                                                              Place Label Here                                                                                          Form # OP1
Dr. Dwarakanath C S                                           Mr-Subeamanya joshi (304/m)
MBBS, MD (Internal Medicine), DM (Endo)
Senior Consultant - Endocrinology
M: +91-91212 29133 / 080-26304199                                          AHB. 0001054300                                                                 Apollo
email: csdnath@yahoo.com                                      If label not available, write PL. Name, UHID No ..
                                                              Age, Sex, Date, Name of Treating Physician                                                        HOSPITALS
  Allergies                                                                                                                                                TOUCHING LIVES
                                                                Fall Risk Assessment
                                                                                                    WE 8 T-2kg :                                                        138/737
                                                      H/O fall (within 1 year)                                                   T.                               BP:
                                                                                      Yes No                                                       P
                                                      Mobility Aid
                                                                                      Yes No
                                                      Gait                                         Pain            /10             [] Psychological & Social Assessment done
                                                                                 Dep. Indep
                    Follow up: Type 2 Dm

                                                                                                                                              03/03/23




                                                                                                                                       Cr-0.14 mg/dl
                      T. Reclidé MR 30

                                                                                                                                      HBA1 C- 6.70%



                                (Before breakfast)                                                                                LP-1821159/39/124/31


                                                                                                                                                                    mglal
                        - T Vildaparido m 501500
                                                                                                                                   OT/PT - 34 |47 U/C




                                          cafter med)                                                                        calp- 9-t/4.5 mg/dl
                                                1


                    Med T Glycomit SR 500 se & F Nalk-142mmol/c


                                                                                                                               Urine Routine - Normal
                                                 1 - o & Plan

                                                        caftes dummes,
                                                                                                                                      Hb - 15.5 gld/



                                                   Rosuvas F10                                                                        T3 - 1.00 ng/ml
                                    T
                        -
                                                                                          -1
                                                                                                                                          T4-9.81 mg/dl
                                                      0-0


                                                                                                                                      TSH. 3.580nd/u/ml.
                                        D Risi 60 K
                            -
                                                                                                              72                        vit-B12-181pg/ml
                                                        1 Cap (months




                      FBS


                      PPBS                            2 months

                                                                                                                           Dr. C.S. DWARAKANATH
                       HbAcc
                                                                                                                             MBBS, MD, DM ( Endocrinology)
                                                                                                                                   KMC Reg No. 23508
                                                                                                                    Senior Consultant Er jocrinologist & Diabetologist
                                                                                                                                     bir ty pic [ Apollo Hospital )
                                                                                                                           Apollo Suscr
              Kindly get this document scanned at the counter for the record purpose                                                               Anod, Bangalore




                                                                                                                                             Signature and Date
                                  Apollo Hospitals, 154/11, Opp. I.I.M ., Bannerghatta Road, Bengaluru-560 076, Karnataka, India
                  D: +91-80-2630 4050 / 2630 4010 / 4030 4050 / 6600 1066, F: +91-80-4146 3151, website : bangalore.apollohospitals.com
                                        Apollo Pharmacy Free Home Delivery Ph : 080-6001 1

{'clinic_pharmacy_details': {'clinic_pharmacy_name': 'Apollo Hospitals', 'clinic_pharmacy_address': '154/11, Opp. I.I.M ., Bannerghatta Road, Bengaluru-560 076, Karnataka, India', 'clinic_pharmacy_city': 'Bengaluru', 'clinic_pharmacy_pincode': '560 076'}, 'doctor_details': {'doctor_name': 'Dr. Dwarakanath C S', 'doctor_qualifications': 'MBBS, MD, DM (Endocrinology)', 'doctor_registration_number': 'KMC Reg No. 23508'}, 'patient_details': {'patient_name': 'Mr. Subeamanya Joshi'}, 'prescription_details': {'date_of_doctor_consultation': '03/03/23'}, 'procedure': {'chief_complaints_diagnosis': 'Follow up: Type 2 DM'}, 'medicine_details': [{'medicine_name': 'T. Reclidé MR 30', 'medicine_dosage': '1 - 0 - 1', 'medicine_frequency': 'Morning and Night', 'course_duration': '2 months'}, {'medicine_name': 'T. Rosuvas F10', 'medicine_dosage': '0 - 0 - 1', 'medicine_frequency': 'Night', 'course_duration': '2 months'}, {'medicine_name': 'T. Glycomit SR 500', 'medicine_dosage': '1 - 0 - 0', 'medicine_frequency': 'Morning', 'course_duration': '2 months'}], 'lab_test_details': {'lab_test_names': 'Urine Routine - Normal, Hb - 15.5 g/dl, T3 - 1.00 ng/ml, T4 - 9.81 mg/dl, TSH - 3.580 mIU/L, Vit-B12 - 181 pg/ml', 'procedure_request': 'FBS, PPBS, HbA1c'}}