                                                                                                                   Dr. Anupama Sharma
               Dr. Vikas Gupta
                                                                                                                                                  MD (Paediatrics)
             MD (Paediatrics) Gold Medalist
                                                                                                                                                          MIAP. MNNF
             MIAP. MNNF                                                                      P          E
                                                                                                                                                       PFCCS (USA)
             Chief Neonatologist & Child Specialist                       SPES

                                                                                                                           Senior Consultant & ICU Incharge
            Ex. Registrar PGIMS, Rohtak                      CHILDREN HOSPITAL

                                                  PRESCRIPTION PAD (To Be Filled By Doctor)

                                                                                                                                                           53
           PATIENT PROFILE                                                                                                             Sr. No.

                       Ridd hit                                           ry3m2 MC Data 11/23                                             ,- pm

           Name ..
                                                                                                                                      9467002137
                                                Mohit
                                                                                                                    .. Phone No.
       ·Father 7 Mother Name :...
                                      Suncity                             Rtk
        Address

       CHIEF COMPLAINT & PRESENT ILLNESS :
                                                            Cc four ×1 day


                                                                                                                                                                kg
       Birth H/o                                                                                                                              W/T
                                                        No URI & family
                                                                                                                                                 LT/HT.
       Past History
                                                                                                                                                 OFC
       Allergies :

       Physical Examination
                                                                                         P
       Temp                                                          GPE :                                                                 Chest:
                         -
      Pulse                                                          Pallor :                                                              CVS:

     BP                      P                                       Icterus                                                                ABD
                  ..
     R/R                                                            Cyanosis :                                                              CNS:

    SpO2                                                            ENT/Oral :
                                                                                                                                            Congenital:
                                                                    Skin :
                                                                                                                                            Miscellanous:


   Provisional Diagnosis :                                                                      Treatment / Prescription

                       URI
                                                                                                Syf. Acima10-200 5ml OD
   Investigation :




                                                                                     -




                                                                                     +xf maltill 5 ml sos

  Screening for Nutritional Needs :


 Follow Up :

        12/3/2)


                        Doctor Stamp                                                                                       Signature of the Doctor


                                  Address : Sheela Bypass Chowk Rohtak, 124001 Phone : 8059993366,77

OPD Timings : Monday to Saturday Morning - 10:00 AM to 2:00 PM, Evening - 5:00 P.M. to 7:00 PM Sunday OPD Closed

{'clinic_pharmacy_details': {'clinic_pharmacy_name': 'CHILDREN HOSPITAL', 'clinic_pharmacy_address': 'Sheela Bypass Chowk, Rohtak', 'clinic_pharmacy_city': 'Rohtak', 'clinic_pharmacy_pincode': '124001'}, 'doctor_details': {'doctor_name': 'Dr. Vikas Gupta', 'doctor_qualifications': 'MD (Paediatrics) Gold Medalist', 'doctor_registration_number': 'MIAP. MNNF'}, 'patient_details': {'patient_name': 'Riddhit', 'age': 3, 'gender': 'male'}, 'prescription_details': {'date_of_doctor_consultation': '11/23'}, 'procedure': {'chief_complaints_diagnosis': 'Cc four ×1 day'}, 'medicine_details': [{'medicine_name': 'Syf. Acima10-200', 'medicine_dosage': '5ml', 'medicine_frequency': 'OD', 'course_duration': 'NA'}, {'medicine_name': 'Maltill', 'medicine_dosage': '5 ml', 'medicine_frequency': 'sos', 'course_duration': 'NA'}], 'lab_test_details': {'lab_test_names': 'NA', 'procedure_request': 'NA'}}