CRH

SIKKIM
MANIPAL
UNIVERSITY
IYY CENTRAL. REFERRAL. HOSPTTAI. SMIMS
5TH MILE TADONG, GANGTOK,
SIKKIM-737102 (INDIA)
PH:03592-232041 FAX 03592-231162

OPD BOOKLET

Name INNIN
885959
Age Ger Name
Address
Sex I Age
M NARSAIAH

SINGTAM,, Sikkim
Male/52 Years
2021-09-09 10:40:00
885959
Mobile NN
 CENTRAL REFERRAL HOSPITAL
Out Patient- Medical Record

Hospital No. * ' * * * * * *

Date.. ***''"

ken No

885959
Name. * * * * * ' * * * *

M NARSAAH

Name SINGTAM Sikkim

Address Male/52 Years

Sex.. Sex I Age
Age. N ' * * * * * * * * * * * * * * * ' ' * * * ' ' ' ' * ' ' * '

MEDICINEI
2021-09-09 10:40:00
Medical History
1. Presenting Symptoms

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2. History of Present illness Dengne 2 PoiGve

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3. Past illness & Treatment
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4. Drug Allergy
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5. Personal History tuine RE,
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6. Family History SNg

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Héania-Ag
-Typherd
7. Menstrual&Obstetric History
-Smb Uypbr
8. Development Status

9. Immunization Status

10. Anthropometry
Height:
Weight:
H.C.
01
 CENTRAL REFERRAL HOSPITAL
agna Date/Time
FOLLOW UP NOTES

Palen adviced for hoepila_

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MR 90 a 02
 aertine
Dater

A N DO
Om Shakü Medical store Daynos
STORE

Patient: Mr.M narsaiah (52/M) [ID: 04042]

Doctor: Dr G Koteshwarao
Bill No: 3471
Date 12/09/2
*****
9:59AM
************************************************************ss*******e********s*****************so****************eeso*eesse*****eceoe**s*eseees....soeeeeeesesssoseeecne*ss*****e********es***ee

S. No Particulars ********* **********

Amount
********************************esese anda

1 COMPLETE BLOOD COUNT(CBC ***

250
**** ************************e*****************

******** ************ ******* *******sst*****e*ssessseeseseeeseeesne*******ossssssssossssssesoeeeeneenneneen ***************************************

Total 250.00

*******eseeasesnsase*******ssesoeo*********ssssssoposseseseoeoesssssnosssseeessnoososoassseessunssssseeseesoossesssse*sseseeeesss s eoessssese.. *******ee*neeees

Net
************* ****************
250.00
*****************

Amount Paid 250.00

eo*eessse**s***ee*o*o***e*********ee********ee ***********************************************

Bled by
Old Central Bank of India Building Om Himalayan Medical Hall, East
Lithndas
Sikkim,
Pin-737 134
Mob: 93398 31472 || 73190 70348 || 83272 86740
/E-mail: omsdiag@gmail.com
 Om ohakti Med'cal tore Diagnoaie
TOE

Patient: Mr.M rarsaiah (52/M) [ID: 04042]

Doctor: Dr G Koteshwarao

Bill No: 3308 Date : 10/09/2021

11:37 AM
**************e*********************e*****ee*****es******

S. No Particulars
*******ee*******e* .
Amount
******eso******************

COMPLETE BLOOD COUNT(CBC)

*****eeeeeese
250 *****************

Totel 250.00

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Net
eeseo*eee***e«
250.00
eeeeeeeeeeeee eseeeoeeee

o 0 n n e s e g e s e g e s e s o e e 0 o0os0eeeecseeoseeessee900e0000eeseeee
Amount Paid. 250.00
eeceeesecececeeessee oeesesse *****ececeeeeeesececeee****e******eese s***esee ce ce seseeeee**eecaeeeesceceeee*

Billed by
Litan das
Old Central Bank of India Building Om Himalayan Medical Hall, East Sikkim,
Fin-737 134
Mob: 93398 31472 || 73190 70348 || 83272 86740/E-mail: omsdiag@gmail.com
 Om dhaki Medical dove Dagnoste
TORE

Patient: Mr.M Narsaiah (52/M) [ID: 03868]

Doctor: self

Bill No: 3157 Date 07/09/2021

*******************************************************e****** ******************e*e* 3:09 PM
S. No Particulars ********************************** *******************e*****
****************

