Health Care No 160453 ‫الرقم الصحي‬

Name ‫نايف عالي مرزوق المطيري‬ ‫االسم‬

Age 26 years ‫العمر‬ Sex male ‫الجنس‬
Nationality saudi ‫الجنسية‬
Hospital : ERADAH COMPLEX - Riyadh ‫االستشاري‬
Consultant In-charge Dr: kilani ‫المسئول‬
.Dept Psychiatry ‫القسم‬ Unit opd ‫الوحدة‬

DOC_STATUS> REFERRAL FORM< ‫نـمــوذج تـحـــــويـــــــل‬

TO DR ER DEPT Neurology department
DESIGNATION HOSPITAL / PHC Prince mohamed abdalaziz hospital
FROM DR Dr: mohamed amin DEPT psychiatry
DESIGNATION HOSPITAL / PHC ALAMAL COMPLEX IN Riyadh
CLINICAL HISTORY :
k/c of k/c of schizophrenia , presented with muscle wastinig and hypotonia , decrease apetite , on wheel
chair

PHYSICAL EXAMINATION :
Muscle waistinig , hypotonia

INVESTIGATIONS :
nil

PROBLEMS / DIAGNOSIS :
k/c Schizophrenia
Muscle waisting and hypotonia for neurological evaluation

TREATMENT/ PROCEDURES DONE SO FOR :

Depakin 500 mg po bid
Procyclidine 5 mg po bid
Olanzapine odt 10 mg po bid
PATIENT'S CONDITION : <PATIENT_CONDITION>
REASON FOR REFERRAL : <REASON_FOR_REFERRAL>
TRANSPORTATION : <TRANSPORTATION>
ESCORT : <ESCORT>
DOCUMENTS SENT : <DOCUMENTS_SENT>
Dr.'s Name Dr: mohamed amin
Date : 21/11/2019
Mobile # 0566203437

Print time :<CURRENT_DATE> <CURRENT_TIME> By User ID :<USER_CREATED> DOCUMENT_ID # <DOCUMENT_ID>