¢ÕߺŸâ®”πÕ߇ªìπ·ª≈ß·¬° ∑’Ë «π/‰√à
∑Ë’π“
∑’.Ë .............
§”¢Õ®¥∑–‡∫¬’ π ‘∑∏·‘ ≈–π‘μ‘°√√¡ πÕ°‡¢μ
„π‡¢μ
·≈–°“√ Õ∫ «π ∑‘ ∏‘„π∑¥’Ë ‘π ª√–‡¿∑.·..∫...àß..°..√..√..¡.. ...‘∑..∏..‘Ï√..«..¡....(.§...√..Õ..∫..›..ª...≈..Õ..¥...®..”.πÕß)
μ”·Àπàß∑Ë’¥‘π ·¬°‹ Ú
√–«“ß...............................5..1..3..6...I.V....7..2..2..8..›..1..................................μ”∫≈.........................................................................................
‡≈¢∑Ë¥’ π‘ ....................................Ú..Û...............................................Õ”‡¿Õ........................................................................................
Àπâ“ ”√«®...............................Ù...Ù..Ù..............................................®ß— À«—¥........................................................................................
’Ë∑¥‘π·ª≈ß∑Ë’·¬°‰ªπÈ’ âæπ®“°°“√®”πÕß μ“¡ —≠≠“®”πÕ߇©æ“– à«π ©∫—∫≈ß«—π∑Ë’...........‡ ◊¥Õπ...........................æ.». ...............‚©π¥∑’Ë¥‘π
μ“¡∫—π∑÷°¢âÕμ°≈ߪ≈Õ¥®”πÕß ≈ß«—π∑’Ë...........‡ ◊¥Õπ...........................æ.». ............... ‡≈¢∑Ë’.....................ı..Û..˘...Ò................‡≈¡à ............ı..Ù..........................Àπ“â ............˘..Ò......................
‡ ⮓æπ—°ß“π ’Ë∑ ‘¥π ®”π«π∑Ë’¥π‘ ..............Ú.....................‰√à................›.................ß“π................›...................μ“√“ß«“
Ò. ¢â“懮⓺Ÿ¡â π’ “¡μàÕ‰ªπÈ’ ¡’§«“¡ª√– ߧ¢å Õ®¥∑–‡∫’¬π ‘∑∏‘·≈–πμ‘ °‘ √√¡‡°Ë¬’ «°—∫Õ ß— À“√¡‘ ∑√æ— ¬å∑’°Ë ≈à“«¢â“ß∫ππ’È ·≈–
‰¥âªØ‘≠“≥μπ·≈«â ¢Õ„Àâ∂âÕ¬§”¥«â ¬§«“¡ —쬮å √‘ß ∂“â ¢“â 懮ⓄÀ∂â âÕ¬§”‰¡‡à ªπì §«“¡®√‘ß„Àâ„™∂â Õâ ¬§”π’¬È π— ¢â“懮Ⓞπ∑“ߧ¥Õ’ “≠“‰¥â
‡≈¢ª√–®”μ—«ª√–™“™π
Ú. ¢“â 懮“â ................Ò.....π...“.¬....°...................... ºâŸ...∂..◊Õ...°..√..√..¡.. ..‘∑...∏..‘Ï ...............
................Ú......π..“..ß...¢......................
................Û....π..“..¬....§... ..................
Õ“¬ÿ........ı.....,..ˆ.....,..Ù..¯..........ªï —≠™“μ.‘ .............‰.∑..¬........................∫‘¥“/¡“√¥“™ËÕ◊ .............................................................................
‚ ¥ À¡“â ¬ §Ÿ à ¡√ ™ÕË◊ ..........................................................................................
Õ¬Ÿà∑∫’Ë “â π/À¡∫Ÿà “â π..........................‡≈¢∑’Ë................μ√Õ°/´Õ¬.......................................∂ππ.....................................À¡∑àŸ .Ë’ .............
μ”∫≈/·¢«ß...................................Õ”‡¿Õ/‡¢μ...................................®—ßÀ«¥— .................................À¡“¬‡≈¢‚∑√»—æ∑.å ....................
Û. ¢â“懮â“..............π..“..ß....¢............................ ‡≈¢ª√–®”μ—«ª√–™“™π ºŸ.â ..∂...◊Õ..°..√..√..¡... ..‘∑..∏..‘Ï...............
Õ“¬ÿ.............Ù..ı...................ªï —≠™“μ‘........‰.∑...¬.............................∫‘¥“/¡“√¥“™Õ◊Ë .............................................................................
‚ ¥ À¡“â ¬ §à Ÿ ¡√ ™Ë◊Õ....................................................... ≠— ™“μ.‘ ......................
Õ¬àŸ∑∫’Ë “â π/À¡Ÿ∫à â“π..........................‡≈¢∑Ë.’ ...............μ√Õ°/´Õ¬.......................................∂ππ.....................................À¡àŸ∑.’Ë .............
μ”∫≈/·¢«ß...................................Õ”‡¿Õ/‡¢μ...................................®—ßÀ«—¥.................................À¡“¬‡≈¢‚∑√»—æ∑å.....................
Ù. ¢â“懮“â ¢Õ· ¥ß√“§“∑√—æ¬å∑Ë¢’ Õ∑”πμ‘ °‘ √√¡π’‡È ªπì ‡ß‘π.............................›............................∫“∑.........›........... μ“ߧå
ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à
(Ò) ¢â“懮“â ‰¡à‰¥√â —∫‚Õπ·∑πÀ√Õ◊ ‡æÕË◊ ª√–‚¬™πå·°à∫ÿ§§≈μ“à ߥ⓫
(Ú) √“§“∑√æ— ¬å∑Ë’· ¥ß‰«â„π Ù. ‡ªìπ√“§“∑Ë·’ ∑â®√ß‘
(Û) ·..∫...ßà ..°..√..√..¡.. ...‘∑..∏..√‘Ï..«..¡....μ..“..¡...§..”..¢..Õ..©...∫..∫—..≈...ß..«..—π..∑..Ë’...............‡.¥..Õ◊...π..........................æ...»..................................................................
(Ù) .....................................................................................................................................................................
(ı) .....................................................................................................................................................................
«π— ∑.Ë’ ...........‡¥Õ◊ π..............................æ.»..................
≈ß™◊ÕË ..............π...“..¬...°.....,..π..“..¬....§..................ºâŸ¢Õ∂Õ◊ °√√¡ ∑‘ ∏‘Ï
≈ß™Õ◊Ë ......................π..“..ß....¢.........................ºŸâ¢Õ∂Õ◊ °√√¡ ∑‘ ∏Ï‘
≈ß™Õ◊Ë ......................................................º Ÿâ Õ∫ «π
(......................................................)
”À√∫— æπ°— ß“π‡®â“Àπ“â ∑’Ë
Ò) √“§“ª√–‡¡π‘ ∑πÿ ∑√—æ¬.å ....................................................................................................∫“∑........................................ μ“ߧå
Ú) ‚©π¥∑Ë¥’ ‘π„À¡√à –«“ß..........5..1.3..6....I.V....7..2..2..8..›.1...........‡≈¢∑’Ë¥π‘ .................Ú..ı............................Àπâ“ ”√«®...........Ù..Ù...ˆ.........................
‚©π¥∑’Ë¥‘π‡≈¢∑’.Ë ......................ı..Û..˘...Û.....................‡≈à¡........................ı..Ù............................Àπ“â .................˘...Û..............................
®”π«π∑¥’Ë π‘ ...........................Ò...........................‰√.à .............................›...................ß“π.............................›.....................μ“√“ß«“
§ß‡À≈Õ◊ ................................Ò...........................‰√.à .............................›...................ß“π.............................›.....................μ“√“ß«“
Û) ‰¥â®¥∑–‡∫’¬π·≈«â ·μ«à —π∑Ë’.................................‡¥◊Õπ............................................æ.»......................
≈ß™◊ËÕ.......................................................
(......................................................)
‡®â“æπ—°ß“π∑’Ë¥‘π
Úˆı
μ«— Õ¬à“ßÀ¡“¬‡≈¢ Û μ“¡√–‡∫¬’ ∫¢Õâ Ú˘ (Û) «√√§ Õß (∑.¥. Ò)
∑∫’Ë “â π
∑ ’Ë «π/‰√à
∑Ë’π“
∑’Ë..............
§”¢Õ®¥∑–‡∫’¬π ∑‘ ∏·‘ ≈–π‘μ‘°√√¡ πÕ°‡¢μ
„π‡¢μ
·≈–°“√ Õ∫ «π ‘∑∏‘„π∑¥Ë’ π‘ ª√–‡¿∑.·..∫...ßà ..°..√..√..¡.. ...∑‘ ..∏..‘√Ï..«..¡....(.§...√..Õ..∫..›..ª...≈..Õ..¥...®..”.πÕß)
μ”·Àπàß∑’Ë¥‘π ·¬°‹ Ú
√–«“ß...............................5..1..3..6...I.V....7..2..2..8..›..1.................................. μ”∫≈.........................................................................................
‡≈¢∑¥’Ë π‘ ....................................Ú..Û............................................... Õ”‡¿Õ........................................................................................
Àπâ“ ”√«®...............................Ù...Ù..Ù..............................................®ß— À«¥— ........................................................................................
’Ë∑¥‘π·ª≈ß∑Ë’·¬°‰ªπÈ’æâπ®“°°“√®”πÕß μ“¡ —≠≠“®”πÕ߇©æ“– à«π ©∫—∫≈ß«—π∑Ë’...........‡ ◊¥Õπ...........................æ.». ...............‚©π¥∑¥’Ë π‘
μ“¡∫—π∑÷° â¢Õμ°≈ߪ≈Õ¥®”πÕß ≈ß«—π∑’Ë...........‡¥◊Õπ...........................æ.». ............... ‡≈¢∑Ë.’ ....................ı..Û..˘...Ò................‡≈¡à ............ı..Ù..........................Àπâ“............˘..Ò......................
®”π«π∑’¥Ë ‘π..............Ú.....................‰√à................›.................ß“π................›...................μ“√“ß«“
‡ ⮓æπ—°ß“π ’Ë∑ ‘¥π
Ò. ¢“â 懮⓺¡Ÿâ π’ “¡μàÕ‰ªπ’È ¡§’ «“¡ª√– ߧ¢å Õ®¥∑–‡∫’¬π ‘∑∏‘·≈–πμ‘ °‘ √√¡‡°Ë’¬«°—∫Õ ß— À“√¡‘ ∑√æ— ¬å∑°Ë’ ≈“à «¢â“ß∫ππÈ’ ·≈–
‰¥âªØ‘≠“≥μπ·≈â« ¢Õ„À∂â âÕ¬§”¥â«¬§«“¡ μ— ¬®å √ß‘ ∂“â ¢“â 懮ⓄÀâ∂âÕ¬§”‰¡‡à ªπì §«“¡®√ß‘ „Àâ„™∂â Õâ ¬§”π’È¬π— ¢â“懮Ⓞπ∑“ߧ¥’Õ“≠“‰¥â
‡≈¢ª√–®”μ—«ª√–™“™π
Ú. ¢“â 懮“â ................Ò.....π...“.¬....°...................... ºŸ.â ..∂..◊Õ..°...√..√..¡.. ..∑‘...∏..‘Ï ...............
................Ú......π..“..ß...¢......................
................Û....π..“..¬....§.....................
Õ“¬ÿ........ı.....,..ˆ.....,..Ù..¯..........ªï ≠— ™“μ‘..............‰.∑..¬........................∫‘¥“/¡“√¥“™ËÕ◊ .............................................................................
‚ ¥ À¡“â ¬ §Ÿ à ¡√ ™ËÕ◊ ..........................................................................................
Õ¬àŸ∑∫Ë’ “â π/À¡∫àŸ â“π..........................‡≈¢∑Ë’................μ√Õ°/´Õ¬.......................................∂ππ.....................................À¡∑àŸ Ë’..............
μ”∫≈/·¢«ß...................................Õ”‡¿Õ/‡¢μ...................................®—ßÀ«—¥.................................À¡“¬‡≈¢‚∑√»—æ∑å.....................
Û. ¢“â 懮â“..............π..“..ß....¢........................... ‡≈¢ª√–®”μ—«ª√–™“™π ºŸâ...∂...Õ◊ ..°..√..√..¡.. ...‘∑..∏..‘Ï...............
Õ“¬ÿ.............Ù..ı...................ªï —≠™“μ.‘ .......‰.∑...¬.............................∫‘¥“/¡“√¥“™ËÕ◊ .............................................................................
‚ ¥ À¡“â ¬ §Ÿà ¡√ ™◊ÕË ....................................................... —≠™“μ‘.......................
Õ¬Ÿ∑à ’Ë∫â“π/À¡Ÿà∫“â π..........................‡≈¢∑’.Ë ...............μ√Õ°/´Õ¬.......................................∂ππ.....................................À¡à∑Ÿ .Ë’ .............
μ”∫≈/·¢«ß...................................Õ”‡¿Õ/‡¢μ...................................®—ßÀ«¥— .................................À¡“¬‡≈¢‚∑√»æ— ∑å.....................
Ù. ¢â“懮“â ¢Õ· ¥ß√“§“∑√—æ¬∑å ¢’Ë Õ∑”π‘μ°‘ √√¡π’ȇªπì ‡ß‘π.............................›............................∫“∑.........›........... μ“ߧå
ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à
(Ò) ¢â“懮“â ‰¡à‰¥â√∫— ‚Õπ·∑πÀ√◊Õ‡æÕË◊ ª√–‚¬™πå·°à∫ÿ§§≈μ“à ߥ⓫
(Ú) √“§“∑√æ— ¬∑å Ë’· ¥ß‰«â„π Ù. ‡ªπì √“§“∑’Ë·∑®â √‘ß
(Û) ·..∫...ßà ..°..√..√..¡.. ...∑‘ ..∏..‘√Ï..«..¡....μ..“..¡...§..”..¢..Õ..©...∫..—∫..≈...ß..«..—π..∑..Ë’...............‡.¥..Õ◊...π..........................æ...»..................................................................
