Supreme Hospital A Passion To Heal DISCHARGE REPORT illing@ supremehospital.in DATE : 31.05.2023 To, TPA NAME - MEDI ASSIST INS. CO. LTD. ‘Subject: Complete Claim Document Submission for Bill Processing & Payments Claim No :- 32638622 Patient Name = MRS, SUDARSHNA KATYAL Dear Sir/Madam With reference to above mentioned subject, please find enclosed herewith all necessary documents. With respect to medical Claim no :-32638622 For Bill amount of Rs.- 28600/- We request you to kindly process this claim and arrange to make payments at the earliest PI 4 revert to us for any cl ing@suprer ation | query by email ; tpa@supremehospital.in, Thanking you For Supreme Hospitals Private Limited Authorized Signatory Enclosed Documents: 4, Final Bill (Summarized) 2, Dotaited 3, Preauth Documents. 4, Approval Letters 5, Discharge Summary 6. Lab Reports 7. Radiology ReportsSupreme Hospital A Passion To Heal DISCHARGE REPORT Email:ipbilling@ supremehospital.in . oa [pees Patieut- Sudauthna Katya Claim ne- 32638622 Date Prout olfs}22 - 22.00 |- ols 23 22.00|~ a6 |s|2> 2260 |- a|s|23 2200|- us| 2200 |- pisi22 7 228° [- ts|s [22 2200|- lals|23 4.200 |— galeis. = eee ars [23 - 2200 |- as\s|oa - 2200]- 27|s|23 2200 [- 2als> 200 [— “38,600 |— Final bill amounk Kindly quve appupval 4 Sunps G@B2RGOO- Pa, All bill attache d OveSupreme Hospital A Passion To Heal DISCHARGE REPORT Emait:ipbiliing@supremehospital.in Final Bill woneuMONe — sruumime — 28Tt beeen Re. saz Parer Mame SUDARSHNA RANI KATYAL Wo MA ‘Age (Gender 78 ¥rsi Female ‘Admission Data W1U0W2003 «4 8 PA Areas nn vetn ee eT Ward Beane DIALYSIS UNIT BED NO 2 Prone srrrszm000 Consultant NEPHROLOGY TEAM. Sponsar OPA sate actors! Comoany ‘creo Particuare Date Rate [ov] Gros “esecot ‘ent a) uROLOGY [FR car ja wtnve Dey Core) puesto Toe] 10] zoe] ooo] za00 a0 Total Bill amount 2200.00 ‘Net Billed Amount 7200.00 ‘Amount rocsived 0.00 Net Amount to Coltect 1200.00 Rupees Two Thousand Two Hundred Zero Only Created By: GAURAVOIST N 6 #911294554400 | «911294554444 Qe £75 Garden, Charmurcod Village, Sector 39, Foridabad, Haryana 121009 eo wrwwsupremehospitainSupreme Hospital A Passion To Heal DISCHARGE REPORT Email:ipbilling@supremehospital in Final Bill Woo SUMIDNo «= STARA NTT Ivoten Me sms Paced kame [SUDARSHNA RAMI KATYAL Wio Bt ‘Age | Gander 78 Ye) Femaie ‘Admission Data: 0B2OZ3 03 SPM en rea Discharge Date = Gavenzezs aS PM DUAL Sts UNMET / ED NO-Z Phone arvrsa9000 NEPHROLOGY TEAM ag cms sims oryora Company creorr Parvcutary Date Rae [Oy] Grows | Diecoun ei ‘not ta} cs) ‘Bay Care) [ososr2023 z0000] 10] 2200. wa] oo9T 200 Total Bill amount 2200.00 Net Bitled Amount 2200.00 Amount recived 9.00 Net Amount te Collect 2200.00 Rup ‘Created By: ‘Twa Thousand Two Hundred Zs 0 Only MaAUSAMOAST @ 21290554500) eo r2sassaaaa © = ce caren i cer Fact nes 00 resemSupreme Hospital A Passion To Heal DISCHARGE REPORT Email:ipbilling@ supremehospital,|n Final Bill woNesuwoNo = sreAaad | F THTY Invoice Ho. sezs Patten Name SUDARSHNA RAN! KATYAL Wio MR ‘Age Gender #1 Yrn! Female Admission Dato; besrezs OT RPA ‘naicosn vex ven Discharge One — obaermazy 13 PA Ward | Bad No (DUAL YSIS UNIT / BED NO 2 vane orereaseeo Conaustant NEPHROLOGY TEAM a uate Haryana Company ‘creo Particulars Rate | ty Amount ‘UROLOGY a [eS cues al cane Dey Owl [oes (cd Ad | Te a) Total Bill amount 2200.00 Net Bitec Amount 2200.00 ‘Amnount recelved : 6.00 Remarks: ° Net Amount ts Collect 2200.00 Rupees Two Thousand Two Hundred Zere Only ‘Crested By: GAURAVOIST 1294554400 | s91agassa4ea Qe Eres Garden, Charmwood Vilage, Sector 39, Faridabad, Haryana 21008 oO vesew supresmehospita inSupreme Hospital @) A Passion To Heal DISCHARGE REPORT Email:ipbilling@ supremehospital.in Final Bill WONO#UWDN: —; sreunaze #2071 invotee No 658 Pant are SUDARSHIVA RANI KATYAL Wio MR ‘nga! Gonder a1 yee! Female ‘namiasion Date UADSTEZD sores maven Discharge Date onios023 wars Ben binky UT BED NO? Prone ssrrrszv000 Coneutant NEPHROLOGY TEAM ‘Sponser GiPsA State Hervene, ompeny creor Pactelars bute ty | Gross | Discount : T= FI = oy UROLOGY Fae ciayaa (m avs, Oy Cae) jowosczaza wow] To] sou] Soy sao] 00 Total Bill amount 200,00 Net Bited Amount 7200.00 Amount received 0.00 Net Amount to Collect» 2200.00 Rupees Two Thousand Two Hundred Zero Only Created By: POQUADEZ3 mint oO ros Garden, Charmwond Vilage, Sector 38, Faridabad Haryana 121009 QJ} worw supreme inSupreme Hospital A Passion To Heal DISCHARGE REPORT Email:ipbilling@supremehospital.in WOMoAUHIDNS — srevaaze #2071 s7es Patent Mane SUOARSHWA RAM! KATYAL Wie MR 78) emate tueszezi 12) 08 Assess ea wan mea) sas PM Ward | Bad Mo (DIALYSIS UNIT/BED NO 4 ‘orrreasees Constant (NEPHROLOGY TEAM ste saryenm sponser ‘airsa Comoany cereort Particulars ome Rate] | Grows | Discount] amount Armt.(few) (Re) UROLOGY [ree inves (at incaive, Day Care) Frvnszoes wae] Te] aeoom] Fe ‘Total Bil amount: Net Billed Amount Amount received: 7200.00 Rupees Two Thousand Two Hundred Zero Only CreatediBy: § POQUADE23 Page tot? 6 #911294554400| 9112945544 QO (crt cormecd ve Fete Hanes 28 @) wwesnnerontinSupreme Hospital A Passion To Heal DISCHARGE REPORT Email-ipbilling@supremehospital.in (WOMo#UMIDNe —: gwuTRaze #2571 Involee No. 584 Potent Mame SUDARSHNA RANI KATYAL Wo MR ‘ge | Gander a1 yer Female Admission Date = User 12:37PM ogress sea Olscharge Date = t3oszers «#320 PM Wore Beano BiALYSIS UNITY Prone: sri7sa9000 Contant ‘MEPHROLOGY TEAM ‘sponser owsa Sine ory Comoany neo Parcicwiars ate Rae [Or] Gree | Dmcoun amegry UROLOGY [i Ses rrais Dey corey rsmse023 [2m] te] 0000] Tota! Bit amount Net Bes Amount: Amount received + Net Amount to Collect 2200.00 Rupees Two Thousand Two Hundred Zero Only Created By: GAURAVOIS7 6 911294554400 | «911294554404 © 2 cor0er,cnrmnooe Vilage, Sector 3 Fardabas Haryana 121009 @ worsuoremenostainSupreme Hospital A Passion To Heal DISCHARGE REPORT Email:ipbilling@supremehospital in —_ Final Bill woNeeuMONe —— aypaamae #2971 nese Mo sree Pasont Name ‘SUDARSHNA PAN! KATYAL Wie MR ‘Age | Gender 1 Ye! Female milo Cen «1808003 DTS sare wees Dichargeete : 18oumma ona Ward ea Ne ous uur Prone srsea00 omact wePHROLOGY TEAM Sponee oss Se foes: Comper cneort clas [oat pate Joy] Grom | Dleowrt] pass amine | Re) UROLOGY EE sap nc Day Cre Feaaraes weoowe | Te[ samme] om] ao] ib Tota Bi amount 220090 Net Bled Amount 2200.00 Amount roceved = o.00 Net Amount to Collect Rupees Two Thousand Two Hundred Zero Only Created By: POOJADS23 B re © Fe carter, crore Viton, Sect 39, Frabad Haryana 121009 @ wre sepremehospratin 4400] #911294554444Supreme Hospital @) A Passion To Heal DISCHARGE REPORT Email:ipbilling@supremehospital.in Bill WPOMO#UMONo = seawnze 2871 tvotcn Wo s708 ationt Mare ‘SUDARSHMA ANS KATYAL Wis At ‘Age | Ganeer ANY! Femate ‘ — Acmission Due == tesze3 4 ASP Discharge Date 805023 OTE PM ‘ward / Bed Ho DIALYSIS UNIT/ BED WO Prone wrr7szo000 Consultant NEPHROLOGY TEAM Sponser esa sae Maryans Company RED Peevcutare Gross ‘Kapoana Ammer) UROLOGY [ee Geir cl cave Day Cored Tanaa0eS [20] rey om] Om) 200 Total Bill amount 2200.00 Not Billed Amount 2200.00 ‘Amount recalved 9.00 Net Amount to Collect 2200.00 Rupees Two Thousand Twe Hundred Zero Only ‘Created By; §— POOADG23 @ +21294554400) sonzoasseaes © oo mcs Sc Fd yrs 2003, wens CE en eeSupreme Hospital @) A Passion To Heal DISCHARGE REPORT Email:ipbilling®@ supremehospital 03: 50pm onoepa Particwiars: Date | Rate oy Amount UROLOGY EE Sie seen Oo on esa [ee] zm] ooo] ao oy Total it amount 2200.00 (Wet Biles Amount 7200.00 Amount received : 6.00 Net Amount to Collect 7200.00 Rupees Two Thousand Two Hundred Zero Only Crested By: GAURAVOTST Paget ot 6 +911294554400 | e9rlz94ssaane Qo 105 Garden, Charrmwood Vilage, Sector 39, Faridabad, Haryane 121009 oO ‘wweu supremetenpstaliaSupreme Hospital A Passion To Heal DISCHARGE REPORT Email:ipbilling@supremehospital.in Final Bill 1PD.Ne # UMIO.Ne tmearsze 2871 Inwotos No. sre laemeh and ‘SUDARSHNA RANI KATYAL Wie Nm ‘Age | Ganaee st yen Fomae ‘Aomiaaton ianszeza oe are ‘Adress en soot ms Discharge Daie 231082028, onarew Ward Baa No DIALYSIS UNIT / BED NO 3 Phone 9717828000 Consutant NEPHROLOGY TEAM Spenser ‘owsa See ee! Parveutars Date ‘rate [ary | Grose | Discount ‘aot Rs) | foe UROLOGY Fes cat at ncusve, Day Carey Pesosze23 BmaGo] NO] e000 ed B00 2200.00 2200.00 0.00 Net Amount to Collect 2200.00 ‘Rupes Two Thousand Two Hundred Zero Only Created By) POOJAN623 age tot Q i= cote Curd Ve St Fat Ha 08) werentSupreme Hospital A Passion To Heal DISCHARGE REPORT Email-ipbilling@ supremehospital.in Final Bill summer Invoice Ho. sv SUDARSHNA RAMI KATYAL Wro MR Age Genter sy yin Fame emission ween 8 SAP Asaress vent ee Discharge Date = 23057023 «usa Wend (Bed No DIALYSIS UNIT / BED NO + Phone arinee Consultant NEPHROLOGY TEAM Bponser oIPsA ‘tote Maryana ‘Company ‘¢REDIT Parteuane ate Rate [aty| Gross | Omcount = hanes) (Rs), ies vROLOGY FES cit a rcv Day Care) fesse wae] 1a] sooo] 00a] ean = 2200 ‘Total Bill amount 7200.00 et Biles Amount 2200.00 Amount received. 