You are on page 1of 1

Madhyabindu Municipality

Office of the Municipality Executive


Gandaki Province, Nepal
Chormara Primary Health Care Center
Madhyabindu-07

EMERGENCY Ticket Health Insurance


Board

Patient Name: RAM NEUPANE Reg. No.:11230


Address: MADHYABINDU-4 Age/Gender:34 Years/Male
Patient UHID: 80000001 INVOICE NO.:10427
Doctor Name: ROOM NO : 3 Amount: 0.00
Registration Date: 13/07/2080
11:00:10AM
*80000001*
INS.ID: | CID:
BP: mmHg PR: /min RR: /min Temp: °F SPO2: % Wt.:

C/O: EXAMINATIONS:
G/E:

S/E:
CHEST:

CVS:

P/A:

CNS:

DIAGNOSIS:

INVESTIGATIONS:
MEDICATIONS:

ADVICE/SPECIFIC INSTRUCTION:

REFER TO:

REASON:
.......................................
SIGN
COUNCIL NO.:

User: YAM -Morning # 13/07/2080#10:56:19AM

हररक पटक आउदद यय परदर अननवदयर रपमद ललई आउनप हयलद ।

You might also like