(Ù) .....................................................................................................................................................................
(ı) .....................................................................................................................................................................
«π— ∑.Ë’ ...........‡¥Õ◊ π..............................æ.»..................
≈ß™ËÕ◊ ..............π...“..¬...°.....,..π..“..¬....§..................ºâŸ¢Õ∂◊Õ°√√¡ ‘∑∏‘Ï
≈ß™Ë◊Õ......................π..“..ß....¢.........................ºŸâ¢Õ∂Õ◊ °√√¡ ∑‘ ∏Ï‘
≈ß™◊ËÕ......................................................º Ÿâ Õ∫ «π
(......................................................)
”À√∫— æπ—°ß“π‡®â“Àπâ“∑Ë’
Ò) √“§“ª√–‡¡‘π∑ÿπ∑√—æ¬å.....................................................................................................∫“∑........................................ μ“ߧå
Ú) ‚©π¥∑Ë¥’ ‘π„À¡√à –«“ß..........5..1.3..6....I.V....7..2..2..8..›.1...........‡≈¢∑¥’Ë ‘π.................Ú..ı............................Àπâ“ ”√«®...........Ù..Ù...ˆ.........................
‚©π¥∑Ë¥’ π‘ ‡≈¢∑’Ë......................ı...Û..˘...Û.....................‡≈¡à ........................ı..Ù............................Àπ“â .................˘...Û..............................
®”π«π∑¥Ë’ π‘ ...........................Ò...........................‰√.à .............................›...................ß“π.............................›.....................μ“√“ß«“
§ß‡À≈Õ◊ ................................Ò...........................‰√.à .............................›...................ß“π.............................›.....................μ“√“ß«“
Û) ‰¥®â ¥∑–‡∫¬’ π·≈â«·μà«—π∑.Ë’ ................................‡¥◊Õπ............................................æ.»......................
≈ß™ÕË◊ .......................................................
(......................................................)
‡®â“æπ—°ß“π∑’Ë¥‘π
Úˆˆ
μ«— Õ¬“à ßÀ¡“¬‡≈¢ Û μ“¡√–‡∫¬’ ∫¢âÕ Ú˘ (Û) «√√§ Õß (∑.¥. Ò)
∑∫Ë’ “â π
°√≥ ’ à«π¢Õߺ⟮”πÕ߇ªìπ·ª≈ß·¬° ∑Ë’ «π/‰√à
∑Ë’π“
∑.’Ë .............
§”¢Õ®¥∑–‡∫’¬π ∑‘ ∏·‘ ≈–πμ‘ °‘ √√¡ πÕ°‡¢μ
„π‡¢μ
·≈–°“√ Õ∫ «π ‘∑∏‘„π∑’Ë¥π‘ ª√–‡¿∑.·..∫...àß..°..√..√..¡.. ...‘∑..∏..√Ï‘..«..¡....(.§...√..Õ..∫..›..ª...≈..Õ..¥...®..”.πÕß)
μ”·Àπàß∑Ë’¥‘π ·ª≈ߧ߇À≈Õ◊
√–«“ß...............................5..1..3..6...I.V....7..2..2..8..›..1.................................. μ”∫≈.........................................................................................
‡≈¢∑Ë¥’ π‘ ....................................Ú..Û............................................... Õ”‡¿Õ........................................................................................
Àπâ“ ”√«®...............................Ù...Ù..Ù..............................................®ß— À«¥— ........................................................................................
’Ë∑¥‘π·ª≈ߧ߇À≈◊Õæâπ®“°°“√®”πÕß μ“¡ —≠≠“®”πÕ߇©æ“– à«π ©∫—∫≈ß«—π∑Ë’...........‡ ◊¥Õπ...........................æ.». ...............‚©π¥∑¥’Ë ‘π
μ“¡∫—π∑÷° â¢Õμ°≈ߪ≈Õ¥®”πÕß ≈ß«—π∑Ë’...........‡¥◊Õπ...........................æ.». ............... ‡≈¢∑Ë.’ ....................ı..Û..˘...Ò................‡≈à¡............ı..Ù..........................Àπ“â ............˘..Ò......................
®”π«π∑Ë¥’ π‘ ..............Ò.....................‰√à................›.................ß“π................›...................μ“√“ß«“
‡ ⮓æπ—°ß“π Ë’∑ ‘¥π
Ò. ¢“â 懮“â º¡âŸ ’π“¡μàÕ‰ªπ’È ¡’§«“¡ª√– ߧå¢Õ®¥∑–‡∫¬’ π ∑‘ ∏·‘ ≈–πμ‘ ‘°√√¡‡°¬Ë’ «°∫— Õ ß— À“√‘¡∑√—æ¬å∑Ë’°≈“à «¢â“ß∫ππÈ’ ·≈–
‰¥ªâ Ø≠‘ “≥μπ·≈«â ¢Õ„Àâ∂âÕ¬§”¥«â ¬§«“¡ —μ¬å®√ß‘ ∂“â ¢“â 懮“â „À∂â âÕ¬§”‰¡à‡ªπì §«“¡®√ß‘ „Àâ„™â∂Õâ ¬§”πȬ’ π— ¢“â 懮“â „π∑“ߧ¥’Õ“≠“‰¥â
‡≈¢ª√–®”μ—«ª√–™“™π
Ú. ¢“â 懮“â ................Ò.....π...“.¬....°...................... ºâŸ...∂..◊Õ..°...√..√..¡.. ..‘∑...∏..‘Ï ...............
................Ú......π..“..ß...¢......................
................Û....π..“..¬....§.....................
Õ“¬ÿ........ı.....,..ˆ.....,..Ù..¯..........ªï —≠™“μ‘..............‰.∑..¬........................∫¥‘ “/¡“√¥“™ÕË◊ .............................................................................
‚ ¥ À¡“â ¬ §à Ÿ ¡√ ™Ë◊Õ..........................................................................................
Õ¬∑Ÿà ’Ë∫“â π/À¡Ÿà∫“â π..........................‡≈¢∑’Ë................μ√Õ°/´Õ¬.......................................∂ππ.....................................À¡∑Ÿà Ë.’ .............
μ”∫≈/·¢«ß...................................Õ”‡¿Õ/‡¢μ...................................®ß— À«—¥.................................À¡“¬‡≈¢‚∑√»æ— ∑.å ....................
Û. ¢â“懮“â ..............π..“..ß....¢........................... ‡≈¢ª√–®”μ—«ª√–™“™π ºŸ.â ..∂...Õ◊ ..°..√..√..¡.. ...∑‘ ..∏..Ï‘...............
Õ“¬.ÿ ............Ù..ı...................ªï —≠™“μ‘........‰.∑...¬.............................∫¥‘ “/¡“√¥“™◊ËÕ.............................................................................
‚ ¥ À¡“â ¬ §Ÿà ¡√ ™ËÕ◊ ....................................................... ≠— ™“μ.‘ ......................
Õ¬∑àŸ Ë∫’ â“π/À¡àŸ∫“â π..........................‡≈¢∑Ë.’ ...............μ√Õ°/´Õ¬.......................................∂ππ.....................................À¡Ÿ∑à Ë’..............
μ”∫≈/·¢«ß...................................Õ”‡¿Õ/‡¢μ...................................®—ßÀ«—¥.................................À¡“¬‡≈¢‚∑√»—æ∑.å ....................
Ù. ¢â“懮“â ¢Õ· ¥ß√“§“∑√æ— ¬∑å ’¢Ë Õ∑”πμ‘ ‘°√√¡π‡È’ ªπì ‡ßπ‘ .............................›............................∫“∑.........›........... μ“ߧå
ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à
(Ò) ¢“â 懮“â ‰¡à‰¥â√∫— ‚Õπ·∑πÀ√◊Õ‡æÕË◊ ª√–‚¬™πå·°∫à ÿ§§≈μà“ߥ⓫
(Ú) √“§“∑√—æ¬å∑·’Ë ¥ß‰«â„π Ù. ‡ªπì √“§“∑Ë·’ ∑â®√ß‘
(Û) ·...∫..àß..°..√..√..¡... ..∑‘ ..∏..‘√Ï..«..¡....μ..“..¡...§..”..¢..Õ..©...∫..∫—..≈...ß..«..—π..∑..Ë’...............‡.¥..Õ◊...π..........................æ...».................................................................
(Ù) .....................................................................................................................................................................
(ı) .....................................................................................................................................................................
«π— ∑.Ë’ ...........‡¥Õ◊ π..............................æ.»..................
≈ß™ËÕ◊ ...............π..“..¬....°....,...π..“..ß...¢.................ºâŸ¢Õ∂◊Õ°√√¡ ‘∑∏Ï‘
≈ß™ÕË◊ ...............π..“..¬....§................................ºâŸ¢Õ∂◊Õ°√√¡ ∑‘ ∏‘Ï
≈ß™◊ÕË ......................................................º Ÿâ Õ∫ «π
(......................................................)
”À√—∫æπ°— ß“π‡®“â Àπ“â ∑Ë’
Ò) √“§“ª√–‡¡π‘ ∑ÿπ∑√æ— ¬.å ....................................................................................................∫“∑........................................ μ“ߧå
Ú) ‚©π¥∑’¥Ë ‘π„À¡à√–«“ß..........5..1.3..6....I.V....7..2..2..8..›.1...........‡≈¢∑’Ë¥‘π.................Ú..ı............................Àπâ“ ”√«®...........Ù..Ù...ˆ.........................
‚©π¥∑¥’Ë π‘ ‡≈¢∑.Ë’ .....................ı...Û..˘...Û.....................‡≈¡à ........................ı..Ù............................Àπâ“.................˘...Û..............................
®”π«π∑¥’Ë π‘ ...........................Ò...........................‰√.à .............................›...................ß“π.............................›.....................μ“√“ß«“
§ß‡À≈Õ◊ ................................Ò...........................‰√.à .............................›...................ß“π.............................›.....................μ“√“ß«“
Û) ‰¥®â ¥∑–‡∫¬’ π·≈«â ·μà«—π∑Ë.’ ................................‡¥Õ◊ π............................................æ.»......................
≈ß™ËÕ◊ .......................................................
(......................................................)
‡®â“æπ—°ß“π∑Ë’¥‘π
μ«— Õ¬à“ßÀ¡“¬‡≈¢ Û μ“¡√–‡∫¬’ ∫¢Õâ Ú˘ (Û) «√√§ Õß Úˆ˜
(∑.¥. Òˆ)
∫—π∑÷°¢âÕμ°≈߇√ÕË◊ ߪ≈Õ¥®”πÕß
∑’Ë¥‘π
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‡≈¢∑Ë¥’ ‘π..................Ú..Û...........Àπâ“ ”√«®..........Ù..Ù................Õ”‡¿Õ.......................................................................
‚©π¥À¡“¬‡≈¢∑Ë.’ ..............ı..Û...˘..Ò.........................................®—ßÀ«¥— .......................................................................
∑’«Ë à“°“√.....................................................................
«—π∑’.Ë ...............‡¥◊Õπ........................................æ.».....................
¢“â 懮“â .....................π..“..¬....™......º..√âŸ..∫—..®..”..π...Õ..ß................................................ ‡≈¢ª√–®”μ—«ª√–™“™π
.....................π..“..¬....°.......º..Ÿ®â ..”..π..Õ...ß....................................................
Õ“¬ÿ...ı.....,...Ù...ı.....ªï ‡™È◊Õ™“μ‘.........‰.∑...¬.................. —≠™“μ.‘ .......‰..∑..¬...................∫¥‘ “/¡“√¥“™ÕË◊ ............................................................
Õ¬Ÿ∑à Ë’∫â“π/À¡Ÿà∫â“π......................................‡≈¢∑’.Ë .............μ√Õ°/´Õ¬.....................................∂ππ.................................À¡Ÿ∑à .’Ë .........
μ”∫≈/·¢«ß...............................Õ”‡¿Õ/‡¢μ...............................®ß— À«¥— ................................À¡“¬‡≈¢‚∑√»æ— ∑.å .............................
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¥//«â//¬//§//«/“/¡// //—μ//¬//®å /√//ß‘ / ¥ß— μÕà ‰ªπÈ’ :›
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............................................................................................≈..ß...™..Ë◊Õ....................................................................................................................................æ...¬..“..π...........................................
............................................................................................≈..ß...™..Ë◊Õ.....................................................................................................................................æ...¬..“..π...........................................
.............................∫...π— ..∑...°÷ ..¢..Õâ...μ..°...≈..ß..π...È’‰..¥..∑â...”..μ..Õà...À..π...“â ......................................................................................................................................
............................................................................................≈..ß...™..◊ËÕ.....................................................................................................................................‡.®..“â..æ...π...°— ..ß..“..π..∑...¥Ë’..π‘..........................
..........................................................................................................ª..√..–..∑...∫—..μ...√..“..μ...”.·...À..π...ßà ..‡.ª...ìπ.. ...”..§..≠—..........................................................
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μ—«Õ¬“à ßÀ¡“¬‡≈¢ Û μ“¡√–‡∫’¬∫ ¢âÕ Ú˘ (Û) «√√§ Õß Úˆ¯
“√∫≠— ®¥∑–‡∫¬’ π (√“¬°“√®¥∑–‡∫’¬π ·ª≈߇¥‘¡ ‚©π¥∑’Ë ıÛ˘Ò)
®¥∑–‡∫¬’ π ª√–‡¿∑°“√ ºâŸ„À â ≠— ≠“ ºâŸ√—∫ —≠≠“ ‡πÈ◊Õ∑Ë’¥‘π ‡π◊ÈÕ∑’Ë¥‘π √–«“ß ‡®â“æπ—°ß“π∑Ë’¥‘π
«π— ‡¥Õ◊ π ªï ®¥∑–‡∫’¬π μ“¡ —≠≠“ §ß‡À≈Õ◊ ‡≈¢∑’Ë¥‘π ≈ß≈“¬¡Õ◊ ™ÕË◊
‚©π¥∑Ë’¥‘π„À¡à ª√–∑∫— μ√“
‰√à ß“π μ“√“ß ‰√à ß“π μ“√“ß
«“ «“
«π— ∑.’Ë ................ ®”πÕ߇©æ“– «à π Ò. 𓬠°. 𓬠™. Ú››››› › (≈ß™Ë◊Õ) 𓬠æ.
