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

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

      Age / Sex : 47pm                                                          UHID Number / Hospital Number :
      Chief complaints : clo alles hlo accidente injury to his

           forehead (got hit by the down) als histore on 3018/2)

           Grand 8.30 pm. c/opair. roblo 200 (samme (1+1s/ nomb

      Co-morbids / Past History : 1 poyndra

                   1ccc lo hy potignor A F. Elthan times In0-0

     Vitals : Temp :
                                                                                                      Examination :

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

                       SPO2 :                                                                         RS :
                                                                                                                         Diure(o)
                       Resp rate :                                                                   P/A :        sofr

                       Pulse :                                                                       CNS : NEW

                       CBG       :                                                                   Drug allergy :

     Provisional diagnosis
                                                             DECIDENTAL FAURE TO FOREHEAD-DSIDE


    Investigations :




    Treatment :
          WE                                                                -IM TT 05 M IM STAT


           sely of 3x3rn
                                                                     STERI STRIDS LOCAL APPLICATION.
                                                             -
      New @sie gaselve                                                                                                                            T.PROXIM
                                                        -T. SETOLAS -P 10m × 3 days /
          regionsobre@@yab.a

    -lenteners@                                          -T. JURYFLAM 10-1 (B) 5) + 3 5 am
     Laredor of
       3XO-Ixo-1c.@
Further advice ro cele blue
                                                                                                                                     Admission
               BILMEM@.
                                                                                                                                      Yes        No


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