                                     OUT PATIENT ASSESSMENT FORM

                                                                                                                                                 olive

                                                                                                                                                  HOSPITAL
                                            UMR260197                 SHANAN                                                            DEVOTED TO SAVING LIVES
             UMRNO                          Mr.K_V RAMAKRI
             Pt Name
              Gender                         Dr.MOHAMMED ASIF S.
              Comoaltagt                     27.03.23/12:19:39 PM
               Date & Time


                       This Consultation is volld up to 1 Week or First review vilt whichever is earlier

                                          Doctor Notes
                                          [Present Complaint Cloud History? Siys

 WEG-65-77

                                                                                                            COD ALLUM
385 159/68
                                                                                                                   CAGE TU




     Investigations                   Treatment Plan
                                                                                                           T Rosulin Gold 10




                                                                                                                      Azmanda 200



                                                                                                                         Dytà plus 10
                                                                                                                                                                  1-0
                                     Other : Dler coup              Weling / Papilotherapy / Life style aspects

                                                                                                              T Cardivas 6-15




 27 erdahil
                                   Review
                                                                                                                               prontocia son



      #12-2-718/3/45; NanaInacar>/Road, Mehidipatnam, Hyderabad - 500 028
                              T. 040 40 499 500 |W: www.olivehospitals.com

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