ealme Shot on realme X7 Max




                                            NAMAKKAL (DT.) TAMILNADU - 637 205
                                            ELAYAMPALAYAM. TRUCHENGODE

                                                                                                  Phone :+91-42882484110SPITAL & RESEARCH INSTITUTE.

                        THOPAEDICS.          DEPARTMENT OF ok 3.
                                                             Date                                                                              OTHERS
                                                                 Doctor's Sign :
                                                                                                                                                SPINE

                                                               SPECIAL STUDIES
                                                                                                                                                ABDOMEN & PELV
                                                                MUSCULOSKELETAL
                                                                                                                                                THROAX
                                                                     SPINE L. S. Spine
                                                                M.R.L. ANGIO                                                                    HEAD & NECK

                                                                HEAD                                                                            BRAIN

                                                                O Plain D with contrast                                                          D Plain D with con


                                      MR!                                                                         CT



                                                                                                   Barium Enema

                                                                                                Follow Through
                                                            Any Other                               Barium Meal


                                                           Scrotum                                 D Barium Meal


                                                            Abdomen & Pelvis                        D Barium Swallow


                                                                                                   DI.V.P/MCU / HSG                          Please Specify area
                                                                     0 Neck

                                                  ULTRA SOUND                                       SPECIAL PROCEDURES                    DIGITAL X - RAY


                                                                              mation
                                                                                                                                                  Provisional Diag
                                            sim                                                        Cheric Low bak

                                                                                                     Localned , 20 ans

                                                                                                      Chanie Low bach Stram                       Clinical Summar

                                                                                                                                                   Ref. Dr. : S YOG
                                                   0:
                                                                                                                                                   Address:

                                                                                                                                                   Patient Name :
                                                   Age/ Sex : 5630


                                                                                                                         X-RAY / USG / CT / MRI REQUISITION FORM

                                                                                                                   Unjanai, Elayampalayam - 637205, Tiruchengode, N

                                                                                          RESEARCH INSTITUTE

                                                                                                                                   SWAMY VIVEKANANDHA MEDIC




2023 03 07 12:43

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