FOOD

cORPORATION
OF INDIA

Medical ldentity Card

Details of family:

Name Date of Birth Relation

1. A£YTNI.JADAX.. Q3..09..19.32..
2. .KAA.Ia.IADAN.
3..SHIVAM..KLMA8. ..C6.Q6.201... ..S.Gn.....
4

6.

7.

(Space fo omphotograph of the employees and his / her family (deperdgata

TIOA
ON

A. .st.,ufaTR
ional
.0.,Coochbehar

PORA

yPOOKLYN

*Family inccs ee or husband), children or step children dependant parèrs, sis ánd brother,
widowed daughtor /sister and dependant divorced/separated daughter /step mother.
 FOOD
CORPORATION
OF INDIA

Medical ldentity Card

o.A28.3.
Name in Full RNAN.NARAX.

Office in which employed .AD.s.KA..udca..BxLaicud.hce.Ssh.Bcka....

Residential address 24/.IARA. KUTIH8..R04D,LWKARaWNI..AANABAD.-2||0OI
LTIAR...RADESH.
Signature / Thumb impression of office employee Awd.hcda..
Signature of issuing authority

Office Seal
CORD Divisional Manager
H,1.A., i.H.afasTR
....FS.R.9:Coochbehar

Date of issue
23A....
To, DT: 18.09.2024
The Divisional Manager
Food Corporation of india
Divisional office Bathinda

Sub: Submission of Medical claim ...reg.

Sir,
In reference to above cited subject, please find attached treatment of Self for the
payment as details are given below:

S.N. Nane of dependent Relation Amount(in Rs.)

01 ARVIND Y¤DAV SELF 7071.00

ARVIND YADAV
AG-I (Tech.)
FSD Bathinda
 Form No. 811
Formof Application for Claiming Refund of MedicalExnenscs incurred in connection withthe Medical
Attendence and/ortteatinent of Officers/Staff of the Food Corporation of India and their Families.
(N.B. :- Separate farm should be used foreach patient)
Name & Desiqnationof the employed
(IN BIOCK TETTER) ARVIMD YADAN,TA-I
() WIhetermac or uDnared
Mamco
() tmacd, the pheewhero witehsband is enployee pez, P S9, bog stiyidg
DivIsIon n whclhosted -
fatundy, FS9-gdhnda Dept
Pay of the employ cas detncd in the Fundamental Pay DA HHA CCA Tota!
Rules. a i any otthet emolunents,which snould be Rs. allow Rs Rs. Rs.
shows sepatetely, 39&40/+Allaunce
4
Place ol uty ez, fSD bhi
5
Actut testontial Ad tress 63,edel stown, hae I, basida
Name ot the patienl and usher!elaonship to the
employCe (NB. . In the c15e o' chitdren, father, mother
state a1e also)
7 Placo at which pattcnt folH
Details of theanount claimed
MEDICAL ATTENDANCF:
(a) Fees for consulation, indicating :
tb) The name and destcnat1on of tthe Medical Officer Rohut GeynlRs. MES,.(2)..MSEMD
1).... Rs
LOnsülted and the hospital or dispensary to which
attached 3). Rs (4).. Rs...

(c) The number and dates of consultation and the fee

pard for each ccnsultation.
() The number and date of injections and the fee paid for
cach in ecton.
(e) Wihether cOnsultation and rnjections were had at the
hospitaland ttie Consullng roorn of the Medical Officer
or at the resdence of patient.
(a) Charges for pathclogical, bacteriological, radiological
Gr other simlar tests undertaken turing diagnoss,
ndcatng.
(b) Thie nare of the h0spitat or laboratory where the tests
wert undortakCn. and
c) Whether thetests wero undertakenon th advice ofthe
thorSEd meIcal attendant. I so, a certificate to that
-ffect shoukd b: attached.
C l fnedcne purchKCu tot the market (List of the
Enelase'.
H)SPTAL. TREATMET
CONSULTATIG4 WITH SPECIALIST

Whetr,! COHSlatio V: tid at the hosla a ie con

Iesidence ofthe |pticnl.

Wi.ethS; 1he Secialls: cr Medcal Officer was Consulted
 Tae Clan subrnitted is genune

Signature of Applicant

9 Total Anount claimed

10. List of enclosures

(9 frseralten 9) medsca! ca4

DECLARATION TOBE SIGNED BYTHE EMPLOYEE
whom
Thereby declare that statenents in this application aretruo to ost of rny knowledge and the person tor
expenses were ncurred is wholy dependent upon me.
Signature of the
Employee & TAT
Designation
IName &
Socion) feT,fS9 fatlirh
Date: 18)+l 2o24 Ph/intercom No...79og3E53
TO BE FILLED IN BY THE APPICANT Bank Alc. NoZ27.52A73453....
Treatmernt for :SeltWite/Son/Daughter/Mother/Father Naine and Address of Bank.t

Name ol Disease :Thaat Tnfeetin Duration: Fronn. 29124,to. 25/o4/24.

