diff --git a/src/components/base/BaseInput.vue b/src/components/base/BaseInput.vue
index efce6e6..13994b4 100644
--- a/src/components/base/BaseInput.vue
+++ b/src/components/base/BaseInput.vue
@@ -25,6 +25,7 @@
       :standout="standout"
       :accept="accept",
       :debounce="debounce",
+      :shadow-text="shadowText"
       hide-bottom-space
     )
       template(v-slot:prepend, v-if="iconLeft")
@@ -80,6 +81,7 @@ export default {
       type: String,
       default: "none",
     },
+    shadowText: String,
     mask: String,
     debounce: [String, Number],
     width: Number,
diff --git a/src/pages/newMedicalCard/components/InitialInspectionProtocol/Forms/ThermometryForm.vue b/src/pages/newMedicalCard/components/InitialInspectionProtocol/Forms/ThermometryForm.vue
new file mode 100644
index 0000000..a3fa09b
--- /dev/null
+++ b/src/pages/newMedicalCard/components/InitialInspectionProtocol/Forms/ThermometryForm.vue
@@ -0,0 +1,113 @@
+<template lang="pug">
+  medical-form-wrapper(:title="data.title")
+    .thermometry-wrapper.grid.gap-x-20.gap-y-5
+      .flex.flex-col.gap-y-4.items-start(v-if="isEdit" v-for="thermometry in configThermometry.temperature")
+        span.font-semibold.text-smm {{ thermometry.title }}
+        base-input.w-full(
+          v-model="dataThermometry[thermometry.name].temperature",
+          type="number"
+          label="Температура"
+          outlined
+          text-color="black"
+          shadow-text="º"
+          placeholder="0º"
+          )
+        .flex.flex-col.gap-y-2.w-full
+          base-input.w-full(
+            v-model="dataThermometry[thermometry.name].result",
+            label="Результат"
+            outlined
+            text-color="black"
+            placeholder="Введите диагноз..."
+          )
+          .results-wrapper.flex.flex-col.rounded.w-full.px-3.py-3
+            .result.flex.w-full.justify-between.items-center(v-for="result in configThermometry.results")
+              .flex.gap-x-4
+                q-radio(
+                  v-model="dataThermometry[thermometry.name].result"
+                  :val="result.value"
+                  :label="result.value"
+                  checked-icon="check_box"
+                  unchecked-icon="check_box_outline_blank"
+                  )
+              .alert-icon.flex.justify-center.items-center.rounded.w-6.h-6(v-if="result.alert")
+                q-icon(size="13" name="warning_amber")
+</template>
+
+<script>
+import MedicalFormWrapper from "@/pages/newMedicalCard/components/MedicalFormWrapper.vue";
+import BaseInput from "@/components/base/BaseInput.vue";
+
+export default {
+  name: "ThermometryForm",
+  components: { MedicalFormWrapper, BaseInput },
+  props: {
+    data: Object,
+  },
+  data() {
+    return {
+      isEdit: true,
+      dataThermometry: {
+        cold: {
+          temperature: null,
+          result: "Реакция нормальная",
+        },
+        heat: {
+          temperature: 50,
+          result: "Повышенная чувствительность",
+        },
+      },
+      configThermometry: {
+        temperature: [
+          {
+            name: "cold",
+            title: "Реакция на холод",
+          },
+          {
+            name: "heat",
+            title: "Реакция на тепло",
+          },
+        ],
+        results: [
+          {
+            value: "Нет реакции",
+            alert: true,
+          },
+          {
+            value: "Слабая реакция",
+            alert: true,
+          },
+          {
+            value: "Реакция нормальная",
+            alert: false,
+          },
+          {
+            value: "Повышенная чувствительность",
+            alert: true,
+          },
+          {
+            value: "Непереносимость",
+            alert: true,
+          },
+        ],
+      },
+    };
+  },
+};
+</script>
+
+<style lang="sass" scoped>
+.thermometry-wrapper
+  grid-template-columns: repeat(2, 1fr),
+  grid-template-rows: 1fr
+  @media(max-width: 1176px)
+    grid-template-columns: 1fr
+    grid-template-rows: repeat(2, 1fr)
+.results-wrapper
+  border: 1px solid var(--border-light-grey-color)
+.alert-icon
+  background-color: var(--bg-light-grey)
+  color: var(--font-grey-color)
+.result
+  border-bottom: 1px solid var(--bg-light-grey)
+</style>
diff --git a/src/pages/newMedicalCard/components/InitialInspectionProtocol/MedicalProtocolsInspection.vue b/src/pages/newMedicalCard/components/InitialInspectionProtocol/MedicalProtocolsInspection.vue
index 9909de5..80d06fb 100644
--- a/src/pages/newMedicalCard/components/InitialInspectionProtocol/MedicalProtocolsInspection.vue
+++ b/src/pages/newMedicalCard/components/InitialInspectionProtocol/MedicalProtocolsInspection.vue
@@ -46,6 +46,7 @@ import MedicalFormTag from "@/pages/newMedicalCard/components/InitialInspectionP
 import DataForm from "@/pages/newMedicalCard/components/InitialInspectionProtocol/Forms/DataForm.vue";
 import BaseButton from "@/components/base/BaseButton.vue";
 import IndexForm from "@/pages/newMedicalCard/components/InitialInspectionProtocol/Forms/IndexForm.vue";
+import ThermometryForm from "@/pages/newMedicalCard/components/InitialInspectionProtocol/Forms/ThermometryForm.vue";
 import { protocolForms } from "@/pages/newMedicalCard/utils/medicalConfig.js";
 
 export default {
@@ -55,6 +56,7 @@ export default {
     DataForm,
     BaseButton,
     IndexForm,
+    ThermometryForm,
   },
   props: { inspection: Boolean, fillInspection: Boolean },
   data() {
diff --git a/src/pages/newMedicalCard/utils/medicalConfig.js b/src/pages/newMedicalCard/utils/medicalConfig.js
index 5c9068d..21bde72 100644
--- a/src/pages/newMedicalCard/utils/medicalConfig.js
+++ b/src/pages/newMedicalCard/utils/medicalConfig.js
@@ -634,4 +634,10 @@ export const protocolForms = [
     key: "data",
     state: "data",
   },
+  {
+    title: "Термометрия (по показаниям)",
+    component: "ThermometryForm",
+    key: "thermometry",
+    state: "thermometry",
+  },
 ];