           A.G. HOSPITAL - CHROMEPET
          (Unit of GAJANAN HOSPITALS PVT. LTD.)
          CIN : U85110TN2003PTC052023
          No. 30, South Street, Radha Nagar, Chromepet. Chennai - 44.                                                    19004                    A G HOSPITAL
          Phone : 044 - 22651325, 48532380
                        INITIAL ASSESSMENT FORM BY EMERGENCY / CASUALTY DEPT DOCTOR

            Name: Mr. HARIHADAN-R                                                                             Date / Time: 30/2/23.

            Age / Sex : 47Pm                                                     UHID Number / Hospital Number :
           Chief complaints : clo alles Llo actifand Injury to ha

               forehead ( got hit by the dow) als his home on 30/8/23

               Grand 8:30 pm. c/oper - 1oblo 10c /terzi /sites/comb
          Co-morbids / Past History : 1 polendia

                        1ccc 10 hypotyre 1 5. Estran times 10-0

         Vitals : Temp :
                                                                                                       Examination :

                           B.P.               : 120/90 mm                                             CVS :               SIS0

                           SPO2                                                                       RS :
                                                                                                                       Biurem
                           Resp rate :                                                                P/A :             Sofr

                         Pulse :                                                                      CNS : NEW

                         CBG              :                                                          Drug allergy :
      Provisional diagnosis
                                                            RESIDENTE ENSURE TO FOREHEAD-DSIDE


     Investigations :


                                                                                                                           n
    Treatment :
          ME                                                                -IM IT 05 M IM STAT



                                                                    STERI STREPS LOCAL APPLICATION.

       Non @sie goselve                                                                                                                                T.PROKYM
          regionschore@@yahoo.                          -T. SATOLAS -P 10% + 3 days/


    - FerJenes@                                         -T. JURYFLAM 10-1(B)51+ 3 + am
    Lavender of
        3X0.1fo.1cp
Further advice to co le blue.
                                                                                                                                      Admission

                                                                                                                                      Yes         No

                                                                            Medical officer
                                                                           Name & Signature :
                                                                           Reg. No. :
                                                                                                                         16/206

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