Rakta Moksha

INDEX
Sl No NAME OF PATIENT PROCEDURE PAGE NO.

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RAKTAMOKSHANA PRACTICAL RECORD

DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA
MUNIYALU INSTITTUTE OF AYURVEDA MEDICAL SCIENCE
INDEX
Name:
Age: O.P.D Number:
Sex: I.P.D. Number:
Religion: Bed Number:
Education: DOA:
Marital Status: DOD:
Socio-economic status: Diagnosis:
Occupation: Procedure:
Postal Address:
Desha:
VEDANA SAMUCHAYA: DURATION:
VEDANA VRITTANTA:
PURVA VYADHI VRITTANTA:
CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:
VAIYAKTIKA VRITANTA:
Appetite -
Sleep -
Bowel -
Micturition -
RAJO PRAVRITTI VRITTANTA: NA
RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
PRASAVA VRITTANTA: G/P/A/D/L
OTHER SYMPTOMS:
DASHA VIDHA PARIKSHA:
PRAKRITHI: V/P/K/VP/PK/KV/S
SATVA: P/M/A
SARA: P/M/A
SAMHANANA: P/M/A
PRAMANA: P/M/A
SATMYA: P/M/A
AHARA SHAKTI: PURVA KALINA--------P/M/A ADHYATANA: P/M/A
JARANA SHAKTI: PURVA KALINA-------P/M/A ADHYATANA: P/M/A
VYAYAMA SHAKTI: P URVA KALINA-------P/M/A ADHYATANA: P/M/A
VAYA: BALA/MADHYAMA/VRIDDHA
GENERAL EXAMINATION:
BUILT: WELL/MODERATE/POOR
NOURISHMENT: WELL/MODERATE/POOR
HEIGHT: ------ CMS
WEIGHT: ------- KGS
TEMPERATURE: -------- 0F
PULSE: -------/MINUTE
RESPIRATORY RATE: --------/MINUTE
BLOODPRESSURE: ------ MM OF HG
PALLOR: PRESENT/ABSENT
ICTERUS: PRESENT/ABSENT
LYMPHNODES: PALPABLE/NON PALPABLE
NAIL CHANGES: CYANOSIS:PRESENT/ABSENT
CLUBBING: PRESENT/ABSENT
SYSTEMIC EXAMINATION:
C.V.S:
R.S:
C.N.S:
P.A:
SAMPRAPTI GHATAKAS:
DOSHA:
DUSHYA:
AGNI:
AMA:
SROTAS:
SROTO DUSTI PRAKARA:
UDBHAVA STHANA:
SANCHARI STHANA:
VYAKTA STHANA:
ADHISTANA:
ROGAMARGA:
DIAGNOSIS:
CHIKITSA KARMA:
Requirements & Medicines:
PRADHANA KARMA
OBSERVATIONS:
SAMYAK SNIGHDA LAKSHANA:
Atiyaog Raktamokshana Lakshana
Ayoga raktamokshana lakshana

PASCHATH KARMA:
PRECAUTIONS:
DISCUSSION:
Signature of the Scholar
Signature of the Staf Signature

of the H.O.D

INDEX
Name:
Age: O.P.D Number:
Sex: I.P.D. Number:
Education: DOA:
Postal Address:
Desha:
VEDANA VRITTANTA:
CHIKITSA VRITTANTA:
Appetite -
Sleep -
Bowel -
Micturition -
RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
OTHER SYMPTOMS:
SATVA: P/M/A
SARA: P/M/A
SAMHANANA: P/M/A
PRAMANA: P/M/A
SATMYA: P/M/A
HEIGHT: ------ CMS
WEIGHT: ------- KGS
C.V.S:
R.S:
C.N.S:
P.A:
SAMPRAPTI GHATAKAS:
DOSHA:
DUSHYA:
AGNI:
AMA:
SROTAS:
UDBHAVA STHANA:
SANCHARI STHANA:
VYAKTA STHANA:
ADHISTANA:
ROGAMARGA:
DIAGNOSIS:
CHIKITSA KARMA:
PRADHANA KARMA
OBSERVATIONS:
PASCHATH KARMA:
PRECAUTIONS:
DISCUSSION:

of the H.O.D

INDEX
Name:
Age: O.P.D Number:
Sex: I.P.D. Number:

