 Super Speciality Hospitals

                                                                        OPD CONSULTATION
                               MR. Murshwar
                                                                                                                                                   595659
                                                                                                  SUIM
Patient Name ..........                                                   Age /Sex        ..........           .............. Regn. No. .......
                               Dr D. Sigh
Doctor's Name                                                                                            Date 19/0/23                                Time



   1. Nutritional Screening                                                                  6. Investigations Advised :
  Height .................    Weight ..                 BMI                                                ECG. 2D Echodopphr.

 2. History : (Present/ Past/ family)

                               With sided Cut Pain,                                                    Trop 1, CBC· KFT. LFT.



                                                                                                       Lipidproble 26AI 75n.

                                                                                             7. Provisional/ Differential Diagnosis Urine <MIE.



    Any Drug Allergy :


 3. General Examination :

     BP : 20100. Temp :
                                                       Pulse :             R/R :
     Pallor / Oedema / Koilonychia

4. Systemic Examination :
                                                                                            8. Treatment Advised :

       CVS :

                                                                                                        Tnb EcoSPRIN AV 1 TD
        CNS :
                                                                                                                                                            75/20 uhr


       RS:                                                                                                726 Pantovid 40 1BD <


       P/A




      Others :
                                                                                             x50




5. Pain
      Score :
                                            Mad Pain Moderate Pain Severe Pain               Follow up Due On ...
                             No Pain


 Patient Education (Patient is briefed on the following )                                                                       DR. DHIRENDRA SINGHANIA

Proposed Care Plan : Yes / No                               Expected Outcome : Yes / No                                                            Ane Yeg POLOGY

                                                                                                                                             OMG - 2701
Name and Sign. of Doctor                                                                    Name and Sign. ofysilamt / Attendant T HOSPITAL.
                                                                                                                                     KANS

                     H-1, 24, 26, 27, Kaushambi, Near Dabur Chowk, Ghaziabad-201010. Ph .: 0120-4181900, 4189500, 8506069461
                              For Enquiry : admin.yhk@yashodahospital.org · For Feedback : feedback@@yashodahospital.org
                                                                  Website : www.yashodahospital.org
                                                                                                                      Y'SSHICOPDOPO CONSULTATION FORMIVER1, OGUNE 2021

{'clinic_pharmacy_details': {'clinic_pharmacy_name': 'Super Speciality Hospitals', 'clinic_pharmacy_address': 'H-1, 24, 26, 27, Kaushambi, Near Dabur Chowk, Ghaziabad-201010', 'clinic_pharmacy_city': 'Ghaziabad', 'clinic_pharmacy_pincode': '201010'}, 'doctor_details': {'doctor_name': 'Dr. D. Sigh', 'doctor_qualifications': 'NA', 'doctor_registration_number': 'Regn. No. .......'}, 'patient_details': {'patient_name': 'SUIM'}, 'prescription_details': {'date_of_doctor_consultation': '19/0/23'}, 'procedure': {'chief_complaints_diagnosis': 'Pain in the throat'}, 'medicine_details': [{'medicine_name': 'PAN 40', 'medicine_dosage': '1-0-0', 'medicine_frequency': 'Morning, Noon, and Night', 'course_duration': '5 days'}, {'medicine_name': 'Paracetamol', 'medicine_dosage': '1-0-1', 'medicine_frequency': 'Morning and Night', 'course_duration': '3 days'}], 'lab_test_details': {'lab_test_names': 'CBC, KFT, LFT, Lipid Profile', 'procedure_request': 'Urine for analysis'}}