        YASHODA
        Super Speciality Hospitals
                                                                  OPD CONSULTATION

Patient Name Mr. Viveka Nand Kung 76 x 36XG/m Regn. No. 578492                                                                                           ......
                                                                                                 21/03/23                      Time .****
                              DR.
 Doctor's Name                                                    WWVAL
                                                  MCL
                                            ART - UROLOGY
                                   DMC REG NO. 62856                                  6. Investigations Advised :
  1. Nutritional ScreeningDA SUPER SERTIALITY HOSPITAL
                          Weight AUSSIAMD                                             CT S/6 => 3.5 mm Puycom
  Height          .......
  2. History : (Present/ Past/ family)
                                                                                                                4mm@my com




                               -73-40lys                                               A Misional Differential Diagnosis:




   Any Drug Allergy :

 3. General Examination :

                               Temp :                Pulse :             R/R :
     BP :

    Pallor / Oedema / Koilonychia

                                                                                          8: Treatment Advised :
 4. Systemic Examination :


       CVS :                                                                            -Aduesion.



       CNS :CBC, KFT, LFT
             RBS, HbA1C, &xme                                                                -> RAC -> 2020
                  URINE-R/M, URINE-C/S
       RS:        ECG, CHEST X-RAY, 2D ECHO                                                                                                                       +
                   PT. APTT, INR, HIV, HBsAg, HCV
                                                                                                 SprAN=> cystoscory
       P/A:



                                                                                               R-> Rup + 12/3/19
       Others :




                    DR. KULDERY AGGARWAL
                              MBBS, XAS, MCH
                                    ALLUROLOGY
                        SR.                1528                OSPITA
 5. Pain
                                                                                                  Follow up Due On
                                         MED     MAZIAL
      ScoreYASHO                           Mild Pain Moderate Pain Severe Pain
                             No Pain


 Patient Education (Patient is briefed on the following )                                                           Possible Complication : : Yes / No
                                                               Expected Outcome : Yes / No

Proposed Care Plan : Yes / No
                                                                                                   Name and Sign. of Patient / Attendant


Name and Sign. of Doctor


                    H-1, 24, 26, 27, Kaushambi, Near Dabur Chowk, Ghaziabad-201010. Ph .: 0120-4181900, 4189500, 8506069461
                               For Enquiry : admin.yhk@yashodahospital.org . For: www.yashodahospital.org
                                                                     Website      Feedback : feedback@yashodahospital.org
                                                                                                                          YSSHK/OPDOPD CONSULTATION FORM/VER1,O/JUNE

{'clinic_pharmacy_details': {'clinic_pharmacy_name': 'YASHODA', 'clinic_pharmacy_address': 'H-1, 24, 26, 27, Kaushambi, Near Dabur Chowk, Ghaziabad-201010', 'clinic_pharmacy_city': 'Ghaziabad', 'clinic_pharmacy_pincode': '201010'}, 'doctor_details': {'doctor_name': 'DR. KULDERY AGGARWAL', 'doctor_qualifications': 'MBBS, MS, MCH', 'doctor_registration_number': 'DMC REG NO. 62856'}, 'patient_details': {'patient_name': 'Mr. Viveka Nand Kung'}, 'prescription_details': {'date_of_doctor_consultation': '21/03/23'}, 'procedure': {'chief_complaints_diagnosis': 'Pain'}, 'medicine_details': [{'medicine_name': 'MAZIAL', 'medicine_dosage': 'Mild Pain: 1-0-1', 'medicine_frequency': 'Before Breakfast, Before Dinner', 'course_duration': 'Follow up Due On: Not specified'}], 'lab_test_details': {'lab_test_names': 'CBC, KFT, LFT, RBS, HbA1C, URINE-R/M, URINE-C/S, ECG, CHEST X-RAY, 2D ECHO, PT, APTT, INR, HIV, HBsAg, HCV', 'procedure_request': 'Not specified'}}