‡¥◊Õπ............... Ú. π“ß ¢. ºâŸ√∫— ®”πÕß (≈ß™◊ÕË ).......................
æ.». ................. ·∫ßà °√√¡ ‘∑∏√Ï‘ «¡ Û. 𓬠§. 𓬠°. ®”πÕ߇©æ“– «à π¢Õßμπ·°à 𓬠™. (≈ß™◊ËÕ).......................
«—π∑Ë.’ ................ (§√Õ∫›ª≈Õ¥ Ò. 𓬠°. π“ß °. «à π¢Õß π“ß ¢. §ß‡¥¡‘
‡¥◊Õπ............... ®”πÕß) Ú. π“ß ¢. (≈ß™◊ËÕ).......................
æ.». ................. Û. 𓬠§. π“ß ¢. Ò››Ò›› 5136IV7228-1
∑Ë¥’ π‘ ·ª≈ß∑·Ë’ ¬°‰ªπ°’È “√®”πÕ߬ߗ §ß¡’Õ¬Ÿà ÚÙ
𓬠§. μ“¡ —≠≠“®”πÕ߇©æ“– à«π ©∫∫— ≈ß«—π∑.Ë’ .... ıÛ˘Ú
‡¥Õ◊ π.......................æ.».............
5136IV7228-1
Ò››Ò›› Úı
∑’¥Ë ‘π·ª≈ß∑Ë’·¬°‰ªπæÈ’ πâ ®“°°“√®”πÕßμ“¡ ıÛ˘Û
≠— ≠“®”πÕ߇©æ“– à«π©∫∫— ≈ß«π— ∑Ë.’ ...........
‡¥Õ◊ π....................æ.».........μ“¡∫π— ∑°÷ ¢Õâ μ°≈ß ›
ª≈Õ¥®”πÕß ≈ß«—π∑’.Ë .....‡¥◊Õπ............æ.»........
Ò›››››
∑¥’Ë π‘ ·ª≈ߧ߇À≈Õ◊ æπâ ®“°°“√®”πÕßμ“¡
—≠≠“®”πÕ߇©æ“– à«π ©∫∫— ≈ß«π— ∑.Ë’ ...........
‡¥◊Õπ......................æ.».........μ“¡∫π— ∑÷°¢Õâ μ°≈ß
ª≈Õ¥®”πÕß ≈ß«—π∑Ë’......‡¥Õ◊ π.............æ.»........
μ«— Õ¬à“ßÀ¡“¬‡≈¢ Û μ“¡√–‡∫’¬∫ ¢Õâ Ú˘ (Û) «√√§ Õß
“√∫≠— ®¥∑–‡∫¬’ π (√“¬°“√®¥·®ßâ ∑’Ë¥π‘ ·ª≈ß∑Ë’·¬°‰ª„À¡à‚©π¥∑Ë’ ıÛ˘Û)
®¥∑–‡∫¬’ π ª√–‡¿∑°“√ ºâŸ„À â ≠— ≠“ ºŸâ√—∫ —≠≠“ ‡πÈ◊Õ∑Ë’¥‘π ‡π◊ÈÕ∑Ë’¥‘π √–«“ß ‡®â“æπ—°ß“π∑’Ë¥‘π
«π— ‡¥Õ◊ π ªï ®¥∑–‡∫’¬π μ“¡ —≠≠“ §ß‡À≈Õ◊ ‡≈¢∑’Ë¥‘π ≈ß≈“¬¡Õ◊ ™ÕË◊
‚©π¥∑¥Ë’ π‘ „À¡à ª√–∑∫— μ√“
‰√à ß“π μ“√“ß ‰√à ß“π μ“√“ß
«“ «“
«—π∑.Ë’ ................ ®”πÕ߇©æ“– «à π 𓬠°. 𓬠™. › Û ı › › › › (≈ß™◊ËÕ) 𓬠æ.
‡¥◊Õπ............... (§√Õ∫®”πÕß) ºâŸ√∫— ®”πÕß «—π∑.Ë’ ...........................
æ.». ................. °“√®”πÕ߬ߗ §ß¡Õ’ ¬Ÿàμ“¡ —≠≠“®”πÕß ‡¥Õ◊ π.........................
‡©æ“– à«π ©∫—∫≈ß«π— ∑Ë’.......‡¥Õ◊ π................ æ.». ...........................
æ.». ............. (≈ß™ÕË◊ ).....................
Úˆ˘
Ú˜
μ—«Õ¬à“ßÀ¡“¬‡≈¢ ÛÒ μ“¡√–‡∫¬’ ∫¢âÕ Ú˘ (Ù) (∑.¥. Ò)
∑∫Ë’ “â π
°√≥’ à«π¢Õߺ®âŸ ”πÕ߇ªπì ·ª≈ߧ߇À≈◊Õ ∑Ë’ «π/‰√à
∑Ë’π“
∑’Ë..............
§”¢Õ®¥∑–‡∫’¬π ‘∑∏·‘ ≈–πμ‘ °‘ √√¡ πÕ°‡¢μ
„π‡¢μ
·≈–°“√ Õ∫ «π ∑‘ ∏‘„π∑Ë¥’ π‘ ª√–‡¿∑...ª..≈...Õ..¥..®..”..π...Õ..ß...................................
μ”·Àπàß∑Ë’¥‘π
√–«“ß.........................................................................................μ”∫≈.........................................................................................
‡≈¢∑¥Ë’ ‘π.....................................................................................Õ”‡¿Õ........................................................................................
Àπ“â ”√«®..................................................................................®ß— À«—¥........................................................................................
’Ë∑ ‘¥π·ª≈ßπÈ’ âæπ®“°°“√®”πÕßμ“¡ —≠≠“®”πÕß ©∫—∫≈ß«—π∑’Ë...........‡¥◊Õπ...........................æ.». ...............‚©π¥∑Ë¥’ π‘
μ“¡∫—π∑÷°¢âÕμ°≈ߪ≈Õ¥®”πÕß ≈ß«—π∑’Ë...........‡ ◊¥Õπ...........................æ.». ............... ‡≈¢∑Ë.’ ....................Ò..Ú...Û..................‡≈à¡............Ò..Û..........................Àπ“â ............Û........................
‡ ⮓æπ—°ß“π ’Ë∑¥‘π ®”π«π∑’Ë¥‘π..............Ò.....................‰√à................›.................ß“π................›...................μ“√“ß«“
Ò. ¢â“懮“⠺⡟ π’ “¡μÕà ‰ªπÈ’ ¡’§«“¡ª√– ߧå¢Õ®¥∑–‡∫’¬π ‘∑∏·‘ ≈–πμ‘ °‘ √√¡‡°Ë’¬«°—∫Õ ß— À“√‘¡∑√æ— ¬∑å °Ë’ ≈“à «¢â“ß∫ππ’È ·≈–
‰¥âªØ≠‘ “≥μπ·≈â« ¢Õ„À∂â Õâ ¬§”¥«â ¬§«“¡ μ— ¬å®√ß‘ ∂“â ¢â“懮ⓄÀ∂â Õâ ¬§”‰¡‡à ªì𧫓¡®√ß‘ „Àâ„™∂â âÕ¬§”πÈ’¬π— ¢“â 懮Ⓞπ∑“ߧ¥’Õ“≠“‰¥â
Ú. ¢“â 懮â“..............π..“..¬...¢............................. ‡≈¢ª√–®”μ—«ª√–™“™π ºâŸ...√..∫— ..®..”..π..Õ...ß......................
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Õ“¬.ÿ ...........ı.....,..Ù..ı.............ªï ≠— ™“μ.‘ ......‰..∑..¬..............................∫‘¥“/¡“√¥“™◊ÕË .............................................................................
‚ ¥ À¡“â ¬ § àŸ ¡√ ™Õ◊Ë ..........................................................................................
Õ¬à∑Ÿ ∫’Ë “â π/À¡Ÿà∫“â π..........................‡≈¢∑’.Ë ...............μ√Õ°/´Õ¬.......................................∂ππ.....................................À¡à∑Ÿ Ë’..............
μ”∫≈/·¢«ß...................................Õ”‡¿Õ/‡¢μ...................................®—ßÀ«—¥.................................À¡“¬‡≈¢‚∑√»—æ∑å.....................
Û. ¢“â 懮“â ...............π..“..¬....°........................... ‡≈¢ª√–®”μ—«ª√–™“™π ºŸâ...®..”..π..Õ...ß..........................
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Õ“¬.ÿ ............ı.....................ªï —≠™“μ.‘ .......‰.∑...¬.............................∫¥‘ “/¡“√¥“™ËÕ◊ .............................................................................
‚ ¥ À¡“â ¬ §à Ÿ ¡√ ™Ë◊Õ....................................................... —≠™“μ‘.......................
Õ¬∑àŸ ∫Ë’ “â π/À¡Ÿà∫“â π..........................‡≈¢∑’.Ë ...............μ√Õ°/´Õ¬.......................................∂ππ.....................................À¡Ÿà∑.’Ë .............
μ”∫≈/·¢«ß...................................Õ”‡¿Õ/‡¢μ...................................®—ßÀ«¥— .................................À¡“¬‡≈¢‚∑√»—æ∑å.....................
Ù. ¢â“懮“â ¢Õ· ¥ß√“§“∑√æ— ¬å∑Ë’¢Õ∑”πμ‘ °‘ √√¡π‡È’ ªπì ‡ßπ‘ .............................›............................∫“∑.........›........... μ“ߧå
ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à
(Ò) ¢“â 懮Ⓣ¡à‰¥√â ∫— ‚Õπ·∑πÀ√Õ◊ ‡æÕ◊Ë ª√–‚¬™πå·°à∫§ÿ §≈μà“ߥ“â «
(Ú) √“§“∑√—æ¬∑å ·Ë’ ¥ß‰«â„π Ù. ‡ªìπ√“§“∑’·Ë ∑®â √ß‘
(Û) ∑...’¥Ë ..‘π..·...ª..≈..ß..π...·È’ ..¬..°..¡...“..®..“..°..‚.©..π...¥..∑..’Ë..........................................................Õ..”..‡.¿...Õ...............................................‰..¥..âæ...âπ..®..“..°..°..“..√..®..”..π..Õ...ß..μ..“..¡.. ...—≠...≠...“..®..”..π..Õ..ß........
©...∫..—∫..≈...ß..«..π— ..∑..Ë.’ ......................................μ..“..¡..∫...—π..∑..°÷...¢..Õâ ..μ..°...≈..ß...≈...ß..«..π— ..∑..’.Ë ......................................................................................
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«π— ∑.Ë’ ...........‡¥Õ◊ π..............................æ.»..................
≈ß™◊ÕË ......................π..“..¬....¢.........................ºâŸ¢Õ √∫— ®”πÕß
≈ß™◊ËÕ......................π..“..¬....°.........................ºŸâ¢Õ ®”πÕß
≈ß™◊ÕË ......................................................º ⟠Õ∫ «π
(......................................................)
”À√∫— æπ—°ß“π‡®â“Àπ“â ∑’Ë
Ò) √“§“ª√–‡¡π‘ ∑ÿπ∑√æ— ¬å.....................................................................................................∫“∑........................................ μ“ߧå
Ú) ‚©π¥∑¥’Ë ‘π„À¡à√–«“ß..........5..1..3.6....I.V....7..2..2..8..›..1..........‡≈¢∑’Ë¥π‘ .................Ò..............................Àπâ“ ”√«®...........Ú..............................
‚©π¥∑Ë¥’ π‘ ‡≈¢∑.’Ë ......................Ò..Ú...Û..Ò.....................‡≈¡à ........................Ò..Û............................Àπâ“..................Û..Ò..............................
®”π«π∑¥Ë’ π‘ ............................Ò..........................‰√.à .............................›...................ß“π..............................›....................μ“√“ß«“
§ß‡À≈Õ◊ ................................Ò...........................‰√.à .............................›...................ß“π.............................›.....................μ“√“ß«“
Û) ‰¥â®¥∑–‡∫’¬π·≈â«·μ«à π— ∑’Ë.................................‡¥Õ◊ π............................................æ.»......................
≈ß™ÕË◊ .......................................................
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‡®â“æπ—°ß“π∑Ë’¥‘π
μ—«Õ¬“à ßÀ¡“¬‡≈¢ ÛÒ μ“¡√–‡∫’¬∫¢Õâ Ú˘ (Ù) «√√§ Õß Ú˜Ò
(∑.¥. Òˆ)
∫π— ∑°÷ ¢âÕμ°≈߇√Õ◊Ë ßª≈Õ¥®”πÕß
∑Ë’¥‘π
√–«“ß.............5..1..3.6....I.V....7..2..2..8..›..1..........................................μ”∫≈........................................................................
‡≈¢∑Ë’¥π‘ ..................Ú..Û...........Àπ“â ”√«®..........Ù..Ù................Õ”‡¿Õ.......................................................................
‚©π¥À¡“¬‡≈¢∑.Ë’ ..............ı..Û...˘..Ò.........................................®ß— À«—¥.......................................................................
∑«Ë’ à“°“√.....................................................................
«—π∑’.Ë ...............‡¥Õ◊ π........................................æ.».....................
¢“â 懮“â .....................π..“..¬....™......º..â√Ÿ..—∫..®..”..π...Õ..ß................................................ ‡≈¢ª√–®”μ—«ª√–™“™π
.....................π..“..¬....°.......º..⟮..”..π..Õ...ß....................................................
