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Lab Reports & Investigations

Hb g/dL

TC ×10³

Plt ×10³

RBS mg/dL

HbA1c %

Cr mg/dL

SGPT U/L

TSH mIU/L

Urine R/E

Others

Date

Sex

Patient Name

Age

BP

HR

Temp

SpO2

R/S

CVS

P/A

CNS

3. Clinical Note

PT

Name

Age / Sex KCO: --

C/O: --

BP --/--

HR --

Temp --

O₂ --

Rx

Known Case

DM HTN Hypothyroid IHD Hyperthyroid S/P CABG S/P PTCA Asthma COPD CKD Epilepsy Psychiatric Disorder RA PIH GDM

Advice & Instructions

Diet:

General:

Warnings:

Recently Used

Days 0 Meds

Follow-Up

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PT

Patient Name

-- YRS / M