                                                                JASLOK HOSPITAL
                                                                       A lifetime of care
                                                                 OPD PRESCRIPTION
                                                                                                                                  Date: 20/4/23
Patient's Name:                       Sarthak Belekas
                                                                                                                                  UHID:
Diagnosis                             Epilepsy

Age: 15y Sex m                                            Height:                            Wt .:
Any Allergies

 Sr.No                   Medication Name                                    Strength                   Frequency                       Route of          Duration
                                                                                                                                      Administracon
                     T. Dicorate ER                                           750                    0-)                                          12    month




 Special Instructions:                                                              "Please issue do not issue
                                                                                     GENERIC SUBSTITUTES AFTER VERIFYING THE INGREDIENTS"
                                                                                    Owing to
                                                                                     Please cirde as appropriate

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                                                                                                                   Next Follow ups:
  Name of the Prescribing Dr.
                                                                                                                   For appointments: (022) 6657 3014
  Signature:
                                                                                             Dr. Anaita Udwadia Hegde
                                             B 7130                                         Consultant Paediatric Neurologist
  Registration No.                                                                          Jasfok Hospital & Research Centre
                                                                                            Mumbal
  Dispensed by:                                                                                                                                               Date
                                      Pharmacist Name                                       Pharmacist Signature

                                 Jaslok Hospital and Research Centre, 15, De, G. Deskmukh Marg, Mumbai - 400 026.
      Tel: (012) - 6657 3333 - Fax: (022) - 2352 0506 . E-Mail: info@jalok hospital.net . Weiniter htpcswww.paulolivorpital.net
                                                                SERVICE . COMPASSION . EXCELLENCE
                                              "Non-Profit Institution and a member of the Association of Hapmal"

{'clinic_pharmacy_details': {'clinic_pharmacy_name': 'JASLOK HOSPITAL', 'clinic_pharmacy_address': 'Jaslok Hospital and Research Centre, 15, De, G. Deskmukh Marg, Mumbai - 400 026.', 'clinic_pharmacy_city': 'Mumbai', 'clinic_pharmacy_pincode': '400 026'}, 'doctor_details': {'doctor_name': 'Dr. Anaita Udwadia Hegde', 'doctor_qualifications': 'Consultant Paediatric Neurologist', 'doctor_registration_number': 'B 7130'}, 'patient_details': {'patient_name': 'Sarthak Belekas'}, 'prescription_details': {'date_of_doctor_consultation': '20/4/23'}, 'procedure': {'chief_complaints_diagnosis': 'Epilepsy'}, 'medicine_details': [{'medicine_name': 'T. Dicorate ER', 'medicine_dosage': '750', 'medicine_frequency': '0-)', 'course_duration': '12 month'}], 'lab_test_details': {'lab_test_names': 'NA', 'procedure_request': 'NA'}}