of the patient Sex Age

Name

Address (full postal address or

stay
temporaryor temporary
that of the permanent
and
residence.)

OP/IP Number:
Ward:
Unit
patient: 6. Income (monthly, random etc)
Occupation ofthe
8. Religion
Social Status

Date of admission / operation/ discharge etc

Condition at discharge
0.
he
DIAGNOSISS
olinls : tangus far
Chie comh let
Itord
Kdanolrveutro
n
fhe
d c on
vn
eent.

Smenhg
het
Pos SCZe
oenf

i
Lnere crd
:
rMode o onde et

O n n a t o n

m o n h 4

hin
Pai ciated H
Ama
J t e a na i

A o c i a t e d
odideode
Leapo l k ra

Di4chong
ivatio o 4 en
Hylan d l

relieved (iil) No improvement

Condition at the time of discharge or result may be (i) cured (i)
be entered.
(iv) expired cause of death of PM findings should
should be entered.
Final diagnosis, made at the time of discharge
 HISTORY - TAKINGG

Complaints and Duration

History of present illness

11. Past History

iv Drug History & allergies

Personal History- a. Smoking

b. Drinking
C. Tobacco Chewing
d. Menstmal Ho & Obestetric history
e. Diet

vi. Family History

vi. Immunization History (incase of children)

Associotod Jidecde
eakoapre t

h rotoule tangf
Tnosil
De hee cho t
F
Tong de vra tro~ JeF srde
Pondan histong
Srmopen
Poan chewen

Alcohe

The complaints to be recorded in simple non technical language.

Should describe the orign, duration and progress of the various complaints in their order of
manifestation.

Refer to the health of parents, brothers, sisters, wife and children.

 Investigation
Provisional Diagnosis

Discussion on the diagnosis and Diferential diagnosis

Greneno cominatro

IndhecFhos
Sze on gheh e
meyWthohe

7 c
Nomban
Singke SalHanyJeen

eukoJo-p
Positio mongietog
aven he enel
Ed evented
-Rafde d on
yeleik
Flen igd +
t
ranetio v
an heealFhy
song
Di4 chongt codeun
achon adblerdy
Sena orgainecd
onnoanoling nea

GaloaAy he e de matow
Include routine investigation like examination of urine, blood, faeces and sputum, biochemical
investigations, radiology, biopsy bacteriological examinations, scopies and scan like CT/ MR
Made prior to operation, based on clinical features and investigations.

Closely simulating conditions must be brought out us differential diagnosis.

 PHYSICAL EXAMINATION FINDINGS
General examination

i. Local examination

Specific examination

P bio
Tendenned
Tene e

arded o-deven f elge

Tmeg Ion o g t
BosC
-

Slight Indand to+

DehH

aleoding el..Jg
Retio it eeen true tone
not adacbo dee touetenss.

Note the appearance of the patient's nutritional status, height, weight, chest
measurement,
hydration, temperature, pulse and respiration. Record the B.P. Examine the mouth. Examinestate
for of
local sepsis, jaundice, cyanosis and pallor & skin eruption and lymphnode enlargement. Examine
respiratory, cardiovascular and other systems.
Draw a sketch to scale wherever possible. Local examination includes inspection palpation, joint
movements, percussion, measurement & drawing lymph nodes.
Includes examination like rectal examination and scopies.
 Treatment
i. Discussion on the treatment and other modalitres of treatment.

I1. Progress and Follow - up

V. Histopathology report
Discussion on the pathology report

E>camiti oenve Je4fon

ediatro-s t t Jebf
T'ei aent H

Signature of the Unit Chief

Pre-operative and post operative treatment, Operation notes should include anaesthesia, Position
of patient on operation table, incision, operative type of findings, procedure or technique of operation
and closure, with or without
drainage.
Il.
Discuss why the particular line of treatment was adopted.
Pathology report should include gross appearance of specimen and its cut section microscopic
findings.
V.
Etiology, Pathogensis and correlation of clinical features to pathology changes etc.
 Name of the patient Sex Age
2 Address ( full postal address or
temporary or temporary stay
and that of the permanent
residence.)
OP/IP Number:
Unit: Ward:
5 Occupation of the patient 6. Income (monthly, random etc)
7 Social Status 8. Religion
9. Date of admission/operation / discharge etc
10. Condition at discharge
DIAGNOSIS:

chie Coai
dcen in fhe onton as fect h t foot
2monf durotio
Mode onset o hiek
nivio
ta ma by
Flleing C

