                                                                                             al Jabalpur
     ALB                                           OPD ASSESSMENT FORM


     SPECIALTY                                     (TO BE FILLED IN CAPITAL LETTERS)

    HOSPITAL
                                                                                                                                                                            NABH
                                      Meha Patel                                                                                           Husband A



     Mrs/Mast./Ms                                                                                              Age
                                                         AM/PM Sex: Male                                                                              OPD No .:
      03/2015 Time:                                                                                  Female
                                                                                                                             Height:
                                                                   Nationality                                                                               Weight:
                                                                                                               History Given By : Self/Other :


                                                                                                                                       Allergy

                                                      Ba- B Meg.

    Complaints :                                                                                                          Plan of Care :

        27/05/2020                                                                                                   Received                                             Adv
                                                   Recurred artiD


       6/03/2023                                                                                                                                                    CBC , Coogulati
                                                                                                                                                                                        T-on
                                                    3 times
                                                                                                                                                        2.eft                          profil

                 43 Polo A3
                                                                  43 POLO A3: 3916                                                                                  KFT


                                                                                                                                                          4 HIV/ubsng
       2 MTP Pills                                                   weeks with Rh Neg



    /Systèmic Examination :                                     Good betal movement                                                                              5 TSH.
  ust - NS.

                                                                                                                                                                 6.ECK

                                                        1/3 Us4 - 5CF
  gy - Recurrent
                                                                                                                                                                          PMC.
                  tonsilitis
                                                                                 AFI 4-5'


                                                                                  cot 3000
  ity Hist- CAD Mother.
                                                                                                                                             1 . Patient for -
                                                                                 FIS 154/wink.


                                                                                                                                                             iss' at 3 pm
                                                         int as closed


                                                                                                                                                 2)                       Muchust
                                                              oligo . 50 rato
                                                                                                     3



  tigation Advisestable
                                                   NIPT - WNL                                                                                                     Amange
   F Velalista

     P/A teur size                                  Double Marker- Internediate
                                                                                                         ash                                               Donar (


   tiHs + R
                                                       TSH- 1.6 2/57
                                                                                                                                                                          Dr. Charu Pathak

                                                                                                                                                      MBBS (Gold Medalist), M.S. FMAS
                                                                                                                                                  Consultant Obsterics & Gynaecology
                                                                                                                                            E-mail: gynaecology2.jabalpur@shalby.org
                                                                                                                                                                  Mob : +91 9575801200
  Follow up Date :



   BY HOSPITAL

REDMI NOrush                   OTE 12 PRO 5G

  (fe-> **: Scheme No.5.Ahinga Chowk. Kachnar Road, Vijaynagar, Jabalpur, Madhya Prad0 6/03/2023 20:15
                                                    1: info.jabalpur@shalby.org | CIN : U85110GJ2004PLC44667

{'clinic_pharmacy_details': {'clinic_pharmacy_name': 'Jabalpur Hospital', 'clinic_pharmacy_address': 'Scheme No.5, Ahinga Chowk, Kachnar Road, Vijaynagar, Jabalpur, Madhya Pradesh', 'clinic_pharmacy_city': 'Jabalpur', 'clinic_pharmacy_pincode': 'NA'}, 'doctor_details': {'doctor_name': 'Dr. Charu Pathak', 'doctor_qualifications': 'MBBS (Gold Medalist), M.S. FMAS', 'doctor_registration_number': 'NA'}, 'patient_details': {'patient_name': 'Meha Patel'}, 'prescription_details': {'date_of_doctor_consultation': '27/05/2020'}, 'procedure': {'chief_complaints_diagnosis': 'Recurrent tonsilitis'}, 'medicine_details': [{'medicine_name': 'ALB', 'medicine_dosage': '1-0-1', 'medicine_frequency': 'After Lunch and Before Dinner', 'course_duration': 'NA'}, {'medicine_name': 'Ba-B Meg.', 'medicine_dosage': '3-0-3', 'medicine_frequency': 'Before Breakfast, After Lunch, and After Dinner', 'course_duration': 'NA'}, {'medicine_name': '43 Polo A3', 'medicine_dosage': '1-0-1', 'medicine_frequency': 'After Lunch and Before Dinner', 'course_duration': 'NA'}], 'lab_test_details': {'lab_test_names': 'CBC, Coagulation Profile, KFT, HIV', 'procedure_request': 'Request for CBC, Coagulation Profile, KFT, and HIV tests'}}