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260802L227 · Mrs. S.Vijaya
Edited 11 Aug 2026, 14:43 IST
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No ID
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Batch 2
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A
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B
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C
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D
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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
2, Periyanan Setiyar sandhu, Karaikudi
✎ Edited
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
?
Hypertension
?
for 3 months on Treatment
Asthma
?
Heart Disease
?
Thyroid Disorders
?
Others
?
Previous Surgeries
?
Allergies
?
Smoking History
Alcohol Use
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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
131
Hba1C
Haemoglobin
Thyroid
Ecg
Done
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)
Fatigue, Knee Pain, Palpitation, Leg pain
✎ Edited
Diagnosis
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ICD codes
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Treatment Advice
Prescription Advice
T. Aspirin 75mg, T. Atorvas 10mg, T. A,long 2.5mg, T. Zincalmig
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Referral: to Dr.
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Referral Department
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