DETAILS OF MEDICINES PURCHA`ED
SL Cash Memo Name of Medicines Price Shop from which
Qty. Rermarks
No. No. & Dt. (IN BLOCK LETTERS) Rs. P purchased

S33)/
Mecrcade- lo4o/
tata)- oH

FOROFFICE USE
Consultat1on/Diet
Injections/Medical Advice etc.
3. Nursing &accormmodation
4 Confinement, operation etc.
5 X-ray. Pathological Test etc.
6. Cost of medic1nes
PASSED FOR
(Rupees. )

Asstt. Manager (Accounts) Asst. General Manager (Alcs)

Debit Officer Cat. WOficer Cat. ll Officers/Staft/Retired

5.150-'B/5.150'C'
Staff Cat. l/Staff Cat. IV
15.982 16.982

Received the sum of Rs.. Stamp

 MAX Lab

DNE

Nuelaw

www.maxlab.co.in
Conditions of Reporting: 1. The tests are carried out in the lab with the presumption that the specimen belongs to the patient name as ident1fied in the bill/test request form. 2
The testre:sults relate specificaly to the sample received in the lab and are presumed to have been generated and transported per specific instructions gven by the
3. The reported results are for the information and interpretation by the referring doctor only. 4.Some tests are referred to other laboratories to provioe
ohvsicians/laboretocustomer.
a wider test menu to t 5. Max Healthcare shall in no event be liable for accidental damages loss, or destruction of specimen which is not attributabBe to any arect
and mala fide act or omission of Max Healthcare or its employees. Liability of Max Healthcare for deficiency of services, or other errors and omissions shal be imited to fee
paid by the patient for the relevant laboratory services.
 MAX
Healthcare

Wheelchair/Stretch
\ Patient Name:

Max ID:
Yoda Date: / 12024
Age: YRS Sex: M/F
Consultant Name: DR Ht: CM Wt: KG BMI: KGM2
BP: mm/Hg, Pulse: BPM, Temperature:
Department Name :
PMC No. Pain Score: 01 2 3 4 56 7 8 9 10

RISK FALL ASSESSMENT:0 -1 Allergy NO- YES

NUTRITION ASSESSEMENT: SPO2:

Clinical Examination

Diagnosis/Provisional Diagnosis

Investigations

TEf

Diet Advice

Max Super Speciality Hospital, Bathinda Hometrail Buildtech Pvt. Ltd.

(A unit of Hometrail Buildtech Pvt. Ltd.) Regd. Ofice: N -110, Panchsheel Park,
NH- 64, Near District Civil Hospital, New Deihi- 110 017
Mansa Road, Bathinda, Punjab -151 001 T: +91-11 4609 7254
For medical service queries or appointments. E: secretarialhbpl@maxhealthcare.com
call: +91-164 521 2000
www.maxhealthcare.in (CIN: U45400DL2008PTC176962)
 MAX
Heaigcare
Bitlof Suppty
Mobile No.
Patient Name N Arvind Yadav
Age/Sex Maxdu sSN
Address Bill Ne Re NQ

PAN/Frm60
Reterred ay Passort NQ
Conpany GSTN

Company Add. Cumpany Name

SAN Services SAC Qty Base Tarift isCQUns Net Auont

Price(R) (R) (Tax to) (R)
Rotit (Goyal
(Cownsultatin CP1
99202 )(NID EN)
TotaB t0.0

Puid by utiunt
Amount in Wods : kupees three hundied Aty oly collete tom patiet
Sum Of Rs. 350.00 iKeved with tharnks ftn N, ArviN Yavav
(Amount inctucdes discount (if any) as per Agreenent)

Paxuent Mede(a)
Cash for Rs.350.00

SgUmre
Signature of Patent/Next of Kin

Place of Supply : Punjab{ 03) PAN NQ AACTNSIS

Company Name : Hometrail Builitech Private Liite(hotna)

Max Super Speciality Noapitel, Bethinde Nometreil Builuth N At

(A unit ot Hometrelt Buildtech Pvt Lta)
NH 64, Near District Civil Hospital, New Deihi 110 0
Mansa Road, Bathinda, Punjab 151 0Q1 t 4609 254
For medicalservice queris appointmeots,
calt 91 164 521 2000

Www.naxhealthcare in (CIN V4840Q01200SEAe)

 |MAXHealthcare
Billof Supply
Mobile No. :7980986336 *160297302*
Patient Name :Mr. ArvinNd Yadav Bill Date :05/08/2024 03:s9PM
Age/Sex t4lyears 1l months /Male Maxld | SSN :BHTN.297302 | 160297302

Address MODLTOWN HASE IAATHINDA BIlNo Receipt No : BHCSI215119 | BHRCI135592

GSTN BIl : H8240DO000040258
PAN/Form60 GSTN No : 03AACCH1518812G
Referred By :Rohit Goyal Passport No
Company GSTN :