Õ“¬.ÿ ..ı.....,...Ù...ı.....ªï ‡™ÕÈ◊ ™“μ.‘ ........‰.∑...¬.................. —≠™“μ‘........‰..∑..¬...................∫¥‘ “/¡“√¥“™Ë◊Õ............................................................
Õ¬∑àŸ Ë’∫“â π/À¡Ÿà∫“â π......................................‡≈¢∑Ë.’ .............μ√Õ°/´Õ¬.....................................∂ππ.................................À¡∑Ÿà .Ë’ .........
μ”∫≈/·¢«ß...............................Õ”‡¿Õ/‡¢μ...............................®ß— À«¥— ................................À¡“¬‡≈¢‚∑√»—æ∑å..............................
¢//Õ//ª//Ø//≠‘ //“/≥///μ//π//·/≈//–//„/À//â∂//âÕ//¬/§//”//μ/àÕ//.....‰..¥..∑â...”.∫...π— ..∑..°÷...¢..Õâ ..μ...°..≈..ß..μ..Õà...‡.®..“â..æ..π...°— ..ß..“..π..∑...’Ë¥..‘π.....................................................................................
¥//«â//¬//§//«/“/¡// //μ—//¬//å®/√//ß‘ / ¥—ßμàÕ‰ªπÈ’ :›
......................∑...’Ë¥..π‘ ...·..ª..≈...ß..‡.§...√..Õ◊Ë ...ß..À..¡...“..¬..¢..“â..ß..∫...π..π...È’ .·...¬..°...¡..“..®..“..°...‚.©..π...¥..‡..≈..¢..∑...Ë’...........................................Õ..”..‡..¿..Õ.....................................................‚.¥...¬..¢..â“..æ...‡.®..â“....π..“..¬....°......º..®âŸ...”..π..Õ..ß...
.‰.¥..â®...”..π..Õ...ß..‰.«..â°...—∫....π..“..¬..‹..¢......º..â√Ÿ..∫—...®..”..π..Õ...ß...μ...“..¡.. ...≠— ...≠....“..®..”..π..Õ...ß..©..∫...—∫..≈...ß..«..—π...∑..Ë’.........................‡.¥...◊Õ..π.....................................................æ....»............................‡..æ..ÕË◊...‡.ª...πì ..ª...√..–..°..π—...À..π...°’È ..Ÿâ¬...◊¡..‡.ß...π‘ ..
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§...ß..®..”..π...Õ..ß..‡..ª..πì...ª..√..–...°..—π..À...π..È’.„.π..«...ß..‡.ß..‘π...‡.¥...¡‘ ..Õ...¬..Ÿàμ..“..¡...‡.¥...‘¡....‡.ß..◊ËÕ...π..‰..¢..·..≈...–..¢..âÕ...μ..°...≈..ß..Õ...π◊Ë ..Ê....„.À...â‡.ª...ìπ..‰..ª..μ...“..¡.. ...—≠...≠...“..®...”..π..Õ..ß...‡.¥...¡‘ ..∑..°ÿ...ª..√...–..°..“..√.....................
......................∫...π— ..∑...÷°..¢..âÕ...μ..°...≈..ß..π...’∑È ..”..‰..«..âÀ..π...÷Ëß..©..∫...—∫....‡.°...∫Á ..‰..«..â .≥..... ...”.π...°—..ß..“..π...∑..’¥Ë...π‘....∑..ß—È... ..Õ..ß...Ω..“É..¬..‰..¥..μâ...√..«..®..¥...Ÿ∫..—π...∑..°÷...¢..Õâ..μ...°..≈...ß..·..≈...–..‡.¢...“â ..„.®..¢..Õâ...§..«...“.¡..........
.μ..≈..Õ...¥..·...≈..â«....®..ß÷..≈...ß..≈..“..¬...¡..◊Õ...™..ËÕ◊ ..À...√..◊Õ..≈...ß..≈..“..¬...æ..¡‘...æ...åπ..‘«È..¡...◊Õ..‰.«...‡â .ª..ìπ...À..≈...—°..∞..“..π...μ..Õà...À..π...“â ..æ..¬...“..π..·...≈..–..‡..®..“â ..æ..π...°— ..ß..“..π...∑..Ë¥’...‘π....................................................
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............................................................................................≈..ß...™..◊ËÕ...........................................................π......“....¬.........¢......................................................º..âŸ√..∫—...®..”..π...Õ..ß..................................
............................................................................................≈..ß...™..Ë◊Õ...........................................................π......“....¬.........°......................................................º..⟮...”..π..Õ..ß.......................................
............................................................................................≈..ß...™..Ë◊Õ....................................................................................................................................æ...¬..“..π...........................................
............................................................................................≈..ß...™..◊ËÕ.....................................................................................................................................æ...¬..“..π...........................................
.............................∫...π— ..∑...÷°..¢..âÕ...μ..°...≈..ß..π...È’‰..¥..∑â...”..μ..Õà...À..π...“â ......................................................................................................................................
............................................................................................≈..ß...™..Ë◊Õ.....................................................................................................................................‡.®..“â..æ...π...°— ..ß..“..π..∑...¥Ë’..π‘..........................
..........................................................................................................ª..√..–..∑...—∫..μ...√..“..μ...”.·...À..π...ßà ..‡.ª...ìπ.. ...”..§..≠—..........................................................
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μ«— Õ¬à“ßÀ¡“¬‡≈¢ ÛÒ μ“¡√–‡∫¬’ ∫ ¢âÕ Ú˘ (Ù) Ú˜Ú
“√∫≠— ®¥∑–‡∫¬’ π
®¥∑–‡∫’¬π ª√–‡¿∑°“√ ºâŸ„À â ≠— ≠“ ºŸâ√—∫ —≠≠“ ‡π◊ÈÕ∑’Ë¥‘π ‡π◊ÈÕ∑’Ë¥‘π √–«“ß ‡®â“æπ—°ß“π∑’Ë¥‘π
«π— ‡¥Õ◊ π ªï ®¥∑–‡∫’¬π μ“¡ ≠— ≠“ §ß‡À≈Õ◊ ‡≈¢∑Ë’¥‘π ≈ß≈“¬¡Õ◊ ™Õ◊Ë
𓬠°. 𓬠¢. ‚©π¥∑¥’Ë ‘π„À¡à ª√–∑∫— μ√“
«π— ∑.Ë’ ................ ®”πÕß º√⟠—∫®”πÕß ‰√à ß“π μ“√“ß ‰√à ß“π μ“√“ß
‡¥◊Õπ............... (§√Õ∫®”πÕß) «“ «“
æ.». ................. 𓬠¢. 𓬠°.
ºâŸ√—∫®”πÕß Ò››››› › (≈ß™ÕË◊ ) 𓬠æ.
«π— ∑.Ë’ ................ ª≈Õ¥®”πÕß °“√®”πÕ߬—ߧߡՒ ¬μàŸ “¡ —≠≠“®”πÕß «—π∑Ë.’ ...........................
‡¥◊Õπ............... ©∫—∫≈ß«—π∑Ë.’ ......‡¥◊Õπ........................æ.»............ ‡¥◊Õπ.........................
æ.». ................. æ.». ...........................
Ò››››› (≈ß™Ë◊Õ).....................
∑¥Ë’ ‘π·ª≈ßπ’æÈ πâ ®“°°“√®”πÕßμ“¡ —≠≠“
®”πÕß ©∫∫— ≈ß«π— ∑.Ë’ .......‡¥◊Õπ......................... ›
æ.»...........μ“¡∫π— ∑÷°¢âÕμ°≈ߪ≈Õ¥®”πÕß
≈ß«—π∑.’Ë .........‡¥Õ◊ π........................æ.»...............
Ú˜Û
μ«— Õ¬“à ßÀ¡“¬‡≈¢ ÛÚ μ“¡√–‡∫¬’ ∫¢âÕ Û˜ (Ò) (∑.¥. Ò)
∑∫’Ë “â π
∑Ë ’ «π/‰√à
∑Ë’π“
∑’Ë..............
§”¢Õ®¥∑–‡∫¬’ π ∑‘ ∏·‘ ≈–π‘μ°‘ √√¡ πÕ°‡¢μ
„π‡¢μ
·≈–°“√ Õ∫ «π ∑‘ ∏‘„π∑¥’Ë π‘ ª√–‡¿∑......¢..“..¬...√.–...À..«..“à ..ß..®..”..π..Õ..ß.......................
μ”·Àπàß∑Ë’¥‘π μ“¡§” Ë—ß.............................(μ“¡Àπ—ß ◊Õ..........∑’.Ë ........../............≈ß«—π∑.’Ë ...............)
√–«“ß.........................................................................................μ”∫≈.........................................................................................
‡≈¢∑Ë¥’ π‘ .....................................................................................Õ”‡¿Õ........................................................................................
Àπâ“ ”√«®..................................................................................®ß— À«—¥........................................................................................
‚©π¥∑’Ë¥π‘
‡≈¢∑’Ë.....................Ò..Ú...Û..................‡≈à¡............Ò..Û..........................Àπâ“............Û........................
®”π«π∑¥’Ë π‘ ..............Ò.....................‰√à................›.................ß“π................›...................μ“√“ß«“
Ò. ¢â“懮⓺⡟ ’π“¡μÕà ‰ªπÈ’ ¡§’ «“¡ª√– ߧå¢Õ®¥∑–‡∫¬’ π ∑‘ ∏·‘ ≈–πμ‘ °‘ √√¡‡°’¬Ë «°∫— Õ ß— À“√‘¡∑√—æ¬å∑Ë’°≈“à «¢â“ß∫ππÈ’ ·≈–
‰¥ªâ Ø≠‘ “≥μπ·≈â« ¢Õ„Àâ∂âÕ¬§”¥«â ¬§«“¡ μ— ¬å®√‘ß ∂“â ¢â“懮“â „Àâ∂Õâ ¬§”‰¡à‡ªì𧫓¡®√‘ß„Àâ„™â∂Õâ ¬§”π’È¬π— ¢â“懮“â „π∑“ߧ¥’Õ“≠“‰¥â
Ú. ¢“â 懮“â ..............π..“..¬...°............................. ‡≈¢ª√–®”μ—«ª√–™“™π ºŸ.â ..¢..“..¬...............................
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Õ“¬.ÿ ...........ı.....,..Ù..ı.............ªï ≠— ™“μ‘.......‰..∑..¬..............................∫‘¥“/¡“√¥“™Ë◊Õ.............................................................................
‚ ¥ À¡“â ¬ § àŸ ¡√ ™ÕË◊ ..........................................................................................
Õ¬Ÿ∑à ’Ë∫â“π/À¡∫Ÿà “â π..........................‡≈¢∑Ë’................μ√Õ°/´Õ¬.......................................∂ππ.....................................À¡àŸ∑Ë.’ .............
μ”∫≈/·¢«ß...................................Õ”‡¿Õ/‡¢μ...................................®—ßÀ«¥— .................................À¡“¬‡≈¢‚∑√»—æ∑å.....................
Û. ¢“â 懮“â ...............π..“..¬....¢........................... ‡≈¢ª√–®”μ—«ª√–™“™π ºŸ.â ..´..ÈÕ◊.................................
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Õ“¬ÿ.............Ùı.....................ªï —≠™“μ‘........‰.∑...¬.............................∫¥‘ “/¡“√¥“™◊ËÕ.............................................................................
‚ ¥ À¡“â ¬ §àŸ ¡√ ™◊ÕË ....................................................... —≠™“μ.‘ ......................
Õ¬Ÿà∑∫’Ë “â π/À¡à∫Ÿ “â π..........................‡≈¢∑.Ë’ ...............μ√Õ°/´Õ¬.......................................∂ππ.....................................À¡à∑Ÿ ’Ë..............
μ”∫≈/·¢«ß...................................Õ”‡¿Õ/‡¢μ...................................®—ßÀ«¥— .................................À¡“¬‡≈¢‚∑√»æ— ∑å.....................
Ù. ¢â“懮“â ¢Õ· ¥ß√“§“∑√æ— ¬∑å ’Ë¢Õ∑”π‘μ°‘ √√¡π‡’È ªìπ‡ß‘π......................ı........,...........................∫“∑.........›........... μ“ߧå
ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à (Àâ“· π∫“∑∂â«π)
(Ò) ¢“â 懮Ⓣ¡à‰¥â√∫— ‚Õπ·∑πÀ√◊Õ‡æÕ◊Ë ª√–‚¬™π·å °∫à ÿ§§≈μ“à ߥ⓫
(Ú) √“§“∑√—æ¬∑å ·Ë’ ¥ß‰«â„π Ù. ‡ªπì √“§“∑·Ë’ ∑â®√ß‘
(Û) ....(..√...–...∫...™ÿ..Ë◊Õ....º...⟡...Õ’...”...π...“..®...Õ...Õ...°...§....”.. ...ßË—...)......¢..“..¬..∑...Õ..¥..μ...≈..“..¥..∑..’Ë¥...‘π..√..–..À...«..à“.ß..®..”..π...Õ..ß..‡.æ...Ë◊Õ..™..”..√..–..¿...“.…...’ ...................................................
.‚.¥..¬..¡...’°..“..√..®..”..π..Õ..ß..μ...‘¥..‰..ª..¥..â«..¬...............................................................................................................................
«π— ∑.’Ë ...........‡¥Õ◊ π..............................æ.»..................
≈ß™ÕË◊ (.μ..“..¡..À...π..—ß.. ..Õ◊...............∑...Ë’.........../.............≈..ß..«..π—...∑..Ë’............)ºŸâ¢Õ ¢“¬
≈ß™Ë◊Õ......................π..“..¬....¢........................ºâŸ¢Õ ´Õ◊È
≈ß™ËÕ◊ ......................................................º ⟠Õ∫ «π
(......................................................)
