                                                                                                                                                                     Form # OP1
 Dr. (Prof) Sunil Narayan Dutt
     MS. DNB, PhD (Holland), FRCS (Edin)                           AH0 0001097568
                                                                 UMR SYED ZARLALA                                                                         Apollo
      FRCS(ORL-HNS), OLD (Eng), DORL
     Clinical Neurotology Fellowship, Toronto, Canada
                                                                  4 May 2003 12 22 :11 PM
      Professor, Senior Consultant & Clinical Director                                                                                                           HOS
     Head of Cochlear Implant Programme
     Dept. of ENT & Head - Neck Surgery
     M : +91-99001 28981
     email . sunildutt@hotmail.com                                                 Fall Risk Assessment
                                                Allergies                                                                   WE         HL
                                                                                                            Yes No                                  T.
Dr. Sumit Kumar Gaur                                                          Hip fall (within 1 year)                                                                  BP
                                                                              Mobility Aid                  Yes No
     MBBS, MS(ENT)                                                                                     Dep Indep            Pain   /10 ] Psychological & Social Assessment done
     Senior Consultant
     Dept. of ENT & Head - Neck Surgery                 S/p 2 profound SNHL
     M: +91-74116 65998
     email : de sumitgaur@@gmail.com


     Dr. Aanchal A Mittal                                             Sudden Idiopathic.
     MBBS, MS(ENT)
     Clinical Fellowship in Otology &
    Hearing Implants (RGUHS)
    Consultant
    Dept. of ENT & Head - Neck Surgery
    M : +91-73500 75555
                                                            2 TTEABR on 22/02/23


Dr. Swathi Vadlamani
    MBBS, MS. DNB (ENT)                                                  - Good response type D' on 1
    Clinical Fellowship in Otology &
    Hearing Implants (RGUKS)
    Associate Consultant
    Dept. of ENT & Head - Neck Surgery                                                                               Sidi
    M : +91-99088 38882
   email : vhkswat@gmail.com



                                                  Medicine Reconciliation Dose & Frequency


                                                                                           plamice & Plan




                                                                                   1) Cochecar implantation on




                                                                                           24/05/23. 1 GA




                                                                                     Admission on 23/05/23



         MA
                                                    To meet Dr Ka In Prevanar IM STAT




                                               Kindly get this document scanned at the counter for the record purpose
                                                      CI Counselling - Achadup


                                                                                                                                            Signature and Date

                                                                                                                                                 CDNSumity
                                    Apollo Hospitals, 154/11, Opp. LL.M ., Bannerghatta Road, Bengaluru-560 076, Karnataka, India
                       D: +91-80-2630 4050 / 2630 4010 / 4030 4050 / 6600 1066 F: +91-80-4146 3151, www.bangalore.apollohospitals.com

                                         Apollo Pharmacy Free Home Delivery: Ph: 080-6001 1111, web: www.apollopharmacy.in

                                                                    In any medical emergency call: 1066
                                         To book appointments or Consult doctors online, visit www.askapollo.com

{'clinic_pharmacy_details': {'clinic_pharmacy_name': 'Apollo Hospitals', 'clinic_pharmacy_address': '154/11, Opp. LL.M., Bannerghatta Road, Bengaluru-560 076, Karnataka, India', 'clinic_pharmacy_city': 'Bengaluru', 'clinic_pharmacy_pincode': '560 076'}, 'doctor_details': {'doctor_name': 'Dr. (Prof) Sunil Narayan Dutt', 'doctor_qualifications': 'MS. DNB, PhD (Holland), FRCS (Edin), FRCS(ORL-HNS), OLD (Eng), DORL, Clinical Neurotology Fellowship, Toronto, Canada', 'doctor_registration_number': 'AH0 0001097568'}, 'patient_details': {'patient_name': 'Dr. Sumit Kumar Gaur'}, 'prescription_details': {'date_of_doctor_consultation': '4 May 2003 12:22 PM'}, 'procedure': {'chief_complaints_diagnosis': 'S/p 2 profound SNHL, Hip fall (within 1 year), Sudden Idiopathic., 2 TTEABR on 22/02/23'}, 'medicine_details': [{'medicine_name': 'Prevanar IM', 'medicine_dosage': '1', 'medicine_frequency': 'STAT', 'course_duration': '1 GA, Admission on 23/05/23'}, {'medicine_name': 'Plamice', 'medicine_dosage': '1-0-1', 'medicine_frequency': 'Before Breakfast, After Lunch, Before Dinner', 'course_duration': 'Cochecar implantation on 24/05/23'}], 'lab_test_details': {'lab_test_names': 'NA', 'procedure_request': 'NA'}}