                                                                                                                                           1t Fortis
Dr. Ram Krishna Modi
                                            Modi General Hospital & ICCU                         Dr. L.H. Hiranandani Hospital      Fortis Hospital
MD (Medicine) Mum.
                                                                                                 Hiranandani Gardens, Powai.        Mulund Goregaon Link Road,
Senior Consultant                            Reg.No. 761409526
                                                                                                 Tel .: 2576 3300 / 3333             Mulund (West). Mumbal.
Internal Medicine                            240/3271, Tagore Nagar, Vikhroll (E), Mumbai.
                                                                                                                                     Tel .: 022 - 49254123
                                             Tel .: 2574 5666 / 2574 8939
Reg .: 2007/05/1627                                                                                                                  OPD - Daily 10-12 p.m.
                                             Con. Time : 12 p.m. to 2 p.m. - 7 p.m. to 10 p.m.                                       Admission : 24 Hrs.
M .: 98210 19124
                                             NABH PRE ACCREDITED                                          Shushrusha's Suman Ramesh Tulsiani Hospital
    : 93210 19124
                                             Cert. No. PESHCO-2019-1133                          Near Kinnari Hall, Kannamwar Nagar-1, Vikhroli (E), Mumbai - 400 083.
                                                                                                         Tel .: 022 - 2578 6100 OPD Time : Daily 4 p.m. to 6 p.m.

                                                    Mr. Hussain Shaikh                                                                         23/04/23
PATIENT NAME :                                                                                                                   DATE :

AGE : Hoyrs GENDER : Male.
                                                                           UHID :
    Physical Assessment & Impression:
                                                                                                        Investigations:

     c/o- Chest pain
                                                                                           P-P-76 her POP - 140/80 mlg
                                            ( .: 1 day)


               - Naussage                                                               Spor-971 T-M.


             - Pain TITSA


           - Now

           -Clochech pain +tsy                                                                              CPK-MB-18.6

                                 (:6pm)
                                                                                                   - Tropain I - Nonal


                                                                                                                (Normal) Megthis

                         ECG: WNL.


NAME OF MEDICINE SHOULD BE GENERIC NAME AS FAR AS POSSIBLE AND CAPITAL LETTERS.
                                                                                                                                   Daily                    Total
                                                                Name of Medicine                                    Strength                 Duration     Quantity
 S.No.        Dosage Form                                                                                                          Dose
                             R1




                                   - Bo. Myopaz forte
                                                                                                                                    T
                                                                                                                      0




                                              B. pan -D
                                                                                                                           1




 "Or any other cheaper generic medicine as per choice of patient"

  DISPENSED BY                                                                                                                              Doctor's Signature

  Pharmacist Name :

  Date :

  Name and Address of Pharmacy :

{'clinic_pharmacy_details': {'clinic_pharmacy_name': 'Modi General Hospital & ICCU', 'clinic_pharmacy_address': '240/3271, Tagore Nagar, Vikhroli (E), Mumbai', 'clinic_pharmacy_city': 'Mumbai', 'clinic_pharmacy_pincode': '400083'}, 'doctor_details': {'doctor_name': 'Dr. Ram Krishna Modi', 'doctor_qualifications': 'MD (Medicine)', 'doctor_registration_number': 'Reg.No. 761409526'}, 'patient_details': {'patient_name': 'Mr. Hussain Shaikh'}, 'prescription_details': {'date_of_doctor_consultation': '23/04/23'}, 'procedure': {'chief_complaints_diagnosis': 'Chest pain'}, 'medicine_details': [{'medicine_name': 'Myopaz forte', 'medicine_dosage': '1 tablet', 'medicine_frequency': 'Daily', 'course_duration': '1 day'}, {'medicine_name': 'Pan-D', 'medicine_dosage': '1 tablet', 'medicine_frequency': 'Daily', 'course_duration': '1 day'}], 'lab_test_details': {'lab_test_names': 'CPK-MB, Troponin I, ECG', 'procedure_request': 'Please perform the above mentioned lab tests.'}}