”À√∫— æπ—°ß“π‡®â“Àπ“â ∑Ë’
Ò) √“§“ª√–‡¡‘π∑πÿ ∑√æ— ¬.å ......5..1..3..6...I..V....7.2..2..8..›..1........................................Ò..............................∫“∑.....................Ú................... μ“ߧå
Ú) ‚©π¥∑Ë’¥‘π„À¡à√–«“ß................Ò..Ú..Û...Ò.....................‡≈¢∑’Ë¥π‘ .................Ò..Û............................Àπ“â ”√«®........Û..Ò...............................
‚©π¥∑Ë’¥‘π‡≈¢∑.’Ë ....................Ò..............................‡≈à¡........................›..............................Àπ“â .................›.................................
®”π«π∑¥’Ë π‘ ...........................Ò...........................‰√.à .............................›...................ß“π.............................›.....................μ“√“ß«“
§ß‡À≈Õ◊ ...........................................................‰√.à ................................................ß“π..................................................μ“√“ß«“
Û) ‰¥â®¥∑–‡∫’¬π·≈â«·μà«π— ∑Ë.’ ................................‡¥Õ◊ π............................................æ.»......................
≈ß™◊ËÕ.......................................................
(......................................................)
‡®â“æπ—°ß“π∑Ë’¥‘π
Ú˜Ù
μ«— Õ¬à“ßÀ¡“¬‡≈¢ ÛÚ μ“¡√–‡∫¬’ ∫¢âÕ Û˜ (Ò)
(∑.¥. ˘)
§”¢Õ.¢..“..¬..√..–..À...«..à“..ß..®..”..π..Õ..ß..μ...“.¡...§..”.. ..ß—Ë....................................................................................................
(μ“¡Àπ—ß ◊Õ...............∑.Ë’ ............/..............≈ß«π— ∑Ë’............................)
©∫—∫∑.Ë’ ......................................
∑Ë’¥‘π
√–«“ß................................................................................μ”∫≈.........................................................................................
‡≈¢∑’.Ë ....................................................Àπâ“ ”√«®..................................................Õ”‡¿Õ..................................................
‚©π¥À¡“¬‡≈¢∑’.Ë ...............................................................®ß— À«—¥.......................................................................................
«π— ∑’Ë................‡¥◊Õπ.....................................æ.». ......................
¢â“懮â“........................π...“.¬....¢.................................................................... ‡≈¢ª√–®”μ—«ª√–™“™π
Õ“¬.ÿ .....Ù.........ªï ‡™ÕÈ◊ ™“μ‘...........‰.∑..¬............... —≠™“μ.‘ .........‰.∑...¬...............∫‘¥“/¡“√¥“™◊ËÕ.....................................................................
Õ¬Ÿà∑Ë∫’ â“π/À¡Ÿ∫à “â π...............................................‡≈¢∑’Ë....................μ√Õ°/´Õ¬............................∂ππ..........................À¡∑àŸ .’Ë ..........
μ”∫≈/·¢«ß..................................Õ”‡¿Õ/‡¢μ..................................®ß— À«¥— ..................................À¡“¬‡≈¢‚∑√»æ— ∑.å ......................
¢Õ¬Ëπ◊ §”¢ÕμàÕ‡®“â æπ—°ß“π∑’¥Ë ‘π®ß— À«—¥....................................................¥«â ¬§«“¡ —μ¬å®√ß‘ «“à :-
¢Õâ Ò. ¥«â ¬...∑...Ë¥’ ..π‘...·..ª..≈..ß..‡..§..√..Õ◊Ë..ß..À...¡..“..¬..¥...—ß..°..≈..“à..«..¢..“â..ß..∫..π...π..È’..¡..’™..Õ◊Ë....π..“..¬....°....‡.ª...πì ..º..∂âŸ...Õ◊ ..°..√..√..¡... ..∑‘ ..∏..Ï‘..∫..—¥...π..’È......(..√..–...∫...™ÿ...Õ◊Ë...º...¡âŸ...Õ’....”..π...“...®........
.........Õ.....Õ.....°......§.....”..... .....Ë—ß.....).............‰.¥...â¡..§’..”.. ...Ë—ß..¢..“..¬..∑..Õ...¥..μ..≈...“.¥...√..–..À..«..à“..ß..®..”..π..Õ...ß...‡.æ...◊ËÕ..™..”..√..–..¿...“.…...’ .·..≈...–..¢..“â..æ..‡..®..â“...π..“..¬....¢.....‡.ª...ìπ..º..´âŸ...◊ÈÕ..‰.¥...â‚.¥...¬..¡..°’..“..√..®..”..π..Õ...ß..μ..‘¥...‰.ª..¥...â«..¬..
.√.“..¬...≈..–..‡.Õ...¬’ ..¥..ª...√..“.°...Ø..μ..“..¡...À..π..—ß.. ...◊Õ.................................................∑..’Ë........................./..............................≈..ß..«..π— ..∑...’Ë........................................∑..’ˉ..¥..â¬..πË◊..¡.(.√.“–..æ∫..™ÿ√..ÕË◊Õâ..¡...π..È’..·..≈..–..¢..â“..æ...‡.®..â“..‰.¥...â™..”..√..–..√..“.§...“..∑..Ë’¥..π‘....
.§..√..∫..∂...â«.π...·..≈..â«...................................................................................................................................................................................
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¢Õâ Ú. ©–ππ—È ¢Õ„À‡â ®“â æπ°— ß“π∑¥’Ë π‘ ...‚.ª...√..¥..¥...”.‡..π..π‘..°...“..√..®..¥..∑..–..‡..∫..¬’..π...¢..“..¬..∑..’¥Ë...‘π..„.À...â·..°..à¢..â“..æ...‡.®..â“..¥..â«..¬....∑..—ßÈ..π...È’ .¢..“â..æ...‡.®..“â..¬..Õ...¡..‡. ..’¬........
.§..à“..∏..√..√..¡..‡.π...¬’ ..¡..μ...“..¡..√..–..‡.∫...¬’ ..∫...............................................................................................................................................................
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..............................π..“..¬....¢.............................. ºŸâ¢Õ
................................................................... 欓π
................................................................... 欓π
μ—«Õ¬“à ßÀ¡“¬‡≈¢ ÛÚ μ“¡√–‡∫¬’ ∫ ¢âÕ Û˜ (Ò)
“√∫—≠®¥∑–‡∫¬’ π
®¥∑–‡∫’¬π ª√–‡¿∑°“√ ºâŸ„À â ≠— ≠“ ºŸâ√—∫ —≠≠“ ‡π◊ÈÕ∑’Ë¥‘π ‡πÈ◊Õ∑’Ë¥‘π √–«“ß ‡®â“æπ—°ß“π∑Ë’¥‘π
«—𠇥◊Õπ ªï ®¥∑–‡∫’¬π μ“¡ —≠≠“ §ß‡À≈Õ◊ ‡≈¢∑’Ë¥‘π ≈ß≈“¬¡Õ◊ ™ÕË◊
‚©π¥∑¥Ë’ π‘ „À¡à ª√–∑∫— μ√“
‰√à ß“π μ“√“ß ‰√à ß“π μ“√“ß
«“ «“
«—π∑Ë.’ ................ ¢“¬√–À«“à ß®”πÕß π“¬ °. 𓬠¢. Ò››››› › (≈ß™◊ÕË ).........................
‡¥Õ◊ π............... μ“¡§” ß—Ë ...(.√...–..∫...ÿ™...◊ËÕ......
æ.».................. .º...â¡Ÿ...Õ’...”..π...“..®...Õ...Õ...°..§...”... ...ßË— ..)..
(μ“¡Àπ—ß ◊Õ...............
∑.Ë’ ................./.................
≈ß«—π∑Ë.’ .......................)
Ú˜ı
Ú˜˜
√–‡∫’¬∫°√¡∑’¥Ë ‘π
«à“¥â«¬°“√®¥∑–‡∫¬’ π ‘∑∏‘·≈–π‘μ°‘ √√¡‡°Ë’¬«°∫— °“√‡™“à ∑¥’Ë ‘π
·≈–Õ —ßÀ“√‘¡∑√æ— ¬Õå ¬à“ßÕπ◊Ë μ“¡ª√–¡«≈°ÆÀ¡“¬·æàß·≈–æ“≥‘™¬å
æ.». ÚııÒ
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∫ÿ§§≈Õ◊Ëπ‡™à“‡©æ“– à«π¢Õßμπ à«π¢Õߺ⟡’ ‘∑∏‘„Àâ‡™à“§πÕË◊π‰¡à‰¥â„Àâ‡™à“¥â«¬
„À⇢¬’ π™◊ÕË ª√–‡¿∑«à“ 燙“à ‡©æ“– «à πé æ√Õâ ¡∑—Èß√–∫√ÿ –¬–‡«≈“∑ˇ’ ™à“„À™â ¥— ‡®π
