ADMISSION AND DISCHARGE RECORD

Room and Bed No: large private 102 PHIC No: 234567
Patient's Name:
Andrade Mary Anne Cosmo
Surname First Name Middle Name
Permanent Address:
# 45 Mamatid Cabuyao Laguna 4025
House Number Barangay Municipality/City Province Zip Code
Provincial Address:
# 45 Mamatid Cabuyao Laguna 4025
House Number Barangay Municipality/City Province Zip Code
Age Sex Civil Status Nationality Religion
27 Female Married Filipino Catholic
Date of Birth Place of Birth
April 22, 1994 Camarines Norte
Occupation Present Employer
Junior Consultant Kojic International Laboratory
Employer's Address Landline/Mobile Number:
Kojic International Laboratory
Name of Nearest Relative Relationship
Ms. Kristina Magcamit Cousin

Address: # 45 Brgy. Mamatid, Cabuyao Laguna Landline/Mobile Number: 91723452531

Name of Spouse Landline/Mobile Number Occupation

Mr. Andrade N/A OFW
Total Number of
Admission: Discharge Attending Physician/s:
days
Date Date 0
Time Time
 Type of Admission:

Informant:

First Name Middle Name Surname

Admitting Diagnosis:

T/C Systemic Viral Infection with signs and symptoms of mild dehydration
Final Diagnosis:

Admitting Physician/ROD: Admitting Nurse:

Dr. Sanchez Nurse Kathie

Dr. Clarissa M. Yee

 LABORATORY REQUEST RECORD
Last Name : Andrade First Name: Mary Anne Middle Name:
Address: Street # # 45 Barangay: Mamatid City/Municipality:

Laboratory Tests:

Date: Kind of Tests: Requesting Physician:

3/4/2023 CBC with PlHBAIC RBS Pregnancy Test Requesting Physician: Dr. Arianne C
Requesting Physician:
4/4/2023 LIPID PROFILE Requesting Physician: Dr. Arianne C
Requesting Physician:
5/4/2023 NA Requesting Physician: Dr. Arianne C
5/4/2023 K Requesting Physician: Dr. Arianne C
Requesting Physician:
Requesting Physician:
Requesting Physician:
Requesting Physician:
Requesting Physician:
Requesting Physician:
Requesting Physician:
Requesting Physician:
Requesting Physician:
Requesting Physician:
Requesting Physician:
Requesting Physician:
 Cosmo
Municipality: Cabuyao Laguna

Dr. Arianne Castillo

Dr. Arianne Castillo

Dr. Arianne Castillo

Dr. Arianne Castillo
Patient's Name: Mary Anne Cosmo Andrade Age: 27 Sex: Female
Admission Number: Room: 102 Attending Physician: Dr. Sanchez
CLINICAL HISTORY
BP: 130/80 mm hg HR:95 RR:22 TEMP.:38.8 WT.:
PAST MEDICAL HISTORY Chief Complaints: dizziness, headache, nauseated and feeling lethargic
Hypertension History:
Diabetes Mother is diabetic
Bronchial Asthma: YES Father is hypertensive and with history of kidney problem
Liver Disease History of allergic reaction to seafoods especially crabs
Hapatitis History of asthma since elementary
Thyroid Disorder
Kidney Disease
Hospitalization
Surgery
Allergies: seafoods ESP. crabs
Cardiovascular Disease
Pulmonary Tuberculosis Review of Systems: Mental Status/ LOC
Meds Zyrtec, Montelukast Neromuscular/Skeletal Status
Others Sensory Status ( Vision, Hearing, Speech)
Cardiovascular Status (Chest Pain)
FAMILY HISTORY Respiratory Status ( DOB)
Hypertension: YES GIT (Abdominal Pain)
Diabetes: YES Others
Bronchial Asthma Physical Examination:
Liver Disease General Survey
Hapatitis HEENT
Thyroid Disorder Chest
Kidney Disease: YES Lungs
Hospitalization Heart
Surgery Abdomen
Allergies Extremities
Cardiovascular Disease Genetalia
Pulmonary Tuberculosis Internal Examination
Meds Rectum
Others
PERSONAL HISTORY
Smoking : NO ADMITTING EMPRESSION:
Alcohol Intake: OCCASIONAL/C Systemic Viral Infection with signs and symptoms of mild dehydration
Illicit Drugs
Sexual
Others
OB HISTORY G: P: Plan:
 LMP: January 10, 2023
AOG:
EDC:

OB Score:
Dr. Arianne Castillo ,MD

License No.:
 PHILHEALTH ACCREDITED

NAME: Mary Anne Cosmo Andrade AGE: 27 years old

ADDRESS: # 45 Brgy. Mamatid, Cabuyao Laguna BIRTHDATE: April 22, 1994
GENDER: Female
DATE/TIME OF ADMISSION: HOSPITAL No.:
CHIEF COMPLAINT: dizziness, headache, nauseated, lethargic PHILHEALTH No. 234567
DIAGNOSIS: T/C Systemic Viral Infection with signs and symptoms of mild dehydration
ATTENDING PHYSICIAN: Dr. Arianne Castillo

VITAL SIGNS: IVF: Laboratory:

temp - 38.8 degrees Celsius D5 LRS 1 liter to run for 6 hrs CBC with/platelet
RR - 22 RBS
PR - 95 Na
BP of 130/80 mm hg Lipid profile
HBA1C
pregnancy test
SIDE DRIP:

DIAGNOSTIC PROCEDURE:
Chest x-ray APL view
MEDICATION: ECG
Paracetamol 500 mg 1 tab e
Cephalexin 750 mg TIV everyIVF TO FOLLOW:
Plasil 1 amp D5 LRS 1 liter to run for 8 hours

CONTRAPTION: DIET:
NPO

SPECIAL NOTES/ENDORSEMENT

WARD: large private

ROOM: 102 NURSE ON DUTY: Nurse Kathie