        Dr. Surojit Mondal                                                                                                         MAA MAHAMAYA HOSPITAL

                                         M.B.B.S ., M.S. (ORTHO)                                                                     KENDUADIHI, BANKURA - 722102 (WB)
                                  Assistant Prof. B.S.M.C & H.
                                                                                                                                          Mobile : 7479006140, 9830618183 (e)
        Reg. No. : 65273 (WBMC)
         E-mail : sm3036@gmail.com                                                                                                           Email : maamahamayahospital92@gmail.com
                                                                                                                                                       admin@maamahamayahospital.com
         Mob. + whatsapp : 8670226781
                                                                                                                                                                                                      88005/F
                                                                                                                                                                           Age & Sex         TISEP 2023
                                                                                                                     MANSUSHREE
        Patient Name                                                                                                .......... KARMAKAR
                                                                                                                                                                                  Date ........................

        Body Weight ...                                      .... B.P. : ..................

                                                                                                                                 Patient's Signature / Left thumb impression


       C/o                                                 sto a tu come

                                                                               of lit Fecie


                                                                                    heard            by
                                                                                                                                                                                       00
                                                                                         CRIE
                                                                                                                                  tab zecal gold

                                                                                                                                                                       -
    O/E

                                                                                                                                      . tab zarodol-e es xiday
    P                                                Conscious                                                                                                    x-

                                                                                                                                             carp Nuponta (40mg) OD AC
   c                                                                                                                                                                                               xpday


   CJ                                                Alert

                                                                                                                                          1 Lumia (cas) weeking
   J                                                Cooperative


   CI                                               GCS                                                                                                                                             12 mmmm
                                                                                                                                                     Review after

  Tem Lympaedinopathy                                                                                                                                                                   10


  Local exam
                                                                                                                                                           PRIMIS machismos
                                                                                                                                                                                       both wp (A)
                                                                                                                                                                                                                         mientas




                                                                                                                                                                                         DR. SUROJIT MONDAL
                                                                                                                                                                                                             M.B.B.S. (M.S.)
                                                                                                                                                                                             ORTHOPEDICS SURGEON
                                                                                                                                                                                                        REG. NO .- 65273


                                                                                                                                             RECIEVed 300/-
 Past Medical / Surgical History
                                                                                                                                                        as consultation for

Comorbid Condition



Open Fracture -



MESS -



Wound Description -                                                                                                                                  DR. SUROJIT MONDAL
                                                                                                                                                                     M.B.B.S. (M.S.)

                                                                                                                                                        ORTHOPEDICS SURGEON
                                                                                                                                                                    REG. NO .- 65273


RSBY · ······ ···· ······· (········ ········· ····· ·· ····· ····· · ······· ··· (········ ··· (··· ····- 7479006140

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