μàÕ∑“â ¬ª√–‡¿∑°“√®¥∑–‡∫¬’ π¥â«¬ (μ“¡μ—«Õ¬“à ßÀ¡“¬‡≈¢ Û)
(Û) °√≥’ºŸâ¡’ ‘∑∏‘„À⇙à“∑’Ë¥‘πÀ√◊ÕÕ —ßÀ“√‘¡∑√—æ¬åÕ¬à“ßÕË◊π¡“¢Õ ç·∫à߇™à“é
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‰¡«à “à ∑¥Ë’ π‘ À√Õ◊ Õ ß— À“√¡‘ ∑√æ— ¬Õå ¬“à ßÕπË◊ ππ—È ®–¡º’ ¡âŸ ’ ∑‘ ∏‘„À‡â ™“à §π‡¥¬’ «À√Õ◊ À≈“¬§π
º¡Ÿâ ’ ∑‘ ∏‘„À‡â ™“à ∑°ÿ §π„À‡â ™“à √«à ¡°π— ‡æ¬’ ß∫“ß «à π „À‡â ¢¬’ π™Õ◊Ë ª√–‡¿∑«“à ç·∫ßà ‡™“à é
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(μ“¡μ«— Õ¬à“ßÀ¡“¬‡≈¢ Ù)
(Ù) °√≥’ºŸâ¡’ ‘∑∏‘„À⇙à“∑’Ë¥‘πÀ√◊ÕÕ —ßÀ“√‘¡∑√—æ¬åÕ¬à“ßÕ◊Ëπ¡’À≈“¬§π ç·∫à߇™“à ‡©æ“– à«πé
·μຟ⡒ ‘∑∏‘„À⇙à“∑’Ë¥‘πÀ√◊ÕÕ —ßÀ“√‘¡∑√—æ¬åÕ¬à“ßÕË◊ππ—Èπ∫“ߧπ¢Õ®¥∑–‡∫’¬π„Àâ › ¡μ’ «— Õ¬“à ß∑’Ë ı
∫ÿ§§≈ÕË◊π‡™à“‡©æ“– à«π¢Õßμπ‡æ’¬ß∫“ß à«π à«π¢Õߺ⟡’ ‘∑∏‘„Àâ‡™à“§πÕË◊π
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√–¬–‡«≈“∑’ˇ™à“„Àâ™—¥‡®πμàÕ∑⓬ª√–‡¿∑°“√®¥∑–‡∫’¬π¥â«¬ (μ“¡μ—«Õ¬à“ß
À¡“¬‡≈¢ ı)
(ı) °√≥’∑Ë’∑Ë’¥‘πÀ√◊ÕÕ —ßÀ“√‘¡∑√—æ¬åÕ¬à“ßÕ◊Ëπ‰¥â¡’°“√®¥∑–‡∫’¬π‡™à“ ç‡™à“™à«ßé
‰«â·≈â« μàÕ¡“ºâŸ‡™à“„Àâ∫ÿ§§≈ÕË◊π‡™à“∑’Ë¥‘πÀ√◊ÕÕ —ßÀ“√‘¡∑√—æ¬åÕ¬à“ßÕËπ◊ π—Èπ∑È—ßÀ¡¥ › ¡μ’ —«Õ¬à“ß∑Ë’ ˆ
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∫ÿ§§≈Õ◊Ëπ‡™à“μÕà ‰ªÕ°’ ∑Õ¥Àπß÷Ë „À‡â ¢¬’ π™◊ÕË ª√–‡¿∑«“à 燙“à ™«à ßé æ√âÕ¡∑ßÈ— √–∫ÿ
Ú¯Ú
√–¬–‡«≈“∑‡’Ë ™“à ™«à ß„À™â ¥— ‡®πμÕà ∑“â ¬ª√–‡¿∑°“√®¥∑–‡∫¬’ π¥«â ¬ ‚¥¬√–¬–‡«≈“
°“√‡™“à ™«à ß®–μÕâ ߉¡‡à °π‘ °”Àπ¥√–¬–‡«≈“°“√‡™“à ‡¥¡‘ (μ“¡μ«— Õ¬“à ßÀ¡“¬‡≈¢ ˆ)
ç‡™à“™«à ߇©æ“– «à πé (ˆ) °√≥’∑’Ë∑’Ë¥‘πÀ√◊ÕÕ —ßÀ“√‘¡∑√—æ¬åÕ¬à“ßÕ◊Ëπ‰¥â¡’°“√®¥∑–‡∫’¬π‡™à“
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π—Èπ‡©æ“– à«π¢ÕßμπμàÕ‰ªÕ’°∑Õ¥ÀπË÷ß À√◊Õ„π°√≥’∑’ˉ¥â¡’°“√®¥∑–‡∫’¬π‡™à“
‰«·â ≈«â ‚¥¬¡º’ ‡Ÿâ ™“à À≈“¬§πº‡âŸ ™“à ∫“ߧπ„À‡â ™“à μÕà ‰ªÕ°’ ∑Õ¥Àπß÷Ë ‡©æ“– «à π¢Õßμπ
„À⇢’¬π™Ë◊Õª√–‡¿∑«à“ ç‡™à“™à«ß‡©æ“– à«πé æ√âÕ¡∑È—ß√–∫ÿ√–¬–‡«≈“∑’ˇ™à“™à«ß
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‰¡à‡°‘π°”Àπ¥√–¬–‡«≈“°“√‡™“à ‡¥‘¡ (μ“¡μ—«Õ¬à“ßÀ¡“¬‡≈¢ ˜ › ¯)
ç·∫ßà ‡™“à ™à«ßé (˜) °√≥’∑’Ë∑’Ë¥‘πÀ√◊ÕÕ —ßÀ“√‘¡∑√—æ¬åÕ¬à“ßÕË◊π‰¥â¡’°“√®¥∑–‡∫’¬π‡™à“
› ¡μ’ —«Õ¬à“ß∑Ë’ ˘ › Ò ‰«·â ≈«â μÕà ¡“º‡Ÿâ ™“à „À∫â §ÿ §≈ÕπË◊ ‡™“à ∑¥Ë’ π‘ À√Õ◊ Õ ß— À“√¡‘ ∑√æ— ¬Õå ¬“à ßÕπ◊Ë ππÈ— ∫“ß «à π
μàÕ‰ªÕ’°∑Õ¥ÀπË÷ß À√◊Õ„π°√≥’∑Ë’∑Ë’¥‘πÀ√◊ÕÕ —ßÀ“√‘¡∑√—æ¬åÕ¬à“ßÕË◊π‰¥â¡’°“√
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„À⇢’¬π™Ë◊Õª√–‡¿∑«à“ ç·∫à߇™à“™à«ßé æ√âÕ¡∑È—ß√–∫ÿ√–¬–‡«≈“∑Ë’‡™à“™à«ß„Àâ
™—¥‡®πμàÕ∑⓬ª√–‡¿∑°“√®¥∑–‡∫’¬π¥â«¬ ‚¥¬√–¬–‡«≈“°“√‡™à“™à«ß®–μâÕß
‰¡‡à °π‘ °”Àπ¥√–¬–‡«≈“°“√‡™“à ‡¥‘¡ (μ“¡μ«— Õ¬à“ßÀ¡“¬‡≈¢ ˘ › Ò)
ç·∫à߇™à“™«à ߇©æ“– à«πé (¯) °√≥’∑’Ë∑Ë’¥‘πÀ√◊ÕÕ —ßÀ“√‘¡∑√—æ¬åÕ¬à“ßÕ◊Ëπ‰¥â¡’°“√®¥∑–‡∫’¬π‡™à“
› ¡’μ«— Õ¬à“ß∑Ë’ ÒÒ › ÒÚ ‡©æ“– à«π‰«·â ≈â« μàÕ¡“º‡Ÿâ ™“à „Àâ∫§ÿ §≈Õ◊Ëπ‡™“à ∑¥’Ë π‘ À√Õ◊ Õ ß— À“√¡‘ ∑√æ— ¬Õå ¬“à ßÕËπ◊
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∑È—ßÀ¡¥À√◊Õ∫“ß à«πμàÕ‰ªÕ’°∑Õ¥ÀπË÷ß „À⇢’¬π™◊ËÕª√–‡¿∑«à“ ç·∫à߇™à“™à«ß
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∑–‡∫¬’ π¥«â ¬‚¥¬√–¬–‡«≈“°“√‡™“à ™«à ß®–μÕâ ߉¡‡à °π‘ °”Àπ¥√–¬–‡«≈“°“√‡™“à ‡¥¡‘
(μ“¡μ«— Õ¬“à ßÀ¡“¬‡≈¢ ÒÒ › ÒÚ)
ç‚Õπ ∑‘ ∏‘°“√‡™“à é (˘) °√≥’∑’Ë∑’Ë¥‘πÀ√◊ÕÕ —ßÀ“√‘¡∑√—æ¬åÕ¬à“ßÕ◊Ëπ‰¥â¡’°“√®¥∑–‡∫’¬π‡™à“
› ¡’μ—«Õ¬à“ß∑Ë’ ÒÛ À√Õ◊ ·∫ßà ‡™“à ‰«·â ≈«â μÕà ¡“º‡Ÿâ ™“à ª√– ߧå„À‚â Õπ ∑‘ ∏°‘ “√‡™“à ¢Õßμπ∑¡Ë’ ’„π∑√æ— ¬ å π‘
∑’ˇ™à“„Àâ∫ÿ§§≈Õ◊Ëπ‡¢â“ √«¡ ‘∑∏‘∑’˺Ÿâ‡™à“¡’Õ¬àŸ∑È—ßÀ¡¥ „À⇢’¬π™Ë◊Õª√–‡¿∑«à“
ç‚Õπ ‘∑∏‘°“√‡™à“é À√◊Õ ç‚Õπ ‘∑∏‘°“√·∫à߇™à“é ·≈â«·μà°√≥’ (μ“¡μ—«Õ¬à“ß
À¡“¬‡≈¢ ÒÛ)
Ú¯Û
(Ò) °√≥’∑Ë’∑’Ë¥‘πÀ√◊ÕÕ —ßÀ“√‘¡∑√—æ¬åÕ¬à“ßÕ◊Ëπ‰¥â¡’°“√®¥∑–‡∫’¬π‡™à“ ç‚Õπ ∑‘ ∏°‘ “√‡™“à
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∑’ˇ™à“πÈ—π„Àâ∫ÿ§§≈ÕË◊π‡¢â“ √«¡ ‘∑∏‘∑Ë’ºŸâ‡™à“¡’Õ¬àŸ∑È—ßÀ¡¥À√◊Õ°√≥’∑Ë’‰¥â¡’°“√®¥ › ¡’μ—«Õ¬à“ß∑’Ë ÒÙ›Òı
∑–‡∫’¬π‡™à“À√◊Õ‡™à“‡©æ“– à«π‰«â·≈â«‚¥¬¡’ºŸâ‡™à“À≈“¬§π μàÕ¡“ºâŸ‡™à“∫“ߧπ
ª√– ߧå„Àâ‚Õπ ‘∑∏‘°“√‡™à“‡©æ“– à«π¢Õßμπ∑’Ë¡’„π∑√—æ¬å ‘π∑Ë’‡™à“„Àâ∫ÿ§§≈ÕË◊π
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‡©æ“– à«πé (μ“¡μ«— Õ¬“à ßÀ¡“¬‡≈¢ ÒÙ › Òı)
(ÒÒ) °√≥’∑Ë’∑’Ë¥‘πÀ√◊ÕÕ —ßÀ“√‘¡∑√—æ¬åÕ¬à“ßÕ◊Ëπ‰¥â¡’°“√®¥∑–‡∫’¬π‡™à“ ç·∫ßà ‚Õπ ∑‘ ∏‘°“√‡™à“é
À√◊Õ·∫à߇™à“‰«â·≈â« μàÕ¡“ºâŸ‡™à“ª√– ߧå„Àâ‚Õπ ‘∑∏‘°“√‡™à“¢Õßμπ∑Ë’¡’„π∑√—æ¬å › ¡μ’ «— Õ¬“à ß∑’Ë Òˆ
‘π∑Ë’‡™à“π—Èπ„Àâ∫ÿ§§≈ÕË◊π‡¢â“ √«¡ ‘∑∏‘∑Ë’ºŸâ‡™à“¡’Õ¬Ÿà‡æ’¬ß∫“ß à«π „À⇢’¬π™Ë◊Õ
ª√–‡¿∑«“à ç·∫ßà ‚Õπ ∑‘ ∏°‘ “√‡™“à é À√Õ◊ ç·∫ßà ‚Õπ ∑‘ ∏°‘ “√·∫ßà ‡™“à é ·≈«â ·μ°à √≥’
(μ“¡μ«— Õ¬à“ßÀ¡“¬‡≈¢ Òˆ)
(ÒÚ) °√≥’∑’Ë∑Ë’¥‘πÀ√◊ÕÕ —ßÀ“√‘¡∑√—æ¬åÕ¬à“ßÕ◊Ëπ‰¥â¡’°“√®¥∑–‡∫’¬π‡™à“ ç·∫àß‚Õπ ∑‘ ∏°‘ “√‡™à“
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¢Õßμπ∑¡Ë’ ’„π∑√æ— ¬ å π‘ ∑‡’Ë ™“à ππÈ— „À∫â §ÿ §≈Õπ◊Ë ‡¢“â √«¡ ∑‘ ∏∑‘ º’Ë ‡Ÿâ ™“à ¡Õ’ ¬‡Ÿà 欒 ß∫“ß «à π › ¡μ’ —«Õ¬“à ß∑’Ë Ò˜
„À⇢’¬π™◊ËÕª√–‡¿∑«à“ ç·∫àß‚Õπ ‘∑∏‘°“√‡™à“‡©æ“– à«πé À√◊Õ ç·∫àß‚Õπ ‘∑∏‘
°“√·∫ßà ‡™à“‡©æ“– «à πé ·≈â«·μ°à √≥’ (μ“¡μ—«Õ¬“à ßÀ¡“¬‡≈¢ Ò˜)
(ÒÛ) °√≥’∑Ë’∑’Ë¥‘πÀ√◊ÕÕ —ßÀ“√‘¡∑√—æ¬åÕ¬à“ßÕ◊Ëπ‰¥â¡’°“√®¥∑–‡∫’¬π‡™à“ ç‚Õπ¡√¥° ‘∑∏‘°“√‡™à“é
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¡√¥° ∑‘ ∏‘°“√‡™à“é (μ“¡μ—«Õ¬“à ßÀ¡“¬‡≈¢ Ò¯)
(ÒÙ) °√≥’∑’Ë∑Ë’¥‘πÀ√◊ÕÕ —ßÀ“√‘¡∑√—æ¬åÕ¬à“ßÕ◊Ëπ‰¥â¡’°“√®¥∑–‡∫’¬π‡™à“ 緰≢‡æ¡Ë‘ ‡μ¡‘ ≠— ≠“‡™“à é
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À√Õ◊ ≠— ≠“·∫ßà ‡™“à „À‡â ¢¬’ π™ÕË◊ ª√–‡¿∑«“à 緰≢‡æ¡‘Ë ‡μ¡‘ ≠— ≠“‡™“à é À√Õ◊ 緰≢
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μ“¡ª√–‡¿∑°“√®¥∑–‡∫’¬π‡™“à ππ—È (μ“¡μ—«Õ¬“à ßÀ¡“¬‡≈¢ Ò˘)
(Òı) °√≥’∑’Ë∑Ë’¥‘πÀ√◊ÕÕ —ßÀ“√‘¡∑√—æ¬åÕ¬à“ßÕ◊Ëπ‰¥â¡’°“√®¥∑–‡∫’¬π‡™à“ ç‡≈‘°‡™à“é
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ç‡≈°‘ ‡™“à é (μ“¡μ«— Õ¬à“ßÀ¡“¬‡≈¢ Ú)
ç‡≈‘°‡™“à ∫“ß à«πé (Òˆ) °√≥∑’ ∑’Ë ¥Ë’ π‘ À√Õ◊ Õ ß— À“√¡‘ ∑√æ— ¬Õå ¬“à ßÕπ◊Ë ‰¥¡â °’ “√®¥∑–‡∫¬’ π‡™“à
› ¡μ’ —«Õ¬à“ß∑’Ë ÚÒ ‡™“à ‡©æ“– «à π ·∫ßà ‡™à“ À√◊Õ·∫ßà ‡™“à ‡©æ“– à«π‰«â·≈«â μÕà ¡“ºâŸ„À‡â ™“à ·≈–ºâ‡Ÿ ™à“
¢Õ‡≈‘° —≠≠“‡™à“¥—ß°≈à“«‡ªìπ∫“ß à«π ‰¡à‰¥â‡≈‘°‡™à“∑—ÈßÀ¡¥ ‚¥¬∫“ß à«π¬—ß
§ß¡’°“√‡™à“μàÕ‰ª „À⇢’¬π™◊ËÕª√–‡¿∑«à“ ç‡≈‘°‡™à“∫“ß à«πé (μ“¡μ—«Õ¬à“ß
À¡“¬‡≈¢ ÚÒ)
ç‡≈°‘ ‡™“à ™«à ßé (Ò˜) °√≥’∑Ë’∑’Ë¥‘πÀ√◊ÕÕ —ßÀ“√‘¡∑√—æ¬åÕ¬à“ßÕ◊Ëπ‰¥â¡’°“√®¥∑–‡∫’¬π
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μàÕ¡“ºâŸ„Àâ‡™à“™à«ß·≈–ºŸâ‡™à“™à«ß¢Õ‡≈‘° —≠≠“‡™à“™à«ß∑Ë’‰¥â®¥∑–‡∫’¬π‰«â¥—ß°≈à“«
∑ßÈ— À¡¥ „À‡â ¢¬’ π™◊ËÕª√–‡¿∑«“à ç‡≈°‘ ‡™“à ™à«ßé (μ“¡μ«— Õ¬à“ßÀ¡“¬‡≈¢ ÚÚ)
ç‡≈‘°‡™“à ™à«ß∫“ß «à πé (Ò¯) °√≥’∑Ë’∑Ë’¥‘πÀ√◊ÕÕ —ßÀ“√‘¡∑√—æ¬åÕ¬à“ßÕ◊Ëπ‰¥â¡’°“√®¥∑–‡∫’¬π
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ç‡≈°‘ ‡™“à ™à«ß∫“ß à«πé (μ“¡μ—«Õ¬“à ßÀ¡“¬‡≈¢ ÚÛ)
