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    Illness and Injury Report: Home Meds 1. Ibuprofen 400 MG 1 Tab BID

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    Victoria Gomez
    This illness and injury report documents Birendra Singh, a 44-year-old Indian rigging foreman, experiencing scrotal swelling on his left testicular area for 1 day. The doctor examined him and found normal vital signs and no other symptoms. He was referred to another medical center for further management and prescribed medications. The incident is being reviewed for work-relatedness and potential lost time.

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    Illness and Injury Report: Home Meds 1. Ibuprofen 400 MG 1 Tab BID

    Uploaded by

    Victoria Gomez
    6 views1 page
    This illness and injury report documents Birendra Singh, a 44-year-old Indian rigging foreman, experiencing scrotal swelling on his left testicular area for 1 day. The doctor examined him and found normal vital signs and no other symptoms. He was referred to another medical center for further management and prescribed medications. The incident is being reviewed for work-relatedness and potential lost time.

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    Birendra Singh (Qcon)

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    This illness and injury report documents Birendra Singh, a 44-year-old Indian rigging foreman, experiencing scrotal swelling on his left testicular area for 1 day. The doctor examined him and found normal vital signs and no other symptoms. He was referred to another medical center for further management and prescribed medications. The incident is being reviewed for work-relatedness and potential lost time.

    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. Ibuprofen 400 MG 1 Tab BID

    Uploaded by

    Victoria Gomez
    This illness and injury report documents Birendra Singh, a 44-year-old Indian rigging foreman, experiencing scrotal swelling on his left testicular area for 1 day. The doctor examined him and found normal vital signs and no other symptoms. He was referred to another medical center for further management and prescribed medications. The incident is being reviewed for work-relatedness and potential lost time.

    Copyright:

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

    ILLNESS AND INJURY REPORT

    Patient Information Name: BIRENDRA SINGH Age: 44 Nationality: INDIAN Area of Assignment: LAYDOWN Section A. To be filled by the Doctor: Position: RIGGING FOREMAN Company: QCON BADGE NO: JBOG-80490

    JBOG Recovery Project

    Incident 00/08/2012 Time of Incident: 0000 HOURS Reported to GV Camp Clinic: 27/08/2012 at 18:50 Hrs. ROOM NO: C4A/01 FF 3 MOBILE NUMBER: 70074181

    CHIEF COMPLAINT: SCROTAL SWELLING - LEFT TESTICULAR AREA X 1 DAY Sick Leave: (Pls. tick) > VS: BP: 127/71 PR: 68 T: 36.4 (-) dysuria (-) pain (-) penile discharge (-) suprapubic abdominal pain Yes If yes, no. of days: No

    > Sent to RLMC/ALMADINA for further management >QRC/FLUOR NURSE INFORMED 20:45:Cameback to GV MAC Home meds 1. Ibuprofen 400 mg 1 tab BID 2. Ciprofloxacin 500 mg 1 tab BID 3. Rabeprazole 20 mg 1 tab OD *For further referral to HMC/ALKHOR* - please see attached form >QRC/FLUOR NURSE INFORMED

    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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