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    Chandrika H L

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    Chandrika H L

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    Sanyra Hospital
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    Chandrika h l

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    Chandrika H L

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    Quality Scanning & Diagnostic Centre e Z ee Unit of AB & KENGER! DIAGNOSTIC CENTRE, medical research centre private limited. e — #978, Opp. Kabir Matt, Beside ICICI Bank, 1st Main Road, Sth B Cross, 1st Stage, e Kengeri Satellite Town, Bangalore - 560 060. Ph : 080 - 28488696 | 98446 62044, E-mail : [email protected] | Web : www.qualltyscanningcenter.in ABDOMEN AND PELVIS ULTRASONOGRAPHY REPORT INAME : MRS. CHANDRIKA AGE / SEX: 38 YRS /F IDATE : 11/02/2023 REF BY : DR. SUNITHA SHARMA |Many thanks for the kind reference Liver is normal in size and shows normal echo-texture. No focal lesions. Intrahepatic biliary radicals are normal. Intra hepatic IVC and Hepatic Veins are normal. The portal vein and CBD are normal. Gall bladder is well distended with normal contents. Wall thickness is normal. No calculus. Pancreas is normal in size and echo-texture. Spleen is normal in size and echo-texture. Both Kidneys are normal in size, shape, position and axis. Renal cortical echo-texture is normal, Cortico medullary differentiation is well maintained. No hydro-nephro- ureterosis or calculi seen bilaterally, Kidneys measure: RK: 10.0 x 1.4.cm. LK: 10.5 x 1.5 cm. Urinary Bladder is well distended. Wall thickness is normal. Contents are clear No calculi/mass lesion, Uterus is normal in size and shows normal echo-texture. No focal lesions. Uterus measures 8.1 x 4.0 x 4.8 cm. Endometrial thickness measures 8.5 mm and is normal. Both ovaries are normal in size and echo-texture. RO-3.7x 2.1m. LO - 3.0 x 2.1 cm. Both adnexa are normal. No free fluid noted in the peritoneal cavity. RIF — No collection / mass noted. The appendix is not visualized due to bowel gas. IMPRESSION: * NO SONOLOGICALLY DETECTABLE ABNORMALITY IN THE ABDOMEN AND PELVIS. * NO OBVIOUS BOWEL WALL THICKENING OR MASS LESIONS. * NO ASCITES/PLEURAL EFFUSION. * NO UROLITHIASIS/CHOLELITHIASIS. Suggested: 1. CT Abdomen and pelvis 2. Clinical and laboratory correlation. PROF. beasnwaras NG MBBS, MDRD PROFESSOR AND HOD SANYRA HOSPITAL AND DIAGNOSTICS MULTI-SPECIALITY HOSPITAL Patient ID 001675 DateTime 12-02-2029/18:28 Name MRS, CHANDRIKA HL Refered By DR DARSHAN AgelGender 30viF INVESTIGATION RESULT REFERENCE RANGE BIOCHEMISTRY noes RENAL FUNCTION TEST ( RFT) Blood Urea 17 magia 13-45 mg/dl Creatinine 0.83 mg/dl Infant 0.2-0.4 mg/dl. Child 0.30.7 mala. Adult Male 0.9-4.3 mg/dl. Fomale 0.6-1.1 mgld. 60.80 Yr Male 0.8-1.3 mg/dL Female 0.6-1.2 mg/dl. Sodium 138.6 mEq Infant: 139 - 146 mEq/L Child: 138 - 145 mEq/L Adult: 136 - 145 mEgiL. Potassium 3.97 mEgiL Infant: 41-53 Child: 3.44.7 Adult: 3.5 -5.1 Chloride 107.2 mEq 98-107 mEq 98-111 mEq >90 Yr ‘Sample Collection Time 12 Feb 2023 / 18:31 Result Approval Time 12 Feb 2023 / 18:35, con SIs Swain onsaianawy tap Teeican Pabst “This is an Electronically Generated Repor. This reports based on the specimenis received. The report may need to De correlated cnically 2 laboratory investigations are dependent on multiple variables. These resulls should not be reproduced in part Tat REPOS Printed by DR SAHANA WW 1202805121 TOBE SANYRA HOSPITAL AND DIAGNOSTICS MULTI-SPECIALITY HOSPITAL Patient 1D 001675 Date/Time 12-02-2023/18:28 Name MRS, CHANDRIKA H L Referred By DR DARSHAN AgelGender 30YIF INVESTIGATION RESULT REFERENCE RANGE BIOCHEMISTRY pacosoze HBAIC Glycosylated Haemoglobin 512% NesPIpccT (40-60) 6-65 % : Excellent 65-75% : Good 75-80% : Fait > 8.0% : Poor MBG (Mean Blood Glucose) 111.48 mgldl “mple Collection Time 12 Feb 2023 / 18:31 Result Approval Time 12 Feb 2023 / 18:35 Ca SIS swatiDR on sAKANAW {ab Teemien Pato i a Eioroniay Goveraia Report This opal bated one specimens reoowed. The report may ned fo be coated clrcal 2 aren reratagatene ere dependent on multiple vanable. These resus should not be reproduced in pat TH REF OTS Prinied by DR SAHANA WV T2025 00-12 | TES62E SANYRA HOSPITAL AND DIAGNOSTICS MULTI-SPECIALITY HOSPITAL Patient ID (001675 DateTime 12-02-2023/18:28 Name MRS. CHANDRIKA HL. Referred By DR DARSHAN AgelGender 30Y/F INVESTIGATION RESULT REFERENCE RANGE HEMATOLOGY Lr coeor ‘COMPLETE BLOOD COUNT Haemoglobin 11.0 qld 42-20 g/dL (0-1Month) 10-14 gid (1-15y0) 43-48 gid (>15yr Adult Male) 42-15 gid (>15yr Adult Female) WBC Count 10500 fut. 9-30 ful (0-7d Newborn) _ifferential Count Neutrophits Lymphocytes Eosinophils Monocytes: Basophils RBC Count Pov McHC Platelet Count ‘Sample Collection Time 12 Feb 2023 / 18:34 Result Approval Time 12 Feb 2023 / 16:35 ce SiathiOR Lab Technion 61% 28% 04% 07% 00% 3.84 million/eumm 295% 7738 28.8 pg 374% 2.40 LakhsipL 8.7 - 18 Jul. (O-tyr Infants) 45-135 ful(1-15 yr Child) “4000 - 11000 ful. (>18 y Adults) 17-60 % (15yr Adult Male) 34-48 % (>15yr Adult Female) 75-9511 Adult 4100-1208 -Birth 72.84 Ar 75-87f1-2-6¢s T7-9Sf-6-12Vts 26-32pq -Adult 27-33pq -2months 24-30pg -Smonths 25-33pg -6-12Yts 30-35% Adult 29-37% Birth - 12¥rs 4.5-4.5LakhsipL This is an Electronically Generated Report. This re investigations are depend Tat por i based on the specimenis received. The report may need tobe corelated cinicaly as laboratory font on multiple variables. These results should not be reproduced in part REFFBIDS Printed by OR SAHANA WW 12025-00-12 116.5705 SANYRA HOSPITAL AND DIAGNOSTICS MULTI-SPECIALITY HOSPITAL Patient 1D 001675 Date/Time 12-02-2023/18:28 Name MRS. CHANDRIKA HL Referred By DR DARSHAN AgelGender 30Y1F INVESTIGATION RESULT REFERENCE RANGE BIOCHEMISTRY bron LIVER FUNCTION TEST (LFT) Bilirubin Total 0.8 mg/d. 10.0 - 14.0 mg/d 3.5 Days (Premature) 4.0-8.0 mg/dl. 3-5 Days (Full Term) 0.0- 1.0 mg/dL (Adult) Bilirubin Direct 0.4 mg/d. 0.0-0.2 mg/d. Bilirubin indirect 0.4 mg/d. 0.0- 0.8 mg/dL scot 31 UML Upto 40 U/L (Males) upto 32 UML (Females) SGPT 26 UiL upto 41 UML (Males) upto 33 UML (Females) Alkaline Phosphatase 42UiL 54-369 UL (4-15 Yrs MIF) 53 - 128 UI. (20-50 Yrs Male) 42-98 UIL (20-50 Yrs Female) 56 - 119 UM. (> 60 Yrs Male) 53-141 UML (> 60 Yrs Female) Total Protein 60a/dL 6.0-8.0 g/dL Albumin 36 gid! 35-5.2gidL Globutin 24 g/d 1.5-3.0 g/dL. AIG 15 1-2 Sample Collection Time 12 Feb 2023 / 18:31 Result Approval Time 12 Feb 2023 / 18:35, uation DR SAHANAW ab Technican Pathologist hiss an Electronically Generated Report. This repor is based on the specimens received. The report may need tobe correlated clinically as laboratory Investigations are dependent on multiple variables, These resulls should not be reproduced in part Tat REFFET2D Piitod by DR SARANA W T2025 02-721 TESESS SANYRA HOSPITAL AND DIAGNOSTICS MULTI-SPECIALITY HOSPITAL Patient ID 001675 Date/Time 12-02-2029/18:28 Name MRS, CHANDRIKA HL. Referred By DR DARSHAN AgelGender 30YiF INVESTIGATION RESULT REFERENCE RANGE BIOCHEMISTRY Lrwonsnse CRP cRP 98 gid. Aduit<5.omglat Cardiac Risk Average 0.1- 0.3 mgldl Cardiac Risk High >0.3mg/dl Cardiac Risk low <0.img/di ‘Sample Collection Time 12 Feb 2023 / 18:31 Result Approval Time 12 Feb 2023/ 18:34 ch SASS ‘swat oR DR SAMANA WW Lab Tectician Pathlonst ‘This is en Electronically Generated Report. This eport is based on the specimen/s received. The report may need tobe correlated clinically 2s laboratory inestigalions are dependent on multiple variables. These resus should not be reproduced in part Tat REFF ETD ried by DR SAHANA WV TRO2S 02-127 18552 SANYRA HOSPITAL AND DIAGNOSTICS MULTI-SPECIALITY HOSPITAL Patient 1D 001675 DateTime 12-02-2028/18:28 Name MRS. CHANDRIKA HL Referred By DR DARSHAN AgelGender 30¥IF INVESTIGATION RESULT REFERENCE RANGE BIOCHEMISTRY Lr 0509 RANDOM BLOOD SUGAR (RBS) Random Blood Sugar 140 maya 70-150 mgial. ‘Sample Collection Time 12 Feb 2023 / 18:31 Result Approval Time 12 Feb 2023 / 18:35 cS Swathi DR Lab Technician OR SAHANAW Pathologist ‘This i en Electronicaly Generatod Repor. This report is based on the specimenis received. The report may need to be corelaied cinially as laboratory Investigations are dependent on multiple variables. These results should not be reproduced in part Tot REFFOTES Printed by BR SAHANA WW 1202305127 185625 SANYRA HOSPITAL AND DIAGNOSTICS MULTI-SPECIALITY HOSPITAL Patient ID 001675 Date/Time 12-02-2023/18:28 Name MRS. CHANDRIKA H L Referred By DR DARSHAN ‘AgelGender 30Y/F INVESTIGATION RESULT REFERENCE RANGE SEROLOGY ursonre HIV 1 & 2 RAPID HIV-182 NON REACTIVE Non-Reactive ‘Sample Collection Time 12 Feb 2023/18:31 Result Approval Time 12 Feb 2023 / 18:35 SR ‘web {a Technican SIs DR SAHANA WY Patitogist ‘This is an Electronically Genorated Report. This repor is based on the specimens received, The repon may neod tobe correlated cincaly as laboratory Investigations are dependent on multiple variables. These resus should not be reproduced in part Tat REF OTD Printed by DR SAHANA WW T2023 02-127 1063 SANYRA HOSPITAL AND DIAGNOSTICS MULTI-SPECIALITY HOSPITAL Patient iD 001675 Date/Time 12-02-2023/18:28 Name MRS, CHANDRIKA HL Referred By DR DARSHAN AgelGender 39YiF INVESTIGATION RESULT REFERENCE RANGE SEROLOGY pwcosor? HBsAg -HEPATITIS B SURFACE ANTIGEN -RAPID HB(S)AG ( Rapid Test) NON REACTIVE, Non-Reactive ‘Sample Collection Time 12 Feb 2023 / 18:31 Result Approval Time 12 Feb 2023/ 18:34 ce oe ren OR SAHANA VW Lab Teehicisn Pathlogs “Tha lan Elpovonicaly Gaverated Report This rpor is based onthe specimen‘s received, The report may need tobe coveted clinically as laboratory Tiwostgations are depengent on muliple variables, These resuls should not be reproduced in part Tat REFESTOD Printed by DR SAHANA W0 7202-00-12 165555 SANYRA HOSPITAL AND DIAGNOSTICS MULTI-SPECIALITY HOSPITAL Patient ID 001675 DateTime 12-02-2028/18:28 Name MRS. CHANDRIKA HL Referred By DR DARSHAN AgelGender 39YiF INVESTIGATION RESULT REFERENCE RANGE SEROLOGY Lmcosnre HCV ANTIBODY(RAPID) ev NEGATIVE ‘Sample Collection Time 12 Feb 2023 / 18:31 Result Approval Time 12 Feb 2023 / 18:34 ce SASS SwahiDR OR SAHANAW Lab Tecnnian Pathologist ‘This ie en Electronicaly Generated Repor. This report is based onthe specimenis received. The repon may ned tobe correlated clinically as laboratory investigations are dependent on multiple variables. These resulls should nol be reproduced in part ToT REFF S120 Printed by DR SAHANA WW TR0Z5.00-121 183636 SANYRA HOSPITAL & DIAGNOSTICS MULTI-SPECIALITY HOSPITAL OY BUS SES & worwrine ges abey—Gevoess sages fo) lalal 2, Mame sd Chemcbrt ka, xt gel eo clot Came we Kehufren cyto Able fete abdomen wobec veoherAy ripe © Nau A vemibsy Prin adon ee ito tty ( Ow ( ers, ole ela So #/ Tage heya veyron. Culler ae bB cvs ee ee ailbe feat fale hbom on | Reaboa fom (\ poole [ dvacbinnl vlow: Ads. Aden itive unde Znwal CY . — 'No.10, HIG-Il, KHB, Kommaghatta Road, Kengerl, Bengaluru-560060. Ph-STS6163360, 76296490 ‘e-mail: [email protected] website: www.sanyrahospital.cor FHPt DECLAATION BY THE PATIENT REPRESENTATIVE [agrees to allow the hospital wo submit all original documents pertaining to hospitalization to the Insuree/T-P-A after the discharge. 