HEALTH RECORD

Name Salmon Kumar Khan In case of emergency, contact:

Date of Birth 12-Jun-79 Name n/a
Phone 9832764723 Phone n/a
Gender Male Alt. Phone n/a
Electric Veng, Champhai,
Address Address n/a
Mizoram, India

Blood Type AB+ Medical Plan n/a

Height 5' 9'' Medical Plan ID n/a
Weight 79 Pharmacy Name n/a
BMI 24.7 armacy Address n/a
Last Update 10/4/2020 harmacy Phone n/a

Doctor Information

Doctor Name / Specialty Phone Address Notes

Electric Veng, Monday -

Primary
Dr. Ramos Rai 9837483273 Champhai, Friday 8:00 am
Physician Mizoram, India - 4:00pm

Dentist

Specialist

Known Conditions / Allergies and Medications

Name Description Medication Dosage Notes

Mild allergy
Penicillin V RTI antibiotics 250 mg reaction/Skin Rashes.
 Vaccination & Immunization
History
Attending
Date Description Facility Notes
Physician

Aizawl Civil
6/21/2002 Bacillus Calmette-Guérin Nurse- Chaiya n/a
Hospital

Surgical Procedures
Attending
Date Description Facility Notes
Physician

n/a n/a n/a n/a n/a

Medical Visits
Diagnosis /
Date Description Tests / Procedures Prescription
Treatment

7/12/2020 Road Rash n/a Dressing ibuprofen

Assessment & Diagnosis

Date Assessment Diagnosis

Bp 125/80 , HR- 80bpm, T- 38C, RR- 16.

7/12/2020 Subjective: My leg and arms skin is so painful.
Objective: Skin rashes on legs, knees and arm Skin Rash due to Road Rash.
 HEALTH RECORD

Name Shwe Tin Par In case of emergency, contact:

Date of Birth 12/4/2001 Name Thartea Rokhum
Phone 9368162836 Phone 9437487823
Gender Female Alt. Phone 9483748334
Tahan/Kalay/Sagaing/Myan
Address Address Tahan/Kalay/Sagaing/Myanmar.
mar.

Blood Type A+ Medical Plan Premier Health Saver Plan

Height 5'3'' Medical Plan ID 21763
Weight 55kg Pharmacy Name Health Plus
BMI 21.2 armacy Address Kalay/ Myanmar.
Last Update 3/22/2020 harmacy Phone (+95) 8738157739

Doctor Information
Doctor Name / Specialty Phone Address Notes

Primary
Physician
Monday -
Tahan/Kalay/Sag
Dentist Dr. U Chit Maung 8712736721 aing/Myanmar.
Friday 8:00 am
- 4:00pm

Specialist

Known Conditions / Allergies and Medications

Name Description Medication Dosage Notes

Fluorometholo
ophthalmic Mild Allergic
ne (Flarex, Eye Inflamation 0.10%
FML) corticosteroids. reaction
 Vaccination & Immunization
History
Attending
Date Description Facility Notes
Physician

Nurse- Chit
8/3/2002 Bacillus Calmette-Guérin Kalay Hospital n/a
Lay

Nurse- Nge
6/31/2020 Varicella vaccine Kalay Hospital n/a
Nge

Surgical Procedures
Attending
Date Description Facility Notes
Physician
Monday -
Dr. U Chit Private Dental
5/2/2019 Wisdom Teeth Extraction Friday 8:00 am
Maung Clinic
- 4:00pm

Medical Visits
Diagnosis /
Date Description Tests / Procedures Prescription
Treatment

Cavity Fluoride Avoid hot and

5/12/2018 Tooth Decay
Daignosis Treatment cold foods.

Assessment & Diagnosis

Date Assessment Diagnosis

5/12/2018
Assessed through cavity diagnosis. Cavity Daignosis
 HEALTH RECORD

Name Saw Khush Say In case of emergency, contact:

Date of Birth 8/27/1999 Name John Realman
Phone 9438273847 Phone 8237492375
Gender Male Alt. Phone 9283423843

Address Munlai/Kalaymyo/Myanmar. Address Munlai/Kalaymyo/Myanmar.

Blood Type 0+ Medical Plan Life Good Health Plan

Height 180 Medical Plan ID 28173
Weight 60 Pharmacy Name Life Good Health Plan
BMI 18.5 armacy Address Kalaymyo/Myanmar.
Last Update 7/9/2020 harmacy Phone (+95) 872638162

Doctor Information
Doctor Name / Specialty Phone Address Notes

Monday -
Primary Tahan/Kalaymy
Dr. Zakamlova 9823674723 Friday 8:00 am
Physician o/Myanmar
- 4:00pm

Dentist

Specialist

Known Conditions / Allergies and Medications

Name Description Medication Dosage Notes

None None None None None

 Vaccination & Immunization
History
Attending
Date Description Facility Notes
Physician

Nurse- Aizawl
3/24/2000 Bacillus Calmette-Guérin n/a
Bawihtei Hospital

Aizawl
2/22/2000 Varicella vaccine Nurse- Siami n/a
Hospital

Surgical Procedures
Attending
Date Description Facility Notes
Physician

Aizawl Civil Laparoscopy due to

4/15/2020 Laparoscopy Dr. Siamthanga
Hospital ectopic pregnancy

Medical Visits
Diagnosis /
Date Description Tests / Procedures Prescription
Treatment

