                               HOSPI                                                                                             HOSPITAL
                                                                                                                           --
                    SSH              TAL                                               (A Unit of Ram Raj Wellness Pvt. Ltd. )
                                                                      ISO 9001: 2015 Certified Multi Super -Speciality Hospital
                                                                 Tulsi Vihar, Near Railway Crossing, Railway Road, Dadri, (G.B. Nagar)                                        N
                                                                           Ph .: 0120-2663340, 41,42,43, Helpline No .: 9811464831
                                                              E-mail:reachkdh@gmail.com. Visit us At : www. krushdivinehospital.com                                        PATBUE ACCRECKLES
                                                                                           OPD CARD                                                                 QUI NABH CERTIFIED
                                     : Indersh Maskul
             Patient Name                                                                                                                                                    4/4/1
                                                                                                                                                             Age/Gender
             Bill No.                 ...
                                     27782                                                                                                                    Dat
            UHID. No.
                                                                                                                                                              Doctor Da Faculy
           Vitals                              Presenting Complaints
                                                                                                                                            Provisional Diagnosis
           GC :

         Pulse : 100

         BP : 120/800)

                                                                                                 Paroitis,
         Temp. : 1000F
                                                                               -

         SPO                                                                                     feuer.
                                                                                   -

      Wt./Ht. (If required)

                                              H/O any Allergy :
      Immunization
                                              Systemic Examinations :
         Past History :


         Family History :                     Rx 1) TOb xepudox CU HEIS


                                                     3) cola Endoyand ASA TUABBIA
         Investigations :


                                                   5) Job Signoffum 1 BIS



                                              4) Ton Levo Me Has



                                            & TUILA ANI HO IN HALA




                                               6




 P'in: Pain visual Analog Scale 04/2010 650 109
                                                                      Senminbulun



No Pain (0)         Mid Pain(1-3) Moderate Pair(4-6) Severe Pain(Z-10)

                                                                                             CB 1,1 RP
Adv. :
   Follow up/Next Visit
  Diet / Nutrition                                                                                                                                                                   (Signature)
  Preventive Steps
· Prognosis Explained

                                  Follow-up on consultant's OPD day or in case of any emergency attend hospital casualty.
                                       *Identity of patient could not be confirmed / Not valid for any Medico-Legal Purpose



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