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260802H009 · Nachiappan M.
Edited 10 Aug 2026, 14:41 IST
form 1125 of 1542 · 1542 reviewed, 0 left
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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
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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
He having DM For past10years, he is under the medicine
Hypertension
Asthma
Heart Disease
Thyroid Disorders
Others
Previous Surgeries
He undervent Bypass surgery before on 2011
Allergies
Smoking History
Alcohol Use
Family History
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
324
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 pain, Knee pain for past 3 months (right side)
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Diagnosis
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ICD codes
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Treatment Advice
Prescription Advice
Tab.tramadol-p BD 3days Tab pan CBF BD 3days Diclotenae.gel 1 Tab.Montal OD 1days Tab.FOPOGLIZ BD 3days
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Referral: to Dr.
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Referral Department
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