      YASHODA
                                                                                                                                         card
       Super Speciality Hospitals
                                                                        OPD CONSULTATION
                          Preeti Sharma Age /Sex 36Y/F, Regn. No. 601563
Patient Name ..

Doctor's Name                                                                                        Date 3/10/23                                  Time
                                             UR:CARINACUP

  1. Nutritional Screening                   CONDUE                                           6. Investigations Advised :
  Height. ...........       Weight                     BMI ..
  2. History : (Present/ Past/ family) 9868881155




                                                                                              7. Provisional/ Differential Diagnosis :

      Any Drug Allergy :                                                                                            italy rashes on base

    3. General Examination :                                                                                                  Parme forcer.

        BP :                        Temp :              Pulse :              R/R:
       Pallor / Oedema / Koilonychia
                                                                                    HC.DM
     4. Systemic Examination :                                                                8. Treatment Advised
                                                                                                     Tab. Defra (6) up
           CVS :
                      T. CornimetE
                                                                                                                                           (ABF)                               10
           CNS :
                                                                             10

                                                                                                                                Montair-fx
            RS:                                                                               Tab.

               PIA                                                                                                                                                             15


                                                                                              Tab. Doxyhac LB
               Others :
                                                                                                                                                          100 mg
                                                       50

                                                                                                                                                                              15
                                                                                                     Deviva-CMS 0.1% 8/
        5. Pain
             Score :                                                                           Follow up Due On (2)
                                   No Pain     Mild Pain Mocarans Pain Severe Pain

        Patient Education (Patient is briefed on the following )                                                                         DR. GARIMA GUPTA

        Proposed Care Plan : Yes / No                           Expected Outcome : Yes / No                     Possible Complication :_ Yes / No
                                                                                                                                                                    OLOGY
       Name and Sign. of Doctor .......                                                        Name and Sign. of Patient / Attendant                               WY HOSPE

                            H-1. 24. 26; 27, Kaushambi, Near Dabur Chowk, Ghaziabad-201010. Ph .: 0120-4181900. 4189500. 8506069461
                                      For Enquiry : admin.yk@yashodahospital.org . For Feedback : feedback@yashodahospital.org
                                                                       Website : www.yashodahospital.org
                                                                                                                        W85-4GGIPO/OFO CONSULTATION FORMUERELGUIUNE 2021

{'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. GARIMA GUPTA', 'doctor_qualifications': 'UR:CARINACUP', 'doctor_registration_number': 'NA'}, 'patient_details': {'patient_name': 'Preeti Sharma', 'patient_age': 36, 'patient_sex': 'F'}, 'prescription_details': {'date_of_doctor_consultation': '3/10/23'}, 'procedure': {'chief_complaints_diagnosis': 'Pain'}, 'medicine_details': [{'medicine_name': 'Nutritional Screening', 'medicine_dosage': 'NA', 'medicine_frequency': 'NA', 'course_duration': 'NA'}, {'medicine_name': 'T. CornimetE', 'medicine_dosage': 'NA', 'medicine_frequency': 'NA', 'course_duration': 'NA'}, {'medicine_name': 'Tab. Defra', 'medicine_dosage': 'NA', 'medicine_frequency': '6', 'course_duration': 'NA'}, {'medicine_name': 'Tab. Montair-fx', 'medicine_dosage': 'NA', 'medicine_frequency': '15', 'course_duration': 'NA'}, {'medicine_name': 'Tab. Doxyhac LB', 'medicine_dosage': '50 mg', 'medicine_frequency': '10', 'course_duration': 'NA'}, {'medicine_name': 'Deviva-CMS 0.1%', 'medicine_dosage': '8', 'medicine_frequency': '15', 'course_duration': 'NA'}], 'lab_test_details': {'lab_test_names': 'NA', 'procedure_request': 'NA'}}