Ex-Servicemen Contributory Health Scheme

Referral Fom Polyclinic: Kumool

Category: Cashless Treatment
Fày then pease contact.
Wg C¡ (Rett) Mohammed Anfur Rahim 9650607308
Dir (H COL BS SUHAG 8800824819
ttteteeNOTE FOR 64B SMART CARD HOLDERS PLEASE USE CARD NUMBERS ONLY PREFIX NOT REQUIRED*tttttt

dekeral infometon
Reteral No: Q2110000105541

Claim ID wll be generated by ECHS empanelled facility

Vaioty Upto 08-09-2023
Date Of sue 09-08-2023
No OF Sesion Alowed 1

Pabent Tpe IPD

atent & ESM Infomation

Name O Patent: M SATYAM Age : 67.1
Gender Male Relationship with ESM Father

UDA (Adhar Number) Advised by: DRAKRISHNA JYOTHI

Rank Nk Category. General
Senvie No: 15323216Y Card No : 000003751986
PURNACHANDRA RAO
ESM Name: M Force Type: Amy

ESM Contat Number: 7382964610 Email ID : puma.madala@gmail.com

a8888
rical Findngs
Siood Pressure (BP):
Pulse :

Cadio Vasaular System (CVS) :

Respiratory System(RS):
Abdomen: no

Central Nervous System (CNS) : no

rovisional Diagnosis
2CAD,WMI, HTN, PRESENTLY GIVES H/O CHEST DISCOMFORT INTERMITTENT ND SWEATING
Cinical Notes: + WITH EXERTIONAL BREATHLESSNESS

Admission: AS REQUIRED
AS REQUIRED,RELEVANT TESTS AS ADVISED
Ivestigation :
Consutation For: CARDIOLOGYCROSS REFERRAL FR KIND CONSIDERATION

Referred o Referred To any ECHS Empanelled Medical Facility Located within the AOR of RC Hyderabad
Attendant Reimbursement: No Travel Reimbursement: No

Pobyciric Rermarks ?CAD, WM, HTN

This Referal Fon is Digitally Signed, hence No in FigA¡ueR4 SMA JYOTHI

Medical Officer Ufticer-In-Char;e
ECHSPolyclinic, Kurnool. `CHSPC Kurnoo