WuorsuEpINP AL WOD'SUEPINPAEMIEUOD | ZOESLEZ LL (Ol ¥6t 4d HPEL YO DOD OP IL) E+ L UE nS € OGOIOD SORIA PENNY € aa rt Ly + pe aT Litt Cs iH ea w : ee SUH PD" pei apt walt) axjo pue jeo1shyd) sBurpul} uoneunwexg ‘wLldsOH SNvauNG Any er6inspempoy i804 _ponacscosbss! Fosurryy a 0 HAAaN, Uojssiuipe soy suoseay Laway pega + : Sve ce busanut ssouberp oul aus yoann mtd é gsyeneds 1910 ‘asyaho Peg oyva5 Je ~ ev seb! PT TTe FEL 111 Lele] *Sey27 yo 0 (6904s wmow 1044) dno.6 pos | [TT Tale [17 LAO | worse yo a1eq Bo ne 8 aun ojewos YSAVAVIVE WAVNES JOU 6102/1090 VOC We XBS SNOT AE ION SIVAVRW A WHVOaD TALLLVaWHVOSSIN MN: SAWN: + 196SPLHA /€0L€60091 LH GIA AJIOUNS/ANIDIGAN - (GUVD SISONDVIG) ANVINWNS 3DYVHISIC sNvauna excoaan aDiagnostic Therapeutic procedure performed [| Yes [1] No if Yes’ please specify (Details on overleaf) ere eae ee Complications during procedure performed Ove [No if Yes’ please specify Ts — 1.08 Ete — 1 ple S-c4 7-3 Gl s-mg ele old Investigations performed n IP lorebyrrl Plows Mer Bran+e M 3 — Noms Shit] Fs $27 pa vLaL Sy Dope — Tard [75 Luprel 3” jo tg 76-8 Lal Pemc_ By/. carn 1 yu— Hb — le WRC — GyEo: FRe— “it _ 210 x134 s5lt | ‘Complications during the stay at hospital OO Yes OO No a ites! please spegiy Mio See Perel h BY Tape 216 Stina Gd -BP ogee Set Ads _4o? 2 pp. Bmte diem — 4 SGI s09 Liver : Qo alnbin— 0-P2 ALTA B 4e7.2/ ‘Any other significant medications used during the stay at hospitalMedication on discharge MeHmur s m4 Bp. Rosuves EQ nme a hook 24 Srey Tee A Spivin Patients condition at the time of discharge rns snl “te ne Mobility Normal [[] impaired vial een hoeitronre 2279S riannin Usine output JB Normal] Impaired Bowel mation r\ormat impaired Follow-up instructions 2 1 Review with reportsin____ 2 Er C1 Routine review in % 1 Referred to another hospital 1 Referred to another specialist J Dietary advice provided [5 Any other (please specify) C1 Please follow the Discharge Instruction as per the attached leaflet [5] The physician/hospital may be contacted urgently if any of the condition as per attached leaflet is noticed by the patient/family aSurgery / Procedure details FULL NAME / OFFICIAL STAMP OF SIGNATURE ‘THE MEDICAL OFFICER “on gine ryote FULL NAME / OFFICIAL STAMP OF PRIMARY SPECIALIST In an emergency please contact +94 11 2 140 002 For ward or unit please contact DURDANS HOSPITAL 53 Aled Place Colombo 3 Sri Lanks 7-494 (0) 112 140000 or 1344. +98 (0) 112575902 E contactus@durdans.com W durdans.com