                                              Sevadham Trust's

                                                                  Sevadham



                                                                              multi-speciality hospital
               NABH
                                                                  NABH Accredited, ISO 9001 :2015 Certified
                             Talegaon Dabhade (Stn.) Tal. Maval, Dist. Pune - 410 507, Ph No ,: 02114-222456


MRN         : POD 35469                                       OPD ASSESSMENT FORM                                                             Date :
                                                                                                                                                                   15/9/2023

Patient Name: Mishka kshitty gajan Complaints :                                                                                                                                                   PAIN SCORE


Age : 448cm.                                 Sex: F                                                        ao rever
                                                                                                                                                                                                         HURTO
                                                                                                                         Blocked Nostril.
                                             Category deep.
OPD No. 15095.


History And Allergies :                                                                                                                                                                                 II      11

                                                        -
                                                                                                                                                                                                   HO



 General Examination : Ht :                                                 Wt : 15kgqwam BP:                                               PR:

 Pallour / Oedema / Cynosis / Icterus / Lymph node


 Systematic Examination : RS .: Occ;in                        Wheeze CVS: SIS2 4)                                                           CNS : NAD.

 Previous Investigation Record :                                                                      Investigation Advice :


                                                                                                                Adr


                                                                                                          -Temp: 102.7ºF.
 Provisional Diagnosis :
                                                                                                          - HR- 180 blm


             DACute URTI.                                                                                        SP02 - 98%




   Sr                     Name of Medicine                           Dose        Route             Breakfast                        Lunch                            Dinner
                                                                                                                                                                                          Days          Total
                                                                                                                                     ····                             ····
                                                                                              Before            After         Before      After             Before            After


       1.       SYP SINAREST PLUS.                                                PIO                                           If fever                   >100F

    2.          SYP. LAVECTA-M                                                    PIO
                                                                                                                                                                          V               5day

   3.           syp. LCF LS                                          3mm         PIO                             V
                                                                                                                                                                          V               5 day

   4.           SYP. OSSOPAN-D                                       5ml          Plo
                                                                                                                                                                                          30 day

  5.             SYP. BECOSULE                                                   PIO
                                                                                                                                                                                         30 day

  6.            SYP. CYCLOPAM                                                    PIO
                                                                     5mg

   ITTAB FRISIUM 5mg
                                                                 1 tab          PIO
                                                                                                          IFFever 10if
                                                                 2
                                                                                                                                                  drager
  Referral :
                                                                                                                                  Sevadham Hospital
  Follow Up :
                                                                                                                                   Talegaon Dabhade (Stn)
                                                                                                                                            Reg. No. 0051
 Signature & Name of Consultant :

 In Case of any Emergency Please Contact On Emergency No .: (02114) 222456
                                                                                                                                                                                      SH/OPD/F-03.01

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