                      SHREYA HOSPITAL
                                                                                                             837, Shalimar Garden, Extn-I, Sahibabad, GZB.
                                                                      we care your smile                       Helpline No .: 0120-4775450, 54 (50 Lines)
                           (A Unit of Shreya Multispeciality Hospital Pvt. Ltd.)
                                                                                                                        Paytm & 3 : 7838737363
    ave care your smile            (Govt. Registration No .: RMEE1901175)                                    E-mail:shreyahospital837@gmail.com, Web .: www.shreyahospital.com

    ·ÚJHID No .: 140665                                                   OPD PRESCRIPTION

                                                     Department : lyn 10                                                          27176                       Date : 16.9.2020
     Receipt No .:.
                                                                                                                                                      304 % Sex: P
     Name of Patient : Jens Prale,                                                                                                                                                                    NA
                                                                                                                                           Age: 30
                                                                                                                                                              cash
     Name of Consultant :                                                                                                                 .. PANEL

       1. PRESENT COMPLAINTS :-                                                                                10. PROVISIONAL/DIFFERENTIAL DIAGNOSIS:

                              Lu A 12.1. 2023
                                                                                                                                               7.6.2003 LFT WML
                                                                                                               11. INVESTIGATION:
                             EDI - 19 - 10 2023

                                                                                                                   Hb                           Unne Ach
                                                       AUG -3600

       2. PAST HISTORY :-
                                                                          ARTHRITIS THYROID                     12. TREATMENT ADVISED: (CAPITAL LETTER ONLY):
           DM       HTN             COPD           SEIZURE
                                                   DISORDER
                                                                                                                     Jab Eios -Fe 10
       3. G. I. PLA, LMP.                                                                     EDD                                                                          Y15 day

                                                                   PIA FH- 3 GUP
       4. FAMILY HISTORY
                                                                                 Ve presencial
                                                                                                                        Jab Ancal-D 10.
                                                                                                                                                                                   Xisday
       5. DRUG ALLERGY & HISTORY :-                                              AUSTRY                                                                   0



        6. GENERAL EXAMINATION :-
           BP: 114/76             PULSE:                                          SPO2
                                                                                                                     Dalimar D3 sept all
                                           R/R:
                  MIP .:
                                                                                                                                                      once avle.

        7. NUTRITIONAL SCREENING:
                               WEIGHT 69/7/10OVER WEIGHT                                                                   Activo Cife.
           HEIGHT

           Pallor/Edema/Icterus/Lymphdnode/Kollonychia/Dermatitis
                                                                                                                            1) file - 10 knekke100g
        8. SYSTEMIC/ LOCAL SITE EXAMINATION :



                                                                                                                                                                                 cesup1




       9. PAIN:



                                                  56                         7-8    9-10                            13. NEXT FOLLOW UP VISIT:
                            1-2          3.4
                  0                                                            SEVERE
                            MILD           MODERATE
G
    PATIENT EDUCATION (patient Is Briefed On The Following)
                                                                                                    ( ) No
                                         ( ) Yes
     Proposed Care Plan                                                                             ( ) No          SMH/GEN/FR/17                                          Consultant Sign, & Stamp
                                             ) Yes ............                                                     Rev.No.05, Dated 02/02/2023
     Expected Outcome                                                                               ( ) No
     Possible Complication ( ) Yes.                     ...................................

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