***************e******** ***********************e*********************************e0******e****************e***********************************e*****
Amount
COMPLETE BLOOD COUNT(CBC) ****° *********************es***

250
2 TYPHI-DOT
300
3 Malaria Antigen
300
4 DENGUE PROFILE
600
* *
***°oo900ee**s0o0oo*ooooseeo***e0ooe
900o0009ee00so0eeeseceee soes9secesee0oseeseece000e0eeeeee * ***********************e******9 ***ee **0***9***** * .
* ***** ***e
******************e**********

Total: 1450.00
os****e**************ce*****eeece*** Net 1450.00
e******ee*****eee *e***e********e se*******s*********************

****************e******o***
Amount Paid : 1450.00
************** * * * * *
****a*************

Billed by
Lian das
Old Central Bank of India Building Om Himalayan Medical Hall, East
Pin-737 134
Sikkim,
Mob: 93398 31472 || 73190 70348 || 83272
86740 /E-mail: omsdiag@gmail.com
 Om 3kaki Medical ore Diaqroa
Patient: Mr.M narsaiah (52/M) [ID: 04042]
Doctor: self
Date: 14/09/2021
Bill No: 3655 3:22 PM
********oe *e*****e aoseooseeooo*oons0oeoosenooeeas

S. No Particulars
e********** * ********e*******9990eeeoo**e***************ee***e*******eeseece******°e*******
Amount
********************

COMPLETE BLOOD COUNT(CBC) 250

eeoossseoo c e e e e e o e e o s e o e s e e e s e e e sosssose ooseoeeossodseoo s e o o s e s s e e e s e e e e e s s e e
eooeeeeeseeessess
Total 250.00

* e e e s e e e e e e e e e n e o e s e e o e s e seeo0eooooeosooobo0
Net 250.00
sess eeoeonessese****

Amount Paid: 250.00 *******

*****************essee*****
******

Billed by
Litan das
Old Central Bank of India Building Om Himalayan Medical Hall, East Sikkim,
Pin-737 134
Mob: 93398 31472 || 73190 70348 || 83272 86740/E-mail :
omsdiag@gmail.com
 http://172.16.185.80/me

CRA
CENTRAL REFERALHs
STH MILE, TADONG,
PAYMENT VOUCHER GANGTOK,.
Involce No. OPB/21-22/85421
MR No 885959
Invoice Date 09/09/2021 11 06 AM
Patient Name: M NARSAIAH
Referred By Self
Gender Male
Patient Type Cash
Age 52 Years
Dr Dr Saptadipa
Token No. 081 Prescribed By:
SERVICEvOUCHER
Patient
SI. No. Serviee Name Gross DisC. Net Amt. Amt.
Apt.Dt.Tm. Qty. Amt. Amt.
0 00 80 00 8000
Blood Glucose Random Walkin 10 80 00
CBC WTH BLOOD SMEAR- 0 00 390 00 39000
10 390 0
COMPLETE URINE ANALYSIS 10 130 00 0 00 130 00 130 00
9500 9500
CREATININE 10 95 0 00

LFT (Liver Functiorn Test) 0.00 590 00 59000

10 590 00
6 130 00
POTASSIUM 10 130 00 0 00 130 00
SODIUM 10 130 00 000 13000 13000
UREA
10 130 00 000 130 00 130 00
WEIL FELIX 160 00
10 16000 0.00 16000

MRNo. 885959 Invoice No. OPB/21-22/85421

Patient Name: M NARSAIAH Invoice Date 09/09/2021 11.C6 AM
Gender Male Referred By Self
Age :52Years Patient Type Cash
Token No. 081 Prescribed By Dr Dr. Saptadipa
SERVICE VOUCHER

SI. No. Service Name Gross DisC. Net Amt.

Amt. Patient
Apt.Dt.Tm. Qty. Amt. Net
Amt. Amt.
1,835.00 0.00 1,835.00 1,835.00

REC/21-22/127076
Total Amount(RS.) 1,835.00
Total Patient
Amount (RS.)| 1,835.00
Total Discourt Amount 0.00
Paid Amount 1,835.00

One Thousand Eight Hundred and Thirty Five Rupees and signature
Recelved .... **

Prepared By: Rebicca Lepcha

Print date: 09/09/2021 11.06 AM

09-09-2021 10:59

I ofl