22 man t h bac k

Donatio
2 mon Hd

Poin
Csactated H haiN
Mo
Dis chog
Ponenh diachengR
T y k 2dinkefe metu

Condition at the time of discharge or result may be () cured (i) relieved (l) No improvement
(V) expired cause of death of PM findings should be entered.

Final diagnosis, made at the time of discharge should be entered.

 HISTORY TAKING
Complaints and Duration

History of present illness

ii. Past History

iv. Drug History & allergies

Personal History - a. Smoking
b. Drinking
C. Tobacco Chewing
d. Menstmal H/o & Obestetric history
e. Diet

vi. Family History

vii. Immunization History (incase of children)
aCn n Cxaninatio

Anaemc
nxt Cyoc
net chns Siy
han tenic

Ja clrzeA 1ympAaders his

t i nght Tgi
zCo
-na

fempanafr

P I3 o n

The complaints to be recorded in

simple non technical languagge.
Should describe the
orign, duration and progress of the various
complaints in their order of
manifestation.
ii. Refer to the health of parents, brothers,
sisters, wife and children.
 Investigation
Provisional Diagnosis
ii. Discussion on the diagnosis and Differential
diagnosis

occ Cocanination
Enshec tion
Srze ond banden
TnegJa bonde
o 7 cm

m b ep

Sie Sliterg IeD

Posi fro
- Plonton t Rght fe estendig oho
iterg ifi t l web Iace

Irtlamne
ede orto es Sreediy Ween
Floon
granul tio tirg n l t i yale~id
hWl

Did chonf
- Pmderd dischorg
Calaen yeloi4
Include routine investigationlike examination of urine, blood, faeces and
investigations, radiology, biopsy bacteriological examinations, scopies andsputum,
biochemical
scanlike CT/ MRI.
Made prior to operation, based on clinical features and investigations.
Closely simulating conditions must be brought out us differential diagnosis.
 PHYSICAL EXAMINATION FINDINGS
General examination

Local examination

Specific examination

Sannosndiy anea
Gdons ned o-e lemot
set dlng
g h t lowen
Dimb oedena pagent

Pophian
Tendonnerd
-Nont +emdon

nd megi
Tnduntio4
seleratos
T m d on
Cvg-Ln
Be
siyht TnJared
DeH

Blec y obden
Note the appearance of the patient's nutritional status,
height, weight, chest measurement, state of
hydration, temperature, pulse and respiration. Record the B.P. Examine the mouth. Examine for
local sepsis, jaundice, cyanosis and pallor & skin eruption and
lymphnode enlargement. Examinee
respiratory, cardiovascular and other systems.
i. Draw a sketch to scale wherever possible. Local examination includes
movements, percussion, measurement & drawing lymph nodes.
inspection palpation, joint

il. Includes examination like rectal examination and

scopies.
 Treatment

Discussion on the treatment and other modalitres of

treatment.
Progress and Follow-up
Histopathology report
Discussion on the pathology report

Relatio i oelen Stnctns

o t Hacbed r deelan S t e t r s
Sonno n d i y Sar

Tncruesrd tearetnu
Cord Seah t

anoderia

Ecominoation y h nodes Fender c

rgaindyhnole enlag d
gh
acutd Tlo m
Exoniuti Verscd) I J etoy
Nor Uahr cod e Vei
n tD avAJis hele nat
PenPereI hodse
,ptonien +e on foy nt
E t o intied nenve eAio
-Serd ne cnaho
- m o rFan ne wma Signature of the Unit Chief

Pre-operative and post operative treatment, Operation notes should include anaesthesia, Position
of patient on operation table, incision,
operative type of findings, procedure or technique of operation
and closure, with or without drainage.