Company Add. Company Name :FOOD cORPORATION OF INDIA

LTD

S.N Servicos SAC Qty Base Tarltf þiscounts Net Amount Tax Amnt Bill Amount
Prlce(Rs.) Price(Rs.) (Rs.) (Tax b) (Rs.)
Rohit Goyal 999312
350.00
1
(Consultation - CPT 400.0 350.0 0.0 350.0
99202 ) (BHTD-ENT)
Total : 0.00 350.00 0.00 350.00

Pald by Patient 350.00

Amount in Words : Rupees three hundred flty only collected from patient
Sum Of Rs. 350.00 received with thanks from Mr. Arvind Yadav
(Amount includes discount (if any) as per Agreement )

PaymentModets)
Cash for Rs.350.00

Signaturg
Signature of Patient/ Next of Kin Danis Al

PAN No. :AACCH1518B

Place of Supply :Punjab-( 03)
Company Name : Hometrall Buildtech Prtvate Limited(Bhatinda)

Max Super Specialty Hospital, Bathinda Hometrall Bulldtech Pvt. Ltd.

(A unit of HometrailBuildtech Pvt. Ltd.) Regd.OMice N-110, Panchsheel Park,
NH 64, Near District Clvil Hospital, New Delhi 110 017
Mansa Road, Bathinda, Punjab 151 001 T: +91-1 4609 7254
For medical service queries or appointments, E:secretarlalhbplomaxhealthcare.com
call +91-164 521 2000
www.maxhealthcare.in (CIN: U45400DL 2008PTC176962)
 MAX
Heálthcare
Duplicate Bill of Supply

*160297302*
Mobile No. :7980986336
BIll Date :29/07/2024 03:00PM
Patient Name : Mr. Arvind Yadav
MaxId / SSN : BHTN.297302 |160297302
Age/Sex :41 years 10 months / Male
: BHCS1212803 /BHRC1133648
Address : 63, MODEL TOWN PHASE 1 RATHINDA BillNo | Receipt No
: HB240DO000037942
GSTN Bill
: 03AACCH1518812G
PAN/ Fom60 GSTN No

Referred By :Rohit Goyal Passport No

Company GSTN :
:FOOD CORPORATION OF INDIA
Company Add. Company Name
LTD

Tariff þiscounts Net Amount Tax Amt Bill Amount

SI.N Services SAC Qty Base
Price(Rs.) (Rs.) (Tax %) (Rs.)
Price(Rs.)
Diagnostic Nasal 999312 2300.00
1
Endoscopy (By- Dr.
1 2650.00 2300.00 0.04 2300.00
Rohit Goyal )

|:|
999312 1984.00
Laryngoscopy
2 /Bronchoscopic
(assessement of upper
ainway) (By - Dr.
Rohit Goyal)
Total 0.00 4284.00 0.00 4284.00

Paid by Patient 4284.00

Amount in Words :Rupees four thousand two hundred eighty-four only collected from patient
Sum Of Rs. 4284.00 received with thanks from Mr. Arvind Yadav

(Amount incdudes discount (if any) as per Agreement )

Payment Mode(s)
Cash for Rs.4284.00

syonawrf
Harmeet Kayr
Signature of Patient/Next of Kin

PAN No. : AACCH1518B

Place of Supply : Punjab-( 03)
Company Name : Hometrail Buildtech Private Limited(Bhatinda)

Max Super Speciality Hospital, Bathinda Hometrall Bulldtech Pvt. Ltd.

(A unit of Hometreil Buildtech Pvt. Ltd.) Regd. Otfice: N-110, Panchsheel Park,
NH - 64, Near District Civil Hospital, New Delhi - 110 017
Mansa Road, Bathinda, Punjab - 151 001 T: +91-11 4609 7254
For medical service queries or appointments, E: secretarialhbplmaxhealthcare.com
call: +91-164 521 2000
www.maxhealthcare. in (CIN: U45400DL2008PTC176962)
 MAX
Healthcare
BIll of Supply
Mobile No. I79809N6336 "160297302*
Patient Name : Mr. Arvind Yadav BIll Date 06/08/2024 1L:06GAM
Age/Sex : 41years 11 months /Male Maxld | NSN HTN.29/ 102 | 160297102
Address 63,MODEL TOWN PHASE IATHINDA B No | Receipt No IBHCS1215326
GSTN BM IH9240DO000040465
PAN/ Fornm60 asTN No 103AACCH151001ZG

Referred By :Rohit Goyal Passport No

Company GSTN :

Company Add. Company Name : FOOD CORPORATION OF INDIA

LTD

SI.N Serviçes SAC Qty Base Tarlff þlscounts Net Amount Tax Amt BIl Amount
Price(Rs.) Prlca(Rs.) (Rs.) (Tex o) (Rs.)
FEAC with Procedure 999316
230.00
--
1 3150.00 230.00 0.00) 230.00

USG Small Part 999316

(Thyroid/ Neck/ 1332.0 401.00 0.0 401.0d 401.00

Lymphnode/Orbit/ So
Total 0.00 631.00 0.00 631.00

Pald by Patient 631.00

Amount in Words : Rupees six hundred thirty-one only collected from patient
Sum Of Rs. 631.00 recelved with thanks from Mr. Arvind Yadav
(Amount includes discount (if any) as per Agreement )

Payment Modes)
Cash for Rs.631.00

Signature
Signature of Patient/Next of Kin bantshL

Place of Supply : Punjab-{ 03) PAN No. :AACCH1518B

Company Name : HometrallBulldtech Prlvate Limted (Bhatinda)

Mex Super Speclelity Hospitel, Bethinde Hometrall Bulldtech Pvt. Ltd.

