                                                              Il Ohm Namo Arihantanam Il
                                            SAMBHAV MEDICO-LEGAL CLINIC
                                                                                                                                    Dr. Dharmesh H. Jain

                                                          SSTI                                                                            (B.AMS, PG-DIP in C.R. LLM)
                                 À Sis :-                                                                                                                  R. No. 1-46816-A
                                                                                                                                                            M .: 9567407581
                                                                                                                                         E-mail: sambhavmic@@gmail.com

                                                     Clinic:
                                                     R. No.1, Hou. No. 709 (1), Survey No. 113, Pachubal Chawl, Opp. Siddhivinayak School, Vikhroll East
                                                     Time: Moming 10 to 02.30 pm & Evening 07:30 pm to 11.30 pm

                                                                   Ismail                              shaller                                 06/05/2023
         Name : Hussain                                                                                                           Date

                    your                                         Mobile : 9987154294
          Age                               Sex :                                                                                  Time

                      Investigation                     H/O :-        Diabetes         Thyroid                                           Temp
                         Advised                                                                                                                    -
                                                                     HTN                    Allergy                                       BP                         mm of Ho
                  CBC ESR-MP CRP
                                                                                                                                         Pulse :131                        /minute
                 NS1D                                                                                                                     SPO2 - 99

                 Widal Test                            C/O :-                                                                             HGT :                              mg/dl

                 Thyroid Profile                                                                                                         WGT :-                                  Kg
                                                                                                                                          BSR :-                              mg/dl
                 Lipid Profile

                 Arthritis Profile

                Hypertension Profile

                                                                  Name of Medicine                       Special
                 Anaemia Profile                                                                                         Moming    Afternoon        Evening         Period     Indication
                                                                                                        Condition
                Urine / Stool (R & M)                 T. Reusepp-om                                   Before
                                                                                                                           1        0                   1           13 4
                Sr. Creatinine

             S. Billirubin                            7. moxivonce                                                          /        0

            SGOT/SGPT                                                                                 Before
                                                                                                                 Atter
            BSL - F / PP
                                                                                                      Before
            Digital X-ray                                                                                        ASpr
                                                                                                      Before
            Digital USG
                                                                                                                 After
           ECG /CST                                                                                   Before
           CT / MRI Scan                                                                                         Ator

           (Plain / Contrast)                                                                         Before

   Next Visit
                                                                                                      Before
     09/05/2023                                                                                                  After
                                                                                                      Before
                                                                                                                 After
  Inv. Advised:

                                                                                       00
 RT-PCR / RAT / TRUENAT FOR SARS-COVID-19 (
                                                                                                                                                                                      W. JAIN

 Referred to:


                                                                                                                                                        DR. DHAR
                                                                                                                                                                                      CRI
                                     One hundred only (Rs. by cash or Anyother mode)
                                                                                                                                                              (only on tosergency)
Received Rupees.


Legal Advisor / Counsellor / Medico-legal Matters / Family Matters
                                                                                                                                                                   VL. VIKHIROLI (E),
 Disputes & Consumer Disputes                                                                                                                                                 OUI (E), MU


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