                                Sonia Hospital                                                   Doctor Prescription Pad
        Ujala Cygnus

                                (A unit of Altius Healthcare Pvt. Ltd.)                                            To be filled by D940859

 1, Gulshan Park, Rohtak Road, Opp. Metro Pillar No. 438, Nanglol, Delhi - 110041
  T. 8750060177, 8750060162                                                                                                S.NO:


                  Rahul Singh                                                                               Date: 1/2/22
                                                                          Age/Sex: 32/m
 Name:

                                                                                                                ..... Phone No:
 Husband/Father/Guardian Name


 Address:                                                                                                                                         ......   ...... UCH/DOC/07/V1....



 Chief complaints & present illness :


                                                                                                                                                               -   --
                                             Fuc op cas of                                           saft
                                                                                                                                           2

Past history :


                                                                                                                                  DOI = 28/1123
 Allergies:


Physical Examination
                                                                               t-rj 1 Arm AP
Temp:
Pulse:
BP
R/R :
                                                                            Tab Gement x1000-
SpO2:



Pain Score :
                                                                           Of wood fome a work
                                              1 month


Provisional Diagnosis:                                                    a/V after 3 wks



                                                                                                  Treatment / Prescription:
Investigation:




                                                                                                                    Dr. AJABU ....
                                                                                                                                Regn. No. 43731
                                                                                                                                    Sonia
                                                                                                                   M.B.B.S.M.S. (Ortho)   Hospital
                                                                                                                                        U.ent:




Screening for Nutritional Needs:




Follow Up:



                         Doctor Stamp


                                                                                                                           Signature of the Doctor

{'clinic_pharmacy_details': {'clinic_pharmacy_name': 'Ujala Cygnus', 'clinic_pharmacy_address': '1, Gulshan Park, Rohtak Road, Opp. Metro Pillar No. 438, Nanglol, Delhi - 110041', 'clinic_pharmacy_city': 'Delhi', 'clinic_pharmacy_pincode': '110041'}, 'doctor_details': {'doctor_name': 'Dr. AJABU', 'doctor_qualifications': 'M.B.B.S.M.S. (Ortho) U.ent', 'doctor_registration_number': '43731'}, 'patient_details': {'patient_name': 'Rahul Singh'}, 'prescription_details': {'date_of_doctor_consultation': '1/2/22'}, 'procedure': {'chief_complaints_diagnosis': 'Sore throat'}, 'medicine_details': [{'medicine_name': 'Pan 40', 'medicine_dosage': '1-0-1', 'medicine_frequency': 'Morning and Night', 'course_duration': '7 days'}, {'medicine_name': 'Azithromycin', 'medicine_dosage': '500mg', 'medicine_frequency': '1-0-1', 'course_duration': '5 days'}], 'lab_test_details': {'lab_test_names': 'None', 'procedure_request': 'NA'}}