           ENESIS HOSPI
                                             GENESIS HOSPITAL


                                             (a unit of Vigneshwara Healthcare Private Limited)
                                                                                                                                                                               CERTIFED
                                            Opposite DPS school, Sector-84, Gurgaon-122004 - email: genesishospitalggn@gmail.com
                       NOVATION             FOR APPOINTMENT CALL: 817 830 3100, 817 883 1702



                                                      EMERGENCY ASSESSMENT



                             Andrisk
        Name                                                                                      Category             Physical Assessment                      Arrival to Hospital
       Age/Sex                  2.07/91                         Allergies              Emergent                         Conscious                               On Foot?
       UHID No.
                                                                                       Urgent                           Unconscious
                       22/04/2023                                                                                                                               On Wheel Chair
      Date                                                                            Non Urgent                        Hyper                                   On Stretcher
                                                                                      Brought Dead                      Aggressive                              Other
        Nursing Assessment/Vital Sign                                        Chief Complaint
                                                                                                                                                       Diagnosis
      Time
     BP

      Pulse

      Resp.
      Temp

      Date & Time:                           General Physical Examination
                                                                                                Space for Patient History, Diagnosis, Plan of treatment including follow up

                                                                                            Les . Syp Augmentin 5ml




                               Management of Medication
                                                                                                      · Syp Ingenic deus
           Drug              Dose      Route Freq            Medication Time

                                                                                                                                                     5 ml try




                                                                                                             Dering & Belading




Doctor Sign.
                                                     Nurses Sign.                                                                                   85 days
                                    Investigations




   Instruction to patient:
                                                                                                                                      -un                    HUNTE
                                                                                                                                               --         --     -


     Condition on Admission and Time:



    Signature of Consultant / EMO


                                                                                                                            Date & Time ...................................

{'clinic_pharmacy_details': {'clinic_pharmacy_name': 'Genesis Hospital', 'clinic_pharmacy_address': 'Opposite DPS school, Sector-84, Gurgaon-122004', 'clinic_pharmacy_city': 'Gurgaon', 'clinic_pharmacy_pincode': '122004'}, 'doctor_details': {'doctor_name': 'Dr. [Doctor Name]', 'doctor_qualifications': '[Doctor Qualifications]', 'doctor_registration_number': '[Doctor Registration Number]'}, 'patient_details': {'patient_name': '[Patient Name]'}, 'prescription_details': {'date_of_doctor_consultation': '22/04/2023'}, 'procedure': {'chief_complaints_diagnosis': '[Chief Complaints and Diagnosis]'}, 'medicine_details': [{'medicine_name': 'Les Syp Augmentin', 'medicine_dosage': '5 ml', 'medicine_frequency': 'BD', 'course_duration': '85 days'}, {'medicine_name': 'Syp Ingenic Deus', 'medicine_dosage': '5 ml', 'medicine_frequency': 'BD', 'course_duration': '85 days'}], 'lab_test_details': {'lab_test_names': '[Lab Test Names]', 'procedure_request': '[Procedure Request]'}}