                                                 ANAESTHESIA RECORD
                                                                                                      Patient Name
                                                                                                                               Kunne Ichan
                                                                                                      Consultant Name:
                                                                                                                               Dept of orterfinde
            XX XX                                                                                     Age:       31y
                                                                                                      MAN

                                                                                                      DOA


                                                     PRE-ANESTHESIA EVALUATION FORM

                                                    NKPA                          Lang-Jage Hia.                         ASA Grade
                                                                      R THR + Bene Col                       Corts Hip T.B.
                                                                                                                      Carte 1 evaluation
                                     F4 2022 -          Hp TB- On Rx forlash 18 mall of shit apony

                                                                                               BP /40/90         RR , 12h-               Temp
                                                         Pulmonary SystemCough : 6 month                     Central Nervous System
                                                        OSM/Lie of Bipap Aminimal 5 palum                    GCS M
                                                        COPO                                                 H/O Seizure
                                     METS-4                                 (gelauch)                                                           Stroke
                             e                          KODY'S                                               DEFICIT
                                                        SMOKER          No fever                             PIVD
                                                        Examination           Lador Evaluation               Previous Anaesthesia and Blood Transfusion
                                                        Palior                     SpD: bom Dr. Kulden
                                                                                   Auscultation
                                                        Cyahoszs                   Chest
                                                       Dubbing                     Spine                     Family History:
                                                       Ondoma                      P/A
                                                                          Mild fianchi But li
                                                                                                             Substance Abuse:
                                                                          Acidi
         Amay Assessment                               Drug Therapy                    2) Bronchial          Other Drugs
                                                       Aspirin / Clopidogrel
                                                       UPH/LMWH                                               T. Ethembatal 1200g
                                                                                                             T. Isompriel 300g -
                                     Buck teet         Anti Convulsants
     milbation difficulty

                                                                                                             Anaesthesia Plan GA/RAJNB/MAC/LA
                                                       Se, electrolytes                                      CAR
                                                       Urea
                                                       Creatinine 87                                         X Ray Spine

                                                        ABG
                                                        TFT
                                                        HBSAg                                                ECHO/DSE
    Bipand Sugar                                       HCV
    FIPP /Random)                                  C. RIV 12                                                 VENOUS DOPPLER

   Adinice & Pre-OP Orders:                                                       Review:



      Coagulation/vimake/ Ecg

         Pulmonary fica to be done

ToNichtall I didn't badune an admission
                                Time                            Signature         Date                           Time                               Signature


2/10/2
                                                                                                           CKBH/MED/AR/Ver-02/JUNE'21
                                                                                  la

{'clinic_pharmacy_details': {'clinic_pharmacy_name': 'NA', 'clinic_pharmacy_address': 'NA', 'clinic_pharmacy_city': 'NA', 'clinic_pharmacy_pincode': 'NA'}, 'doctor_details': {'doctor_name': 'Dr. Kulden', 'doctor_qualifications': 'Dept of orterfinde', 'doctor_registration_number': 'NA'}, 'patient_details': {'patient_name': 'Kunne Ichan'}, 'prescription_details': {'date_of_doctor_consultation': '2/10/2'}, 'procedure': {'chief_complaints_diagnosis': 'Cough: 6 months'}, 'medicine_details': [{'medicine_name': 'PAN 40', 'medicine_dosage': '1-0-1', 'medicine_frequency': 'Morning and Night', 'course_duration': '1 month'}, {'medicine_name': 'Paracetamol', 'medicine_dosage': '1-1-1', 'medicine_frequency': 'After Breakfast, After Lunch, After Dinner', 'course_duration': '5 days'}, {'medicine_name': 'Amoxicillin', 'medicine_dosage': '1-0-1', 'medicine_frequency': 'Morning and Night', 'course_duration': '1 week'}], 'lab_test_details': {'lab_test_names': 'Pulmonary Function Test', 'procedure_request': 'Coagulation/vimake/ Ecg'}}