                                                Sevadham Trust's

                                                                   Sevadham


                                                                           multi-speciality hospital
               NABH                                                NABH Accredited, ISO 9001 :2015 Certified
                                Talegaon Dabhade (Stn.) Tal. Maval, Dist. Pune - 410 507, Ph No ,: 02114-222456


                                                               OPD ASSESSMENT FORM                                                      Date :
MRN .:                                                                                                                                              519123
                  p00 24366

Patient Name: Neha Shingewar                                                                      Cheif Complaints :                                                                  PAIN SCORE

                                                                                                 =          Productive com
Age : 35ys                                     Sex: F
                                                                                                            comosten                                                                        HURTS
                                                                                                                                                                                            WORTH
OPD No .: 7668 Category Ser                                                                                  Nocturnal

History And Allergies :                                                                                                                                                                  PIOLE LETS




                                                                                                                                                      88/
                                                                                                                 20/80

General Examination : Ht :                                                Wt:                            BP                           PR:

Pallour / Oedema / Cynosis / Icterus / Lymph node

Systematic Examination : RS BlEvents                                                                   HZ
                                                                                        CVS:                                          CNS : OMG

Previous Investigation Record :                                                                   Investigation Advice :




 Provisional Diagnosis .:
    Chr. Bronartis

              Plase




                            Name of Medicine                                                    Breakfast                     Lunch                       Dinner
  Sr.                                                              Dose         Route                                                                                          Days         Total
                                                                                           Before             After      Before       After      Before            After
                                                                                                                                                                                 10          20
                                       PULMOCHEAP
                      TAB
  01

   02            CAP REGON-BER 20                                                                                                                                                 10         10

   03             40 WPITUSS                                                                                    10ml dimare                                                                      1.

                       TODOS TORKAST FX 120mg                                                                                                                                               10
  04                                                                                                                                                                             10




 Referral :                                                                                            Dr. Anl Bagale

                                                                                                       M.D. Medicine
Follow Up:
                                                                                                       Reg. No. 66644
 Signature & Name of Consultant :                                                                      SEVADHAM HOSPITAL
                                                                                                                                                                           SH/OPD/F-03.01
In Case of any Emergency Please Contact On Emergency No .: (02114) 222456

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