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Director
Dr. Prakash Chandwani GHEARTTGENERAL QS
sO9001
crer
MD, DM (CARDIOLOGY), FACC, FSCAI (USA), FESC
Chief Consultant
HOSPITAL NAB H

Interventional Cardiologist (A Unit of Cardiac Care & Allied Health Pvt. Ltd.)
Reg. No. 12318 (Raj.)
Mob. 9829052290 (CIN-3791)

OPD PRESCRIPTION& ASSESSMENT Name of the Patient Mw 2la JO

Registration No.

VITAL ASSESSMENT: Age Sex

Temp: BP. Pulse
Date Time
Height Weight
Consultant:
BMI

cONSULTANTS ASSESSMENT: DIAGNOSIS:

Medication Order /Advise

Present Complaint:

Significant History:

Past Medical/Surgical History

Ca
H/O Allergy/ Drug Allergy

Investigations:

ClonO.I

Vulnerable Patient: Yes / No.

Diet Advise
Need to consult Dietician: Yes/No.

Precautions:

Exercise Advice:
Need to consult Physiotherapist: Yes /No. Next Follow up on. ******'''**"'

I have Explained to the Patient the disease process & Proposed Plan ofCare: Yes / No

Consultant Name & Sign. ****°*********°*"**********°°***********************

Ddl& e********* Time. **********

7, VivekanandMarg, C-Scheme,Jaipur-302 001 Phone : (0141) 2370271,2370104, 2370105 Fax:(0141) 2378859

Email: heartghospital@gmail.com Website:www.heartandgeneralhospital.com
 ST INVOiCE
SHREE MAHAVEER MEDICOSE
AGROUND FLOOR VIVEKANAND MARG Patient Name MRS.BHANWARI DEVI
NEAR HEART & GENERAL HOSPITAL
C-SCHEME JAIPUR Patient Phone No.
Phone:9351231999.9214444232 Doctor Name DR.P.CHANDWANI
E-Mail jainpankaj33.piagmail.com
DLNo. :JPR2016/29465/68

GSTIN:08AFQPJ3490J1ZX Invoice No. 2021008813 Date: 13/10/2020

TIN.NO : 08324753425

Sn. QtyY. Product HSN Pack. Batch No. Exp. MRP. Dis% SGST CGST Amount

1 NITROCONTIN 2.6MG 3004 1*30 E02320 4/22 234.00 0.00 6.0 6.0 234.00
15 CLAVIX AS 150 CLOPID 3004 1 15 N2001481 4/22 65.50 0.00 6.0 6.0 65.50
3 5 PROLOMET XL 25MG 3004 110 ESX1099 5/22 45.00 0.00 6.0 6.0 67.50
15 STORVAS 20MG 3004 1*15 EMX1591 11/22 222.51 0.00 5.0 6.0 222.51
15 CLONA 0.5MG {CLONAZE 3004 1*10 072002 6/22 34.70 0.00 6.0 6.0 52.05