Education: DOA:
Postal Address:
Desha:
VEDANA VRITTANTA:
CHIKITSA VRITTANTA:
Appetite -
Sleep -
Bowel -
Micturition -
RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
OTHER SYMPTOMS:
SATVA: P/M/A
SARA: P/M/A
SAMHANANA: P/M/A
PRAMANA: P/M/A
SATMYA: P/M/A
HEIGHT: ------ CMS
WEIGHT: ------- KGS
C.V.S:
R.S:
C.N.S:
P.A:
SAMPRAPTI GHATAKAS:
DOSHA:
DUSHYA:
AGNI:
AMA:
SROTAS:
UDBHAVA STHANA:
SANCHARI STHANA:
VYAKTA STHANA:
ADHISTANA:
ROGAMARGA:
DIAGNOSIS:
CHIKITSA KARMA:
PRADHANA KARMA
OBSERVATIONS:
PASCHATH KARMA:
PRECAUTIONS:
DISCUSSION:

of the H.O.D

INDEX
Name:
Age: O.P.D Number:
Sex: I.P.D. Number:
Education: DOA:

Postal Address:
Desha:
VEDANA VRITTANTA:
CHIKITSA VRITTANTA:
Appetite -
Sleep -
Bowel -
Micturition -
RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
OTHER SYMPTOMS:
SATVA: P/M/A
SARA: P/M/A
SAMHANANA: P/M/A
PRAMANA: P/M/A
SATMYA: P/M/A
HEIGHT: ------ CMS
WEIGHT: ------- KGS
C.V.S:
R.S:
C.N.S:
P.A:
SAMPRAPTI GHATAKAS:
DOSHA:
DUSHYA:
AGNI:
AMA:
SROTAS:
UDBHAVA STHANA:
SANCHARI STHANA:
VYAKTA STHANA:
ADHISTANA:
ROGAMARGA:
DIAGNOSIS:
CHIKITSA KARMA:
PRADHANA KARMA
OBSERVATIONS:
PASCHATH KARMA:
PRECAUTIONS:
DISCUSSION:

of the H.O.D

INDEX
Name:
Age: O.P.D Number:
Sex: I.P.D. Number:
Education: DOA:
Postal Address:
Desha:
VEDANA VRITTANTA:
CHIKITSA VRITTANTA:
Appetite -
Sleep -
Bowel -
Micturition -
RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
OTHER SYMPTOMS:
SATVA: P/M/A
SARA: P/M/A
SAMHANANA: P/M/A
PRAMANA: P/M/A
SATMYA: P/M/A
HEIGHT: ------ CMS
WEIGHT: ------- KGS
C.V.S:
R.S:
C.N.S:
P.A:
SAMPRAPTI GHATAKAS:
DOSHA:
DUSHYA:
AGNI:
AMA:
SROTAS:
UDBHAVA STHANA:
SANCHARI STHANA:
VYAKTA STHANA:
ADHISTANA:
ROGAMARGA:
DIAGNOSIS:
CHIKITSA KARMA:
PRADHANA KARMA
OBSERVATIONS:
PASCHATH KARMA:
PRECAUTIONS:
DISCUSSION:

of the H.O.D

INDEX
Name:
Age: O.P.D Number:
Sex: I.P.D. Number:
Education: DOA:
Postal Address:
Desha:
VEDANA VRITTANTA:
CHIKITSA VRITTANTA:
Appetite -
Sleep -
Bowel -
Micturition -
RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
OTHER SYMPTOMS:
SATVA: P/M/A
SARA: P/M/A
SAMHANANA: P/M/A
PRAMANA: P/M/A
SATMYA: P/M/A
HEIGHT: ------ CMS
WEIGHT: ------- KGS
C.V.S:
R.S:
C.N.S:
P.A:
SAMPRAPTI GHATAKAS:
DOSHA:
DUSHYA:
AGNI:
AMA:
SROTAS:
UDBHAVA STHANA:
SANCHARI STHANA:
VYAKTA STHANA:
ADHISTANA:
ROGAMARGA:
DIAGNOSIS:
CHIKITSA KARMA:

PRADHANA KARMA
OBSERVATIONS:
PASCHATH KARMA:
PRECAUTIONS:
DISCUSSION:

of the H.O.D

INDEX
Name:
Age: O.P.D Number:
Sex: I.P.D. Number:
Education: DOA:
Postal Address:
Desha:

VEDANA VRITTANTA:
CHIKITSA VRITTANTA:
Appetite -
Sleep -
Bowel -
Micturition -
RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
OTHER SYMPTOMS:
SATVA: P/M/A
SARA: P/M/A
SAMHANANA: P/M/A
PRAMANA: P/M/A
SATMYA: P/M/A
HEIGHT: ------ CMS
WEIGHT: ------- KGS
C.V.S:
R.S:
C.N.S:
P.A:
SAMPRAPTI GHATAKAS:
DOSHA:
DUSHYA:
AGNI:
AMA:
SROTAS:
UDBHAVA STHANA:
SANCHARI STHANA:
VYAKTA STHANA:
ADHISTANA:
ROGAMARGA:
DIAGNOSIS:
CHIKITSA KARMA:

PRADHANA KARMA
OBSERVATIONS:
PASCHATH KARMA:
PRECAUTIONS:
DISCUSSION:

of the H.O.D
INDEX
Name:
Age: O.P.D Number:
Sex: I.P.D. Number:
Education: DOA:
Postal Address:
Desha:
VEDANA VRITTANTA:
CHIKITSA VRITTANTA:
Appetite -
Sleep -
Bowel -
Micturition -
RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
OTHER SYMPTOMS:
SATVA: P/M/A
SARA: P/M/A
SAMHANANA: P/M/A
PRAMANA: P/M/A
SATMYA: P/M/A
HEIGHT: ------ CMS
WEIGHT: ------- KGS
C.V.S:
R.S:
C.N.S:
P.A:
SAMPRAPTI GHATAKAS:
DOSHA:
DUSHYA:
AGNI:
AMA:
SROTAS:
UDBHAVA STHANA:
SANCHARI STHANA:
VYAKTA STHANA:
ADHISTANA:
ROGAMARGA:
DIAGNOSIS:
CHIKITSA KARMA:

PRADHANA KARMA
OBSERVATIONS:
PASCHATH KARMA:
PRECAUTIONS:
DISCUSSION:

of the H.O.D
INDEX
Name:
Age: O.P.D Number:
Sex: I.P.D. Number:
Education: DOA:
Postal Address:
Desha:
VEDANA VRITTANTA:
CHIKITSA VRITTANTA:
Appetite -
Sleep -
Bowel -
Micturition -
RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
OTHER SYMPTOMS:
SATVA: P/M/A
SARA: P/M/A
SAMHANANA: P/M/A
PRAMANA: P/M/A
SATMYA: P/M/A
HEIGHT: ------ CMS
WEIGHT: ------- KGS
C.V.S:
R.S:
C.N.S:
P.A:
SAMPRAPTI GHATAKAS:
DOSHA:
DUSHYA:
AGNI:
AMA:
SROTAS:
UDBHAVA STHANA:
SANCHARI STHANA:
VYAKTA STHANA:
ADHISTANA:
ROGAMARGA:
DIAGNOSIS:
CHIKITSA KARMA:
PRADHANA KARMA
OBSERVATIONS:
PASCHATH KARMA:
PRECAUTIONS:
DISCUSSION:

of the H.O.D
INDEX
Name:
Age: O.P.D Number:
Sex: I.P.D. Number:
Education: DOA:
Postal Address:
Desha:
VEDANA VRITTANTA:

CHIKITSA VRITTANTA:
Appetite -
Sleep -
Bowel -
Micturition -
RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
OTHER SYMPTOMS:
SATVA: P/M/A
SARA: P/M/A
SAMHANANA: P/M/A
PRAMANA: P/M/A
SATMYA: P/M/A
HEIGHT: ------ CMS
WEIGHT: ------- KGS
C.V.S:
R.S:
C.N.S:
P.A:
SAMPRAPTI GHATAKAS:
DOSHA:
DUSHYA:
AGNI:
AMA:
SROTAS:
UDBHAVA STHANA:
SANCHARI STHANA:
VYAKTA STHANA:
ADHISTANA:
ROGAMARGA:
DIAGNOSIS:
CHIKITSA KARMA:
PRADHANA KARMA
OBSERVATIONS:

PASCHATH KARMA:
PRECAUTIONS:
DISCUSSION:

of the H.O.D
PHYSIOTHERAPY PRACTICAL RECORD

INDEX
Name:
Age: O.P.D Number:
Sex: I.P.D. Number:
Education: DOA:
Postal Address:
Desha:
CHIEF COMPLAINTS: DURATION:
DIAGNOSIS:
PERSONAL HISTORY:
HEIGHT: ------ CMS
WEIGHT: ------- KGS
PHYSIOTHERAPY MANAGEMENT:

of the H.O.D
INDEX
Name:
Age: O.P.D Number:
Sex: I.P.D. Number:
Education: DOA:
Postal Address:
Desha:
DIAGNOSIS:
PERSONAL HISTORY:
HEIGHT: ------ CMS
WEIGHT: ------- KGS

of the H.O.D
INDEX
Name:
Age: O.P.D Number:
Sex: I.P.D. Number:
Education: DOA:
Postal Address:
Desha:
DIAGNOSIS:
PERSONAL HISTORY:
HEIGHT: ------ CMS
WEIGHT: ------- KGS

