48 lines
9.1 KiB
Plaintext
48 lines
9.1 KiB
Plaintext
<!-- <script>
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var checkup_type_id_select = sessionStorage.getItem("checkup_type_id_select");
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console.log(checkup_type_id_select);
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</script> -->
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<center>
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<table border="1">
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<thead>
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<tr>
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<th>examination_date</th>
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<th>examination_type</th>
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<th>emp_code</th>
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<th>patient_name</th>
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<th>father_name</th>
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<th>dob</th>
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<th>age</th>
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<th>gender</th>
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<th>blood_group</th>
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<th>designation_id</th>
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<th>dept_id</th>
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<th>aadhar_no</th>
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<th>primary_phone</th>
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<th>present_medication_if_any_1</th><th>past_medication_history_of_1_month_duration_if_any_1</th><th>present_comlaints_if_any</th><th>height</th><th>weight</th><th>bmi</th><th>chest_inspiration</th><th>chest_expitation</th><th>waist_person_in_person_1</th><th>built_1</th><th>joints_1</th><th>oedema_1</th><th>nasal_mucosa</th><th>buccal_mucosa</th><th>tonsils_1</th><th>thorat</th><th>teeth</th><th>gums_1</th><th>tongue_1</th><th>lymph_nodes</th><th>thyroid_gland</th><th>nail_2</th><th>skin_2</th><th>speech_2</th><th>extremeties_1</th><th>any_other_abnormalities_1</th><th>1_identifications_marks</th><th>2_identifications_marks_1</th><th>audiogram</th><th>liver_1</th><th>spleen_1</th><th>any_abdominal_lumps_1</th><th>any_others_sign_1</th><th>hydrocele_or_vericocele_1</th><th>cryptorchidism_phimosis</th><th>hernia</th><th>varicose_veins</th><th>cryptorchidism:</th><th>hb_2</th><th>rbc_count</th><th>tlc_wbc_count_1</th><th>platelets_count</th><th>mcv</th><th>mch</th><th>mchc</th><th>pcv_1</th><th>neutrophils</th><th>lymphocyte</th><th>eosinophilia</th><th>monocyte_1</th><th>basophils_1</th><th>esr</th><th>serum_bilirubin_total_1</th><th>bilirubin_direct_conjugated</th><th>bilirubin_indirect_unconjugated</th><th>sgpt_1</th><th>sgot_1</th><th>total_serum_protein_1</th><th>serum_alkaline_phosphatase</th><th>albumin_2</th><th>globulin_1</th><th>a/g_ration_1</th><th>appearance</th><th>ph_1</th><th>specific_gravity</th><th>albumin_1</th><th>glucose_1</th><th>ketone_bodies_1</th><th>bile_pigments</th><th>bile_salts</th><th>urobilinogen</th><th>pus_cell</th><th>epi_cells</th><th>rbc_2</th><th>casts</th><th>crystals_1</th><th>bacteria</th><th>psychological_make_up</th><th>higher_functions:</th><th>posture_1</th><th>gait</th><th>plantar_reflexe_1</th><th>tendon_reflexes_1</th><th>name_of_company_organization_2</th><th>designation_1</th><th>service_in_years</th><th>nature_of_job</th><th>past_occupational_illness_2</th><th>name_of_company_or_organization_1</th><th>designation_2</th><th>service_in_years_1</th><th>nature_of_job_1</th><th>past_occupational_illness_1