SREE RENGA SRH/ OP/P/Form/CN31/AF & Re•AF(Ver.

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··· Quali ty " Sm,ct1 · · lASSESSMENT FORM/ RE-ASSESSMENT F~KM ]
J)r. S. GAYATHRl.,M.D.,on. ~ UHID No : -w,')_s no Si llS
consultant Obstetrician & Gynaecologl lopNo. / IOR Ne:>: ]'2.)1, bR
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oepartment : l5\ ~ Consultant Name : 'n
patient Name : t--..\.. Age/Sex :
Nurses Assessm ent :
pR: · mt BP : \ -~ :-<9 m Hg
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. whole lot Ima gine

octor's lni~ial Assessment : t ~ , 0/E : Anaemia p/ /\t

Chief Complaints : kt\ ... . ~~r/V " Pedal Oedema :f ·,c--\. _. , 4'L
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Past H/o : H/o HT/OM/Asthma/Allergy/Surgery ~fi\1_(1} Abdome n ~ '
F;:imily H/o .: H/o HT/DM/P T ( . CNS
Provisional Diagnos is :

DRUG ALLERGY: Finding

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D Life Style Modifica tion □ Diet
,J~eS. / .tt~~ [HRI, M.8.B.S.,M,D.,(OOf
□ Immuni zation Dr. Na : t;z;Reg. No: 79333
. s nt Obsterician & Gynecology
-SREE RENGA HOSPITAL., NO. 12, VARADA REDDY STREET, VEDACHALA NAGAR, CHENGALPATTU •1· Ph : o44 • 27432240127431544
Regn. ~ .
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Sa l fertility centre
& hospital

PHARMACY SLIP
S.No : 23 1 2To be filled by staff nurse)
Patient Name : ......... ...................·~..... Age/Sex .......... ...
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UHID No : Mrs.POONGOTHAI(39/F)
Bi ll No. : RCR-131499
Da te : 13 .Dec ,2023 18': 47 :'07 _: , Name
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M.C. Arumugam M.D.D.A (R.'-'eg.-No: 51319)
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 No Sree Renga Hospital
2 m Na gar, Chengalpaltu - 603001.
· 1 Varada Reddy Stteet, Vedach ala
43 '1544
Ph one Number 044 274 3 2240 / 27
m/l abo ratory
Website: W~Vvv .sreere ngahospltal .co

Bi ll/ Receipt
Nam e : Mrs.POONGOTHAI Bill No. : OPSAG230044717
Doctor : Dr. Gayathri
: 202 300 580 5 Bill Date : 13-12,.-2023 17:0$:19
MR No . Department : Obstetrics and Gyneco logy
Corporate/ · OP No. : OP 0000074660
Age / Sex : 39 Years/ Female
Camp
Phone No. : 9677498205
llllllllllllll II 111111111
Rate Q.ty Discount Amount
S.No. Service
1.00 0.00 250 .00
250 .00
1 CROSS MATCHING ( LA0394 J
Bill Amount 250 .00
Less Disc./ Adj 0.00

Less Paid 250 ,00

·1 . 0.00
• I
,. i, Balance
,·
Pa ym en t Details
Bank Amount
Date Mode Card Type
Re ce ipt /Adj No. 250 .00
13-12-2023 EFT
OPBAG230044717

ndred Fifty.Only/-
Re cei ve d With Thanks: '. Two Hu
1·
1 .,, ". ,· •

· · Printed Date / Time

' , '1

Che cked By
13-1 2-2023 17:08:19
Prepared By / Signature