           Plot B-Scheme No-5.                       Association with SMJ Trust
           Ahinsha CK- VAL
                                                 Shalby Hospital Jabalpur
    SHALBY                                                                                                                                                                                        ih


      MULTI-SPECIALTY                                        OPD ASSESSMENT FORM
              HOSPITAL
                                                              (TO BE FILLED IN CAPITAL LETTERS)                                                                                     NABH

                                                                                                                                                Husband AS

                                                Meha Patet
     Name: Mr./Mrg/Mast./Ms
                                                                                                                     Age :                                 OPD No .:
     Date: 2/03/2015 Time:
                                                                    AM/PM Sex: Male                              Female         Height:                             Weight:
    Address                                                                  Nationality                             History Given By : Self/Other :
     Diagnosis :
                                                                                                                                          Allergy


    History / Complaints :                                     B4- B Meg
                                                                                                                               Plan of Care :
                                                                                                                                                                              Adv
  LMP- 27/05/2022                                                                                                         Received

                                                               Recurred arti D
                                                                                                                                                            1 CBC , Coogulati
   EDD- 6/03/2013
                                                                                                                                                                                           I-on
                                                              3 times
                                                                                                                                                            D.eFT

                              43 Polo Az.
                                                                                                                                                                       KFT
                                                                            43POLO Az: 3916
                                                                                                                                                            4 HIV/ubsAg
                        2 MTP Pills
                                                                              weeks with Rh Neg.


   General / Systèmic Examination :
                                                                         Good betal movement                                                                       5 TSU'
    astuist - NS.

                                                                                                                                                                   6.ECK
  Allergy - Recurrent                                             1/3 Usy- 5CF

                                   tonsilitis                                                                                                                  2 PMC.
                                                                                           AFI 4-5.


                                                                                             cot 3000
  Family Hist - CAD Mother.
                                                                                                                                                 1. Patient for.
                                                                                           FHS 154/ win k.


                                                                                                                                                               iss' at 3 pm
                                                                 int as closed
                                                                                                sib rato
                                                                     oligo                                                                                                  Muchust
                                                                                                             3



  Investigation Advisestable
                                                             NIPT - WN
                                                                                                                                                                   Amange


                   P/A temi syge                             Double Marker - Intermediate
                                                                                                                                                            Donos

            tis PR
                                                               TSH - 1.6 2/07
                                                                                                                                                                        Dr. Charu Pathak

                                                                                                                                                       MBBS (Gold Medalist), M.S. FMAS
                                                                                                                                                    Consultant Obsterics & Gynaecology
                                                                                                                                            E-mail: gynaecology2.jabalpur@shalby.org
                                                                                                                                                               Mob : +91 9575801200

Next Follow up Date :



SHALBY HOSPITAL
(In ARE DM With {J Trust) 2 PRO 5G
Address : Plot B, Scheme No-5, Ahinsa Cnowk, Kachnar Road, Vijaynagar, Jabalpur, Madhya Pradesh - 482 002, India
     +91 9575801200 / 9575801020 | E-mail : info.jabalpur@shalby.org | CIN : U85110GJ2004PLC402/ 03/2023 16:49

{'clinic_pharmacy_details': {'clinic_pharmacy_name': 'SHALBY', 'clinic_pharmacy_address': 'Plot B, Scheme No-5, Ahinsa Cnowk, Kachnar Road, Vijaynagar, Jabalpur, Madhya Pradesh - 482 002, India', 'clinic_pharmacy_city': 'Jabalpur', 'clinic_pharmacy_pincode': '482002'}, 'doctor_details': {'doctor_name': 'Dr. Charu Pathak', 'doctor_qualifications': 'MBBS (Gold Medalist), M.S. FMAS', 'doctor_registration_number': 'NA'}, 'patient_details': {'patient_name': 'Meha Patet'}, 'prescription_details': {'date_of_doctor_consultation': '2/03/2015'}, 'procedure': {'chief_complaints_diagnosis': 'Recurrent tonsillitis'}, 'medicine_details': [{'medicine_name': 'Azithromycin', 'medicine_dosage': '500 mg', 'medicine_frequency': '1-0-1', 'course_duration': '5 days'}, {'medicine_name': 'Mefenamic Acid', 'medicine_dosage': '500 mg', 'medicine_frequency': '1-1-1', 'course_duration': '3 days'}, {'medicine_name': 'Paracetamol', 'medicine_dosage': '500 mg', 'medicine_frequency': '1-0-1', 'course_duration': '5 days'}], 'lab_test_details': {'lab_test_names': 'CBC, Coagulation Profile, HIV/HbsAg Screening, NIPT, Double Marker, TSH', 'procedure_request': 'Please do the necessary lab tests'}}