Discuss why the particular line of treatment was adopted.

Pathology report should include gross appearance of specimen and its cut section microscopic
findings.
N.
Etiology, Pathogensis and correlation of clinical features to pathology changes etc.
 Name
of the patient Sex Age
postal address or
Address (full
temporary stay
temporaryor
the permanent
and that of
residence.)

OP/IP Number:

Unit Ward:

patient: 6. Income (monthly, random etc)

Occupation of the

Social Status 8. Religion

Date of admission/ operation/ discharge etc

Condition at discharge
10.
DIAGNOSIS

chie com-Painto Yeo

yeoh fa
l
Gunaat toe nt t

oven
tkcen
Poattive

modt onet
o r d e

Ensro tog
Dctfen

Yewn

P a iaactotrd i t hui
(eo
fo
A torce
Joadcntios
c Pat l'oyiFruO

MO di4 chongt
Anso c Cofed d rdecm
)CAD ea
Tzo
, S
Co o

cured (i) relieved (lii) No improvement

Condition at the time of discharge or result may bebe()entered.
)expired cause of death of PM findings should

Fihal diagnosis, made at the time of discharge should be entered.

 HISTORY TAKING
Complaints and Duration

History of present illness

Past History

Drug History & allergies

Personal History a. Smoking

b. Drinking
C. Tobacco Chewing
d. Menstmal H/o & Obestetric history
e. Diet

Family History
vi. Immunization History (incase of children)

Gteneneexainaton

-no c.

- non d t e n r e

no dlabbig
nonn femlenat
P2-S-
OP- 13e | Fo

Loc escomintrond

TspeTo
& 7cm
Nam ben Sigle SIF deen.
The complaints to be recorded in simple non technical language.
Should describe the orign, duration and
progress of the various
manifestation complaints in their order ot
Refer to the health of parents, brothers, sisters, wife and children.
 Investigation

Provisional Diagnosis

Discussion
on the diagnosis and Differential diagnosis

onfrre f
ren fe Gnce fe, trvaluing tt

neaibnitfJe , cei na gh[vedel, JisJennca hn

Blecl cdbn

uJ4-dondu

Sena wn dent d achey

Suonaunol o

J n e bs ch icelo)
obdenT
p henihenc e u

Ponsi did absen

mondnteng .Jat fdlh

nclude routine investigation like examination of urine, blood, faeces and sputum, biochemical
Vestigations, radiology, biopsy bacteriological examinations, scopies and scan like CT/ MRI.
wade prior to operation, based on clinical features and investigations

OSely simulating conditions must be brought out us differential diagnosis.

 PHYSICAL EXAMINATION FINDINGS
General examination
Local examination

Specific examination

Tendars
Torden.

hntv dod
nae bnttte
Dvnayn meng
1Seaesl:yhtly T-Jra rirt
0t
Blecdiy bledig
pdton irL deeler st-utuns
Na-facdir elen Stoaetns
Soreondiy sk
Codd
JJonmy
-Lons SesH

- fenikjan hIye sAe

S C
Nole the appearance of the patient's nutritional status,
nydralion, temperature, pulse and respiration. Record height, weight, chest measurement, state of
the
local sepsis, jaundice, cyanosis and pallor & skin eruption B.P. Examine the mouth. Examine for
and lymphnode
respiratory, cardiovascular and other systems. enlargement. Examine
Draw a sketch to scale wherever possible. Local examination
movements, percussion, measurement & drawing lymph nodes.includes inspection palpation, joint
Includes examination like rectal examination and scopies.
 Treatment

Discussion on the treatment and other modalitres of treatment.