0.00 Net Amount to Collect 2200.00 ‘Rupees Two Thousand Two Hundred Zero Only Croatod By: POOJADE2S 6 +911294554400| ¢911294554404 © cee rd vis Scr Fa Hana 2003 @ weesupemchopatinSupreme Hospital @) A Passion To Heal DISCHARGE REPORT Email:ipbilling@supremehospital.in Final Bill WOMo# UNS srenizsM wm 2art sa22 Peteet Name 'SUDARSHNA RANI HATYAL to Wi Age Gender Tyre Femate AgmiesionDete 278022 12:60PM A sear Dueharge Oate —< armsanz) =O TEP ‘mara ed Mo BUALYSIS UNIT BED NO? Prone srerazsco0 ‘Gonautan NEPHROLOGY TEAM ‘Sponsor sa state arvana ‘Sompeny creo Pameuars Date rate [ry | eons | Dincour mtn (way) Amann UROLOGY Ty Sane an nce, Day Cary wim] 10] 20000] Ooo] amo 706 Total Bill amount 7200.09 Net Bitied Amount 2200.00 Amount received : 0.00 NetAmount to Collect: 7) 7200.00 Rupees Two Thousand Two Hundred Zero Only Created By; © GAURAVO137 © (6210 rms vg Seer ans Hanaa 21009 GH sneusspemetowstinSupreme Hospital A Passion To Heal DISCHARGE REPORT Email:ipbilling@supremehospital.in Final Bill ONC HUHONo =: SMA 8 2TT tveice Mo sa Pavan ame 'SUDARSHNA RAN! KATYAL Wo MR ‘Age | Gender a1 Yra | Female ‘Adminsion Dein; u0023 (02: SOPH =a ‘Oeecharge Date 2082023 03:68 Pi Ward / Bed No. DIALYSIS UNIT /BEO MO 3 baad svirenem Consatant NEPHROLOGY TEAM sume + Haryana ‘sponser oirsa Comeeny rent Pantene ‘ate Rate [or] Orove [= Plas UROLOGY FS cores ncn Ow OPW pacenaas aoe] TO] some] am] 00 Total Bil amount: 2200.00 Net Billed Amount : 7200.00 ‘Amount received 9.00 Net Amount to Gollect 2200.00 ‘Rupees Two Thousand Two Hundred Zero Only ‘Created By: GAURAVO137 gs 1 © fe Geren charmed vase Sector 38, Fed Hanana 121009 @) wr sunremehosoian1. Carrenily do you have any other medicaim ‘health insursese: [—] Yes Gs ‘UCampasy Name: i.Give Detail: 1K: Do you have a family Physician: Cove Ge. 1 Name of te Pamy Pye Me Contact member, if ay: Nermeatiostinesrace — DBE, Gaal-as Agiladb, Del. ©: Occupation of Insured Patient:Duration ofthe present wlan — Pas 1, Date of Fir comsutation: boaMeryyy Hi. Past history of present nilmem, ifany P.Proisioal agai Ce tcp toeove ees tere g ieee Propose: : Matic! Managemen a Sanpea! Managemen « Imensive owe ( ( ¢ PRPr vestigation |. Neteallopathie wextmert . tfinvestigationandior Medical Management, provide deals Rie of Dewy Adinsiron _ ZV " 1 pce, ame of segeey tcp pcs code 4 tf her wentment. provide det AK How did injury occur Litem Ve WaRTA: ye eo Dawe Uk Repo tee re Popo iv, FIR NO. ¥. Injury (Disease caused due wo substance abuse'alcohol consumption es Ro, Si Tet Condel ee hi ie, ac ear ve Con in cxtc of Maerity oe cr ceo ‘ expected date of Delivery DOMMYYYY Page dof 1Poe Pp oe E rR [ Z i i i uit ePgses TER oom Type Payaare Por day room rentnursing and service charges purtients diet Expected com of nventgation dhagnonic ICU charges Haemodlial K OT charge « Professional fees Surgson + Anesthetist Fees + Medicines + Congumables + Cost of Implants (i applicable please speci) ‘Other hospital expenses if any All-inclusive package charges if any applicable ‘Sen Total expected cont of hospitalization — Page Sof 11DECLARATION (Pense rend very carefoity) “Weconfirm having read unerwtoud and ngreed 1 the of ti Form Page 6of 12A. Mt me tO 0A Hf mpm ttn re Cyb.bbetiKCoe a Agderneon se Time Adaissiom = Time of (i) Declaration when patient has no insuronce policy: © Ideciare that | donot have any insurance policy. (W) Bectaration when patient has insurance policy: © I declare that | have following Insurance Policies Policy No/TPA card No: Insurance Company. 2)Whether patient apted for Eligible Room Categary under Policy.tes / No 3) In case, policyholder wishes to avail better faciity: Name of the Additional Facility/ Provision/ Pracedure/ Treatment ou Which costs ~~) only. ‘On my own option, |wish to avail above better facilty and | hereby agree to pay on my free will, after being explained in detail by the Hospital authority in my own and understandable language about the” above mentioned Additional Faciity/Procedure/Treatment and associated cost of it, whichis overand above the agreed PPN tariff Further, i opt to go for final tall reimbursement with insurance company, respective insurance company will reimburse only as peragreed PPN tarifirates and