                  ROTARY AMBALA CANCER AND GENERAL HOSPITAL


                                             Opp. Dussehra Ground, Ram Bagh Road, Ambala Canti (Haryana)
                   Phone No. : 0171-2690009, Mobile No. : 09034056793 General Enquiry and Emergency. : 09034056791

 Receipt No.                   566581              Date/Time :            2023-03-05 5:46:40 AM                      Token No.
  Patient Name:                KULDEEP             Patient Type           Unknown                                    Age/Gender :
                               SINGH                                                                                                                      40 years
  UHID:                        0000200181950                                                                          Amt Received :                      60
  Consultant Name:              DR ABHISHEK MITTAL                                                                   Generated By:
                                                          NURSING INITIAL ASSESSMENT
                                        90
  Start Time:                  PULSE : 1   .. /min       B.P. : 2017
                                                                  DL mmHg              TEMP. : ......... F             WT. : ..........   Kg       SPO2
                                                                                                                                                   End Time:
  Pain Score                     (Score :- 0 : No Pain, 1-3 : Mild Pain, 4-7 : Moderate Pain, 8-10 : Severe Pain
                                                                                         euguval
                Regular OPDs                 PAST HISTORY & CHIEF COMPLAINTS
   · Carsology                                          Port chicken quela/ Arme
   . Neurology
   · Oncology
  . Medicine
  * Surgery
  · Orthopedics
  Physician                                 DIAGNOSIS
  * Radiology
  " Physiotherapy
  · Vain Clinic
                                                 Ro
              Visiting OPDs
 · Endocrinology
 * Gastroenterology                        PHARMACOLOGICAL TREATMENT
  Nephrology
 * Psychiatry
                                             a) Tab M-Life(H/1)
   Plastic Surgery
   Dermatology Cosmetology(Skin)
   Speech & Audiology
   Urologist                                   a Tab. Nestiton
   ENTIEar,Nose & Throat
                                                                                                             6




 INVESTIGATIONS




                                                                                                                                                                        Brain Stroke Servic
                                   6

 ALLERGY(IF ANY)                                                                                                                                                     Cardiac Care Services




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                                                                                                                                  CONSULTANT SIGN & STAMP




                                                                           Nutritional Advice
Normal Dier                       Low Salt Diet ...                   Low Fat Diet:                          High Calorie Diet:                Diabetic Diet
Renal Dier                        Other Special Diet


                      Sunday : Working, Saturday : General OPD Closed, EMERGENCY : 24×7

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