çª≈Õ¥°“√‡™“à é (Ò˘) °√≥’∑’Ë∑’Ë¥‘πÀ√◊ÕÕ —ßÀ“√‘¡∑√—æ¬åÕ¬à“ßÕË◊π√«¡°—πμÈ—ß·μà Õß
› ¡μ’ «— Õ¬à“ß∑Ë’ ÚÙ Õ —ßÀ“√‘¡∑√—æ¬å¢÷Èπ‰ª‰¥â¡’°“√®¥∑–‡∫’¬π‡™à“‰«â·≈â« À√◊Õ°√≥’∑Ë’¡’°“√·∫àß·¬°
∑’Ë¥‘π∑Ë’‰¥â¡’°“√®¥∑–‡∫’¬π‡™à“‰«â·≈â«ÕÕ°‡ªìπÀ≈“¬·ª≈ß‚¥¬∑’Ë¥‘π·ª≈ß·¬°
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μ—Èß·μà Õß·ª≈ߢÈ÷π‰ª μàÕ¡“§Ÿà°√≥’μ°≈ß®¥∑–‡∫’¬π„ÀâÕ —ßÀ“√‘¡∑√—æ¬å„¥
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·≈â«·μà°√≥’πÈ—πæâπ®“°°“√‡™à“ à«πÕ —ßÀ“√‘¡∑√—æ¬å∑Ë’‡À≈◊Õ¬—ߧߡ’°“√‡™à“Õ¬Ÿà
μ“¡‡¥¡‘ „À‡â ¢’¬π™◊ËÕª√–‡¿∑«à“ çª≈Õ¥°“√‡™“à é (μ“¡μ«— Õ¬à“ßÀ¡“¬‡≈¢ ÚÙ)
ç·∫ßà ·¬°„ππ“¡‡¥‘¡ (Ú) °√≥∑’ ∑Ë’ ¥’Ë π‘ ‰¥¡â °’ “√®¥∑–‡∫¬’ π‡™“à ‡™“à ‡©æ“– «à π ·∫ßà ‡™“à ‰«·â ≈«â
(ª≈Õ¥°“√‡™à“), ‡®â“¢Õß∑’Ë¥‘πª√– ߧ宖·∫àß·¬°∑Ë’¥‘πÕÕ°®“°°—π ‚¥¬„π¢≥–®¥∑–‡∫’¬π
·∫àß·¬°„ππ“¡‡¥‘¡ ·∫àß·¬°§Ÿà°√≥’μ°≈ß°—π„Àâ∑Ë’¥‘π·ª≈ß·¬°ÕÕ°‰ªÀ√◊Õ∑’Ë¥‘π·ª≈ߧ߇À≈◊Õ‰¡à¡’
(§√Õ∫°“√‡™“à )é
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°√≥’μ°≈ß„Àâ∑Ë’¥‘π·ª≈ß·¬°·≈–·ª≈ߧ߇À≈◊Õ¬—ß¡’°“√‡™à“§√Õ∫μ‘¥Õ¬àŸ∑È—ßÀ¡¥
„À⇢’¬π™Ë◊Õª√–‡¿∑«à“ ç·∫àß·¬°„ππ“¡‡¥‘¡ (§√Õ∫°“√‡™à“)é À“°°“√®¥
∑–‡∫’¬π·∫àß·¬°‡ªìπª√–‡¿∑ÕË◊π„À⇪ìπ‰ªμ“¡ª√–‡¿∑°“√®¥∑–‡∫’¬ππÈ—π
(μ“¡μ—«Õ¬à“ßÀ¡“¬‡≈¢ Úı › Úˆ)
Ú¯ı
(ÚÒ) °√≥’∑Ë’∑’Ë¥‘π‰¥â¡’°“√®¥∑–‡∫’¬π‡™à“ ‡™à“‡©æ“– à«π ·∫à߇™à“ ç·∫ßà ·¬°„ππ“¡‡¥¡‘
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‚¥¬„π¢≥–®¥∑–‡∫¬’ π·∫àß·¬°§Ÿà°√≥μ’ °≈ß°π— „Àâ∑Ë¥’ π‘ ·ª≈ߧ߇À≈◊Õ·≈–·ª≈ß › ¡μ’ —«Õ¬“à ß∑’Ë Ú˜
∑Ë’·¬°ÕÕ°‰ª∫“ß·ª≈߬—ߧߡ’°“√‡™à“Õ¬àŸ ·≈–∫“ß·ª≈ß∑Ë’¡’°“√‡™à“Õ¬àŸæâπ®“°
°“√‡™à“ „À⇢’¬π™Ë◊Õª√–‡¿∑«“à ç·∫àß·¬°„ππ“¡‡¥¡‘ (§√Õ∫ › ª≈Õ¥°“√‡™“à )é
À“°°“√®¥∑–‡∫’¬π·∫àß·¬°‡ªìπª√–‡¿∑ÕË◊π„À⇪ìπ‰ªμ“¡ª√–‡¿∑°“√®¥
∑–‡∫’¬ππ—Èπ (μ“¡μ—«Õ¬à“ßÀ¡“¬‡≈¢ Ú˜)
°√≥’°“√‡¢’¬π™◊ËÕª√–‡¿∑°“√®¥∑–‡∫’¬π·≈–μ—«Õ¬à“߇°Ë’¬«°—∫‡™à“„π °√≥Õ’ Ëπ◊ „Àâ‡∑¬’ ∫‡§¬’ ß
°√≥’ÕËπ◊ πÕ°®“°∑Ë°’ ”À𥉫â„π√–‡∫’¬∫πÈ’ „À⇢’¬π™Ë◊Õª√–‡¿∑‚¥¬°“√‡∑¬’ ∫‡§’¬ß
·≈–ª√—∫‰ªμ“¡ª√–‡¿∑°“√®¥∑–‡∫¬’ π∑Ë’°”À𥉫·â ≈â«„π√–‡∫¬’ ∫π‚È’ ¥¬Õπÿ‚≈¡
À¡«¥ Û
°“√‡¢’¬π§”¢Õ®¥∑–‡∫¬’ π ‘∑∏·‘ ≈–π‘μ°‘ √√¡ °“√®¥— ∑”Àπß— ◊Õ —≠≠“
·≈–°“√·°∑â –‡∫¬’ π
¢âÕ ÒÙ °“√‡¢¬’ π§”¢Õ®¥∑–‡∫¬’ π ∑‘ ∏·‘ ≈–πμ‘ °‘ √√¡ (∑.¥.Ò, ∑.¥.Ò °) °“√‡¢’¬π§”¢Õ
„ÀâªØ‘∫μ— ‘ ¥ß— πÈ’
(Ò) „π™àÕߪ√–‡¿∑ „À⇢’¬π™Ë◊Õª√–‡¿∑°“√®¥∑–‡∫’¬πμ“¡¢âÕ ÒÛ › ™◊ËÕª√–‡¿∑
·≈â«·μà°√≥’
(Ú) °“√‡¢’¬π™Ë◊պ⟄Àâ‡™à“„π¢âÕ Ú ¢Õߧ”¢Õ®¥∑–‡∫’¬π ‘∑∏‘·≈– › ™◊Ëպ⟄À⇙à“
π‘μ‘°√√¡ μ“¡·∫∫ ∑.¥.Ò À√◊Õ ∑.¥.Ò ° „À⇢’¬π‡©æ“–™Ë◊պ⟄À⇙à“∑Ë’¢Õ
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ºŸ∂â Õ◊ ‘∑∏§‘ √Õ∫§√ÕßÕË◊π∑Ë’‰¡à‡°Ë¬’ «¢Õâ ß·μàÕ¬à“ß„¥
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(Û) °“√‡¢’¬π™◊Ëպ⟇™à“≈ß„π¢âÕ Û ¢Õߧ”¢Õ®¥∑–‡∫’¬π ‘∑∏‘·≈– - ™Õ◊Ë º‡Ÿâ ™“à
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(Ù) °√≥’®¥∑–‡∫’¬π‡™à“‡©æ“– à«π „ÀâÀ¡“¬‡Àμÿ ≥ √‘¡¥â“π´â“¬ ›·∑ߢ“â ß°√≥’‡™à“
¢Õߧ”¢Õ®¥∑–‡∫’¬π ‘∑∏‘·≈–π‘μ‘°√√¡ (∑.¥.Ò, ∑.¥.Ò °) ·≈–„π “√∫—≠ ‡©æ“– «à π
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Ú¯ˆ
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„À‡â ™à“∑¥’Ë π‘ ‡©æ“– à«π¢Õßμπ·°à𓬠¢. «à π¢Õß∫§ÿ §≈ÕπË◊ §ß‡¥¡‘ é
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·≈«â ·μ°à √≥’„À⥔‡π‘π°“√ ¥—ßπ’È
› °√≥’∑”‡ªπì ≠— ≠“‡™à“ (Ò) °“√®¥∑–‡∫’¬πª√–‡¿∑‡™à“ ‡™à“‡©æ“– à«π ·∫à߇™à“ ·∫à߇™à“
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› °√≥∑’ ”‡ªπì ≠— ≠“ (Ú) °“√®¥∑–‡∫’¬πª√–‡¿∑‚Õπ ‘∑∏‘°“√‡™à“ ‚Õπ ‘∑∏‘°“√‡™à“
‚Õπ ∑‘ ∏°‘ “√‡™“à ‡©æ“– à«π ·∫àß‚Õπ ‘∑∏‘°“√‡™à“ ·∫àß‚Õπ ‘∑∏‘°“√‡™à“‡©æ“– à«π „Àâ∑”„π
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—≠≠“‚Õπ ∑‘ ∏°‘ “√√—∫........(∑.¥.ˆ)
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≈—°…≥–·Ààßμ√“ “√ Ò ·Àßà ∫≠— ™Õ’ —μ√“Õ“°√· μ¡ªá ∑“â ¬À¡«¥ ˆ „π≈°— …≥– Ú
› °√≥’§”π«≥§à“‡™à“‰¥â ·Ààߪ√–¡«≈√…— Æ“°√ „πÕ—μ√“ Ò ∫“∑μÕà ∑°ÿ ®”π«π‡ß‘π Ò, ∫“∑ À√◊Õ‡»…
¢Õß Ò, ∫“∑ ·Ààß§à“‡™à“À√◊Շߑπ°‘π‡ª≈à“À√◊Õ∑È—ß ÕßÕ¬à“ß√«¡°—πμ≈Õ¥
Õ“¬°ÿ “√‡™à“ ∑ßÈ— πÈ’ °“√‡√¬’ °‡°∫Á §“à Õ“°√· μ¡ªá„Àâ‡√’¬°‡°∫Á ®“°§“à ‡™“à ∑Ë ’ “¡“√∂
› °√≥’§”π«≥§“à ‡™à“ §”π«≥‡ªìπμ—«‡ß‘π∑Ë’·πàπÕπ‰¥â„π¢≥–®¥∑–‡∫’¬π‡™à“ °√≥’∑Ë’¡’∫“ß à«π¢Õß
∫“ß «à π‰¡à‰¥â §“à ‡™“à ‰¡Õà “®§”π«≥‡ªìπμ«— ‡ß‘π‰¥·â ππà Õπ„π¢≥–∑Ë®’ ¥∑–‡∫¬’ π‡™à“ ∂Õ◊ ‡ªìπ°√≥’
∑’ˉ¡àÕ“®√«¡‡Õ“§à“‡™à“ à«π¥—ß°≈à“«¡“√«¡‡ªìπ§à“‡™à“‡æ◊ËÕ‡√’¬°Õ“°√· μ¡ªá‰¥â
°√≥’πÈ’„Àâ‡√’¬°Õ“°√· μ¡ªá°“√‡™à“‡©æ“–§à“‡™à“´÷Ëß “¡“√∂§”π«≥‡ªìπμ—«‡ß‘π∑Ë’
·πàπÕπ‰¥â„π¢≥–®¥∑–‡∫’¬π‡™à“‡∑à“π—Èπ
™”√–Õ“°√‡ªìπμ«— ‡ßπ‘ ¢Õâ Ûˆ °“√¢Õ®¥∑–‡∫’¬π ‘∑∏‘·≈–π‘μ‘°√√¡‡°Ë’¬«°—∫‡™à“∑’Ë¥‘πÀ√◊Õ
Õ —ßÀ“√‘¡∑√—æ¬åÕ¬à“ßÕË◊π°√≥’∑’ËμâÕß¡’°“√‡√’¬°‡°Á∫§à“Õ“°√· μ¡ªáμ“¡≈—°…≥–
·Ààßμ√“ “√ Ò ·Ààß∫—≠™’Õ—μ√“Õ“°√· μ¡ªá „Àâæπ—°ß“π‡®â“Àπâ“∑’˺Ÿâ√—∫®¥
∑–‡∫’¬π ‘∑∏‘·≈–π‘μ‘°√√¡μ“¡ª√–¡«≈°ÆÀ¡“¬∑’Ë¥‘π·®âß„À⺟⡒Àπâ“∑’ˇ ’¬Õ“°√
· μ¡ªá (ºâŸ„À⇙à“) ™”√–Õ“°√‡ªìπμ—«‡ß‘πμàÕæπ—°ß“π‡®â“Àπâ“∑’˺Ÿâ√—∫®¥∑–‡∫’¬π
∑‘ ∏·‘ ≈–πμ‘ ‘°√√¡°Õà πÀ√Õ◊ „π«—π∑¡’Ë ’°“√√—∫®¥∑–‡∫’¬π¥ß— °≈à“« ·≈–„Àâæπ°— ß“π
‡®â“Àπâ“∑Ë’∫—π∑÷°¢âÕ§«“¡«à“ 牥♔√–§à“Õ“°√· μ¡ªá‡ªìπμ—«‡ß‘π................∫“∑
·≈â«μ“¡„∫‡ √Á®√—∫‡ß‘π‡≈à¡∑’Ë..........‡≈¢∑’Ë............≈ß«—π∑’Ë.............é æ√âÕ¡∑È—ß
≈ß≈“¬¡◊Õ™◊ÕË ·≈–«π— ‡¥Õ◊ π ªï °”°—∫‰«â
°√≥’‰¡àμâÕ߇√’¬°‡°Á∫ ¢Õâ Û˜ „π°√≥∑’ §Ë’ °Ÿà √≥’‰¥∑â ” ≠— ≠“‡™“à °π— ‰«·â ≈–‰¥ªâ ¥î Õ“°√· μ¡ªá
Õ“°√ §√∫®”π«πÕ“°√‚¥¬‰¥â¢’¥¶à“· μ¡ªá·≈–„Àâ∂◊Õ‡Õ“ —≠≠“‡™à“¥—ß°≈à“«‡ªìπ
≠— ≠“μÕà ∑“â ¬ —≠≠“μ“¡·∫∫¢Õß∑“ß√“™°“√ °√≥’‡™πà πÈ’„À∂â ◊Õ«“à ≠— ≠“‡™à“πÈπ—
‰¥âªî¥· μ¡ªá∫√‘∫Ÿ√≥å·≈â« æπ—°ß“π‡®â“Àπâ“∑’ˉ¡àμâÕ߇√’¬°‡°Á∫§à“Õ“°√· μ¡ªá
”À√∫— μ√“ “√ππ—È Õ°’
Õ“°√°√≥’‡™à“™à«ß ¢Õâ Û¯ °√≥’∑’ˉ¥â¡’°“√®¥∑–‡∫’¬π°“√‡™à“‰«â·≈â«μàÕ¡“ºŸâ‡™à“‰¥â
·≈–‚Õπ ‘∑∏°‘ “√‡™à“ ®¥∑–‡∫’¬π„Àâ‡™à“™à«ßÀ√◊Õ®¥∑–‡∫’¬π‚Õπ ‘∑∏‘°“√‡™à“„Àâ·°à∫ÿ§§≈ÕË◊π ‚¥¬
ºâŸ‡™à“™à«ßÀ√◊ÕºâŸ√—∫‚Õπ ‘∑∏‘°“√‡™à“‰¥â®à“¬‡ß‘π‡ªìπ§à“μÕ∫·∑π„Àâ·°àºŸâ‡™à“‡ªìπ‡ß‘π
®”π«πÀπ÷Ëß °√≥’‡™àππÈ’ —≠≠“‡™à“™à«ßμâÕߪ μ¡ªá∫√‘∫Ÿ√≥åμ“¡≈—°…≥–·Ààß
Ú˘˜
μ√“ “√ Ò ·Ààß∫—≠™’Õ—μ√“Õ“°√· μ¡ªá ”À√—∫°“√‚Õπ ‘∑∏‘°“√‡™à“À“°¡’°“√
®¥∑–‡∫’¬π°“√‡™à“„À¡μà Õâ ߪ¥î · μ¡ª∫á √∫‘ Ÿ√≥‡å ™àπ‡¥’¬«°—π
¢Õâ Û˘ °√≥’°“√‡™à“∑’Ë¥‘π∑’Ë√“™æ— ¥ÿÀ√◊ÕÕ“§“√√“™æ— ¥ÿ ‚¥¬ °√–∑√«ß°“√§≈—ß
°√–∑√«ß°“√§≈—߇ªìπºâŸ„Àâ‡™à“´÷Ëßμ“¡ª√–¡«≈√—…Æ“°√∫—≠≠—μ‘„À⺟⡒Àπâ“∑Ë’‡ ’¬ ºŸâ„À‡â ™à“‰¥â√—∫¬°‡«πâ
Õ“°√· μ¡ªá°“√‡™à“ §◊Õ ºâŸ„Àâ‡™à“ ©–π—Èπ®÷߇ªìπ°√≥’∑Ë’°√–∑√«ß°“√§≈—߇ªìπ Õ“°√
ºŸâ‡ ’¬Õ“°√· μ¡ªá Õ¬Ÿà„πÀ≈—°‡°≥±å‰¥â√—∫°“√¬°‡«âπ‰¡àμâÕ߇ ’¬Õ“°√· μ¡ªá
μ“¡¡“μ√“ ÒÚÒ ·Ààߪ√–¡«≈√—…Æ“°√ æπ—°ß“π‡®â“Àπâ“∑Ë’®÷߉¡àμâÕ߇√’¬°‡°Á∫
§à“Õ“°√· μ¡ªá„π°√≥π’ ’È
¢Õâ Ù °√≥’ à«π√“™°“√‡ªìπºâŸ‡™à“‚¥¬‡Õ°™π‡ªìπºŸâ„Àâ‡™à“·≈–μâÕß °√≥ ’ «à π√“™°“√‡ªπì
®¥∑–‡∫’¬π°“√‡™à“μàÕæπ—°ß“π‡®â“Àπâ“∑Ë’ ´÷Ëßμ“¡ª√–¡«≈√—…Æ“°√∫—≠≠—μ‘„À⠺⇟ ™à“μÕâ ߇°∫Á Õ“°√