balance amount will bbe bore by myself or patient only, have also been explained that when room service of a category better thaneligible room re ntis availed by the patient, not only the difference in room rent but also an equal proportion of all other charges, associated with the treatment shall be borne by me. sume Fades. Signa ca ame of the Patient/Patent’s a Name af the fe tative BHospital Seal‘The Oriental insurance Company Limited ORIENTAL INSURANCE BANK SAATHI POLICY -GROUP POLICY SCHEDULE UIN:OIGHLGP22026V012122 -, eto Policy No. + Bravowasraaaaray71 Gevnenny Eee ‘Cover Note Na, Gover Hale Dale: - feo tnaures Code Issue Otice Cose : 272900 insurex's Name Issue Office Nama : DO 20 New Delhi (GSTIN: OTAAACTOSZTRIZ!) Ascress Address BB. JANPATH.GROUND FLOOR NEW ELH! ELH T0008 ‘Tet Faxréman + 99SB040000/ J sa68046000 1 ‘Tel Pex femed = 23328008 123325607 | # negaceountaggereerds com 772900{gorantainsurance 22. ‘AgervBroker Details Dev.0fLcede : NHOSEBOGGIOR ‘AgerdBroker ; BFOQQODD1958 PNB GREATER KAILASH I! (061910) Address 2 PNG New DethisGreater Kaliash | (061910).M 33, M BLOCK.OREATER KAILASHALMEW DELM)GREATER KAILASHLDELWLOELML,110048 ‘Tou avail: 1129218100/011-20219100 Periadlol inaurence ; FROM 00:00 GN 1SG6!Z022 TO MIDNIGHT OF 12/N6/2023 Colleton We. & OL; CC-ORE4QDTEDD 3082022 GSTINVOICE NO 0721139008 UI: Gross Premium 32,344 ost: 5822 Stamp Duty S$ Total: 98.166 (Ceinevrarce Detale : NiL Bate Poicy details fo each meured portion TPA Dette: TAD TAODIOONT 45. J Ws MED ASSIST mesu ene NOAN, IBC Knowlextge Tower Hoa To FreeNo $800 425 9445 BANGALORE 560020 f FAXNO. ‘1800 425 9559 “Teleprone tig ; 1000 45.9440 RISK DETAILS Name of Primary Insured Account No, INDER LAL KATYAL oa19201 1002082 Sum insured Plan Type Numberef Dependents 00000 PLARB 1 ace For ad on a ot Dale: 308082 The Oriental neutance Company Lenied Incase of any query segarding the Poicy please coll Toll Fige No. 1800 11 9486 and OT 33208465 ‘esnommed Signatory ‘Gite: 6801001 1847601007158 Aine Amounts mentioned in is pokey are in Indian Rupee Paget oft IRDA Regn, No, 696 + Now you can buy and renew selected policies online at wwrw.crientalinsurance.orgin‘@) ‘The Oriental Insurance Company Limited Auuacher te and forming part of policy number 7200648823247 Particulars of the Persons covered: pO Sr, Name of The Gender ate of Relatienshia Age with Ne Persons = (MIFITG) Birth, pcktler ss 1 INDER LAL MALE OLMAR4I = 81 Self AT YAL 2 SUDARSHNA == FEMALE 27-MAY.40 82 Shouse KATYAL ‘Nominee Detalis: Nome Ofthe Nominee Relationship With the Insured Age Of the Nomine (MIFITG* a In therevent of a diaim under the pobey exceeding Rs. 1tsc.or a claim for relund of premium excseding Rs. 1 ac, he insured will comply wih the provisions of the AML policy of the Company. The AML policy ts avatable in ‘operating offices as. woll as Company's website. ‘The policy shall pay for hospitalization expenses for medical/surgical treatment taken a an In-patient or day care at ‘any Nursing Home/Hospital in INDIA as defined in the poly. ‘Wecanted atin case of dahonour of premium cheque(s) he Company shat not be lable under tne eokay en the poy thal be vod stint trom “We at Oriental continuously strive to:enaure thal you gét the Bett possible treatment from our network hospitals. Pletse contact your TPA or any ef the Oriental offices for our preferred hospitals In your area betore going for a {veatment. This will help us serve you in the best ‘mannier™ Policy History Data Policy No. Period From Period To tnsurer Name ‘Sum inaures raso0aw2e1770909 ASYUN-E 12.JUN-17 The Oneal nturance Company Lid. soneoo rr 200/l46r207180564 A8MUN-? —{26JUN-T8 ‘The Oran insurance Company Lis ‘800000 zrzoaw 20198015 TBUUNCB 12.JUN19. The Osama ngurance Company Lis, 0000 ince: mes For and on bea ot Dolo = s0sra022 ‘The Orleaial Inawance Company Limited cone of me Policy please cal Toie——~ ' | Eggert om‘Modi Assist - $2638621_202305011037410507997.pdf oan em Orme am ae sg emit mom od Somme Panta Imeem ‘mad sccabal er ian Rc met aa a » gee tae cama, we . om ome met mane nes 1 [thats pape} 5 — ot tnd amet ae (Ta an Ma me 01-05-2023. 