Progress and Follow up

Histopathology report
Discussion on the pathology report

tenda
fArodes endergg d
ight
acu

alon Tduicency
m ation 6 vosc

trre
Vonic o d e vel f A - D o s dl i s h e d r e
PenilerA hye
Hoy abde
Gb4ed Ptena+TLr
E x o m i n t i o n N
nenve ye4 o
ne o

n > na
e y -h
metoN

Se dng

Signature of the Unit Chief

Pre-operative and post operative treatment, Operation notes should include anaesthesia, Position
of patient on operation table, incision, operative type of findings, procedure or technique of operation
and closure, with or without drainage.

Discuss why the particular line of treatment was adopted.

Pathology report should include gross appearance of specimen and its cut section microscopic
findings.
N. Etiology, Pathogensis and correlation of clinical features to pathology changes etc.
 Name of the patient Sex Age
Address ( full postal address or
temporary or temporary stay
and that of the permanent
residence.)
OP/IP Number:

Unit Ward:

5 Occupation ofthe patient 6. Income (monthly, random etc)

Social Status 8. Religion

Date of admission / operation / discharge etc:

10. Condition at discharge

DIAGNOSIS:

checom
e d
nght fes {n
g h t fera
dr
dcen oven
2Yecrd Juneti

Modt erse ef
Tosio Tas orde

Doration
2Yec4

Pain
orsocieted LPai

piMchr
nJent d ra choge
S
AMocotrd t4ten even !:
H Ripht
VonlcoAe ver

cured (i) relieved (ii) No improvement

Condition at thetime of discharge or result may be (i)entered.
be
(V) expired cause of death of PM findings should
should be entered.
Finaldiagnosis, made at the time of discharge
 HISTORY TAKINGG

C w m w a l n a n d Duretion
i.
dlhess
esent
Hisoy of

Past Histoy

& allergies
Drug History
a. Smoking
Personal History b. Drinking
c. Tobacco Chewing
Obestetric history
Menstmal Ho &
d.
e. Diet

Family History
of children)
Immunization History (incase

C x a n i r a t o v

Grere
-AnoCie

gio
-nod ctenic ( n g h t Tgoi
-lacadi-d
ypdn tid +

- no clabb
hoCyono

-nosnm-Itomsnoh.
- PR-g-/
-3h- (30 /gomhg

oc comiretio

S2e und shs

8+1 c
The complaints to be recorded in simple non technical language.
Should describe the orign, duration and progress of the various complaints in their order of
manifestation.

Refer to the health of parents, brothers, sisters, wife and

children.
 Investigation

Provisional Diagnosis

Discussion on the diagnosis and Differential diagnosis

Nomben
SS e o0hry Acon
-orton
o ven f d lleoSas niyhl los

sede~rtony
Jen
telig Jee
lamred
Plen
OnwodThy gror

Dr&chg
Seno honden idchrg
Coon rellosta
iCooR
Snnound derrog Kiy ht locn i n b
von

domg, Acd
ver hge

Ppetin
Terderns

Ten d t

iDTmdoratind+

TAJnrd. scde~tos

Include routine investigation like examination of urine, blood, faeces and sputum, biochemical
investigations, radiology, biopsy bacteriological examinations, scopies and scan like CT/ MRI.
Made prior to operation, based on clinical features and investigations.

Closely simulating conditions must be brought out us differential diagnosis.

 PHYSICAL EXAMINATION FINDINGS
General examination

Local examination

Specific examination

De H

olee
No
Rdatrn ireelen nactents
NotttocbeditH Jeeler Stuedn

Dnovoged Ter tt

Na fer pler nonved fich-aa

Exanirin
Jos
ght Tgui-s ~phad eng d, e ndo A

Note the
appearance of the
hydration, temperature, pulsepatient's nutritional status, height,
and respiration. Record the weight, chest measurement, state o
local sepsis, B.P. Examine the mouth.
jaundice, cyanosis and pallor & skin Examine tor
respiratory, cardiovascular and other eruption and lymphnode enlargement. Examine
systems.
11. Draw a sketch to scale
wherever possible. Local examination
movements, percussion, measurement & drawing lymph nodes.includes inspection palpation, jolint
ii. Includes examination like rectal
examination and scopies.
 Treatment
Discussion on the treatment and other
modalitres of treatment.
ii.
Progress and Follow- up
iv. Histopathology report

