	MEDICAL DEPARTMENT PREVENTION IS BETTER THAN CURE



	PRESCRIPTION

MRN:	Employee Id:
In Time :	Clearance Time :
Patient Name:	Father Name:
Age: y : "Not Available"; ?>	Gender:
Division:	Department:
UTE:	Station:
Cadre:	Employer/Contractor:

Weight: kg

Height: cm

BMI:

BP: / mmhg

Pulse: min

Temp: C

SPO2%: %

RBS: mg/dl

FBS: mg/dl

PPBS: mg/dl

Respiratory Rate:

Urine Output:

AVPU:

Trama:

Mobility:

Oxygen Supplementation:

Glasgow coma scale:

Case Type:		Remarks/Follow-up Invetigation Details
Complaints		Examination
Incident Location

Injury Details:

Type	Part	Classification

Procedures Done if Any:

Additional Recommendations(if Any)

Referral		Follow-up
Health Advices		Recommended Tests
Additional Precautions		Chronic Illness
Status		Half Day
Period Of Rest From		Period Of Rest To
Leave Remarks		Advices
Precautions		Medical Tests Recommended
Followup-Remarks
Observation Note
Previous Medical History
Current Medical History

Signature & Stamp