10:39Medi Assist - 32638621 202305011037410587997.pdf cee ete ee pee mage ee Pete Panne ree et et mc tee ate ne ee a eas ‘ ‘eo . * Ease sateetiraantores + SESE carn seep sma oe reenter rome = ccuMNTE Tone AROWRED Pe SORTA, KL FT bad 01-05-2023, 10:39‘Medi Assist 32638621 202305011037410587997.pat ao mee ee Seta 3of 01-05-2023, 10:39 oh aaa csp ii Reis), »-Supreme Hospital @) A Passion To Heal DISCHARGE REPORT Email:ipbilling@supremehospital in [DISCHARGE SUMMARY DEPARTMENT Of NEPHROLOGY [Patient name 7 Ms. Sudarsona Rant atyal Age /Sex at yrs/Female \eaceme: a = | consuitant Nephrology Team PDO, war | Date of Admission 01052023 Time of Admission - 04:56PM Date of Discharge 01.05.2023 Time of Discharge +08 Diagnosts: CKD an MHD Quiet comptaints: MHD History of present illness: Patiene admitted for MD. No complatnts of fever, breathlessness, cough and cold No camplaints of vomiting, pain in abdomen, loose stool Past history: Known case of CKD on MHD. On examination (at the admission): Pulse S2/min RR 22fmin Blood pressure 170/90mmbe SPOR 9856 at room alr Temperature ‘Afobrile Systemic examination. Ns Conscious & oriented ows StSZ+ Chest Bilateral ai entry+ PA Soft, nontendert Course of hospital: Patient admitted for dialysis, done for 4 hours with monitoring of vital, saturation, = parameters. No complaints of fever, cough, sweating, breathlessness during dialysis, ‘uneventful. Now patient is being discharge JF and other dialysis Advice on discharge: Continue al previous medication, hes Dr. Sanjiv fasta : Sr.Consuttane \+\ °°? J] Supreme Hospital § Eros gardea, Charraivoai Faridabad = 121008 211294854400) -srr204sse004 © be: coven, Charmood 1009, wrressremeeasa lage, Sector 39, Faridabad, HaryanaSupreme Hospital Email:ipbilling@supremehospital.in @) DISCHARGE REPORT DISCHARGE SUMMARY DEPARTMENT OF NEPHROLOGY Patient name Mrs. Sudarshna Rant Katyal Age/Sex 81 yrs/Pemale Location name Supreme Hopital ump 2o71 Consultant Nephrology Team Pp S7H0/2324 Date of Admission 4.052023 Time of Admission —-03: 54 PM Date of Diseharge 104.05.20% Time of Discharge: 00:55 PM Diagnosis: CKD on MHD: (Chief complaints: MHD Mistory of present ilines Patient admitted for MHD. No complaints of fever, breathlessness, cough and cold, No complaints of vomiting, pain in abdomen, loose stool Past history: Known case of CKD on MHD, (On examination (at the admission) Pulse 82/min RR 22/mnin Blood pressuire 170/3mmhg sPOz 99% at room air Temperature ‘febrile Systemic examination: ors Conscious & oriented ws s1s2+ Chest Bilatora avr entry PA =Sott, nontenders ‘Course of hospital: Patient acimitted foe dialysis. done for 4 hours with manitoring parameters. No complaints of fever, cough, sweating. breathlessn ‘uneventful, Now patient is being discharge: Advice on discharge: Continue all previous medication, Dr-Sanitv fas — Se.Consultagt, / "0 Supreme Hoypitale-09 | « Eros garden, Charmwaod village Faridabad - 121609 54400) +911294554444 n, Sugar and oth lysis. Post dialysisSupreme Hospital A Passion To Heal DISCHARGE REPORT Email:ipbilling@supremehospital.in DISCHARGE SUMMARY DERARTMENT OF NEPHROLOGY | Patiemt name Mrs. Sudarshna Rani Katyal Age/Sex 81 yrs/Female | cation nae Supreme Hopsital ump 2371 Consultant Nephrology Team IPD No. 5755/2324 Date of Admission 06.08.2028, Time of Admission -07:22PM Date of Discharge :0605.2023 Time of Discharge: 09:13 EM | Diagnosis: CKD on MD Chief complaints: MHD History of present Hiness: Patient admitted for MHD. Na comp No complaints of vomiting, pain ina 8 of fever, breathlessness, cough and cold, men, loose stook Past history: Known case of CKD on MHD, ‘On examination (at the admission) Pulse 82/min RR 22min Blood pressure 170/S0mmhg SPOz 98% atroom air ‘Temperature Afebrile Systemic examination. Ns ‘Conscious & oriented cys sus2+ Chest Bilateral air entry PYA Soft, nontender+ Course of hospital: Patient admitted for dialysis, done for 4 hours with monitoring of vital saturation, sugar and other Parameters No complaints of fever, cough, sweating, breathlessness during dialysis. Post dialysis uneventful. Now patient is being discharge. Advice on discharge: ‘Continue all previous medication. Dr. Sanjiv Sr. Consultant Supreme Eros garden, Charmweind village Faridabad - 121009 6 sa1nza4ss. oO Eros Garden, Charmwood Vilage, Sector 39, Faridabad, Haryana 121009 oe www supremehosptalin 400) e911294554444Supreme Hospital A Passion To Heal DISCHARGE REPORT Email:ipbilling@supremehospital.i ‘DISCHARGE SUMMARY DEPARTMENT OF NEPHROLOGY [ Patient name Mrs Sudarshna Rani Katyal Age/Sex aiiyn/femae | | Location name Supreme Hopsital UHID 22971 ‘Consultant Nephrology Team IPD No. 5768/2324 DaeorAdmission 08052028 Timeatadminion 10:00 | Date of Discharge 08.05.2028 Time of Discharge = 06:26 PM Diagnosts: CKD on MHD Chief complaints: MAD History of present iliness: Patient ad mitted for MHD. No complaints of fever, bre ‘No complaints of vorniting, pzin in abdomen, loose sto hlessness, cough and cold Past histary: Known case of CKD on MHD. On examination (at the adinission); Pulse 82/min RR 22min Blood prescure 170/90mmbg SPO2 + 9896 at room air Temperature Atebrile ‘Systemic examination: Ns ‘Conscious & ariented cvs S182 Chest Bilateral air entry P/A Soft, nontender+ Course of hospital: Patient admitted for dialysis, done for 4 hours with monitoring of vital, saturation, sugar and other Paramoters. No complaints of fever, cough, sweating, breathlessness during dialysis. Post dinlysis luneventhil. Now patient is being discharge Advice on discharge: Continue all previous medication Dr. Sanjiv pasa | Sr. Consultant \* Supreme Hospital <0 Erou garden, Charmed lage Faridabad 121009 © <2 220554400 s9rre945sa048 105 Garden, Charmwoo Sector 39, Faridabad, HiSupreme Hospital @) A Passion To Heal DISCHARGE REPORT Email-ipbilling@ supremehospital.in DISCHARGE SUMMARY DEPARTMENT OF NEPHROLOGY Patient name Mrs. Sudarshina Rani Katyal Age/Sex 81 yrs/Female Location name Supreme Hopsital um 271 Consultant Nephrology Teara IPD No. 79/2324 Date of Admission 11952023 Time of Admission ©1209 PM | bate of Discharge 11952024 Time of Discharge 0535 PM | Diagnoste (CKDron MHD Chief complaints: MHD History of present illness: Patient admitted for MHD. No complaints of fever, breathlessness, cough and cold. ‘Na complaints of vomiting, pain in abdomen, loose stool Past history: Known case of CKD on MHD, Of examination (at the admission) Pulse 82/min RR 22/ma Blood pressure 170/50mmng sPoz 999% at room air Temperature Aobrile Systemic examination: CNS Conscious & ortented cvs 8182+ Chest Bitateral alr entry Pa Soft, nantenders Course of hospital: Patient admitted for dialysis, done for 4 howrs with monitoring of vital, saturution, sugar and other Parameters, No complaints of fever, cough, sweating, breathlessness during dialysis Pox dara, \Wneventiul. Now patient is being discharge Advice on discharge: Continue al previous nedicaton. °D Dr. Sanjiv fhsya”°9 ‘Sr. Consulta Supreme Hasptay > [Eros garden, Charmwood Faridabad "121009 oO 08 Garden, Charmwood Vilage, Sector 38, Faridabad, Haryana 121009 oO Wwrwsupremehospital inSupreme Hospital 9 ‘A Passion To He: DISCH: Emailipbiling®@supremehospital.in al CHARGE REPORT DISCHARGE SUMMARY mV |=. Sudarshna Raat katyal ‘Age/Sex 81 yrs/Female ae ea a | Consultant Nephrology Team IPD No. 5007/2524 | Date of Discharge 13.05.2028 tmeof Discharge 08:20 | Diagnosis: ‘ekD-on MHD Chief complaints: Mio History of present Illness: Patient admitted for MHD, No complaints of fever, breathlessness, cough and cold. Nocomplaints of vorniting, pain in abdomen, loose sto Past history: Known case of CKD on MHD. On examination (at the admission): Pulse 2ymin RR 22/min Blood pressure 170/90menig sPOz ‘98% at room air ‘Temperature Atebrile Systemic examination: CNS. Conscious & oriented vs suse ‘Chest Bilateral alr entry P/A Soft. nontender Course of hospital: Haat aaimited for dialysis, done-for 4 hours with monitoring of vital, saturation, sugar and other farameters, No cornplants of fever, cough. sweating, breathlessness during daly, Post dlalysis neventful Now patient i being discharge Advice on discharge: Continue all previous medication. Dr. Sanjiv Jasuja Sr. Consultant Faridabad - 121009 6 +911294554400| wariz9455a444 ros Garden, Ch " Qo Charmwood Vitage, Sector 39, ° 008 wera sipremehospltalin abad, HaryanaSupreme Hospital A Passion To Heal DISCHARGE REPORT pbilling@supremehospital.in DISCHARGE SUMMARY DEPARTMENT Of NEPHROLOGY {Mra Sudarsiina Rani Katyal ‘Age /Sex ‘ai yrsffemale | ‘Supreme Nopsital wustio 271 Nephroory Team 1D No. 820/224 Date of Adrnission 15.05.2023 ‘Time of Admission 03:15PM | Date of Discharge 15082023 ‘Time ofDischarge —_: 00:21PM | Diagnosis: CKD.on MHD Chief complaints: MHD History of present illness: Patient ainitted for MID, No complaints of fever, breattiessness, cough and cold. [No complaints of vomiting, pain in abdomen, loose stool Past history: Known case of CXD on MHD. ‘On examination (at the admission) Pulse 82/min RR 2ymin Blood pressure 170/30mmhg P02 ‘9896-at room air ‘Temperature febrile Systemic examination CNS Conscious & ortented cvs S1sZ+ Chest Bilateral airentry+ PFA Sot, nontenders Course of hospital: Patient admitted for dialysis, done for 4 hours with monitoring of vital, saturation, sugar anc! other parameters. Na complaints af fever, cough, sweating, breathlessness during dialysis. Post dialysis lwneventful, Now patient is being discharge. Advice on discharge: Continue all previous medication. De. Sanjiv fasta’ 1 Sr. Consultant | 99), } Supreme nos 7 Eros garden, Charmivood village Faridabad - 121009 oO Eras Garden, Charmwood Vilage, Sector 39, Faridabad, H 4554400 | +911294554444Supreme Hospital 2 A Passion To Heal DISCHARGE REPORT ipbilling@supremehospital.in DISCHARGE SUMMARY DEPARIMENT OF NEPHROLOGY | Patient name "Mex Sudarshna Rani Katyal ‘Age/Sex 1 yrs/Female | tcationname Supreme Hopital ump sam consultant Nephrology Team IPD Ne. 04972324 Dateof Admission 1052023 Time of Admission: 04:45 PM Date of Discharge 92025 Time fDischarge _:07:12 PM Diagnosis: CKD on MHD Chief complain MD History af present ilness: Patient admitted for MHD, No complaints of fever, breathlessiness, cough and cold, ‘Nocomplaints of vomiting, pain in abdomen, loose xtook Past history: Rnowrn case of CKD on MHD. (On examination (at the admission): Pulse 82/min RR 22/min Blood pressure 170/90mmhg spo2 98% at roam air Temperature Alpbrile Systemic examination: cNs Conscious & oriented ws, SuSZe Chest Lilateral air entry+ PIA Saft nontenders Course of hospital: Patient admitted for dialysis, done for 4 hours with monitoring of vital, saturation, sugar and other Parameters. No complaints of fever. cough, sweating, breathlessness during dialysis. Past dialysis uneventful. Now patient is being discharge Advice on discharge: Continue all previous medic: De. Sanjiv Jasuia 57". -\ Se. consutant zr Supreme Hospitak® \"" / ros garden, Charing Fa bad 121009 © -21 294554400; 431 Qo Eros Garden, Charmwood Vilage, Sector 39, Faridabad, Haryana 121009 oe vee: supremenospitaln 299554444Supreme Hospital A Passion To Heal DISCHARGE REPORT Email:ipbilling@supremehospital.in ‘DISCHARGE SUMMARY DEPARTMENT OF NEPHROLOGY sire al on Pa 1 Patient name ‘Mrs. Sadarshna Rani Katyal Age/Sex 1 yrs/Female | ian ane supreme eal ona a | consatcant Nephrology Team IPD No. 5569/2324 | Date of Admission: + 20.05.2023 ‘Time of Admission 403:50 PM Date of Discharge 20.05.2023 ‘Time of Discharge 07:06PM Diagnosis: €XDon MHD Chiet compl MHD History of present iliness: Patient admitted for MHD. No complaints of fever, breathlessness, cough and cold. No complaints of vomiting, pain in abdomen, loose stool Past history: Known case of CKD on MHD, (On examination (at the admission): Pulse 82/min RR 22/min Blood pressure 170/90mmbg sPOz 98% at room air Temperature Alebrile Systemic examination. Ns Conscious & ortented cvs S1sze Chest Bilateral air entry+ P/A San, nontenders Course of hospital: Patient admitted for dialysis, done for 4 hours with monitoring of vital, saturation, sugar and other Parameters, No complaints of fever, cough, sweating, breathlessness during dialysis. Post dialysis Lneventful. Now patient is being discharge. Advice on discharge: Continue all previous medication, Dr. Safi a Sr. Consultant Supreme ios} Eros garden, Faridabad » 12100 $4900 | +911294554444 Qo 0% Garden, Charmwood Vilage, Seetor 39, Faridabad, Haryana 121009 @ vr peemenos anSupreme Hospital A Passion To Heal DISCHARGE REPORT Email:ipbilling@supremehospital.in DISCHARGE SUMMARY DEPARTMENT OF NEPHROLOGY Patient mare {Mrs Sadarshna ami Karyal——Age/Sex Bi yre/femate | ‘Location name | Supreme Hopital uni 2971 Consultant ‘Nephrology Team TPD No. $984/2324 | Date of Admivsion: 22,05,2023 Time of Admission 04:27PM | Date of ischarge £2205.2023 Time of Discharge 07:47PM | Diagnosis: CKD an MHD Chief complaints: MHD History of present tines: Patient admitted for MHD. No complaints of fever, breathlessness, cough and cold, No.complaints af vomiting, pain in abdomen, loose stook Past history: Known case of CKD on MHD. ‘On examination (at the admission): Pulse 82/min RR 222/min Blood pressure £170/90mmbg, sPO2 918% at room air ‘Temperature Afebrile ‘Systemic examination: CNS Conscious & oriented cvs 1 S1S2+ Chest Bilateral air entry PIA Soft nontendere Course of hospital: Patient admitted for dialysis, done for 4 hours with monitoring of vital, saturation, sugar and other Parameters. No complaints of fever, cough, sweating, breathlessness