BAKSON HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL

Plot No. 36 B, Knowledge Park Phase-I, Greater Noida- 201306 (U.P.)

ACUTE CASE RECORD FORMAT

Session (2023-24)

1. INTRODUCTION
IPD/OPD Registration No.: _________________________________ Date: _____________________
Name of Patient: ___________________________________________________________________
Age: ___________ Sex: ___________________ Religion: __________________________________
Occupation: _______________________ Marital Status: ___________________________________
Name of Father/Husband/Guardian: ____________________________________________________
Address (Res.): ___________________________________________ Tel. No.:_________________
Attending Physician: ___________________________Department/Unit: ______________________

2. INTERROGATION

2.1 Presenting Complaints (With reference to Duration, Location; Sensations/Character/

Pathology; Modalities; Concomitants &Extension of each complaint, write separately for each
complaint)

2.2 History of Present Complaints (In chronological order of their appearance; mode of
onset-(sudden/insidious); probable immediate cause; course of illness, treatment adopted for
each complaint and effect thereof)

1 (Session 2023-24)
2.3 Past History/ Family History/ Treatment History (if any):

2.4 Physical Generals

(Appetite,Thirst,Desire,Aversion,Intolerance,Stool,Urine,Perspiration,Thermals
,Sleep,Dreams) / Mentals:

3. PHYSICAL EXAMINATION (Level of consciousness,Built,

B.P.,Pulse ,Temperature,Pallor,Cyanosis, Clubbing, Anaemia, Jaundice) /
SYSTEMIC EXAMINATION:

2 (Session 2023-24)
4. LABORATORY INVESTIGATIONS

Previous Investigations and reports Investigations advised

5. DIFFERENTIAL DIAGNOSIS

6. PROVISIONAL DIAGNOSIS

7. TOTALITY OF SYMPTOMS

3 (Session 2023-24)
8. SELECTION OF MEDICINE

8.1 Non- Reportorial Method (remedy selection with justifications at least 4 remedies)

9. FIRST PRESCRIPTION (medicine, potency, dose, repetition)

10. GENERAL MANAGEMENT

Signature of Attending Physician

4 (Session 2023-24)