Check up for Laparoscopy

5/22/2020 Palpation None None
Surgery

Assessment & Diagnosis

Date Assessment Diagnosis

5/22/2020 Bp 130/80 , HR- 80bpm, T- 38C, RR- 16,

Subjective: I fell a little bit discomfort in my Pain due to ectopic pregnancy and
abdomen. Objective: PT looks fine but having little laparoscopy.
discomfort
 HEALTH RECORD

Name Lalduhsaki In case of emergency, contact:

Date of Birth 9/5/1998 Name Jessie PuiPuii
Phone 9128732827 Phone 9128738912
Gender Female Alt. Phone 9278398237
Chhingveng/Aizawl/Mizoram/In
Address
dia
Address Chhingveng/Aizawl/Mizoram/India

Blood Type A+ Medical Plan Good Well Life Plan

Height 161 cm Medical Plan ID 3126459
Weight 50 Pharmacy Name Grace Pharmacy
BMI 19.3 armacy Address Kulikawn/Aizawl/Mizoram
Last Update 5/4/2021 harmacy Phone (+91) 872638162

Doctor Information
Doctor Name / Specialty Phone Address Notes

Monday -
Primary Kulikawn/Aiza
Dr. Madika 8737487236 Friday 8:00 am
Physician wl/Mizoram
- 4:00pm
Monday -
Chanmari/Mizora
Dentist Dr. Rolenga 8721372163 m
Friday 8:00 am
- 4:00pm
Monday - Friday
Vaivakawn/Mizo
Specialist Dr. John Duhsaka 8723276422 ram
11:00 am -
4:00pm

Known Conditions / Allergies and Medications

Name Description Medication Dosage Notes

Latex Latex Allergy

 Vaccination & Immunization
History
Attending
Date Description Facility Notes
Physician

Nurse- Aizawl
5/3/1999 Bacillus Calmette-Guérin n/a
Bawihtei Hospital

Aizawl
3/22/1999 Varicella vaccine Nurse- Siami n/a
Hospital

Surgical Procedures
Attending
Date Description Facility Notes
Physician
meperidine
Aizawl Civil tablet: Schedule
12/17/2019 Tubectomy Dr. Manghaka II is given to
Hospital
reduce the pain

Medical Visits
Diagnosis /
Date Description Tests / Procedures Prescription
Treatment

3/12/2020 Check up for Tubectomy Palpation n/a n/a

Assessment & Diagnosis

Date Assessment Diagnosis

3/12/2020 Bp 125/80 , HR- 80bpm, T- 38C, RR- 16. Palpation

Uterus Hemmorage due to hormonal
of Abdomen, Subjective: My Lower Abdomen is
changes.
Pain and It bleed.
 HEALTH RECORD

Name SUM MANG In case of emergency, contact:

Date of Birth 24-Jul-01 Name HRIATPUIA
Phone (+91) 9362594729 Phone (+91) 6009698336
Gender Male Alt. Phone 9362592342
CHHINGA VENG,
CHANMARI WEST, AIZAWL,
Address AIZAWL, MIZORAM, Address
MIZORAM, INDIA.
INDIA.

Blood Type A+ Medical Plan Premier Health Saver Plan

Height 5' 5'' Medical Plan ID 42342
Weight 50kg Pharmacy Name Beyond Health
BMI 19.7 armacy Address ELECTRIC VENG, AIZAWL, MI
Last Update 4/30/2021 harmacy Phone (+91) 9438157739

Doctor Information
Doctor Name / Specialty Phone Address Notes
CHHINGA VENG, Monday -
Primary AIZAWL,
Dr. HREKIMA 94682217837 MIZORAM, Friday 8:00 am
Physician
INDIA. - 4:00pm
CHHINGA VENG, Monday -
AIZAWL,
Dentist Dr. Mapuia 94776216372 MIZORAM, Friday 8:00 am
INDIA. - 4:00pm

Specialist

Known Conditions / Allergies and Medications

Name Description Medication Dosage Notes

Mild allergy
Skin Rash RTI antibiotics 250 mg
reaction
 Vaccination & Immunization
History
Attending
Date Description Facility Notes
Physician

Aizawl Civil
1/4/2002 Bacillus Calmette-Guérin Nurse- Kimi n/a
Hospital

Surgical Procedures
Attending
Date Description Facility Notes
Physician

Aizawl Civil
24/5/2007 Tonsilectomy Dr. Hrekima n/a
Hospital

Medical Visits
Diagnosis /
Date Description Tests / Procedures Prescription
Treatment

Flomist NS
8/40/2021 Cough By Symptoms Postnasal drip
Spray

Assessment & Diagnosis

Date Assessment Diagnosis

Bp 125/80 , HR- 80bpm, T- 38C, RR- 16. Coughing due to Postnasal drip.
8/40/2021
Bp 125/80 , HR- 80bpm, T- 38C, RR- 16. Coughing due to Postnasal drip.