1 agre wo sign on the Final Bill & the Discharge Summary, before my discharge '. Payment to hospital is governed by the terms and conditions ofthe policy. Incase the Insurer TPA isnot liable to Sette the hospital bill, I undertake to settle th bill as per the terms and conditions ofthe policy. ‘Aijnon-medical expenses and expenses not relevant to current hospitalization and the amounts over & above the timitauhrizcd bythe Insue/TP-A not governed bythe terms and conditions ofthe policy wil be paid by me 4. T hereby declare to abide by the terms and conditions ofthe poticy and if at any time the facts disetosed by me are found to be false or incorrect I forfeit my claim and agree 10 indemnify the Insurer / TPA & F agree and understand that T.P.A isin no way warranting the service ofthe hospital & thatthe Insurer /TPA is inno way guaranteeing that the services provided by the hospital willbe ofa particular quality or standard, 1 darcy warrant the truh ofthe forgoing particulars in every respect and I agree that if Ihave made or shall inake any false or uieus statement, suppression or concealment with respect tothe claim, my right te onan reimbursement ofthe said expenses shall be absolutely forfeited, & agree to indemnity the hospital against all expenses incurred on my behall, which are not reimbursed by the Insurer /TPA. 4h *IAWVe authorize Insurance Company/TPA to contact me/us through mobile/email for any update on this claim 8) Patient's /Insured's Name: __ b) Contact number: __s)e-mail Id (optional) __ ) Patients /Tasur Date: _ Time: HOSPITAL DECLARATION ‘We have no objection to any authorized TPA Insurance Company offical verifying documents pertaining to hospitalization, All valid original documents duly countersigned by the insured/patent as per the checklist below will be sent to TPA Insurance Company within 7 days of the patoats discharge. We agree that TPA / Insurance Company will not be fiable to make the payment in the between the facts in this form and discharge summary or other documents ‘The patent declaration has been signed by the patient oF by his representative in our presence We agree to provide clavfications for the queries raised regarding this hospitalization and wwe take the sole responsibility for any delay in offering clarifications We will abide by the teams and conditions agreed ia the MOU. ‘Weconfiem that no additonal amount would be collected ftom the insured in excess of Agrecd Package Rates except costs towards non-admissible amounts (including additional charges due to opting. higher ‘oom rent than cligibiltychoosing separate lie of treatment which is not envsaged/considred in package) ‘Weconfirm that no retoveries would be made from the deposit amount collected from the Insured except {or costs towards non-admissible amounts (including additional charges due to opting higher room rent ‘han eligiblity/ choosing separate tine of treatment which is not envisaged/considered in package) Jn the event of unauthorized recovery of any ational amount fom the Insured in excess of Agreed Package Rates, the authorized TPA lnsurance Company reserves the right to recover the sume fom us (the Network Provider) andiortake necessary action, as provided under the MoU or applicable laws. Hospital Seal Doctor's Signature Date: Time |B. Mandatory Past History of any chronic illness ifyes (Since month/year) i i Diabetes No Ty ii, Heart disease WO iii, Hypertension V0 iv. Hyperlipidemia /Oumionnie ¥ Osteoarthritis HO - Vi, Asthma/COPD/Bronckitis —_ vO | vii. Cancer No aes viii, AlcohoV/Drug abuse V0 ix. Any HIV/or STD Related ailment NO i X Any other silment, give details ae ORB ta, |B. Expected mumber of Days/tay in hospital BS days | R Daysinicu == ___ ays ee Caen | HL Per day room rent + nursing and service charges patients diet Rs, eat jx Expected cost of investigation + diagnostic Rs, J. [CU changes lene ces ae K. OT charges Rs_ L. _ Profesional fees Surgeon + Anesthetist Fees +onsulation Charges: Rs M. Medisins + Consumables + Cost o Implant appliabe please specif) Rs. —__—____ N. Other hospital expenses i any Re | © Allsinclusive package charges ifany applicable Rs oak Fs

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