PATIENT PROFILE FORM
DEPARTMENT OF PHARMACY PRACTICE
Nargund College of Pharmacy, Bangalore
PATIENT NAME: resamika HOSP. NO:19220 DATE OF ADMN: 3/4/2016
AGE: 45 WEIGHT: SEX: M/F: F DATE OF DISCGE: 6/4/2016
COMPLAINTS ON ADMISSION: Fever, urgency and frequency, pus in urine, abdominal pain,
burning micturation
MEDICAL HISTORY:
MEDICATION HISTORY: Tab. Dolo
SOCIAL HISTORY: Menopausal
FAMILY HISTORY:
PREVIOUS ALLERGIES: No allergies
PHYSICAL EXAMINATION:
GENERAL - P‾I ‾C ‾C ‾L‾ E‾
VITAL SIGNS - BP-110/70mm Hg
HEENT - NAD
CVS - S1S2 (+)
RS - NAD
GIT - NAD
GU - burning micturition
EXT -
CNS - NAD
PROVISIONAL DIAGNOSIS: UTI
ROUTINE BIOCHEMICAL INVESTIGATIONS HAEMATOLOGY:
DA INVESTIGATIONS
Urea: RBS: Alb: RBCY: Retics:
S.Cr : Tc: Glob: WBC: 13000cells/mm3
Cr.Clearance: TGs : AST: Hb:10.5gm/dl
Na: T Bili: ALT: N: 61% PCV:
D1 Microscopy done,
K: D Bili: ALP: L: MCV:
E.coli found. Drugs
FBS: T. Prot: M: MCH:
given.
PPBS: E: 1% MCHC:
D2 Condition fair due
B: 0 ESR:
drugs given
Platelets:
URINE ANALYSIS OTHERS D3 Condition of patient
pH: WBC: seen LDL: is good and feel
Protein: RBC: HDL: comfortable
Sugars: EP. Cells: TC/HDL: discharged with
Blood: seen PSA: discharge
Casts: more than 1lakh bacteria/ml medication.
Crystals:
Urine analysed with E. coli.
FINAL DIAGNOSIS: Urinary Tract Infection
DRUG TREATMENT CHART:
DRUG WITH DOSE & ROUTE 4/4 5/4
3/4 FOLLOW UP/REVIEW:
GENERIC NAME BRAND 2 3 To review in MED after one
week.
1.Ciprofloxacin Tab.ciplox √ √ √
500mg(0-1-0)
2.Paracetamol 500mg √ √ √
(1-1-1)
3.Tab.Cotrimoxazol 480mg (1-0-1) √ √ √
e
(0-1-0) √ √ √
4.Tab.Bcomplex
Tab. Rantac √ √ √
5.Tab.Ranitidine 150mg
DISCHARGE MEDICATIONS:
RX
1.Ciprofloxacin 500mg 0-1-0
2.Tab.Cotrimoxazole 400+80 mg 1-0-1
3.Tab.Bcomplex OD
4.Tab.Ranitidine
PROGRESS CHART: