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260802B271 · Jeya V.
Edited 18 Aug 2026, 16:32 IST
form 672 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
Thirumayam
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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
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Notes
Diabetes
she having DM for past 5 years
Hypertension
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Asthma
Heart Disease
Thyroid Disorders
Others
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Previous Surgeries
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previous eye surgery before 9 month rt eye , site problem, 6 month
Allergies
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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
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Result
Cbg
134
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)
knee pain, shoulder pain,cold,headache,lower abdominal pain
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Diagnosis
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ICD codes
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Treatment Advice
Prescription Advice
T-chyrmoral forte 5D 3 daysT. Pregabalin NMT OD 3days. onit.Orthogel bcA
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Referral: to Dr.
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Referral Department
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