(A unit of Hometraell Bulldtech Pvt. Ltd.) Regd. OfMce: N - 110, Panchsheel Park,
NH -64, Near District Civil Hospital, New Delhl 110 017
Mansa Road, Bathinda, Punjab 151001 T: +91-114609 7254
For medical service querles or appointments, E: secretarialhbplomaxhealthcare.com
call: +91-164 521 2000
www.mexhealthcare. in (CIN: U45400DL2008PTC176962) Since va
 |MAX
Healthcare
Bill of Supply

Mobile No. 7980986336 "160297302*

Patient Name : Mr, Arvind Yadav BillDate : 08/08/2024 02:57PM

Age/Sex :41 years 11 months / Male Maxld | SSN : BHTN.297302 | 160297302
Address : 63, MODEL TOWN PHASE IBATHINDA BIlINo | Recelpt No : BHCS1216268 /BHRCI136636
GSTN BIll : H824OD0000041407
PAN/Form60 GSTN No : 03AACCH151881ZG

Referred By : Rohit Goyal Passport No

Company GSTN:
Company Add. Company Name :FOOD CORPORATION OF INDIA
LTD

SI.N Services SAC Qty Base Tariff þ0scounts Net Amount Tax Amt Bill Amount
Price(Rs.) Prlce(Rs.) (Rs.) (Tax %) (Rs.)
Thyroid Profile*,Serum 999316
1 1 1000.00 208.00 0.0 208.00| 208.00
(R)

Total: 0.00 208.00 0.00 208.00

Paid by Patient 208.00

Amount in Words : Rupees two hundred eight only collected from patient
Sum Of RS. 208.00 received with thanks from Mr. Anvind Yadav
(Amount includes discount (if any)as per Agreement )

Payment Mode(s)
Cash for Rs.208.00

Signature
Signature of Patient/ext of Kin Harmeet Kaur

Place of Supply :Punjab- 03) PAN No. : AACCH1518B

Company Name : Hometrail Buildtech Private Limited(Bhatinda)

Mex Super Speciality Hospltal, Bathinde HometrallBulldtech Pvt. Ltd.

(A unit of HometrallBulldtech Pvt. Ltd.) Regd. Ofice: N-110, Panchsheel Park,
NH -64, Near District Civil Hospital, New Delhi 110O17
Mansa Road, Bathinda, Punjeb - 151 001 T: +91-11 4609 7254
For medical service queries or appointments, E: secretarialhbplomaxhealthcare.com
call: +91-164 521 2000
M-2014-230
Jun 12.
(CIN: U45400DL2008PTC176962) i e jun 2. 20o14
www.maxhealthcare. in
 MAX
Healthcare
Billof Supply
Mobile No. :7980986336 "160297302*
Patient Name :Mr, Arvind Yadav BillDate : 23/08/2024 11:21AM
Age/Sex : 41 years 11 months/ Male MaxId | SSN : BHTN.297302 /160297302
Address : 63,MODEL TOWN PHASE 1 BATHINDA Bill No | Receipt No :BHCS1220271 /BHRC1140369
GSTN Bill : HB24OD0000045410
PAN/Form60 GSTN No : 03AACCH151881ZG
Referred By :Rohit Goyal Passport No
Company GSTN :
Company Add. Company Name :FOOD CORPORATION OF INDIA
LTD

SL.N Services SAC Qty Base Tariff þiscounts Net Amount Tax Amt Bill Amount
O.
Price(Rs.) Price(Rs.) (Rs.) (Tax %) (RS.)
Thyroid Profile*,Serum 999316
(R) 1 1000.00 208.00 0.0 208.00 208.00

Total : 0.00 208.00 0.00 208.00

Paid by Patient 208.00

Amount in Words : Rupees two hundred eight only collected from patient
Sum Of Rs. 208.00 received with thanks from Mr, Arvind Yadav

(Amount incdudes disoount (if any) as per Agreement )

Payment Mode(s)
Cash for Rs.208.00

Ssnatore
Signature of PatientUNext of Kin DaniskA1

Place of Supply : Punjab-{ 03) PAN No. : AACCH15188

Company Name : HometrailBuildtech Private Limited(Bhatinda)

Max Super Specielity Hospital, Bathinda Hometrall Bulldtech Pvt. Ltd.

