                      Institution Run By Brahm Shakti Trust                                                         OPD PRESCRIPTION SLIP
 BSH
             BRAHM SHAKTI                                                                               U-1/78, Buch VIhar, Hein Kanihawolus Road, Delhi-86
                                                                                                    Helpline :1800-119-120 Ph. : 27531483, 27537967, 27537894
                                                                                ISO 9001 : 2015
BSH/P5086              HOSPITAL                                     PEH-7019-083 CERTIFIED
                       WE TREAT HE CURES                                                                                Imoll: beshenshaktihospital@gmail.com

 Date              04-Oct-2023 09:17                                     Patient No        PU087363
 Reg No            OP2329273                                             Age/ Sex          53 Yrs / F
 Patient Name      Mrs. SHEELA BANSAL                                    Mobile            9555596888
 Consultant        Dr Jyotsna Gupta                                      speciality         Gynaecology
 Med. Reg. No     DMC 19870                                              Receipt No         RCN2441983
 Qualification MBBS,DNB(Obs & Gynae)                                     Token No           0010
FRoom No ver isBapplicable
                   Wed & Sat (Gen) 09:00AM to 12:00 Noo
 Received with Thanks from Mrs. SHEELA BANSAL Rupees 100.00 ( One Hundred only ) vide DRAFT Draft No 7723 drawn

Pulse/min
                                                       go itching
RR/min


 B.P.

                                                                                                                        3
Po2

                                                                                                 a-M
Allergy
                                                                                             B.A. AF KITx1 day

Height                                                                                                                               =


 Weight
                                                                                    4 Cap well wonen
                                                                                                                       (50+).on)
 Length


 Head®
                                                                                   filial vaginal Persay
 MUAC                                                          10/10
                                                                                                                            65 × 6 days

DLMP


 E DOD
                                                              20/11
  Gravida


  Par


  Abortion                                0             2                                                  8
                                                                                       6                                    10

  Vision                                                                                                                             PAIN SCALE

                                      No Pain        Mild Pain Discomforting Distressing            Intense          Excruciating
 PR/E
 V
   L/E                                                                          Next follow up

   ON PANEL - AAI . CCRT . CGHS . DERC. DJB . DITDC . DU . DTL . DTC . IGNOU . MOTHER DAIRY (SAFAL) . MOTHER DAIRY (MILK & ICE cream) . NDPL
   . TRAI . ALANKIT . UNIVERSAL . MD INDIA . EAST WEST MEDICLAIM . E-MEDITEK . GENNIS . HDFCERGO . HEALTH INDIA . PARAMOUNT . ITK_
   VIPUL MEDICLAIM . BUREAU OF INDIAN STANDARDS'. CHOLAMANDALAM . FOCUS HEALTHCARE . GOOD HEALTH PLAN / APPOLO MUNICH / DHS / DVD
   PENSION TRUST / GOKUL HEALTH CARE / ICICI PRUDENTIAL / PAREKH HEALTH MEDICARE . STAR HEALTH . SAFEWAY TPA . DELHI POLICE . BAJAJ ALLIANZ
   . GRAND HEALTH SERVICE . UTI . RELIGARE                                                                     For lab tests - Associated with
      24 HOUR SERVICES - BLOOD BANK - PHARMACY - Dr Lal PathLabs

{'clinic_pharmacy_details': {'clinic_pharmacy_name': 'BRAHM SHAKTI', 'clinic_pharmacy_address': 'U-1/78, Buch VIhar, Hein Kanihawolus Road, Delhi-86', 'clinic_pharmacy_city': 'Delhi', 'clinic_pharmacy_pincode': '86'}, 'doctor_details': {'doctor_name': 'Dr Jyotsna Gupta', 'doctor_qualifications': 'MBBS,DNB(Obs & Gynae)', 'doctor_registration_number': 'DMC 19870'}, 'patient_details': {'patient_name': 'Mrs. SHEELA BANSAL'}, 'prescription_details': {'date_of_doctor_consultation': '04-Oct-2023'}, 'procedure': {'chief_complaints_diagnosis': 'Genital itching'}, 'medicine_details': [{'medicine_name': 'AF KIT', 'medicine_dosage': '1 tablet per day', 'medicine_frequency': '1 course per day', 'course_duration': '6 days'}, {'medicine_name': 'Wellwoman', 'medicine_dosage': '4 capsules per day', 'medicine_frequency': '1 course per day', 'course_duration': '10 days'}, {'medicine_name': 'Persay vaginal cream', 'medicine_dosage': '1 application per day', 'medicine_frequency': '1 course per day', 'course_duration': '6 days'}], 'lab_test_details': {'lab_test_names': 'NA', 'procedure_request': 'NA'}}