Вы находитесь на странице: 1из 1

DEPARTMENT OF COMMUNITY & FAMILY MEDICINE MD-DCFMc-046-O1

CBHP
JUNE 01, 2017

Consultant On Duty: Dr. _____________ SHPC Consultant On Duty: Dr. _____________ Resident On Duty: Dr. _____________ PGI-OD: _____________ CCOD: _____________

ADMISSION ADMISSION
TOTAL PATIENTS: DISCHARGED: THOC Outgoing Referral Incoming Referral
CHARITY: PRIVATE

BREAK DOWN OF PATIENTS


Male Female Child Health (<19 years old) Adult Health (19-59 years old) Womens Health (Reproductive Age) Geriatrics (60 years old)

No Hospital Number / Name Category Age / Address Chief Assessment Procedures Follow up Remarks
Sex Complaint Initial Final done
Primary Other
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Вам также может понравиться