                  REFERRAL FORM

                                                                                                                  PRIMA
                                                                                                                  PRACNOST
                                                    Una                                             JAYANAGAR
                                  This Showdet
         Name :                                                                                             Date: 09.05.23

        Ace
                                                                          Investigation Required


        Referred by Doctor:

                  DEHL VENU-
                                                                                -FNAC - of
                   98 443 41579


                                                                                   Right cervical

     Clinical detale
                                                                                  Lymph node




Special Instructions




                                                                  Vinod

                                                       9008872738
                                                                                                                Signature of Doctor



                                                 L das 46382333 | 463822223

{'clinic_pharmacy_details': {'clinic_pharmacy_name': 'NA', 'clinic_pharmacy_address': 'NA', 'clinic_pharmacy_city': 'NA', 'clinic_pharmacy_pincode': 'NA'}, 'doctor_details': {'doctor_name': 'DEHL VENU', 'doctor_qualifications': 'NA', 'doctor_registration_number': '98 443 41579'}, 'patient_details': {'patient_name': 'Vinod'}, 'prescription_details': {'date_of_doctor_consultation': '09.05.23'}, 'procedure': {'chief_complaints_diagnosis': 'Right cervical lymph node'}, 'medicine_details': [], 'lab_test_details': {'lab_test_names': 'NA', 'procedure_request': 'FNAC of Right cervical lymph node'}}