DEPARTMENT OF ENT Gandhi Medical College, Bhopal Registration/Case no. R O in charge! Na#e o$ patient! Age/se%! Address! Religion!

'( TOR)! Presenting co#plaints! Date "ard/OPD!

Occ&pation!

'/O presenting co#plaints!

Past illness!

Personal histor*!

O+s/Mens histor*! ocial histor*! Fa#il* histor*! Treat#ent histor*! E,AM(NAT(ON! General e%a#ination!

*ste#ic e%a#ination!

ENT e%a#ination! EAR Right Prea&ric&lar region Pinna Posta&ric&lar region .incl&ding #astoid/ EAC TM -e$t

D(AGRAM!

Right

-e$t

Right T&ning $or0 tests 1Rinnes test 1"e+ers test 1ABC E&stachian t&+e .2alsal3a #anea3&r/ Facial ner3e pontaneo&s N*stag#&s Ro#+ergs test

Left

Fist&la test Caloric test Gait assess#ent

NOSE Nasal pro$ile! Nasal passages! Patenc*! Ol$action! Palpation! Anterior rhinoscop* ept&#! Floor! Roo$! -ateral 4all.in$/#iddle t&r+inate/! Nasophar*n%! Paranasal sin&ses!

in&s (nspection Palpation Transill&#ination THROAT: Oral ca3it*! 2oice! -ips! B&ccal #&cosa! G&#s and teeth! Tong&e! Floor o$ #o&th! 'ard palate! Retro#olar trigone! Orophar*n%! Anterior pillar! Posterior pillar! Tonsil!

Ma%illar*

Frontal

Eth#oid

Base o$ tong&e! Posterior phar*ngeal 4all! (ndirect lar*ngoscop*! NECK -*#ph nodes o$ head and nec0!

D(FFERENT(A- DD!

(N2E T(GAT(ON !

R,

Case s&##ar*!

Date!

ignat&re!

.No.

CA E T5D)

Date

Re#ar0

ENT RECORD BOOK

GAND'( MED(CA- CO--EGE,B'OPA-

NAME! RO-- NO.! E (ON/)EAR!

1111