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RVRS MEDICAL
COLLEGE &MAHATMA GANDHI HOSPITAL
CHWARA
BHILWARA, RAJASTHAN 311001
arrN TICKET
Patient Name
Age Sex
UHID No....
on.....
Department.....
Type of Admission (Mark) /Emergency
Provisional
ROUWIE
End result
Admission Diagnosis
CA DATE TIME
arscharge
Final Diagnosis
(principal Diagnosis
First)
Supsagain DAMA/LAMA
Absconded
LReferred
Operative Procedure
If Death Autopsy Done
Plon er maehessteay Autopsy not Done
Death
Cause of Death
MMCSBY Seal
MMCSBY YES( ) NO )
Package Booked JNISNA
Discharge ward
Totaldays Of Routine ward
With Venti
Total days
of ICU Without Venti
Add on investigation
(CT/MRI)
Total transfused Blood Units
(WB, PRBC, FFP, SDP, RDP)
Name & signature of duty doctor with seal Nafhe &sienatstg of Unittead withggal Name &signature of Nursing Staff
If Medicolegal Case (MLC) (Filled by FoyénsicMedicin) Date &time Name & Sign of Dr.
MLC No
Reg.No.44785/24655
Assistant
Hospital
College
t P r a
BHILWARA
Medical
&
(Raj.)
X.V.R.S.
If referred from
Outside then details M . G .
dical Record Department
Received By Date
Checked By Sheets
RVRS
MEDICAL COLLEGE & MAHATMA CJ S Jb
) 11OCP!T! L
11LRE, RAJISHAN
Sample No.: LID 569 A 759
DEPARTMENT OF PATHOLO 3
Patient ID: Doctor:
RG8628 2025/07, 2: ):59.13
Name: BRA JI Age: 80
Sex
Parameter Result
Male
Reference Interve! IR
WBC 12.14 + [10^3/uL]
RBC 4.66 [10^6/uLi 4.00 11.00
HGB 13.8 5.50)
4.50 -
HCT 40.7
8/dL] ( 13.0 - 17.0)
MCV 87.3 (36.0 - 50.0)
MCH fL] ( 80.e - 100.0)
29.6 PgJ
MCHC 33.9 ( 26.0 - 35.0)
8/dL]
PLT 295 19^3/uL] 31.0 - 36.0)
RDW-SD 48.0 [fL] 150 - 450)
RDW-CV 15.1 37.0 - 54.9)
PDW
[%] 11.0 16.0)
8.9 - [fL] 9.0 - 17.0)
MPV 9.4 [fL]
P-LCR 19.4
9.0 - 13.0)
[%7 13.0 - 43,9)
PCT 0.28 [%
NRBC
6.17 - 6.35)
0.0 [%]
NEUT 80.4 + [% (37.0 - 72.0)
LYMPH 9.2 - (%1 (29.e -
MONO 10.1 + % 50.9)
EO 0.2 [%
0.0 - 10.0) FBC
[%
e.0 - 6.0)
BASO 0.1
IG 0,4 o 0.0 - i.9)
0.0 - 1.05
NRBC# 0.00 [10^3/uL]
NEUT# 9.76 + [10^3/uL] 2.00 7.09)
LYMPH# 1.12 [10^3/uL 1.00 4.90)
MONO# 1.23 + [10^3/uL 0.00 - O.70)
E0# 0.02 [10^3/uL] 0.00 - 0.50)
BASO% 0.01 [10^3/l 010)
IGI# 0.05 + [10^3/uL] ( 6.00 - 0.91)
BODY FLUID
WBC-BF [10^3/uL]
RBC-BF 10^6/uL
10^3/ul [%
MN
PMN 10^3/uL] [%)
TC-BF# [10^3/ulL]
WBC IP Message RBC IP ilessage
Monocytosis
PATIENT TEST REPORT
20-12-2024 01:19PM
MR. ROOP CHAND Registered On
JPB1435616 Collected On 20-12-2024 01:30OPM
23-12-2024 04:17PM
:72 YEARS / MALE Authorized On
nder
23-12-2024 04:17PM
Printed On
Doctor
Barcode
J P
ate of Birth
:B40904
LIS Number
Passport No
Case Number :B40904 Page 1 of 1
Client Name M.O.
HISTOPATHOLOGY REPORT
REPORT - B40903 ALSO )
GROWTHVC (KINDLY SEE
Specimen
containers not labelled separately
Details
Specimen received in two
measuring
tissue pieces together
comprises of four grey brown soft
Gross The specimen
0.6x 0.6 cm.
embedding in one cassette.
Entire taken for
squamous
hyperplastic
lined by seen to
fragments of tissue epithelial cells are
Biopsy comprises
of masses of
Irregular masses are
Microscopic severe dysplasia. tissue. The cells
of these
epithelium with
d o w n w a r d into
the deeper
variationin size
and shape, mild
slight bridges are seen.
proliferate
squamous with Intercellular
mature seen.
predominantly
pearls are is
nuciei.Many horn
Histomorphology
hyperchromatic
infiltrate.
inflammatory
tissue shows marked cellcarcinoma.
The deeper differentiated
squamous
consistent with well
carcinoma.
squamous cell
differentiated
Well
Impression
Endof Report condition
correlate with clinlcal
received.
Kindiy
sample as
only to the
Results relate
D r . N i d h i P . C h a n c h l a r n l
DNB Pathology
Dr. G.N. Gupta RMCNO:023892/25547
M.D. Pathology
RMC NO: 005841/12949
PURPOSE
95210 22108
M E D I C O L E G A L
FOR
NOT VALID Mob.
(RAJ.) /
Arvoday
AGNOSTICS
" MRI (3T
Upgraded
C.T. Scan (500 SliceSoftware)
" Sonography 3DI4D
Colour Doppler
Digital X-Ray 500MA
with VHS)
Pathology Lab
MRI REPORT (1.5
NAME: RUPARAM TESLA/16 channel)
REF. BY: DR. AGE/SEX: 79Y/M
0.P.SHARMA SIR
DATE: 27-12-2024
CE-MRI NECK
On a 1.5 Tesla system,
in multiple planes. IV MRI of neck has been performed
using
Imaging Features:gadolinium is used for contrast portion ofSTIR,
the
TIW & T2W weighted
study. sequences
There is moderate
supraglottis involvingheterogeneously enhancing ulcero-proliferative
right lateral aryepiglottic
vestibular fold (false vocal mucosal
28mmx 18mm. cord) and adjacent fold and posterior wall of it with thickening noted in
posterior aspect of right vocal involvement of right
cord measurìng 26mm x
The nasopharynx appears normal
excluded.) The tongue, in signal
oropharynx and bilateral intensity and symmetry (mucOsal
faucial tonsils appear disease cannot be
The hypopharynx, rest of normal.
epiglottis and bilateral vallecula
Bilateral parotid and appear normal.
submandibular glands appear normal in
masticator, parapharyngeal and carotid spaces
appear normal. size and signal
The visualized cervical
intensity. Bilateral
lymph nodes (levels I-VI)
morphologies. are within normal size
limits, and maintain nomal
Visualized muscles appear normal in
volume and signal intensity.
Major vessels of the neck reveal
normal luminal flow voids.
Limited evaluation of visualized
paranasal sinuses does not reveal any
Conclusion: significant abnormality.
Moderate heterogeneously enhancing
ulcer0-proliferative mucosal thickening in
supraglottis involving right lateral aryepiglottic
involvement of right vestibular folds (false fold and posterior wall ofit with
aspect of right vocal cord, ikely vocal cord) and adjacent posterior
represent malignant(T2 stage)
lesion. supra-glottic
ADVISE -Clinical correlation.
DR.AJAY SINGA CHOUHAN
Note: -This is only aRadiological Impression 8& not M.D. (RADIO DIAGNOSIS!
the
Therefore MRI report should be interpreted in correlation final diagnosis. Like all diagnostic MioVhas its limitationy
to invasive procedures and in case of clinical with clinical & pathological findings, Please take sccond opiaion prio
diserepancy. Patient identity not verified before procedure.
Plot No. 26/27. Opp, Gayatri Shakti Peeth, Love Garden Road,
Bhilwara- 311001 (Rajasthan)
Ph. 01482-225555, +91 78520 72900, 63782 78600
E-mail: sarvoday.bhilwara@gmail.com Website: www.sarvodaydiagnostics.com
RE-ASSESSEMENT FORM
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Assistant
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Sign. &
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NOTES
RE-ASSESSEMENT FORM / PAC / OT
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