\

-----
,:arne f
th
-----
'"'ddres: e Patient : Mr. Jitendra Kumar Tiwari
: 22, VASISTH PURAM,JANKIPURAM.,LKO,
FACE SHEET

Madiyaon
. 02/20/1971 Age: 52Y
DOB •
s.o,LUCK
Gender. M I
NOW uttar Pradesii,226021 lndi
I a
• ae

Narne Of F Married
ather I Husband • KAMLA RAMAN TIWARI / Marital Status :
Religion: • Indian
Hindu Nationality :
Occupat·ion: 7985180028
Mobile No:
IP No Bed No.
: 21227607 Patient ID . Dengue ward DC12
ML10245593 Ward No.
Forrn No. 60 . 213838803023

-
~No PAN CARD Aadhaar card
Next of tr --------------------
7985180028 ----
in : DDEPENDRA TIWARI Relationship : .Tele No :
Son
Category 0 f
Patient-lndivldual/Corporate/TPA :
Name ofth A
e Co'l)orate/TPA(lf Applicable)

Admitting p
. ractitioner Dr Ila Pandey Referral Doctor
ttend·
ing Practitioner/ Tele No.
: Dr Ila Pandey
uate of Admission 12:07 PM
: 07/11/2023 Time of Admission
Date of Discharge
: /0/11/1..5 Time of Discharge

Autho razation
• • for Treatment
! her~by authorize the medical & paramedical staff of Medanta-Lucknow to conduct assessment, evaluation & n:1edical treatm7nt
including administration of drugs, blood & blood products as may be necessary & for performing major/minor o~erat1ve/non
operative
proced~res ·under anesthesia or otherwise, as may be deemed nec'essary in their medical judgement. further give !
consent to release
professional and/or other information from the medical record as deemed necessary in accordance with rules of Medanta-Luckn
ow: I
furth7~ consent & submit to the exclusive jurisdiction of the competent forum at New Delhi/Gurgaon only. I accept
conditions. the aforesaid

I have received Inpatient Information sheet, Rights & Responsibilities of Patient & Their Families.Booklets. I undertake
to abide by
them.

I ~'•? authorize.........0 0 . ~.......(Name) my....J;).,l;t\.~..!{\il.<e..........(Relafionship/Friend) •

signing as witness below to take decision & give consent on my behalf as & when required and to be given information
of my
treatment/ investigation results and all related documents during and after my treatment.

--•ienUGuardia n Signature : ll,I(~ Si~

In case of Guardian - Name/Sign/Relationship

Witness Signature : Name of Docto~ l \\@

I
Date :· 07/11/2023 Signature (Admission Desk) :

·--+-------
Condition of Discharge(Please Circle) •
;
- 1- •

IMPROVED LAMA SATISFACTORY ABSCONDED EXPIRED

Please Declare your mode of payment Attendant Name: ,

Signature:
cash D [iZ{Corporate/PSU c=J yi _. C~ntact ~o,:"'
I
I
TPA
\J P-
\-
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••. EO:ir... 1 JJC'<rJOW
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(U;:1 • m: MED;\~Hi~ Hoto;~~~s PVT. Li [ .} !,.)( t9
SEC1TIR-A, POKET-1, SUSH~.!ff GOLF CIH
~. "AR SH!,HEED r, TH, WCi' ·o::-22( J ..J
 -
b mebanra
dl l\1l•danta Lucl<nO'''
DischnrJ!l' Summnr)'

Patrent Name Ml1024SS93

Mr. Jitendra Kumar Tiwari Patient UHID
Age Male
52Y Gender
Ad1t1lsslon Date Inpatient
07/11/2023 12:07 Encounter Type
Encounter ID 21227607 Internal Medicine
Specialty
Location Dengue ward DC12
Bed No
Consultant Incharge Dr Ila Pandey

