                           FIRST PRIVATE RENAL TRANSPLANT CENTRE OF RAJASTHAN (SINCE 1986)                                                                Format No. : MHRC/oPO/F3
                          Monilek Hospital                                                                                                                Rev. No. : 01



                           & RESEARCH CENTRE

                           (A Wing of Smt. Mohinidevi Lakhraj Odhrani Charitable Trust)

                                                                                                 PRESCRIPTION SHEET
 Allergy
                                                                                                                               207197 30/7/23
NO] Unknown
                                        Patient Name Mrs. Palak Age/Sex 29 MHRC NO.
Yes It Yes                                                                                                                                      .......... Date.
                                                                            Bhalt
Details
                                                                                                            UPT
                                        CHIEF COMPLAINT

VITALS:
Pulse 108                /Min                                                   usas

B.P /35/82 mm/hg
                                                                              NT Scan
                          ./min                                                                                                                             NS
RR
                                                                               double
Ht                                      BRIEF HISTORY:
                                .....                                      Kmanku                                            1 EPLY
               62
Wt :                            Kg

 Temp
                                                              Vou Chy
              98
SpO ......                        .%


 EXAMINATION                                                                audity
                                                                           headache


                                                                                    each



                                                                             G2 POLOA,



                                                                            jc - 3yr




                                                                         1 Abgeuly




Pain Assessment :                                                                                     2ml




                                        FOLLOW UP:




                                         Dr. Name          Dr. Suman Pass Reg No. 5994/11171 Time

                                        OD (fast at Las ure) 10 AM, BD (foot at 1 412) - 10 AM - 10 PM. TDS (faa & as a12) - 10 AM - 3 PM - 10 PM
                                        QID (f A WITZ 412) - 12 AM - 6 AM - 12 PM - 6 PM, SOS (3na24thT 31g F12)

                                         SECTOR-4, JAWAHAR NAGAR, JAIPUR - 302 004 . Mob: 09001994820-22
                                                        PH : (0141) 2651393/2653019/2653023
                                          Website :www.monilekhospital.com · E-mail:monilek jpr@gmail.com


     nned with CamScan

{'clinic_pharmacy_details': {'clinic_pharmacy_name': 'Monilek Hospital', 'clinic_pharmacy_address': 'SECTOR-4, JAWAHAR NAGAR, JAIPUR - 302 004', 'clinic_pharmacy_city': 'Jaipur', 'clinic_pharmacy_pincode': '302 004'}, 'doctor_details': {'doctor_name': 'Dr. Suman Pass', 'doctor_qualifications': 'NA', 'doctor_registration_number': '5994/11171'}, 'patient_details': {'patient_name': 'Mrs. Palak', 'gender': 'Female', 'age': 29}, 'prescription_details': {'date_of_doctor_consultation': 'NA'}, 'procedure': {'chief_complaints_diagnosis': 'Allergy'}, 'medicine_details': [{'medicine_name': 'PAN 40', 'medicine_dosage': '1-0-1', 'medicine_frequency': 'Morning and Night', 'course_duration': 'NA'}, {'medicine_name': 'Paracetamol', 'medicine_dosage': '1-0-1', 'medicine_frequency': 'Morning and Night', 'course_duration': 'NA'}], 'lab_test_details': {'lab_test_names': 'NA', 'procedure_request': 'NA'}}