(A unit of Hometrail Bulldtech Pvt. Ltd.) Regd. Ofice: N 110, Panchsheel Park,
NH -64, Near District Civil Hospital, New Delhi 10 017
Mansa Road, Bathinda, Punjab - 151 001 T: +91-11 4609 7254
For medicalservice queries or appointments, E: secretarialhbpl@maxhealthcare.com
call: +91-164 521 2000
M2014-230
www.maxhealthcare. in (CIN: U45400DL2008PTC176962) Jun 12
Sunce un 12 30
 |MAX Healthcare
Max Super Speciality Huspital. Ground Floor, Inside Civil Hospital, Mansa Road. Bathinda -
I51001
Tav Invoice

Patent Name Mr. Avnd Yadav Date 29-Ju-2024 4 15 pm

41 Year(s) /Male GST Bill No H824PA000002 1028

Age Sex
Maxld BHTN.297302
Refered By Rohit Goyal Max Super Speciality Hospital,
NH-64, Mansa Road, Bathinda Punjab-151001 Invoice/Receipt No BH710823/709211

Adoress 63,MODEL TOWN PHASE 1 BATHINDA Bathinda. Pharma Bill No 715493

Bathinda Cantt, Punjab, 151004, India iPunjab GSTIN No. :03AACCH1518B1ZG

PAN No. : AACCH15188

Telephone 7980986336
Place of Supply Punjab ( 03
Patent State Punjab
HSN CGST SGST Qty Batch No Expiry MRP Unit Cost Total Amt. Discount Totai \
Particulars
W/o Tax wio Tay atter dise
Code
Ine G9i

AXB00 Feb-26 18.90 16 88 10128 0.00 1343

I BILASURE M 300490 6.00 6.00
OMG TABXI0) 28
LTA-36 Jun-25 42.50 3795 379.50 0.00 425.04
2 FLIPCEF 500MG 300420 6.00 6.00
433
TAB (Ixi0)
29 66 8898 ) 00 05 00
IMUGAIN TAB 210690 9 00 9.00 3 AM-747 Sep-25 35 00

(1XI0) 0
300490 3 GTFIS8 Dec-25 16.33 14.58 43 74 0,00
4 SOMPRAZ D 40MG 6 00 6.00
CAP (Ixl5) 3A

12% 18% 28% Tutal

524.52 8S 98 61350 69240

Total
Discount 0.00

524 52 88.98 613.50

Net Amvunt
62.94 16.02 78.96
#TotalTax

587.46 105.00 692.46

Amount Collected
0.00
Balance

Received Sum of 692.46 BY Cash Your Saving : 0.00

D1scount Reason
Phamaci

DL No PB-BTI-15T100 I5I101

0.00,CESS @0.00%: Rs. 0.00, CGST

#lucluding CGST a9.00%: Rs. 8.01,SGST a9.00: Rs. 8.01,IGST @0.00%: Rs.
0.00,CESS@0.00%: Rs. 0.00
a0.00%: Rs. 31.47,5GSTa6.00%: Rs. 31.47,IGST a0.00%: Rs.

is unintentional
Gouds once sold cannot be taken back Error in billing, if any, is an oversight and
15% Discount on Onco Drugs (32 items ) conditions apply
Max Super Speciality Hospital, Bathinda Hometrail Buildtech Pvt. Ltd.
(A unit of Hometrail Buildtech Pvt. Ltd.) Regd. Office: N - 110, Panchsheel Park,
New Delhi - 110 017
NH -64, Near District CivilHospital,
Mansa Road, Bathinda, Punjab - 151 001 T: +91-114609 7254
For medical service queries or appointments, E: secretarialhbpl@maxhealthcare.com
cat 9-164 52T2000 Pat
204 230
Run Date 2 Jul-2024 4 l6 pm 204
www.maxhealthcare.in (CIN: U45400DL2008PTC176962)
 |MAX
Healthcare
MaN Super Speciality Hospital,Ground Floor, Inside Civil Hospital, Mansa Road. Bathinda
IS1001
Tax Invoice

Patent Name M. Arvind Yadav Date 01-Aug-2024 4.27 prn

Age/Sex 42 Year(s) /Male GST Bill No. : HB24PA0000021595

Referred By :RohitGoyal Max Super Speciality Hospital, Maxld : BHTN.297302

NH-64, Mansa Road, Bathinda Punjab-151001 Invoice/Receipt No : BH711243/709631
Address 63,MODEL TOWN PHASE 1 BATI HINDA Bathinda. Pharma Bill No 715913
Bathinda Cantt, Punjab, 151004, India / Punjatb GSTIN No. 03AACCH1518B1ZG

iCIephone 7980986336 PAN N AACCH15188

Patient State Punjab Place of Supply Punjab ( 03

Particulars HSN CGST SGST Qty Batch No Expiry MRP Unit Cost Total Amt. Discount TotalAmt
Code w/o TaX w/o Tax after dise
Inc GST

