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  • Illness and Injury Report: Home Meds 1. Flazol 500 MG 1 Tab BID

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    Victoria Gomez
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    This illness and injury report summarizes an incident involving a 42-year-old Indian national working as a mason. He reported to the GV Camp Clinic on August 11, 2012 with right-sided facial swelling and toothache. He was examined and his vital signs were taken. He had been previously treated at other medical facilities for this issue. He was given medications and referred to another medical center for further management. The report documents his treatment and management for classification and return to work purposes.

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    ADARISH LUHAR (QCON)

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    This illness and injury report summarizes an incident involving a 42-year-old Indian national working as a mason. He reported to the GV Camp Clinic on August 11, 2012 with right-sided facial swelling and toothache. He was examined and his vital signs were taken. He had been previously treated at other medical facilities for this issue. He was given medications and referred to another medical center for further management. The report documents his treatment and management for classification and return to work purposes.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    6 views1 page

    Illness and Injury Report: Home Meds 1. Flazol 500 MG 1 Tab BID

    Uploaded by

    Victoria Gomez
    This illness and injury report summarizes an incident involving a 42-year-old Indian national working as a mason. He reported to the GV Camp Clinic on August 11, 2012 with right-sided facial swelling and toothache. He was examined and his vital signs were taken. He had been previously treated at other medical facilities for this issue. He was given medications and referred to another medical center for further management. The report documents his treatment and management for classification and return to work purposes.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    of 1

    ILLNESS AND INJURY REPORT

    Patient Information Name: ADARISH LUHAR Age: 42 Nationality: INDIAN Area of Assignment: CORRIDOR Section A. To be filled by the Doctor: Position: MASON Company: QCON BADGE NO: JBOG-80114

    JBOG Recovery Project

    Incident 00/08/2012 Time of Incident: 0000 HOURS Reported to GV Camp Clinic: 11/08/2012 at 06:15 Hrs. ROOM NO: C 5 18 FF4 MOBILE NUMBER: 66732346

    CHIEF COMPLAINT: RIGHT SIDED FACIAL SWELLING Sick Leave: (Pls. tick) > VS: BP: 162/98 PR: 78 T: 36.5 Yes If yes, no. of days: No

    (+) peri orbital swelling (+) toothache Hx - was sent to RLMC last 9 Aug 2012; was eventually sent to HMC/ALKHOR HOSPITAL for dental consult

    > Sent to RLMC/ALMADINA for further management >QRC/FLUOR NURSE INFORMED 13:10> cameback to GV MAC Home meds 1. Flazol 500 mg 1 tab BID 2. Ciprofloxacin 500 mg 1 tab BID 3. Diclofenac Na 50 mg 1 tab TID 4. Amlodipine 5 mg 1 cap OD

    ristan Palacpac

    Classification: (Pls. tick) Work-related Injury Work-related Illness Non-work-related Illness/Injury

    Referral: (Pls. tick) Yes If yes, referred to: __________________

    Attended by: NIKKO ANDREW B. PIGTAIN - GV MAC NURSE JBOG Recovery Project

    RLIC/Al Madinah Medical Center Al-Khor Hospital Hamad Medical Center

    Note: Please attach all relevant documentation including sick leave forms issued by RLIC, Al-Khor Hospital, etc. before forwarding to HSE for classification.

    Section B. To be filled by Health Safety and Environment (HSE) Manager

    Classification: (Pls. tick) First Aid Medical Treatment Restricted Work LTA

    If LTA, how many days?

    If Restricted Work, state details:

    Comments / Justification of Classification:

    Classified by:

    Section C. Return To Work (RTW) Certification - To be filled by JBOG Recovery Project Doctor Comments: (Please provide details) Fit to return to work Unfit to return to work Reassignment

    Important: Please fax signed copy to Qatargas Medical Center at 4473-6189.

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