V.
Discussion on the pathology
report

xominuti on Voscdn ccrong

von icoIe
Peniler Pdes Jall AF-Porsdra edi<
Pootentn r l r onteny l
Ecominntron nave Jedio
n
Se y hecn
odefaehi
ne mten newnepa
ha Je o s
- Spi d

Signature of the Unit Chief

Pre-operative and post operative treatment, Operation notes should include anaesthesia, Position
of patient on operation table, incision,
and closure, with or without
operative type of findings, procedure or technique of operation
drainage.
i. Discuss why the particular line of treatment was adopted.
Pathology report should include gross appearance of specimen and its cut section microscopic
findings.
iv Etiology, Pathogensis and correlation of clinical features to pathology changes etc.
 Name of the patient Sex: Me Age: 2
2. Address (full postal address or
temporary or temporary stay
and that of the permanent
residence.)

3. OP/IP Number:
4. Unit Ward:

5 Occupation ofthe patient: CngineD 6. Income (monthly, random etc)

Social Status: 8. Religion

9. Date of admission/ operation / discharge etc

10 Condition at discharge

DIAGNOSIS:
Prst
Post 7on
chie comla is Srdeeafer f
t Det
Swelli onee
nam
ben- G n o a
fta

Danatros non
CoUtco g
Aght
Jee
Un

neniffen/aue

Cntonmitt ed pot a o e
ae

Me euident orle Fite a

e F r t e pnegenf

ysphaeen
Dysag ta
ins gative
Congatto Jo
ae lena a vd no

Condition at the time of discharge or result may be () cured (i) relieved (ii) No improvement
(iv) expired cause of death of PM findings should be entered.
Final diagnosis, made at the time of discharge should be entered.
 HISTORY TAKING
Complaints and Duration

History of present illness

i Past History

IN. Drug History & allergies

Personal History a. Smoking

b. Drinking
c. Tobacco Chewing
d. Menstmal H/o & Obestetric
e. Diet
history

vi. Family History

Vi. Immunization History (incase of
children)
Podt histoy
-hox T O1
no S u T

n e CAP
na hrat y T
nA b J r c h r thoo

r e hiat
physic examinatin
Gneren exunio to
-modnutitroJ

The complaints to be recorded in

simple non technical language.
Should describe the orign, duration and progress of the various
manifestation. complaints in their order off

Refer to the health of parents,

brothers, sisters, wife and children.
 Investigation
Provisional Diagnosis
i. Discussion the
on diagnosis and Differential diagnosis

Loc e>eomiro fro-

T-3perons
Pryht deefs cenviè mg
Mon oeh.
omelhed o s j e
voncble sree

M h n a n be)
n fmJ o cop
ha nove snt w (f Jfti t
Shoven u Sel
na MovC en tAio
no dloked seis
Ppatrors
ic o
ht Hn Jee conv

Rry
nonnal foprta
hestendenb

nefie ond nub bey Coa ten

a Matled

p dcne

Include routine investigation like examination of urine, blood, faeces and sputum, biochemical
investigations, radiology, biopsy bacteriological examinations, scopies and scan like CT/ MRI.
Made prior to operation, based on clinical features and investigations.
Closely simulating conditions must be brought out us differential diagnosis.
 PHYSICAL EXAMINATION FINDINGS
General examination

Local examination

ii. Specific examination

CVS IS2
RS
bo ho r g r o

odghir ora

Note the
appearance of the
hydration, temperature, pulsepatient's nutritional status,
and respiration. Record height, weight, chest measurement, staie
local sepsis, the B.P. Examine the mouth. Examine
jaundice, cyanosis and pallor & skin for
respiratory, cardiovascular and other eruption and lymphnode enlargement. Examine
systems.
1. Draw a sketch to
scale wherever
movements, percussion, measurementpossible. Local examination includes
& drawing lymph nodes. inspection palpation, Joln
ii. Includes examination like rectal
examination and scopies.