                  SHRI MARUTHI                                                                ASSESSMENT FORM / RE-ASSESSMENT FORM

                                                                                               UHID NO : 118582-
                      MULTISPECIALITY HOSPITAL

                      No.33, G.S.T. Road,                                                      DRUG ALLERGY :
                      Madurantakam - 603 306.

                      Ph : 044-27554466 Cell : 9789726694

 No :             73626

                                                 Dr. Balamurugan.                                                 Date: 07/05/22 Time: 6.25
  Doctor Name :


                                               Mr. To                                                              Age / Sex : 36/m.
 Patient Name :                                                Loganathan.


Nurse's Assessment                                                                                                                     HT :                      cm


                                                                                                      RR                         :                         /min
PR                        : 96.                      / min


                                                                                                      SPO2                       : 99                      % VRA
BP                         : 120/80 mmHg


                                                                                                      WT                             ...                   Kg
Temp                      : 97.8F


Doctor's Initial Assessment                                                                           O/E : Anaemia                                          :

Chief Complaints                                                                                                       Pedal Oedema
                                                                      ..

                                                                                                                       CVS                                   :
                                  do cetral that pain , ou a off
                                                                                                                       RS                                    :
                           more from today                                                                             Abdomen                                   ..
                                    His pain agg ou preming                                                            CNS                                       ..



Past H/o : HT/DM/Asthma/Surgery/Thyroid/CAD

Family H/O : HT/DM




 Provisional Diagnosis : ? Costochondritis                                                                                                    CBG :


                                                                                                                                                      Local tudenn & ou
 Findings :                                                                                          Investigation :
                                               ECG - NIR
                                                                                                                                                                      palpation +


     Medication Name                                  Dose          Route Frequency Morning Afternoon Night Duration




        7. Hiper MK
                                                                                  1-0-1

              Tipau                                                                             1x 2 days
                                                        40mg                        1-07




         Diclo get 401




 Diet
                            :


Review after
                                                                       ... days                       Dr. Signature                             :

{'clinic_pharmacy_details': {'clinic_pharmacy_name': 'SHRI MARUTHI MULTISPECIALITY HOSPITAL', 'clinic_pharmacy_address': 'No.33, G.S.T. Road, Madurantakam - 603 306.', 'clinic_pharmacy_city': 'Madurantakam', 'clinic_pharmacy_pincode': '603 306'}, 'doctor_details': {'doctor_name': 'Dr. Balamurugan', 'doctor_qualifications': 'NA', 'doctor_registration_number': 'NA'}, 'patient_details': {'patient_name': 'Mr. To Loganathan'}, 'prescription_details': {'date_of_doctor_consultation': '07/05/22'}, 'procedure': {'chief_complaints_diagnosis': 'Chief Complaints: Pedal Edema, Anaemia\nDiagnosis: Costochondritis'}, 'medicine_details': [{'medicine_name': 'Hiper MK', 'medicine_dosage': '1-0-1', 'medicine_frequency': 'Morning, Afternoon, Night', 'course_duration': '2 days'}, {'medicine_name': 'Tipau 40mg', 'medicine_dosage': '1-0-1', 'medicine_frequency': 'Morning, Afternoon, Night', 'course_duration': '7 days'}, {'medicine_name': 'Dicloget 401', 'medicine_dosage': 'NA', 'medicine_frequency': 'NA', 'course_duration': 'NA'}], 'lab_test_details': {'lab_test_names': 'NA', 'procedure_request': 'NA'}}