</th><th>blood_urea</th><th>serum_creatinine_1</th><th>uric_acid</th><th>fvc_l</th><th>fev_1_l</th><th>fev1_fvc</th><th>predicted_1</th><th>measured_1</th><th>pasentage_of_predicted</th><th>remarks</th><th>cad_1</th><th>hypertension</th><th>diabetes_1</th><th>epilepsy_2</th><th>mental_disorder_1</th><th>tuberculosis</th><th>any_major_operation_or_surgery</th><th>other_chronic_illnesses</th><th>in_female_any_lump_in_breast</th><th>disorders_of_menstruation</th><th>pregnancy</th><th>any_other_disease</th><th>any_comments</th><th>cad_2</th><th>htn_1</th><th>diabetes_3</th><th>epilepsy_3</th><th>tuberculosis_3</th><th>any_other_disease_2</th><th>any_comments_1</th><th>smocking</th><th>tobacco_chewing</th><th>alcohol_2</th><th>diet</th><th>bowel_habits_regular</th><th>others_if_any</th><th>marital_status_1</th><th>no_of_children_male</th><th>no_of_children_female</th><th>family_planning_history_on_self</th><th>family_planning_history_on_spouse</th><th>eye_external_examination</th><th>colour_vision_by_ishihara_chart_1</th><th>binocular_vision</th><th>vision_distant_lt</th><th>vision_distant_rt</th><th>vision_near_lt_1</th><th>vision_distant_rt_1</th><th>glass_lens_no</th><th>comments</th><th>pulse_rate_min</th><th>pulse_rate</th><th>bp_at_rest</th><th>murmur_1</th><th>peripheral_pulsations_1</th><th>other_signs_1</th><th>chest_movements_1</th><th>respiratory_rate_3</th><th>breath_sounds_1</th><th>other_signs_4</th><th>ecg_2</th><th>chest_x_rays_pa_view_3</th><th>spine_1</th><th>other_signs_5</th>
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</tr>
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<tr>
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<th rowspan="2">Examination date </th>
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<th rowspan="2">Examination Type</th>
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<th colspan="11">Patient details</th>
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<th colspan="3">TREATMENT HISTORY </th><th colspan="23">GENERAL PHYSICAL EXAMINATION </th><th colspan="2">GENERAL EXAMINATION </th><th colspan="1">AUDIOMETRY PME</th><th colspan="4">ABDOMEN </th><th colspan="5">GENITO URINARY </th><th colspan="14">BIO CHEMICAL INVESTIGATION </th><th colspan="10">LIVER FUNCTION TEST PME</th><th colspan="15">URINE EXAMINATION PME</th><th colspan="6">NERVOUS SYSTEM PME</th><th colspan="10">PAST OCCUPATIONAL HISTORY </th><th colspan="3">RENAL FUNCTION TEST PME</th><th colspan="7">PULMONARY FUNCTION TEST PME</th><th colspan="13">PAST HISTORY </th><th colspan="7">FAMILY HISTORY </th><th colspan="11">PERSONAL HISTORY </th><th colspan="9">SYSTEMIC EXAMINATION PME</th><th colspan="6">CARDIO VASCULAR SYSTEM PME</th><th colspan="6">RESPIRATORY SYSTEM PME</th><th colspan="2">LOCOMOTOR/MUSCULOSKELETAL SYSTEM PME</th> </tr>
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<tr>
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<th>Employee Code</th>
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<th>Patient name</th>
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<th>Father name</th>
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<th>DOB</th>
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<th>Age</th>
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<th>Gender</th>
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<th>Blood Group</th>
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<th>Designation</th>
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<th>Department</th>
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<th>Adhaar Number</th>
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<th>Phone</th>
