EmpCode Medical Type Patient name Designation Department Aadhar No Asthama Diabetes T.B Hbd Epilepsy Medical Date Illness Heart Deases Typhoid Major Injury DOB Gender Height Weight Pulse BP Waist Hip Nails S1 S2 Any Other Sound Ecg Findings Near with Right Eye Tmt Findings Near Without Right Eye Dis With Right Eye Dis Without Right Eye Dis Without Left Eye Dis With Left Eye Near Without Left Eye Near With Left Eye Skin Color Vision RS Musculo Skeletal Cns ENT Chest Radiograph Urine Re Me Stool Re Me Fvc Pre Fvc Post Fev1 Pre Fev1 Post Fev1 Fvc Post Peak Expiratory Flow Pre Peak Expiratory Flow Post Air Cond Left Air Cond Right Bone Cond Left Bone Cond Right HB TLC Dlc_n Dlc_l Dlc_m Dlc_e Platelets S_Urea S_Creatinine Blood_Sugar ESR Bun Uric Acid PSA Lipid Profile Live Function Test Thyroid Profile Dental Exam Report Mammography Conversational Hearing Pap Smear Any Other Auroscopy Throat Nose EAC Liver Speen Tenderness Any Other Abnormality Appearance Pus Cells Rbcs Epithelial Cells Other Relevant Findings Albumin Sugar Blood Group Pallor CVS Ident of Individual Colors Physical Status Abdomen Medical Assistant Opinion Remarks Vdrl Speech Higher Function Motor Function Vertigo Reflexes Vibration Syndrome PPO Grade Any Other Eye Disease Hydrocele Phimosis Piles Fistula Fvc Hiv Smoking Tobacco Alcohol