during dialysis. Post dialysis luneventitl, Now patient isheing discharge. Advice on discharge: Continue all previous medication. Dr. Sanjiv Jasui ta Sr. Consultant Supreme Hospital \ Eros garden, Cha ‘village Faridabad - 122009 G@ 1211294554800) vonrzsassacas oO Eros Garden, Charmwood Vilage, Sector 35, Faridabad, Haryana 121008 eo www suprémehospitalin aSupreme Hospital A Passion To Heal DISCHARGE REPORT Email:ipbilling@ supremehospital.in DISCHARGE SUMMARY DEPARTMENT OF NEPHROLOGY [Patient name Mrs. Sudarshna Rani Katyal —— Age/Sex 81 yrs/Female location name Supreme Hopsital ump 2971 Consultant Nephrology Team 1D No 5913/2824 | | Date of Admission 25.05.2023 Time of Admission 06:54 PM | Date of Discharge 25.05.2023, ‘Time of Discharge 0944 PM | Diagnasis: CKD on MHD Chief complaints: MiD History of present illness: Patient admitted for MHD. No complaints of fever, breathlessness, cough and cold No complaints of vomiting. pain in abdomen, ose stool Past history: Known case of CKD on MHD. On examination (at the admission): Pulse 82/min RR :22/min Blood pressure 170/90mmhg spoz 985% at room air ‘Temperature febrile Systemic examination: ens Conscious & oriented ws S1S2+ Chest Buateral ai entry PIA Soft, nontenders Course of hospital: Patient admitted for dialysts, done for 4 hours with monitoring. of vital, saturation, sugar and other parameters. No complaints of fever, cough, sweating, breathlessness during dialysis. Post dialysis ‘uneventful. Now patient is being discharge. Advice on discharge: Continue all previous medication Dr. Sanjiv fas Sr. Consultant Supreme Hospi Eros gardon, Chat Faridabad - 121009 a wo \e\ 1} 6 #911294554900 | +911294554444 oe Eos Garden, Charmmivand Vilage, Sector 39, Faridabad, Haryana 121005 @ worsevremenosotat in9 Supreme Hospital SS, Email:ipbilling@supremehospital.in DISCHARGE SUMMARY DEPARTMENT OF NEPHROLOGY | Pationt name Mrs. Sudarshna Rani Katyal Age /Sex 1 yrs/Female Location name Supreme Hopsital HID 2971 | contin Henly Team 1D. srayyzis | Date of Admission +27.05.2023 Time of Admission —; 12:56PM | Date of Discharge 27052003 Time of Discharge :03:15 PM | Diagnosis: CKD on MHD Chief complaints: MHD History of present ness: patteat admitted for MHD. No complaints of fever, breathlessness, cough and cold ‘Na complaints of vomiting, pain in abdomen, Ioose stool Past history; Known case of CKD on MHD. On examination (at the admission); Pulse 82/min RR 222/min Blood pressure 170/90mmhg sPoz 98% at room aie ‘Temperature Afebnile ic examination: Conscious & oriented S126 ‘Bilateral air entry+ Soft, nontenders Course at hospital: Patient admitted for dialysis, done for 4 hours with ‘monitoring of vital, saturation, sugar and other ineveneare ne? “OUPlaints of fever, cough, sweating, breathisiene during dialysis. Post dialysis uneventful. Naw patients being discharge EST ee Advice on discharge: Continue all previgas Dr. Sanit Jasuja Sr. Consultant Supreme Mospit Eros garden, Charmwood village Faridabad 121009 8 4971294554400 | +5112945s4444 oO Garde, Cuaron Vilage, Sain 38 Fada Hanan 121009 BY wen suprenchospati I aSupreme Hospital A Passion To Heal DISCHARGE REPORT supremehospital.in DISCHARGE SUMMARY DEPARTMENT OF NEPHROLOGY [Patient name Mis Sularshna Rant Katya Age/Sex ft yes/Femate Location name Supreme Hopatal zon Consultant Nephrology Team 1PDNo. 5745/2324 | | Date of Admiss 19.05.2023 Time of Admission 02:50PM | Date of Discharge 29.05.2023 ‘Time of Discharge 203248 PM =: | Diagnosis: CKDon MHD Chief complatnts: MuD History of present illness: atient admutied for MID. No complaints of fever, breathlessness. cough and cold No complaints of vomiting, pain in abslomen, loose stool Past history: Known case of CKD on MHD; On examination (at the admission): Pulse S2/min RR 2B/min Blood pressure 170/90menhg SPOz 989% at room air Temperature Afcbrile Systemic examination: Ns Conscious & oriented cvs SiSze Chest Bilateral air entrye PIA Soft, nontenders Course of hospital Patient admitted for dialysis, done for 4 hours with monitoring of vital, saturation, sugar and other parameters. No complaints of fever, cough, sweating, breathlessness during dialysis Pose ais uneventful. Now patient is being discharge, ws sinbysis. Post clatysta Advice on discharge: Continue all previous medication Dr. Sanjiv taf > Sipcere igh ™°2 5 Eres garden, silage Faridabad ~121009 @ 221250554200) -on2a4ssasae remeipital