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<th>PRESENT MEDICATION IF ANY</th><th>PAST MEDICATION HISTORY OF UNDER 1 MONTH DURATION IF ANY</th><th>PRESENT COMLAINTS IF ANY</th><th>HEIGHT</th><th>WEIGHT</th><th>BMI</th><th>CHEST INSPIRATION </th><th>CHEST EXPIRATION</th><th>WAIST PERSON IN CMS</th><th>BUILT </th><th>JOINTS</th><th>OEDEMA </th><th>NASAL MUCOSA</th><th>BUCCAL MUCOSA</th><th>TONSILS</th><th>THROAT </th><th>TEETH </th><th>GUMS</th><th>TONGUE</th><th>LYMPH NODES</th><th>THYROID GLAND</th><th>NAIL</th><th>SKIN</th><th>SPEECH </th><th>EXTREMETIES</th><th>ANY OTHER ABNORMALITIES </th><th>1 IDENTIFICATION MARKS </th><th>2 IDENTIFICATION MARKS</th><th>AUDIOGRAM </th><th>LIVER</th><th>SPLEEN</th><th>ANY ABDOMINAL LUMPS </th><th>ANY OTHERS SIGN</th><th>HYDROCELE OR VERICOCELE</th><th>CRYPTORCHIDISM / PHIMOSIS</th><th>HERNIA</th><th>VARICOSE VEINS</th><th>CRYPTORCHIDISM: </th><th>HB </th><th>RBC COUNT</th><th>TLC/WBC COUNT</th><th>PLATELETS COUNT</th><th>MCV</th><th>MCH</th><th>MCHC</th><th>PCV</th><th>NEUTROPHILS </th><th>LYMPHOCYTES</th><th>EOSINOPHILIA</th><th>MONOCYTE </th><th>BASOPHILS </th><th>ESR </th><th>SERUM BILIRUBIN TOTAL </th><th>BILIRUBIN DIRECT CONJUGATED </th><th>BILIRUBIN INDIRECT UNCONJUGATED </th><th>SGPT </th><th>SGOT </th><th>TOTAL SERUM PROTEIN </th><th>SERUM ALKALINE PHOSPHATASE </th><th>ALBUMIN</th><th>GLOBULIN</th><th>A/G RATIO </th><th>APPEARANCE </th><th>PH</th><th>SPECIFIC GRAVITY</th><th>ALBUMIN</th><th>GLUCOSE</th><th>KETONE BODIES</th><th>BILE PIGMENTS</th><th>BILE SALTS</th><th>UROBILINOGEN</th><th>PUS CELL</th><th>EPI CELLS</th><th>RBC</th><th>CASTS</th><th>CRYSTALS</th><th>BACTERIA</th><th>PSYCHOLOGICAL MAKE UP</th><th>HIGHER FUNCTIONS</th><th>POSTURE </th><th>GAIT</th><th>PLANTAR REFLEXES </th><th>TENDON REFLEXES</th><th>NAME OF COMPANY ORGANIZATION</th><th>DESIGNATION </th><th>SERVICE IN YEARS</th><th>NATURE OF JOB</th><th>PAST OCCUPATIONAL ILLNESS</th><th>NAME OF COMPANY ORGANIZATION</th><th>DESIGNATION</th><th>SERVICE IN YEARS</th><th>NATURE OF JOB</th><th>PAST OCCUPATIONAL ILLNESS</th><th>BLOOD UREA </th><th>SERUM CREATININE</th><th>URIC ACID </th><th>FVC L</th><th>FEV 1 L</th><th>FEV1 FVC</th><th>PREDICTED</th><th>MEASURED</th><th>PASENTAGE OF PREDICTED</th><th>REMARKS</th><th>CAD</th><th>HYPERTENSION</th><th>DIABETES</th><th>EPILEPSY</th><th>MENTAL DISORDER</th><th>TUBERCULOSIS </th><th>ANY MAJOR OPERATION OR SURGERY</th><th>OTHER CHRONIC ILLNESSES </th><th>IN FEMALE ANY LUMP IN BREAST</th><th>DISORDERS OF MENSTRUATION</th><th>PREGNANCY</th><th>ANY OTHER DISEASE</th><th>ANY COMMENTS</th><th>CAD</th><th>HTN</th><th>DIABETES</th><th>EPILEPSY</th><th>TUBERCULOSIS </th><th>ANY OTHER DISEASE</th><th>ANY COMMENTS</th><th>SMOCKING </th><th>TOBACCO CHEWING</th><th>ALCOHOL </th><th>DIET</th><th>BOWEL HABITS REGULAR </th><th>OTHERS IF ANY</th><th>MARITAL STATUS</th><th>NO OF CHILDREN MALE</th><th>NO OF CHILDREN FEMALE</th><th>FAMILY PLANNING HISTORY ON SELF</th><th>FAMILY PLANNING HISTORY ON SPOUSE</th><th>EYE EXTERNAL EXAMINATION</th><th>COLOUR VISION BY ISHIHARA CHART</th><th>BINOCULAR VISION </th><th>VISION DISTANT LT</th><th>VISION DISTANT RT</th><th>VISION NEAR LT</th><th>VISION NEAR RT</th><th>GLASS LENS NO</th><th>COMMENTS</th><th>PULSE RATE/MIN</th><th>PULSE RATE</th><th>BP AT REST</th><th>MURMUR </th><th>PERIPHERAL PULSATIONS</th><th>OTHER SIGNS</th><th>CHEST MOVEMENTS</th><th>RESPIRATORY RATE</th><th>BREATH SOUNDS </th><th>OTHER SIGNS</th><th>ECG</th><th>CHEST X RAYS PA VIEW</th><th>SPINE</th><th>OTHER SIGNS</th> </tr>
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</thead>
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</table>
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</center> |