                                                                                                                                                           it Fortis
 Dr. Ram Krishna Modi
                                                                                                           Dr. L.H. Hiranandani Hospital       Fortis Hospital
 MD (Medicine) Mum                               Modi General Hospital & ICCU
                                                                                                                                                Mulund Goregaon Link Road,
 Senior Consultant                               Reg.No. 761409526                                          Hiranandanl Gardens, Powai.
                                                                                                                                                Mulund (West), Mumbai.
                                                 240/3271. Tagore Nagar, Vikhroll (E), Mumbai.              Tel .: 2576 3300 / 3333
 Internal Medicine                                                                                                                              Tel .: 022 - 49254123
                                                 Tel .: 2574 5666 / 2574 8939                                                                   OPD - Daily 10-12 p.m.
  Reg .: 2007/05/1627
                                                 Con. Time : 12 p.m. to 2 p.m. · 7 p.m. to 10 p.m.                                              Admission : 24 Hrs
  M .: 98210 19124
                                                 NABH PRE ACCREDITED                                                  Shushrusha's Suman Ramesh Tulsiani Hospital
         : 93210 19124                           Cert. No PESHCO-2019-1133                                 Near Kinnari Hall, Kannamwar Nagar-1, Vikhroli (E), Mumbai - 400 083.
                                                                                                                    Tel .: 022 - 2578 6100  OPD Time : Daily 4 p.m. to 6 p.m.

                                                        Mr. Hussain Shaikh                                                                                      23/04/23
   PATIENT NAME :                                                                                                                              DATE

               Hoyes GENDER : Male.
   AGE                                                                           UHID :
         Physical Assessment & Impression:                                                                       Investigations:

           c/o- chest pain                                                             04
                                                                                                     P.P -- 76 min PSP - 140/30mlg
                                                C .: 1 day


                                                                                               Spor-971 T-1.                                                                0
                             Nausstage


                         pain TITS9



              -Naw
                                                                                            Adm
            - Clo chest pain Its4                                                                              - CPK-MB-18.6

                                      (:6pm)
                                                                                                              - Tropain I - Noral


                                                                                                                              (Normal ) Megthis

                                ECG: WNL.



 NAME OF MEDICINE SHOULD BE GENERIC NAME AS FAR AS POSSIBLE AND CAPITAL LETTERS.
                                                                                                                                                 Daily                      Total
                                                                                                                                    Strength Dose          Duration        Quantity
               Dosage Form                                            Name of Medicine
 S.No.
                                    R.




                                                                      Myospaz forte
                                         - Tb
                                                                                                                                             77




                                                                                                                                                         4×5g



                                                     To pan - D




*Or any other cheaper generic medicine as per choice of patient"                                                                                            Doctor's Signature


DISPENSED BY

Pharmacist Name :

Date :

Name and Address of Pharmacy :

{'clinic_pharmacy_details': {'clinic_pharmacy_name': 'Modi General Hospital & ICCU', 'clinic_pharmacy_address': 'Hiranandanl Gardens, Powai.', 'clinic_pharmacy_city': 'Mumbai', 'clinic_pharmacy_pincode': '240/3271. Tagore Nagar, Vikhroll (E), Mumbai.'}, 'doctor_details': {'doctor_name': 'Dr. Ram Krishna Modi', 'doctor_qualifications': 'MD (Medicine)', 'doctor_registration_number': 'Reg.No. 761409526'}, 'patient_details': {'patient_name': 'Mr. Hussain Shaikh'}, 'prescription_details': {'date_of_doctor_consultation': '23/04/23'}, 'procedure': {'chief_complaints_diagnosis': 'Chest pain'}, 'medicine_details': [{'medicine_name': 'Myospaz forte', 'medicine_dosage': '1 tablet', 'medicine_frequency': '4 times a day', 'course_duration': '5 days'}, {'medicine_name': 'Pan-D', 'medicine_dosage': '1 tablet', 'medicine_frequency': 'once daily', 'course_duration': '4 days'}], 'lab_test_details': {'lab_test_names': 'ECG', 'procedure_request': 'WNL (Within Normal Limits)'}}