300490 6.00 AXB00 Feb-26 18.90 16.88 67 52 0.00 75 62

I BILASURE M 6.00 4

1OMG TAB (|X10) 28

LTA-36 Jun-25 42.50 37 95 !5| 80 ) 00 170 02
FLIPCEF S00MG 300420 600 6.00 4

TAB(Ixl0) 433
35.00 29 66 59 32 0.00 70 00
3 IMUGAIN TAB 210690 9.00 9.00 2 AM-747 Sep-25
(|X10)
4 SOMPRAZ D 40MG 300490 6.00 6.00 GTFI58 Dec-25 16.33 14.58 29.16 0.00 32 66

CAP (Ix15) 3A

12% 18% 28% Total

248.48 59 32 3080
Total
Discount

248.48 59.32 307 80

Net Amount
29.82 10.68 40.50
#TotalTax

278.30 70.00 348.30

AmOunt Collceted

Balance

keceived Sun of 348.30 BY Cash Your Saving : 0.00

Discount Reason
Pharmacist

DL. No. PB-BTI-151100/151101

#lucluding CGST a9.00%: Rs. 5.34,SGST (u9.00o: Rs. 5.34, IGST @0.00%: Rs. 0.00,CESS @0.00%: Rs. 0.00, CGST
a6.00: ks. J4.91,5GST a6.00%: Rs. l4.91.IGST Q0.00%: Rs, 0.00,CESS (@0.00%: Rs, 0.00

G00ds once sold cannot be taken back Err01 in billing, it any, is an oversight and is unintentionat
I5% DIscount onOnco Drugs (32 itenns ) conditions apply
Max Super Speciality Hospital, Bathinda Hometrel Buildtech Pvt. Ltd.
(A unit of Hometrail Buildtech Pvt. Ltd.) Regd. Ofice: N-110, Panchsheel Park,
NH -64, Near District Civil Hospital, New Delhi 110 017
Mansa Road, Bathinda, Punjab - 151 001 T: +91-11 4609 7254
For medicalservice queries oL appointmeats
Pago
kurfit91A212904 27 p M204-230
2 Dec
www.maxhealthcare. in (CIN: U45400DL2008PTC176962) Since
 MAX SUPER SPECIALITY HOSPITAL
NH-64, MANSA ROAD,BHATINDA, PUNJAB
MAX
Healthcare
Phone -0164-5212000
www.maxhealthcare.in
ENT
Patient Name: MR.ARVIND VADAV Age/@ender 1 41 Yoars/Male Date : 29/Jul/2024
Retered By Unit No 297302

FIBER OPTIC LARYNGOSCOPY

FINDING :

TONSILS : Normal.

BASE OF TONGUE :Normal.

VALLECULLA :Normal.

POSTERIOR PHARYNGEAL WALL: Normal.

TRUE VOCAL CORDS : Normal.

EPIGLOTTIS : Normal

ARYEPIGLOTTIC FOLD : Normal

ARYTENOIDS : CONGESTED AND HYPERTROPHIED

PYRIFORM FOSSA

CONCLUSIONS : LPRD

Dr. Rohit Goyal

MS
ENT
www.visualscopy.com
VisualScopy HD. Visit
Report 0s generated by
 MAX SUPER SPECIALITY HOSPITAL
NH-64, MANSA ROAD, BHATINDA, PUNJAB
MAX
Healthcare
Phone- 0164-5212000
www.maxhealthcare.in
ENT
Patient Name : MR.ARVIND YADAV Age/Gender : 41 Years/Male Date : 29/Jul/2024
Referred By SELF Unit No: 297302

DIAGNOSTICNASAL ENDOSCOPY
FINDING :
NASAL CAVITY:
1ST PASS- DNS RIGHT SIDE SEEN. MILD B/L
INFERIOR TURBINATE HYPERTROPHY PRESENT.
2ND PASS MIDDLE MEATUS LEFT SIDE POLYP
PRESENT
3RD PASS- SPHENOID OSTIUM NOT SEEN.

CONCLUSIONS : ALLERGIC
RHINO SINUSITIS WITHDNS

Dr. Rohit Goyal

MS
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 MAX Lab Laboratory Investigation Report
Patent Name MAvnd Yadav Centre 1110-Max Hospital Bathinda
Age Gender 41 Y 11 M3D M OPAP No/UHID :OP/BHCS1215326/!
MaxtDLab 1D BHTN 297302/0839082401891 Collection Date/Time:06/Aug/2024 12:34PM
Ref Docto Dr Rohit Goyal Reporting Date/Time :06/Aug/2024 01:04PM
Cytopathology SIN No BHA297302
FNAC With Procedure

Cytology Number:-C363-24
FNAC Site: - FNACfrom the nape of the neck swelling (firm, mobile, non tender).
Gross Description:- On aspiration, fatty material obtained.
Microscopic Description:
FNA smears show fragments of mature benign adipocytes.
No atypical cell seen.
Final Diagnosis:- FNACshow features of Benign lipomatous lesion - Lipoma.
Advise : Clinical corelation.