of the H.O.D
INDEX
Name:
Age: O.P.D Number:
Sex: I.P.D. Number:
Education: DOA:
Postal Address:
Desha:
DIAGNOSIS:
PERSONAL HISTORY:
HEIGHT: ------ CMS
WEIGHT: ------- KGS

of the H.O.D
INDEX
Name:
Age: O.P.D Number:
Sex: I.P.D. Number:
Education: DOA:
Postal Address:
Desha:
DIAGNOSIS:
PERSONAL HISTORY:
HEIGHT: ------ CMS
WEIGHT: ------- KGS

of the H.O.D
INDEX
Name:
Age: O.P.D Number:
Sex: I.P.D. Number:
Education: DOA:
Postal Address:
Desha:
DIAGNOSIS:
PERSONAL HISTORY:
HEIGHT: ------ CMS
WEIGHT: ------- KGS

of the H.O.D
INDEX
Name:
Age: O.P.D Number:
Sex: I.P.D. Number:
Education: DOA:
Postal Address:
Desha:
DIAGNOSIS:
PERSONAL HISTORY:
HEIGHT: ------ CMS
WEIGHT: ------- KGS

of the H.O.D
INDEX
Name:
Age: O.P.D Number:
Sex: I.P.D. Number:
Education: DOA:
Postal Address:
Desha:
DIAGNOSIS:
PERSONAL HISTORY:
HEIGHT: ------ CMS
WEIGHT: ------- KGS

of the H.O.D
INDEX
Name:
Age: O.P.D Number:
Sex: I.P.D. Number:
Education: DOA:
Postal Address:
Desha:
DIAGNOSIS:
PERSONAL HISTORY:
HEIGHT: ------ CMS
WEIGHT: ------- KGS

of the H.O.D
INDEX
Name:
Age: O.P.D Number:
Sex: I.P.D. Number:
Education: DOA:
Postal Address:
Desha:
DIAGNOSIS:
PERSONAL HISTORY:
HEIGHT: ------ CMS
WEIGHT: ------- KGS

of the H.O.D

Rakta Moksha

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INDEX

Sl No NAME OF PATIENT PROCEDURE PAGE NO.

RAKTAMOKSHANA PRACTICAL RECORD

Age: O.P.D Number:

Sex: I.P.D. Number:

Religion: Bed Number:

Marital Status: DOD:

Socio-economic status: Diagnosis:

VEDANA SAMUCHAYA: DURATION:

PURVA VYADHI VRITTANTA:

RAJO PRAVRITTI VRITTANTA: NA

DASHA VIDHA PARIKSHA:

Requirements & Medicines:

Atiyaog Raktamokshana Lakshana

Ayoga raktamokshana lakshana

Signature of the Scholar

Signature of the Staf Signature

RAKTAMOKSHANA PRACTICAL RECORD

Age: O.P.D Number:

Sex: I.P.D. Number:

Religion: Bed Number:

Marital Status: DOD:

Socio-economic status: Diagnosis:

VEDANA SAMUCHAYA: DURATION:

PURVA VYADHI VRITTANTA:

DASHA VIDHA PARIKSHA:

Requirements & Medicines:

Atiyaog Raktamokshana Lakshana

Ayoga raktamokshana lakshana

Signature of the Scholar

Signature of the Staf Signature

RAKTAMOKSHANA PRACTICAL RECORD

Age: O.P.D Number:

Sex: I.P.D. Number:

Marital Status: DOD:

Socio-economic status: Diagnosis:

VEDANA SAMUCHAYA: DURATION:

PURVA VYADHI VRITTANTA:

RAJO PRAVRITTI VRITTANTA: NA

DASHA VIDHA PARIKSHA:

Requirements & Medicines:

Atiyaog Raktamokshana Lakshana

Ayoga raktamokshana lakshana

Signature of the Scholar

Signature of the Staf Signature

RAKTAMOKSHANA PRACTICAL RECORD

Age: O.P.D Number:

Sex: I.P.D. Number:

Religion: Bed Number:

Marital Status: DOD:

VEDANA SAMUCHAYA: DURATION:

PURVA VYADHI VRITTANTA:

RAJO PRAVRITTI VRITTANTA: NA

DASHA VIDHA PARIKSHA:

Requirements & Medicines:

Atiyaog Raktamokshana Lakshana

Ayoga raktamokshana lakshana

Signature of the Staf Signature

RAKTAMOKSHANA PRACTICAL RECORD

Age: O.P.D Number:

Sex: I.P.D. Number:

Religion: Bed Number:

Marital Status: DOD: