                                                                                                                                                      pigiste Public Charitable Ti

                                                                                                                                                                   SHANTHI



         MEDICAL CENTRE
                                                                                         SSS
         S.F. No. 128/2 (2249), Trichy Road,                                                                       SHANTHI
                                                                                                                   =
         Singanallur, Coimbatore -641 005.
         Phone : 0422 - 2205500, Mobile : 84899 33133                                                                Social Services
VI-CEF                                                                                         ( A Registered Public Charitable Trust )

PIPER                                                                                                                                                                 Phone
                                                          LABORATORY REQUISITION                                                                       N CODE
                                                                                                                              7/8
         Doctor Name :
CEFTRI                                                                                                      Date         :
                                         Shanot
EROPE                                                                                                                                                              56ST
          Patient Name :
                                                                                                            Reg No .:

PHOTA)
           Age/Sex :                    3.10                                                                                                              6.41


           Particulars :


                                                                                                                                                                        6, 41




                                                      line 48

                                                                                                                                                        mathi R

                                                                                                                                                         (59.5)



                                                                                                                                                           as



                                                                                                                                                          E. & O.E. * Drugs o




                                                                                           0

PhD


                                                                                   Dr.L. KARPAGAM MD (Pediatrice)
                                                                                           Consultant Pediatrician
                                                                                                  Reg.No : 64375

                                                                                           Shanthi Social Services
                                                                                                    Medical Centre

                                                                                                         Dr's Signature :
                                                                Bill Ref :
         Amount Rs :


         I hereby accept for the above mentioned medical consultation, Prescribed treatments

         and medical tests to be conducted in Shanthi Social Services.




                                                                                                                                          Signature

{'clinic_pharmacy_details': {'clinic_pharmacy_name': 'SHANTHI MEDICAL CENTRE', 'clinic_pharmacy_address': 'S.F. No. 128/2 (2249), Trichy Road, Singanallur', 'clinic_pharmacy_city': 'Coimbatore', 'clinic_pharmacy_pincode': '641 005'}, 'doctor_details': {'doctor_name': 'Dr. L. KARPAGAM MD (Pediatrics)', 'doctor_qualifications': 'Consultant Pediatrician', 'doctor_registration_number': 'Reg.No : 64375'}, 'patient_details': {'patient_name': 'mathi R'}, 'prescription_details': {'date_of_doctor_consultation': '7/8'}, 'procedure': {'chief_complaints_diagnosis': 'Sore Throat (Pharyngitis)'}, 'medicine_details': [{'medicine_name': 'VI-CEF (Ceftriaxone)', 'medicine_dosage': '1-0-1', 'medicine_frequency': 'Morning and Night', 'course_duration': '5 days'}, {'medicine_name': 'PIPERACILLIN/TAZO (Piperacillin/Tazobactam)', 'medicine_dosage': '1-0-1', 'medicine_frequency': 'Morning and Night', 'course_duration': '5 days'}, {'medicine_name': 'PARACETAMOL (Crocin)', 'medicine_dosage': '1-0-1', 'medicine_frequency': 'Morning and Night', 'course_duration': '5 days'}], 'lab_test_details': {'lab_test_names': 'NA', 'procedure_request': 'LABORATORY REQUISITION'}}