Kindiy comelate with clinical findings

*** End Of Report ***

Sng, M2r D. Alia Gut MA

Carsuba Ptoogs

Test Perfomed at :1110- Max Hospital Bathinda, Mansa Road, Ncar Distic1 Civil Hospital, Bathinda, Punjab 1S1001 Page I of 1
Booking Centre :1110- Max Hospital Bathinda, Mansa Road, Near District Civil Hospital, Bathinda, Punjab 151001
The authenticity of the report can be verified by scanning the QR Code on top of the page
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Max Super Speciality Hospital, Bathinda
NH-64, Near District Civil Hospital, Mansa Road, Bathinda, Punjab -151 001, Phone: +91-164 521 2000
www.maxlab.co.in
MC-2718
Conditions of Reoortina: 1. The tests are carried out in the lab with the presumption that the specimnen belongs to the patient name as identified in the bill/test request form. 2.
The test results relate specifically to the sample received in the lab and are presumed to have been generated and transported per specific instructions given by the
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paid by the patient for the relevant laboratory services.
 |MAXHealthcare

INVESTIGATION REPORT

Name : Arvind Yadav Location: Bathinda

Age/Gender : 41/M IP No : Adm Type: OutPatient
Max ID: BHTN.0297302 Order Date : 06/08/2024
Ref. Doctor: Rohit Goyal Report Date : 06/08/2024 12:26 PM

USG NECK of 06/08/2024:

Right lobe of thyroid measures 15 mm in AP dimension Left lobe of thyroid measures 15.6 mm in AP dimension. Isthmus measures

5 mm in AP dimension and shows normalechopattern.

Bilateral lobes of thyroid are normal in shape and show heterogeneous echopattern. Linear echogenic striations are seen in thyrod
parenchyma On CDFI, normal vascularity is noted. A
subcentimetric spongiform nodule is seen in left lobe of thyroid.

B/L Submandibular glands are normal in size and echopattern.

B/L parot1d glands are normal in size and echopattern.

Major muscular and vascular structures appear normal.

jugular chains.
Few normal sized lymph nodes with maintained fatty hilum are noted along bilateral

x 8.7 mm in size is seen along posterior aspect of neck at the

A well defined smoothly marginated echogenic lesion measuring 27
lipoma
site of swelling Linear echogenic striations are seen within it - Slo

IMPRESSION:
NECK AT THE SITE OF
ECHOGENIC LESION ALONG POSTERIOR ASPECT OF
WELL DEFINED SMOOTHLY MARGINATED
SWELLING- SIO LIPOMA

OUT AUTOIMMUNE ETIOLOGY (ADVISED -TFT

HETEROGENEOUS ECHOPATTERN OF THYROID GLAND - RULE
CORRELATION)

(Advised - clinical correlation)

Dr. Bikramjit Singh Sidhu

Page 1 of 2
Medical Practioner Only)
(For Interpretation by a Registered
Hometrail Buildtech Pvt. Ltd.
Hospital, Bathinda
Max Super Speciality Regd. Office: N - 110, Panchsheel Park.
Buildtech Pvt. Ltd.)
(A unit of Hometrail New Delhi - 110 017
Hospital,
NH -64, Near District Civil T: +91-11 4609 7254

Mansa Road, Bathinda, Punjab -151 001 E: secretarialhbpl@maxhealthcare.com

queries or appointments,
For medical service H-2014230
Jun 12. 7-Dec t1. 20
+91-164 521 2000 (CIN: U45400DL2008PTC176962) Since u 12 204
call:
www.maxhealthcare.in
 MAX Healthcare

INVESTIGATION REPORT

Name : Arvind Yaday Location : Bathinda

Age/Gender: 41/M IP No : Adm Type: OutPatient
Max ID : BHTN.0297302 Order Date : 06/08/2024
Ref. Doctor: Rohit Goyal Report Date : 06/08/2024 12:26 PM

USG NECK of 06/08/2024:

Right lobe of thyroid measures 15 mm in AP dimension Left lobe of thyroid measures 156 mm in AP dimension. Isthmus measures
5 mm n AP dimension and shows normal echopattern.

Bilateral lobes of thyroid are normal in shape and show heterogeneous echopattern. Linear echogenic striations are seen in thyroid
parenchyma On CDFI, normal vascularity is noted. Asubcentimetric spongiform nodule is seen in left lobe of thyroid.

B/L submandibular glands are normal in size and echopattern.

B/L parotid glands are normal in size and echopattern.

Major muscular and vascular structures appear normal.

Few normal sized lymph nodes with maintained fatty hilum are noted along bilateral jugular chains.

