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                  Dr. Sameer C. Verma
                                                                                                               Dr. Sameer Verma's Clinic                                         LASIK

                                   MBBS MD (General Medicine)                                                  202. Chandraraj Commercial Complex
                                                DTM & H ( Trop Med )                                           Chincholi Bunder Road
                Regd. No. 072356                                                                               Malad (W), Mumbai - 400 064
                                                   CONSULTING PHYSICIAN                                        Phone : 022-28768855
               Mob. : +91 98202 11350 / +91 9324482199                                                          Timing : 1.00 pm to 4.00 om & 7 pm to 10 pm
                                                                                                                Vivanta Multi Speciality Hospital
               E-mail : drsameercv@yahoo.com
                           : sameer.c.verma@gmail.com                                                          Chincholi flunder Road, Malad (W), Mumbai - 64
                                                                                                               Tel: 2873 7071 / 2873 7073


                                                                 Fitness for Surgical Procedure


             This is to certify that Madhu Vinod Mandawaria, 57 years old, Male, resident of Malad West, has been
             medically examined by me on 15-02-2023 at 3.30 pm


            E low is Noted history and findings of the Patient

            Sigery Planned Inj Ozurdex implant under GVP.
           History Right eye discomfort and redness.
           Past Surgical History HTN.

           Family History HTN.

          Allergies NAD.

          Pulse 74/minute

         Blood Pressure 140/90 mm Hg.

         RR 16/minute .

        Temp 98.

        Respiratory NAD

        Cardiac NAD

     Gastrointestinal NAD.

     CNS NAD.



    I. estigation noted.

        CG WNL.

   CXR NA

  Any other problem Nothing significant .




Hereby, No evidence of acute medical illness detected clinically at present. This certificate is valid for a


week.

Impression: pt is fit for contemplated right eye procedure .



                                                                                                                                                                      Vance

                                                                                                                                                                Dr. Sameor Vom

{'clinic_pharmacy_details': {'clinic_pharmacy_name': "Dr. Sameer Verma's Clinic", 'clinic_pharmacy_address': '202. Chandraraj Commercial Complex, Chincholi Bunder Road, Malad (W), Mumbai - 400 064', 'clinic_pharmacy_city': 'Mumbai', 'clinic_pharmacy_pincode': '400 064'}, 'doctor_details': {'doctor_name': 'Dr. Sameer C. Verma', 'doctor_qualifications': 'MBBS MD (General Medicine), DTM & H (Trop Med)', 'doctor_registration_number': 'Regd. No. 072356'}, 'patient_details': {'patient_name': 'Madhu Vinod Mandawaria'}, 'prescription_details': {'date_of_doctor_consultation': '15-02-2023'}, 'procedure': {'chief_complaints_diagnosis': 'Right eye discomfort and redness, History of HTN, Family history of HTN'}, 'medicine_details': [{'medicine_name': 'Ozurdex implant', 'medicine_dosage': '1', 'medicine_frequency': 'Single dose', 'course_duration': 'N/A'}], 'lab_test_details': {'lab_test_names': 'CG, CXR', 'procedure_request': 'WNL'}}