ºŸâ¡’Àπâ“∑’ˇ ’¬Õ“°√· μ¡ªá°“√‡™à“ §◊Õ ºŸâ„Àâ‡™à“ ©–πÈ—π°√≥’∑’Ë à«π√“™°“√‡ªìπ
ºâŸ‡™à“®÷߉¡àÕ¬Ÿà„πÀ≈—°‡°≥±å∑’Ë®–‰¥â√—∫°“√¬°‡«âπ°“√‡ ’¬Õ“°√· μ¡ªáμ“¡
¡“μ√“ ÒÚÒ ·Àßà ª√–¡«≈√…— Æ“°√ ®ß÷ ‡ªìπ°√≥∑’ Ë’æπ—°ß“π‡®“â Àπâ“∑μ’Ë âÕ߇√¬’ °‡°Á∫
§à“Õ“°√· μ¡ª°á “√‡™à“®“°ºâŸ„À⇙à“
ª√–°“» ≥ «π— ∑’Ë Ò˘ ß‘ À“§¡ æ.».ÚııÒ
(≈ß™Õ◊Ë ) ∫≠ÿ ‡™¥‘ §¥‘ ‡ÀπÁ
(π“¬∫ÿ≠‡™¥‘ §¥‘ ‡ÀπÁ )
√ÕßÕ∏∫‘ ¥’ √—°…“√“™°“√·∑π
Õ∏∫‘ ¥’°√¡∑’¥Ë ‘π
(ª√–°“»√“™°®‘ ®“πÿ‡∫°…“ ‡≈à¡ ÒÚı μÕπ摇»… Ò˘ ß ≈ß«—π∑Ë’ ÒÒ ∏π— «“§¡
ÚııÒ)
Ú˘¯
μ«— Õ¬“à ßÀ¡“¬‡≈¢ Ò (∑.¥. Ò)
∑∫Ë’ “â π
∑ Ë’ «π/‰√à
∑’Ëπ“
∑.Ë’ .............
§”¢Õ®¥∑–‡∫’¬π ‘∑∏‘·≈–πμ‘ °‘ √√¡ πÕ°‡¢μ
·≈–°“√ Õ∫ «π ∑‘ ∏‘„π∑Ë’¥π‘ ª√–‡¿∑......‡..™..à“...(.¡...’°..”..À..π..¥...........√.....–....∫.......ÿ®.....”...π......«.....π.....ª.....ï.........).. „π‡¢μ
μ”·Àπàß∑’Ë¥‘π
√–«“ß.........................................................................................μ”∫≈.........................................................................................
‡≈¢∑Ë’¥‘π..................................................................................... Õ”‡¿Õ........................................................................................
Àπâ“ ”√«®..................................................................................®—ßÀ«—¥........................................................................................
‚©π¥∑’Ë¥π‘
‡≈¢∑Ë’.....................Ò..Ú...Û..................‡≈à¡............Ò..Û..........................Àπ“â ............Û........................
®”π«π∑¥’Ë ‘π..............Ò.....................‰√à................›.................ß“π................›...................μ“√“ß«“
Ò. ¢â“懮⓺¡Ÿâ ’π“¡μÕà ‰ªπ’È ¡’§«“¡ª√– ߧ¢å Õ®¥∑–‡∫’¬π ‘∑∏·‘ ≈–π‘μ°‘ √√¡‡°¬’Ë «°∫— Õ ß— À“√‘¡∑√æ— ¬å∑Ë’°≈“à «¢â“ß∫ππÈ’ ·≈–
‰¥âªØ≠‘ “≥μπ·≈«â ¢Õ„Àâ∂Õâ ¬§”¥«â ¬§«“¡ μ— ¬®å √‘ß ∂“â ¢“â 懮“â „À∂â âÕ¬§”‰¡à‡ªì𧫓¡®√ß‘ „Àâ„™∂â Õâ ¬§”πȬ’ —π¢â“懮“â „π∑“ߧ¥Õ’ “≠“‰¥â
Ú. ¢“â 懮“â ..............π..“..¬....°............................ ‡≈¢ª√–®”μ—«ª√–™“™π ºŸâ...„.À...‡â .™..“à............................
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Õ“¬.ÿ ...........ı.....,..Ù..ı.............ªï —≠™“μ‘.......‰..∑..¬..............................∫‘¥“/¡“√¥“™ÕË◊ .............................................................................
‚ ¥ À¡“â ¬ §Ÿ à ¡√ ™ËÕ◊ ..........................................................................................
Õ¬∑Ÿà ’Ë∫“â π/À¡∫àŸ â“π..........................‡≈¢∑Ë’................μ√Õ°/´Õ¬.......................................∂ππ.....................................À¡à∑Ÿ Ë.’ .............
μ”∫≈/·¢«ß...................................Õ”‡¿Õ/‡¢μ...................................®—ßÀ«—¥.................................À¡“¬‡≈¢‚∑√»æ— ∑.å ....................
Û. ¢“â 懮â“...............π..“..¬....¢........................... ‡≈¢ª√–®”μ—«ª√–™“™π º.⟠..‡..™..à“...............................
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Õ“¬ÿ.............Ùı.....................ªï —≠™“μ‘........‰.∑...¬.............................∫‘¥“/¡“√¥“™◊ÕË .............................................................................
‚ ¥ À¡“â ¬ § Ÿà ¡√ ™◊ÕË ....................................................... ≠— ™“μ‘.......................
Õ¬Ÿ∑à Ë∫’ â“π/À¡Ÿ∫à “â π..........................‡≈¢∑’Ë................μ√Õ°/´Õ¬.......................................∂ππ.....................................À¡àŸ∑.’Ë .............
μ”∫≈/·¢«ß...................................Õ”‡¿Õ/‡¢μ...................................®—ßÀ«—¥.................................À¡“¬‡≈¢‚∑√»æ— ∑.å ....................
Ù. ¢“â 懮“â ¢Õ· ¥ß√“§“∑√—æ¬å∑¢Ë’ Õ∑”πμ‘ ‘°√√¡π’ȇªπì ‡ß‘π...............(.√..–..∫...ÿ§..“à..‡.™..“à..∑...ßÈ— ..À..¡..¥...).............∫“∑.................... μ“ߧå
ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à
(Ò) ¢â“懮Ⓣ¡à‰¥√â ∫— ‚Õπ·∑πÀ√Õ◊ ‡æÕ◊Ë ª√–‚¬™πå·°à∫§ÿ §≈μ“à ߥ⓫
(Ú) √“§“∑√æ— ¬∑å ’Ë· ¥ß‰«â„π Ù. ‡ªìπ√“§“∑Ë·’ ∑â®√‘ß
(Û) .√..–..∫..ÿ ..“..√..–.. ...”.§...≠— ....‡..™..πà ....‡.™..“à..‡.æ...◊ËÕ..∑..”..Õ..–...‰.√...°...“.√..‡..™..à“..‡.√..Ë¡‘..π...—∫..«..—π..„..¥...®...”.π...«..π..§..à“..·..≈...–..°..“..√..™..”..√..–..§..à“..‡.™...“à .‡..ª..πì..√..“..¬..‡..¥..◊Õ..π....À...√..Õ◊ ..ª..ï
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°√≥’º‡Ÿâ ™à“쓬μ°≈ß„À â ≠— ≠“‡™à“μ°∑Õ¥‡ªπì ¡√¥° «π— ∑.Ë’ ...........‡¥Õ◊ π..............................æ.»..................
„Àâ·°∑à “¬“∑¢ÕߺŸ‡â ™“à À√Õ◊ ‰¡à „À‡â ™“à ™à«ß‰¥Àâ √Õ◊ ‰¡à
¡’ —≠≠“μÕà ∑“â ¬ ≠— ≠“‡™à“°Á√–∫ÿ‰«â¥«â ¬ ≈ß™◊ËÕ.....................π...“.¬....°.........................ºŸâ¢Õ „À‡â ™“à
≈ß™◊ËÕ.....................π...“.¬....¢..........................ºâŸ¢Õ ‡™“à
≈ß™◊ÕË ......................................................º Ÿâ Õ∫ «π
(......................................................)
”À√—∫æπ°— ß“π‡®“â Àπâ“∑’Ë
Ò) √“§“ª√–‡¡‘π∑πÿ ∑√æ— ¬.å ....................................................................................................∫“∑........................................ μ“ߧå
Ú) ‚©π¥∑¥’Ë ‘π„À¡√à –«“ß..........5..1..3.6....I.V....7..2..2..8..›..1..........‡≈¢∑Ë’¥‘π.................Ò..............................Àπâ“ ”√«®...........Ú..............................
‚©π¥∑Ë¥’ ‘π‡≈¢∑’Ë.......................Ò..Ú...Û..Ò.....................‡≈à¡........................Ò..Û............................Àπ“â ..................Û..Ò..............................
®”π«π∑¥Ë’ π‘ ............................Ò..........................‰√.à .............................›...................ß“π..............................›....................μ“√“ß«“
§ß‡À≈Õ◊ ................................Ò...........................‰√.à .............................›...................ß“π.............................›.....................μ“√“ß«“
Û) ‰¥®â ¥∑–‡∫’¬π·≈«â ·μ«à π— ∑Ë’.................................‡¥◊Õπ............................................æ.»......................
≈ß™Õ◊Ë .......................................................
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‡®â“æπ—°ß“π∑’Ë¥‘π
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