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    Patient Case Sheet: Hospital Logo

    Uploaded by

    Birupakshya Rout
    This document contains a patient case sheet for a hospitalized patient. It includes fields for the patient's name, ID number, age, sex, admission details like date and time, emergency and permanent addresses, contact information, medical legal case details if applicable, diagnosis and treatment details, outcome at discharge like cured or expired, and areas for doctor signatures. The case sheet is used to document all relevant information for a patient during their hospital stay.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Patient Case Sheet: Hospital Logo

    Uploaded by

    Birupakshya Rout
    870 views2 pages
    This document contains a patient case sheet for a hospitalized patient. It includes fields for the patient's name, ID number, age, sex, admission details like date and time, emergency and permanent addresses, contact information, medical legal case details if applicable, diagnosis and treatment details, outcome at discharge like cured or expired, and areas for doctor signatures. The case sheet is used to document all relevant information for a patient during their hospital stay.

    Original Description:

    fgfg

    Original Title

    Cash Sheet in Op

    Copyright

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    This document contains a patient case sheet for a hospitalized patient. It includes fields for the patient's name, ID number, age, sex, admission details like date and time, emergency and permanent addresses, contact information, medical legal case details if applicable, diagnosis and treatment details, outcome at discharge like cured or expired, and areas for doctor signatures. The case sheet is used to document all relevant information for a patient during their hospital stay.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    870 views2 pages

    Patient Case Sheet: Hospital Logo

    Uploaded by

    Birupakshya Rout
    This document contains a patient case sheet for a hospitalized patient. It includes fields for the patient's name, ID number, age, sex, admission details like date and time, emergency and permanent addresses, contact information, medical legal case details if applicable, diagnosis and treatment details, outcome at discharge like cured or expired, and areas for doctor signatures. The case sheet is used to document all relevant information for a patient during their hospital stay.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    HOSPITAL LOGO

    PATIENT CASE SHEET















    Name of the Patient :

    UMR. No / IP No : __________________________________
    Consultant Name :





    (Hospital address)
    HOSPITAL LOGO


    PATIENTSS NAME............................................................................. GENDER
    M/F


    AGE


    IPNO


    ADMISSION RECORD

    Name of Patient :

    IP No:

    Age :

    Sex:

    Date of Admission:

    Time:

    WAP No:

    Unit : Ward : Claim No:

    Fathers / Husbands Name :

    Occupation :

    Annual Income :

    Emergency Address:

    Permanent Address:

    House no:

    Street:

    House no:

    Street:

    Village/Town:

    Mandal:

    Village/Town:

    Mandal:

    District:

    Pincode:

    District:

    Pincode:

    Mobile No:

    Telephone No. :

    Email id:

    Prepared by :

    Medico legal case: Yes/No
    Details of Police information :

    Name of the informant:
    Police Station.......

    PC No.& Name :
    Date & Time of Discharge :

    Hospital Stay :
    Identification marks:1

    2.

    ICD :

    Provisional Diagnosis On Admission:
    Final Diagnosis :
    Secondary Diagnosis :
    Complications :
    Operative Procedures / Medical Managment :
    Consultans:
    Discharge Status : Cured/RELIEVED / Not Relived/Improved/Referred to higher Center

    LAMA : Signature of the Patient / Thumb impression]

    Expired :

    Date & Time :

    AUTOPSY Yes/No


    (Stamp & Signature of Treating doctor) : Date & Time

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