                                              KODLIKERI MEMORIAL HOSPITAL (KMH) (Gen.Apor
                                              8,9, Manest Nager Opp. Akashwant Jaits Road, Aurangabed - 431001; (M.S.)
                                        Contact No. (0240) 2335751. 3551717 / Emergency Contact : + 91 9022936001
                                                           Referral Slip For Obstetric Scan
                                                                                                                                    Date : 30-01-23
   To.
         Dr. - Jyoti Rui

    Centre : Shanti Imagina

                               centro
                                                                                      Mrs. Mustan                                     Hullawake
                Poetal Medicine Consultant

                Sonologist

  OBSTETRIC HISTORY                                                                     LMP- 31.10.22                                 G.A .-               13to wke

         G                 P              A                                              No of living children : Male[                                   Female

               sp.abortion@17                                                                                                    Remark
     G
     G,            Present one




   INDICATIONS FOR CONDUCTING USG



                                        TWIN IUCD Wnsite of suspected pregnancy
                                                                                                                         evous
             Vaginal biendne fivesking
             Follow up of comes of atormont                                                           Colo
                                                     d dameter of Several os.                                  ourd
             Dittepancy betweenute                                                                                                        if Their Sol

                                                                                                         charonie .F
             and other                                                                                                                     intrauterine infusion, plasmare
  11.           vallsate &              person and pocithon.
   12.       A                                                                                  2       JOtnervation
                                                               sture of   mærve                          Medical / S
                                                                                                                                            mptard
  REFERRING
  DOCTOR
                                                                                                                           Jr. Pushpa          Kodliker
                                                    DR. AMEY R. KODLIKERI
                                                           MBBS, M.S. (OBGY)                                                     MBBS, PGDHAM
                                                        Consultant Gynascologist                                             DR. PUSHPER HODLIKERI
                                                      Gynas Endoscopic Surgeon                                                                PORHAM
                                          Dip ART and Reproductive Medicine (Germany)
                                                      MMC Reg. No. 2019/02/0554                                                     MMC Reg. No. 57037
                                                                                                                                                                      KMHICHIO




2023.01.30 10:58

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