                                                                 http://192.168.1.11/EXIMIUS/


      NIVA


                 SURYA


                Mother & Child Care
                                                                                                                                                                NABH

                                                                                                                                                             H-2021-0797
                                              OUT-PATIENT ASSESSMENT FORM (Paediatric/Neonate)


                     Name : alirui Jain
                                                                                   Age : 1.8y Sex : F PRN : 62473 Date : 7/03/23
d To
                     Allergy (If Any) :
                                                                                                                           Height : 77cm Weight : 8.2019
ess
                     Chief Complaint:
                                                                                   Examination:
Sex                                                                                                                               Temperature-
                                                                                   Pulse -
tor
gor                   Cold × 1 day
                                                                                   RR-                                           Head Circumference-
                                                                                   Nutritional screening -
                                                                                        . Well nourished
                                                                                         · Underweight
                                                                                        · Overweight
                                                                                   Reference to Dietician [ ] Yes [ ] No

                   Provisional Diagnosis:

                    ARi
                                                                                                                                                                    --
                   Recement episode
ce                                                                               Pain Score:

pe                 Treatment:
C
                   Nasodeas nasal spray 6 hourly




                Syp cetzine 1ml 2 times a day x5 days




                Huf puf kit




                 Budecort 200 mcg 1puff 2 times a day


                                                                                                                           × 1 month

                 fren chianti


                                                                                                      Advice, if any:
                Investigation:

                                                                                                      Next Follow up:

                                                                      Dr. Amita Kaul
                                                                                                                                Time :                     Sign :
             Name of Consultant with Reg. No .: M.B.B.S .; D.N.B.(PEDIATRICS)
                                                             . . Reg.No. 2002/01/197 .
                                                                                                T : 020 - 67986400 / 67915456 /55        E : hrpune@suryahospitals.com
                                          Surya Mother and Child Care Pvt. Ltd.
             SMCSSH/MED/F/03                                                                    E: 020 - 67915400                        Website : www.suryahospitals.com
                                          Sr. No. - B, Devi Yash, Near Wakad Octroi Naka,
                                                                                                Paediatricians available 24x7
                                          Hinjewadi fly Bridge, Wakad, Pune - 411057
                                                                                                 18002665400                                                             CONFIDENTIAL

{'clinic_pharmacy_details': {'clinic_pharmacy_name': 'Surya Mother and Child Care', 'clinic_pharmacy_address': 'Sr. No. - B, Devi Yash, Near Wakad Octroi Naka, Hinjewadi fly Bridge, Wakad, Pune - 411057', 'clinic_pharmacy_city': 'Pune', 'clinic_pharmacy_pincode': '411057'}, 'doctor_details': {'doctor_name': 'Dr. Amita Kaul', 'doctor_qualifications': 'M.B.B.S.; D.N.B.(PEDIATRICS)', 'doctor_registration_number': 'Reg.No. 2002/01/197'}, 'patient_details': {'patient_name': 'alirui Jain'}, 'prescription_details': {'date_of_doctor_consultation': '7/03/23'}, 'procedure': {'chief_complaints_diagnosis': 'Cold', 'examination': 'Temperature- Normal, Pulse- Normal, Head Circumference- Normal, Nutritional screening- Well nourished', 'provisional_diagnosis': 'ARI (Acute Respiratory Infection)'}, 'medicine_details': [{'medicine_name': 'Nasodeas nasal spray', 'medicine_dosage': '6 hourly', 'medicine_frequency': '1', 'course_duration': '1 month'}, {'medicine_name': 'Syp cetzine', 'medicine_dosage': '1ml', 'medicine_frequency': '2 times a day', 'course_duration': '5 days'}, {'medicine_name': 'Budecort 200 mcg', 'medicine_dosage': '1 puff', 'medicine_frequency': '2 times a day', 'course_duration': '1 month'}], 'lab_test_details': {'lab_test_names': 'NA', 'procedure_request': 'None'}}