                                                                                                                             Gheesibai Memorial
                                                                                                                             MITTAL HOSPITAL

                                                                                                                         .... & RESEARCH CENTRE

                                                                                                                                     Pushkar Road, Ajmer - 305004
                                                                                                                             Tel .: (0145) 2 603 603 Mob .: 80030 53111
                                                                                                                         Info@mittalhospital.com www.mittalhospital.com




                                                                      OPD CASE PAPER                                                                Token No. :       1
 Room No: 27

                                                                                   Patient No : 22058859                               Date : 04/05/2023 17:55:10
Case No. 23058342                             Receipt No : 23098393

                                      : Baba MOHD.HAMZA KAZMI                                             Age/Sex            : 10 MONTH/M
     Name
                                                                                                          Tel Number        : 9829667999
    Father/Husb. Name                 :
                                      : H.NO .- AZAD NAGAR KHAN PURA AJMER                                Category           : INDIVIDUAL
    Address
                                                                                                          Company           :
                                                                                                          Department : PAEDIATRICS
    Consultant                       : Dr. PREETI GARG



     Present complaint




                                                                                     Provisional diagnosis
      History of past illness



                                                                               Vaccinativ                                                                 VITALS

                                                                                                                                             BP :

     Systemic examination
                                                                                                                                             PULSE :


                                                                                                                                             TEMP :
     Drug allergies
                                                                                                                                             WT: 8.4kg-


                                                                                    Treatment plan / Medication / Diet advised
     Investigations advised
                                                                              Rx
                                                                                         1 Flusix Teter 0.5ml instal.



                    1. Typba tw 0. 5aliment

                                                                                              Aubint 3 forte 0.5ml of.

                                                                                                                                    ( upto 1 yer)




                                                                                     26. Rxplan 1 ml OD




                                                                                   Rf Sumar 1.2 ml sos.




                                                                                                                                        PL

      Preventive aspects


      Review date/after day(s)

                                                                                                                                     Signature

{'clinic_pharmacy_details': {'clinic_pharmacy_name': 'MITTAL HOSPITAL', 'clinic_pharmacy_address': 'Pushkar Road, Ajmer - 305004', 'clinic_pharmacy_city': 'Ajmer', 'clinic_pharmacy_pincode': '305004'}, 'doctor_details': {'doctor_name': 'Dr. PREETI GARG', 'doctor_qualifications': 'NA', 'doctor_registration_number': 'NA'}, 'patient_details': {'patient_name': 'Baba MOHD.HAMZA KAZMI'}, 'prescription_details': {'date_of_doctor_consultation': '04/05/2023'}, 'procedure': {'chief_complaints_diagnosis': 'Present complaint'}, 'medicine_details': [{'medicine_name': 'Flusix Teter', 'medicine_dosage': '0.5ml', 'medicine_frequency': 'instal.', 'course_duration': 'NA'}, {'medicine_name': 'Typba tw', 'medicine_dosage': '0.5ml', 'medicine_frequency': 'aliment', 'course_duration': 'NA'}, {'medicine_name': 'Aubint 3 forte', 'medicine_dosage': '0.5ml', 'medicine_frequency': 'of.', 'course_duration': '(up to 1 year)'}, {'medicine_name': 'Rxplan', 'medicine_dosage': '1 ml', 'medicine_frequency': 'OD', 'course_duration': 'NA'}, {'medicine_name': 'Rf Sumar', 'medicine_dosage': '1.2 ml', 'medicine_frequency': 'sos', 'course_duration': 'NA'}], 'lab_test_details': {'lab_test_names': 'NA', 'procedure_request': 'NA'}}