No.

30, JALAN AINSDALE 15/4, BANDAR AINSDALE

70200 SEREMBAN, NEGERI SEMBILAN
Tel: 06-775 8000 / 011-5137 6490
email: uniklinikainsdale@gmail.com
Managed by THRU MEDIC SDN. BHD. (1292046-P)

Date : 04-01-2023
To : A&E Dr/ Surgeon, KPJ Hospital Seremban

Dr. / Sir / Mdm.,

REFERRAL OF PATIENT
Patient Name : MUHAMMAD ABDUL HAFIZ BIN IMRAN
I/C Number : 100519040171

I have examined the above patient and provide treatment as per below notes:

Referral Reason :
12/M/M

p/w RIF pain 1/7

a/w nausea
BO normal
no fever

o/e in pain
T 37.1
p/a soft
tender over RIF, + guarding
no rebound tenderness

Imp: TRO Acute Appendicitis

I would like to request your kind service to further aid the patient.

Thank you.

Signature :
Name of Medical Officer : Dr Siti Syuhada Binti Yusof