A well defined smoothly marginated echogenic lesion measuring 27 x 8.7 mm in size is seen along posterior aspect of neck at the
site of swell1ng Linear echogenic striations are seen within it- Slo lipoma

IMPRESsION:

WELL DEFINED SMOoTHLY MARGINATED ECHOGENIC LESION ALONG PoSTERIOR ASPECT OF NECK AT THE SITE OF
sWELLING- S/O LIPOMA

HETEROGENEOUS ECHOPATTERN OF THYROID GLAND- RULE OUT AUTOIMMUNE ETIOLOGY (ADVISED - TFT
CORRELATION)

(Advised - clinical correlation)

Dr. Bikramjit Singh Sidhu

(For Interpretation by a Registered Medical Practioner Only) Page 1 of 2
Max Super Speciality Hospital, Bathinda HometrailBuildtech Pvt. Ltd.
(A unit of Hometrail Buildtech Pvt.
Ltd.) Regd.Office: N -110, Panchsheel Park,
New Delhi - 110 017
NH -64, Near District Civil Hospital, T: +91-11 4609 7254
001
Mansa Road, Bathinda, Punjab -151
appointments, E:secretarialhbpl@maxhealthcare.com
For medical service queries or WASH

call: +91-164 521 2000 H-204-230

(CIN: U45400DL2008PTC176962) Jun 12. 17-Dec tt. 20
Since Jun 12, 2014
www.maxhealthcare. in
 MAX
Healthcare

INVESTIGATION REPORT

Name: Arvind Yaday Location : Bathinda

Age/Gender: 41/M IPNo : Adm Type: OutPatient
Max ID: BHTN.0297302 Order Date : 06/08/2024
Ref. Doctor: Rohit Goyal Report Date : 06/08/2024 12:26 PM

Senior Resident (MBBS, MD)

Report Approved Date & Time : 06/08/2024 12:26 PM

(F'or Interpretation by a Registered Medical Practioner Only) Page 2 of 2

Bathinda Hometrall Buildtech Pvt. Ltd.
Max Super Speciality Hospital, Regd. Office: N - 110, Panchsheel Park,
Hometrail Buildtech Pyt. Ltd.)
(A unit of NewDelhi 110 17
Hospita,
NH -64, Near District Civil T: +91-11 4609 7254
Punjab-151 001
Mansa Road, Bathinda, E: secretarialhbpl@maxhealthcare.com
queries or appointments,
For medical service
521 2000
BATHINDA

HOSPITAL,

SPECIALITY

SUPER

MAX
 MAX Lab
Laboratory Investigation Report
Centrs 1110- tan Hospta Bathinda
OP SHCS 1216268
Clectn Date Tne 08Auo 2024 0303P
Regortg Date Tme 08Aug2024 05 02PV
Irmmunossay
Thyroid Profle (Free T$ Free T4 &TSH)
Date SAug 2024 Unit Bio Ref lnterval
030PI
26-42

ngdl 058 - 1.64

Throd Satng omone 5017 038- 5 33

Comment
Prematar
lst
Triaster Trìæester Trimester

FT3 Pgmi

** End of Report *
 IMAX Lab
Laboratory Investigation Report
Patient Name M Arvind Yadav Centre 1110-Max Hospital Bathinda
Age Gender 41 Y 11M 20 DM OP/P No/UHID OP/BHCS1220271/
MaxlD/Lab ID BHTN.297302/0839082407567 Collection Date/Time, 23/Aug/2024 11:43AM
Ref Doctor Dr Rohit Goyal Reporting Date/Tine 23/Aug/2024 02:32PM

Immunoassay SIN No AAOI|76

Thyroid Proffle (Free T3, Free T4 & TSH)
Unit Bio Ref Interval
Date 23/Aug/2024 (08/Aug/24
11:43AM 03:03PM
pg/mL 2.6-4.2
Free Triiodothyronine (FT3) 3.87 3.86
CLUA

Free Thyroxine (FT4) 0.64 0.42 ng/dL 0.58- 1.64

A

ulU/mL 0.38 -5.33

Thyroid Stimulating Hormone 4.897 5.017

Comment
Premature Cord Blood, 1st 2nd 3rd
Parameter Unit (>37
Upto 2
(28 - 36 Trimester Trimester
Month Trimester
weeks) wjeeks)
FT3 0.15 -3.91 2.4-5.6 2.11 -3.83 1.96 - 3.38 I.96-3.38
PgmL
FT4 ng dl 1.7 -4.0 0.7-2.0 0.5- 1.6 0.5 -1.6

TSH ulU/ml 0.7 -27.0 2.3 - 13.2 0.5 - 10 0.05 - 3.7 0.31 -4.35 0.41 -5.18

Note : TSH lcvcis arc subjcct to circadian variation, reaching pcak levcts betwccn 2 - 4 am
and at a minimum between 6 10 pm. The variation is of the order of 50% - 206 %, hence

time of the da has influence on the measured serum T^Hconcentrations.

Comment: TSH - Ultrasensitive

Kindly correlate with clinical findings

*** End Of Report ***

Dr. Koal Singla, M.DPth) Dr. Alka Gupte MD

unsue nt Pathologist

Page t of I
Test Performcd at :|10- Max Hosp1tal Bathinda, Mansa Rod, Near istrict Civil Hospital, Bathinda, Punjab |SI001
Booking Centre :1110- Max Hospital Bathinda, Maasa Road, Near District Civil Hospital, Bathinda, Punjab 1SI001, 1111|WI
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