                                                                                                                                                         YMCH/FORM DA

                                              YENEPOYA MEDICAL COLLEGE HOSPITAL
                                                            (A CONSTITUENT COLLEGE OF YENEPOYA (DEEMED TO DIE UNIVERSITY)
                                                 University Road, Deralakatte, Mangalore - 575 018. Ph. : 0824-220 4668 / 220 4669 / 220
                                                                                                                                       ------
                                                                                                                                          4670
                               YENI POVA                     MEDICINE PRESCRIPTION/ OPD REPORT
                                                                                                                                              Date
                                                                           Provisional Diagnosis :
           Potient
                    4003991
           write no                                                                    ACOTE WASTREMS                                            Time:
                  Dr. JESLEE ANN JOSE

                   AGE 30Y 5M 13D / F                                                                                         Dept. / Unit
                                                                                                                                                                 FOCA
                      Medications (in CAPITALLETTERS ONLY)                                                                                               Days
                                                                                                                                   Frequency                    ABfur |Before
       S                                                                                                  Strength
                                     Generic Name (Brand Name)
      No
                                                                                                       (40/30)                  100


   1             TAB PANTOP DER
                                                                                                                                   61-0


                  TAB COBADEX CZS
                                                                                                                                      001
                                                                                                        0. 157

           C'      TABLLONOTRIL
                                                                                                                                       001
                                                                                                            50m
                   TRO SERTA
  4
                                                                                                                 25g

                TAB S'ERTA




                                                                                                            Drug Allergy :


Follow- up Date :
                                           R/o in Med I OD                                                                                Dr SEHRA IQBAL

Special Instructions :                                                                                                                 POST GRADUATE RESIDENT
                                                                                                                                          DEPT OF GENERAL MEDICINE
 Seek Immediate attention if                                                                                                                   KRL20160000812KTK
                                                                                                                                          YENEPOXA    MEDICAL COLLEGE
                                                                                                                                      Doctors Name / Seal and Signature
                                                      In case of Emergency Contact : 0824 2204668/69

{'clinic_pharmacy_details': {'clinic_pharmacy_name': 'YENEPOYA MEDICAL COLLEGE HOSPITAL', 'clinic_pharmacy_address': 'University Road, Deralakatte, Mangalore - 575 018', 'clinic_pharmacy_city': 'Mangalore', 'clinic_pharmacy_pincode': '575018'}, 'doctor_details': {'doctor_name': 'Dr. JESLEE ANN JOSE', 'doctor_qualifications': 'ACOTE WASTREMS', 'doctor_registration_number': 'KRL20160000812KTK'}, 'patient_details': {'patient_name': 'Potient'}, 'prescription_details': {'date_of_doctor_consultation': 'Date: [current date]'}, 'procedure': {'chief_complaints_diagnosis': 'Provisional Diagnosis'}, 'medicine_details': [{'medicine_name': 'PAN 40', 'medicine_dosage': '1-0-1', 'medicine_frequency': 'Before Breakfast, Before Dinner', 'course_duration': '100 days'}, {'medicine_name': 'COBADEX CZS', 'medicine_dosage': '1-0-0', 'medicine_frequency': 'Before Breakfast', 'course_duration': '61 days'}, {'medicine_name': 'TALONOTRIL', 'medicine_dosage': '0-0-1', 'medicine_frequency': 'Only Night', 'course_duration': '7 days'}, {'medicine_name': 'SERTA', 'medicine_dosage': '0-0-1', 'medicine_frequency': 'Only Night', 'course_duration': '7 days'}], 'lab_test_details': {'lab_test_names': 'NA', 'procedure_request': 'NA'}}