~HARGE SUMMARY I

Patient Address
22, VASISTH PURAM,JANKIPURAM,,LKO,Madiyaon
B.O,LUCKNOW,Indla,2 2602 l
Discharge Date
10/11/2023 14:43
Reason for admissions
*
•
Medical Management
Discharge Status
Discharged to home (routine discharge)
Diagnosis & Co-morbidities :
~engue ~ever with Thrombocytopenia with Transaminltls
HYPe 2 Diabetes Mellitus A4 O , DC:, e, . G I Cl J' &
YPertension
-:r. I o
• Medical History & Presenting Complaints :
Th_is, 52 years old male, is a known case of Type 2 Diabetes Mellltus & Hypertension, had complaints of fever with
chills assocla.ted with generalized body pain, burning mlcturltlon, loss of appetite since S days & constipation since
1
day for which he was taken to local hospital, where he was diagnosed Dengue NS1Ag Positive & Low platelet
~ount - 85000 & managed conservatively, patient was brought to Medanta with aforesaid complaints and admitted
ere for further evaluation and management.
Allergies
Not kn0wn
Physical & Systemic Examination
On admission patient was conscious, oriented
GC - Sick Looking, Dehydration - Present
Temp : 98°F
Pulse : 84/min
• RR: 20/min
BP : 124/82 mmHg
Chest : Bilateral air entry present
P/A : Soft, BS present, No organomegaly; No tenderness
CNS : No focal neurological deficit
CVS: 51 & 52 normal
9 Course in Hospital
Patient was admitted in ward with above mentioned complaints for which all routine & relevant investigations were
done and appropriate treatment was started. Reports revealed Hemoglobin- 13.6 gm/di, White Blood Cells- 3.19
x103 /ul, Platelet Count- 30 10"3/ul, Serum glutamic oxaloacetic transaminase/Serum glutamic pyruvic
transaminase- 158/104 U/L & RFT·-~ . ..:.s normal. Dengue NS1Ag - Positive, CRP - 35.j mg/L, HbA1C- 35.5 mg/L.
AccrEWIMi ~ole abdomen (09.11.2023j· ~i,owed mild hepatomegaly with grade I fatty chdnges & left renal simple

(i
al cysts. During the hospital stay he was managed with IV antibiotics, IV fluids, nutritional support and other
rtive measures. Patient & his family well counselled regarding disease condition. At present, patient is
le, hemodynamically stable and accepting orally well. Patient's platelet count at the time of discharge is 80
/ul (Increasing trend). Now he is being discharged in stable condition with following advice and medication.
Aprs.~°2m.w&:ant Medications Given

edanta ·- Lucknow
n~1tio~at Discharg
e an :- l,.lflli!fam
1
: For Emergency & Ambulance: Dial~ 1~ _

+ Sector. A, Pocket. 1, Shushant Golf City, Amar Shaheed Path, Lucknow

+sector-38.Gurugram.Haryana,lndia
: Stable
0)01244141414 I
!ll.0522.4505 050,.
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- Regd. Office: Medanta Holdings Private Limited, E-18, Defence Colony, New Delhi -11002~. l~q!51 reg91 t 44 f.1,~ 1l' • - "'"" •~ ,
[email protected] www.medanta.org
1 ld.entityfl'um~ ,-'U74t40Dl2013PTC250579
Medanta Network: Gurugram I Delhi I Lucknow I Patna I Indore I Ranchi I Noida* -- - - - -

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~tl~l'llel!)a nra Mr. Jltendra Kumar Tiwa ri patient UHID
ML10245593
Male
ge . : 52Y . Gender
dmlsslon Date Inpa tien t
07/1 1/20 23 12:0 7 encounter Type
Enc oun ter ID 21227607 Inte rnal Medicine
specialty
Loc atio n : Dengue ward DC12
eed No
Con sult ant Inch arge Dr Ila Pandey

Radiology
Attached
labo rato ry
Attached
Disc harg e Advise
Discharge Medication
Tab let CEFZUM CV 500mg twice
dally for 5 days
Tab let PAN 40mg twice dally befo
re meals (7am -7pm ) for 7 days
Tab let LIMCEE 500mg thrice dally
for 10 days
• Tab let FOLVITE 5mg once dally
for 10 days
Tab let UDIUV 300mg thrice dally
for 10 days
Tab let NURIVITA 03 1 table t once
dally
Tab let DOLO 650mg as needed
for fever / pain
Tab let NAXDOM 500 mg thrice
dally
Tab let LONAZEP-MD 0.5 mg once
dally at bedtime
• Tab let DIAMICRON-XR 60 mg 1
tablet once dally
. Tab let JARDIANCE 25 mg 1 table
t once dally
Tab let ATARAX 25 mg thrice dally
LACTOC:ALAMINE Lotion local appl
ication thrice daily
S')'rup SUCRAFIL-O 15 ml thrice
dally

Die tary Inst ruct ions :

Norm al Diet
Specia I Inst ruct ions • .
Plenty of fluids
• Do not stop any medications with
out consulting physician.
When & How to obtain Urg ent
Care
In case of any problem like:
1. Fever more than 100 degree
F.
2. Loose stools/motions/vomitin
g or passing black stools like coal
tar.
9
3. Bleeding from any site.
4. Chest pain, breathing difficulty,
profuse sweating, giddiness, pain
5. Reduced urine output. in abdomen.
6. Severe weakness/severe mou
th ulcers.
7. Rash over skin, swelling over
body.
Contact:
other m~rfical problem which you
Acc r~i~ 'M:a -Luc know as early may thin k requires urgt?-"1t,attent
as pos sible / you may reach out ion please repo rt to Emergency
to us at - 0522-4505050. at
up
~Ii i~ up with Dr. Ila Pand
ey in Medicine OPD in EHC, Room
...._ ~rts with p or pointme # 11, afte r 5 days with CBC +
t.. Diff, LFT and RFT
For Emergency & Ambulance: Dial @ 1068
/M e + S tor. A et 1 ushant Golf i
J~__NJPR (,Q T T- EPAR ME O
mar haheed Path. Lucknow .. (l) '0522 4505'650
~f tT ~~ ·N8w NTERNAL M DI CINE
+Secor- 38, Gurugram. Haryana. India · -
- r ' •'.
J. '--" .,; - r.
:c
(l) 0124 4141 414 •• - J:..lu -
,... J" •1:, W~K :!
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•
Regd. Oft1ce: Medanta Holdings Private Limit
ed, E-18, Defence Colony, New Delhi •.. •r .. ..... •• 'l t t • "' PVT. l10 l
r8I [email protected] -110024, ~~dia :_Tel:'01J ·4,1$'44j'f. ; .. ·.. ·,
www.medanta.org
Medanta Network: Gurugram I Delhi I Luckno Corpq_rat~ iaJn\i~Ntm&er, -U74140Dl.2013PTC250579
w I Patna I Indore I Ranchi I Naida•
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Wllllll Illillll lJ 111JU Ill 1111 llllllLI 11111111111111111111111111111 LI 1111l lll lIIIIlIU111111
IIII Ill 111111111 H11111111111 lI11 1111 UIlJ IlllW 11 LI I • '-

11111 m lilllU
U111111 11111 l II
 meea nrc) Mr. Jltendra Kumar Tlwarl
ML1024SS93
Male
ge : 52Y Gender Inpatient
Admissio n Date 07/11/2023 12:07 Encounter rype
Internal Medicine
Encounte r ID 21227607 speclaltV : DC12
Location Dengue ward Bed No
Consulta nt Incharge : Dr Ila Pandey

You can book Medanta Care Services from your moblle phone• 4505050
For Appointments
For Emergency and Ambulance Services
:o5222•4505050 / 1068
:052 • 0505 0 or 91-9559050050
For Home sample Collection (Only for Lucknow) :052 2•4; 9050 50 (Call / Whatsapp)
For Home Medicine Oellvery (Only for Lucknow) : 91·75245050 50/+91 8130771414 (Call/
For Home care (Nursing / Physiotherapy) : 0522-
WhatsApp) 505050
Preventive Health Check-UP packages starting 999/-onwards :0522·4
• ferencing by downloading Medanta
• Access your Medical reports and follow up with Doctors through video con

•
eCLINIC App or by visiting www.medantaecllnlc.org nta (ML***** ***)
• Activate your eCUNIC account using the Patient's UHID registered at M~~; . sooso 1 or write to
• For any assistance or query regarding eCLINIC / Telemedlclne please ca 522 4
Iko. [email protected]

Happy to get your feedback on our services:- .

You will receive a message post discharge, please ensure to visit the lrnk (lnSlghts. zYkrr.com) through your mobile
• Phone and share your valuable feedback / suggestions .

•
•
Accfedited by

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.,., • I ;n•'
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,

H-2022-0936 For Emergency & Ambulance· Dial @f1068= :o~·nA PiJT. lJO.}
Apr 9, 2022 -Apr 8, 2026 • .
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~danta - Lucknow + Sector. A. Pocket • 1, Shushant Golf City, Amar Shaheed Path. Lucknow Q) 0522 4505 050
~danta - Gurugram + Sector -38. Gurugram. Haryana. India 0) 0124 4141 414
Regd. Office: Medanta Holdings Private Limited, E-18, Defence Colony, New Delhi -110024,
India Tel: 011 4411 4411
[email protected] www.medanta.org
Corporate Identity Number • U741400l2013PTC250579
Medanta Network: Gurugram I Delhi ILucknow IPatna !Indore I Ranchi I Naida•

,Willml lil lJ Illll ll IIll UI 111 IU lllilllliJ 11 WI Illlll UlJllJ 11111 lU llllllWJlU WI lillJllU lllill IUlllUillliU Ill llIIlIIU IlU 111111 WJ 11 IJ 11 llli WlllillllllUllU
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-tme oanr a
ML10Z455tl lex: MA"e. • •S2Y
L,oc1tlon : Dengue w1rd / oc12
Dr 111 Pandey/7346

Adult In-Patient Initial Assessment Record (Doctor) -

Source of History : D Self D Attendant -
P~enting Complaints :

q O --_Ac-~

I ~tM.,~ I J ~
)

..
Review of systems :
System Symptoms Duration ~rks/ Other Symptoms
.· ... fi

Nervous System , H t/Je ODizzin~ _t]Faints

symptoms - 1J Fits·D Altered sensation. .
VJSU81 disturbance problem
D Memory and concentration changes

Psychological 0 Anxiety O Fearfuln~ Sleep

Status disturbances DDepression
D No Symptoms D Sulcidal intent O Umeasonably overjoyed
CVS D Chest pain on exertion
0 NO sy,mptoms' Breathlessness Lying flat At Night
DOn minimal exertion
D Palpitations
D Pain in legs on walking
,· .-

Respiratory .• D S~ess of.breath . Cough ',

Tract •• 0 Sputum prodliciion

D No Symptoms 0 Bl~~ sputum O Chest pain _
(lnsp~on or coughing)

· Page No. 1 to 8
Medi Jan 1911P4101/ReY7

>
1. ·.1. LTr )
.... i: al y
I ._
I r-1 pif1icultY
in 5wa}towing
iting blood
Gastro;:;i=nte::-s-:-:-tin_a_Ll
u1cers; - ' ~ Cl \l~-Abdomin,1
O No SYJnptoms 11 pain
(J ~~ ~U fll
• ai;dige5_~on tor of sto0ls (J /
., 'O ~t h~ e~ rs ~- -- +
ochal18e ill co tUJJl J~ -- -_ ;_ -- f- -~ -- -- -7
eeduig per reC
riui;:.i:·:::-:::---_J!:O~B::;l::. tJ freq uen cy . /
0flnary Tract
No symptoms
. urine
0contineOC:
others , . ess
•
·n pa.%illg CJB!<JOCI in uriJ__e
I _:__
_
__ +-----+-----------7
r,B::-o-ne/_J_o_int--~~~:::.:.:- O Deformity
Pain [J ::i tY [Jfalls
O No Symptoms swellini CJ
Endocrine Heat or cold into!eran(J BJ(cessive
0 O thirst •
No Symptoms
------==-::-::---.-~~-----ir- •
in sweating,
Prosthesis/ o~m ---~--:--1
I

hnPa O Dental 0 pacern

Ost.nts er
I nts ,t.. "'...

•
~e OW ht change
Others . 0L o§ ofapr.---~.. _'_n eigSki
D No symptoms n rash
or ~U lgL -'
0() the rs g
Allergies/Advene Reactio
ns :0 No KnoWD Yes
lfY es:
D Medication :
0 Blood Tramfusion
History of Present lllaess :

<Ao ~ v v E,c\\\ \\J> .

\\ \c ~ 'v \
Significant Family History:
IfYes:
0 Negative D Unknown D Yes
.
0 Mother:
0 Siblings:
Others:
~n om ic status : Oc c~ on 0
of earning family member/s :
D Self-employed _D Sal Q·
aried D Others
~ I History
Do you consume any of the
_ _ substance bel .
•
Yes '
.
Tobacco •
Alcohol D Opioids (Smack/he~in/afeem
/ po st/ d~ ,
D Sleeping Pi~s Cannabis (CluuufGanja/ Bh
ang/ weed) - - -
If yes, Frequency : D <>tpers D
- - - - - : - -_ _ ,. - -
_ _ _ Duration
Med1Jan1911P4101/Rev7 • Amount:
-----
------
Page No. 2 to 8

a
-- .
 Past Medical History

-----
Yes No Duration No
Yes Duration
DM
Epilepsy D
HTN
Stroke
V
CAD
Cancer
I . -
Tuberculosis
Thyroid Disease
7 -
COPD/ Bronchial Asthma
Kidney Disease -
Jaundice
Substance Abuse
-
\
Ostcoporsis
\ Others
-
Psychiatric diso~

'
, \
• -
I Past Surgical_History Year

.r

Medications reconciliation •
(Current Medicatiom with special refe.-mce to Anti-Hypertemive, Anticoagulants, Oral Hypoglyc
emic, Insulin, Anti-epileptics
Antiwc ~tic, Anti microb ~ lmm~o ·suppressants etc.) • •
S.No. . Curtent Medications• Dose Frequency Route To_be continued in hospital
' ..
.. .. .. .. . ..[JNo ·- ...

.
. qves.
.
'\ . .. . ...
\ .
\
,
I ..

\ ·
·t

• Medications marked 'yes' to be included in the Medication Administration Record

-
Page No. 3 to 8
Medi Jan 1911_P4101/ReY 7 •
)
~,. 1·oc:::.J1~.1::"R.STED
r~ZP,. ,,; 'UCKfJC'./
(U."IT o:: r.iED,rn:, HOW!r'GS f VT. LTD.I
.,. s:cro1H, POKIT-1, sus1C,: ,- Go~r- c· v
,. ~P~l'.E:D P:~TII, we. ". ,.,. ,
rI
I
0 Pain Score:
On Examination --
--- -::::n a
~;; ;;-; z~ ~s
RR 9Um in p0 2•·.=Iar,_ --
--.-11-fg Tem p
Gen eral o J1lllll"''
. Cl
• 0---
s15
Clubbing
Vital Signs : Pulse cyan° Edema
Pallor D Icterus CJ
D LymphadenopathY tube/ others)
Catheter/ ET tube/ Tra che osto o1J
yes CJ ?.Jo I1~ Y~~ :_:: :::,: :;.;. ..--- --
tersl Ur- ii~n ~a r/~ ~= ~~ =-= ----
Any Invasive devices tral venous cathe ==
If yes, tick relevant (Cen

Systemic~mi nat ioD :

CVS : El NAD 0M unn ur ·p Jagular Venous pressure
beat
O peripheral pulses
D Additional heart souocis oot her s
O Ankle edema
Findings : .,._

Vocal Resonance
Findings

Pe¢ dom en: DNAD

Abdominal Distension O Ascites O Tenderness
Eillargement O Liver O. Kidney D Spleen
Hernial Orifices· 0 Normal Ab~onnal._ _ _ _ _ _ _ _ _ _ _
Findings: . • •• :...... . _ __

Others
Speech. D Cranial Nerves : Record Abnormalities if any
•
,· '
,, •: ...
Obstetric·history (for re al ) .
Menstrual cycle :O Re ml es_ • LMP .(12-50 Yea •
rs age group):
gu ar •days D Irregular _ __ ___
_....
•t,.
'!

Medi Jan 19nP 4101/Rev • ••• • - I • :'> ;, I•

., ":,
7

Page No. 4 to 8
Q)
------
 Local examination: Skin/ Vascular/ Ext~emities/ Back/ Others

Population from if any box is ticked) Mark X

Assessment-of special population (Fill Assessment of Special initi~ assessment_
D _F~I el~e~ly .(~g~ 5, <16) - For patie~ts with age> 65, please·check BMI from nursing .
.• · .
D Pati~nt with mtense (pain score>7) or chrome (>6 weeks) pain
D Immunocompromised patient
0 Suspected drug/alcoh9l depen~cy
D Infections/ communicable disease •
D Yictim of abuse and neglect
D Patient on Chemotherapy
0 Patient on radiotherapy
D Patient requiring termination of pregnancy
D Yes If yes, give d_etails :
Result of p~vious investigations:·~n e
--- --- --- --- --- --- --- --- -.·
--- -,. --- --- --- ---:Resul .,

Investigations t
. Date ;/
I

Page No. 5 to 8

;!,-
Medi Jan 1911P 4101/ReY 7
)
, ~,..., :-,r,
_, .IT~ ~ __ ii;J
' Dp
·• - •
1
• .. , ''"'''
L' "'•\1:.JU
j CA JIA HOL[i'."3S PVT. LiO.I
'- OKIT-1,SUSHANTGOLFC:;y
EEO PATH, WC:· Q",'-2;'
 • I education needs. to plan
.
Spec1a 0
n·•scharge Planning : ed or sign of infection
No If yes, educat d edication advised
PFEdone an m
}Jodle No If yes, h ical limitations, if any
Wound care needs anticipated at If yes educated 00 P ys
No
Pain~e ment , cated on diet restrictions, food
Yes No If yes, edu . d allergies
Physiothe rapy at home antici~ drug interactions an
• • ment. advised
Special dietary needs Yes No If yes, PFE done and eqwp
If yes, cowicelling done .
Honie equipment anticipated Yes No
• pectof
Social support needed at holDC If yes; educated o~ various u
Yes No ongoing care reqwred
ContinUOUsl ongoing care anti~ipated
Yes No If yes, PFE done
Other special education/needS
i.e ···••····..................................•.............••••••••••
.
I , • ·, ' •

Yes· No If y~, s~cifi..~.·edu~tion. gi_veµ

Nature ofpost wpital care needs like
infection controt;Tall risk
etc addressed 1· t)
• "d"ti (Problem IS . ,1. ' •.• '

I)
Provisional Diagnosis and Comorbi I es · •

·j) ~~ ,{u 0
1<.fr_ if ~If _p m
Plan of Care Expected outcomes/ Measurabte
.. Goals ·

-
-~

Psychiatry referral needed

Physiotherapy referral needed
0Yes D No (Refer psychological evaluation and social history) 0
No (Refer functional assessment by nurse)
Diet Advised I

P~n of care d" cussed with. patie relatives : Expected outcome discussed :
. .

Signature of th Docto~ taking historw,: Name of doctor DatP: Tune

• @DOY w?ho~ -,
~\)0:0 hQW) ~
Name of the Patient/ Attendant Signature of the Pa~:nt/Attenda~t Relations 1p
• \~ \
Consultant's Signature ~}>( ' fl
Name ·J»
Medi.Jan 19/IP 4101/Rev 7
\\'t - Page No. 6 to 8

'~ ~,- •

- ---- - ___ ___ ___ ____,_

 . n at ad111ission •
Interdisciplinary Plan of Care and Patient and Family Educatao •
\ Time :
___
oa_t~ :_)++_\\~\~~?1---------~------~-
1. Education provide to :

2. Literacy/Education ievel : Under graduate/ Graduate/ Post-Gradauate

3. Language known : Englis~ers, specify _ _ _ __

4. Healthcare literacy/awareness about present illness : Yes _ _ No _ __

5. Special beliefs and v~ues/ spiritual and religious needs : None

lfany, specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

6. Barriers : ~iscomfort/Anxiety/ Disinterest/ Hearing loss/ Visual impaimment/

Language barrier : Cognitive impairment/ Emotional barrier

.. I .
7 • lnteiventio~ to reduce banier : None/ intervention for pain/ Reassure/ Provide written education
. .
Material/ Review ·and repeat/ Use of translater/ Track family

8. Ability to learn: Yes/N/ • ·

9. Readiness to learn/ Motivation: v3/

;.,.

Focus area/need identified, plan or care drawn and patient and family educated on the following
• • • l 1. •• ,• ,' • • • \ •

By Nurse : Teaehiqg method : D Discussion D Demonstration D Handouts

·Edu~tion outcome acceptable level of Requires additional education

P~~ntrol D Risk of hypoglycemia

D High risk for fall Strict intake and output recording (Fluid management/.

Risk for pressure ~cer Fluid restricti~n)

Enhanced elimination needs (Diarrhoea/ O. Special needs_ (d~dumb/~sually idipaired/ using aids or prosthesis/
• • • I •

Urgency/ Incontinen~) ~ble to perform ADI.( pregnant/language barrier)

• I.
.-.. ,....
Wound care needs •• • On restraints .
\ J

[] ~ - sensorium Education provided to attendant/ care talce . • •:·a1·· · ts ·r,...- ·

• . -~ ronspec1. pom o ""°"""
u('Inf~~~:piwention

•Medi Jan 1911P4101/Rev 7 Page No. 7 to 8

)
: __ )TOCO~'7'ESTED
rt.E'DrrlTA WCKNOW
(U,;IT OF MEDANTA HOLDl~GS PVT. LTV.)
SEcmn-A, POKFf. 1, SIJ.5nl\ITT GOLF c:iY
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-
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•
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. .
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b Assessment and ~unselling

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ergies
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pecial diet based on di - condition
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r~ Position Chanp
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INTERVEN TIONS FOR MODERAT E/HIGH & VERY RISK LEVELS
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Initials: lnltlals: Initials: Antibiotics
Present Day Previous Start Date Stop Date
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Med/Feb WNunln, 9568a/l.udt /Rev Z
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