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260802G132 · B. Jeyanthi
Edited 19 Aug 2026, 16:44 IST
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Patient Information
Full Name
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Gender
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Marital Status
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Mobile Number
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Address
Subramaniyapuram, Karaikudi
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Register Number / UHID
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Age
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Father / Spouse Name
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Blood Group
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Aadhar Number
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Insurance Name/No
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Medical History
Condition
Present
Notes
Diabetes
?
DM for past 10 years. she taken medicine
Hypertension
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HT for past 10 years. T.Ecrsprin 75mg
Asthma
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Heart Disease
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Thyroid Disorders
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Others
Breathing difficulty
Previous Surgeries
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Allergies
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Smoking History
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Alcohol Use
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Family History
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Screening Vitals
Height
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Weight
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Blood Pressure (BP)
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SPO2
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Pulse
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Temperature
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Screening Tests
Test
Done
Result
Cbg
123
Hba1C
Haemoglobin
Thyroid
Ecg
Xray
Bmd
Biothesiometry
Purpose of Visit / Department Needed
General Medicine
General Surgery
OrthoPaedics
Dermatology
Dental
Physiotherapy
ENT
OBG
Pediatrics
Oncology
Others
Ophthalmology
Diabetology
Cardiology
Neurology
Psychiatry
Urology
Nephrology
Gastroenterology
Pulmonology
Doctor's Consultation
Chief Complaints (C/O)
Leg numbness, Knee Pain
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Diagnosis
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ICD codes
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Treatment Advice
Prescription Advice
Tab. Plegaba 75mg
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Referral: to Dr.
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Referral Department
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