ECHS POLYCLINIC KANPUR

Emergency Admission Information Within 48 Hrs

ECHS Card No: PN0103690 ECHS Poly Clinic: Kanpur

Name of Patient: Mr. Shiv Mohan Singh Age: 54 yrs Relation with ESM: Self

Service No: 14480884 Rank: Ex-HAV Name of ESM: Mr. Shiv Mohan Singh

Entitled Room: General ward Date of Admission: 01.04.2018 Time of Admission: 10:46

Patient admitted under supervision of Dr V. K. Mishra MD DM (Gastroenterology) in General Ward

Emergency Complaint: Patient was admitted in emergency with complaints of abdominal distension
with DOE Pt was a follow up case of Decompensated Cirrhosis .

 Reason of Emergency : Evaluation & management of decompensated Cirrhosis

 Level of Consciousness : Average
Brief History of presenting complaint:

Vitals: HR: 79 /min Pulse Rate: 76min BP: 110/70mm Hg

RR: 20 /min SPO2 in Room: 99 % RBS: 136 mg/dl

Systemic Examination CVS: S1& S2 (N) RS: Mild Rt. Basal Decreased Air Entry CNS: Conscious & Oriented

Relative Investigation : As per requirement.

Remark by Doctor: Patient needs work up for Decompensated Cirrhosis & management as per
evaluation. As such kindly facilitate the approval for Admission and Further management.

Doctor’s signature (Cont No 9935556699)

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 ECHS POLYCLINIC KANPUR
Emergency Admission Information Within 48 Hrs

ECHS Card No: LUC/10/F/06/03/18/AR/303 ECHS Poly Clinic: Orai

Name of Patient: Mrs. Savitri Devi Age: 62/yrs Relation with ESM: Wife

Service No: JC6610434 Rank: Ex-Sub Name of ESM: Mr. Madan Mohan

Entitled Room: Semi Private Date of Admission: 03.04.2018 Time of Admission: 19:35

Patient admitted under supervision of Dr V. K. Mishra MD DM (Gastroenterology) in ICU

Emergency Complaint: Patient was admitted in emergency with complaints of intractable nausea
vomiting, Anorexia with increased frequency of micturition with drowsiness with slurred spec.

 Reason of Emergency : Hypotension with severe dehydration with drowsiness

 Level of Consciousness : drowsiness

Brief History of presenting complaint:- Neck rigidity (+) peantav decreased B/L pupils small neation

Vitals: HR: 78 /min Pulse Rate: 80min BP: 70/50mm Hg

RR: 18 /min SPO2 in Room: 96 % RBS: 113 mg/dl

Systemic Examination CVS: S1& S2 (N) RS B/L EAE CNS: Drossiness

Relative Investigation : As per requirement.

Remark by Doctor: Patient needs work up Low General Condition & management as per evaluation. As
such kindly facilitate the approval for Admission and Further management.

Doctor’s signature (Cont No 9935556699)

Hospital seal

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Sign of the MO ECHS

Counter signature of the OIC ECHS

 ECHS POLYCLINIC KANPUR
Emergency Admission Information Within 48 Hrs

ECHS Card No: LK0115211 ECHS Poly Clinic: Kanpur

Name of Patient: Mr. Ashok Kumar Age: /yrs Relation with ESM: Wife

Service No: 14296563 Rank: Naik(Retd.) Name of ESM: Mr. Madan Mohan

Entitled Room: Semi Private Date of Admission: 03.04.2018 Time of Admission: 19:35

Patient admitted under supervision of Dr V. K. Mishra MD DM (Gastroenterology) in ICU

Emergency Complaint: Patient was admitted in emergency with complaints of intractable nausea
vomiting, Anorexia with increased frequency of micturition with drowsiness with slurred spec.

 Reason of Emergency : Hypotension with severe dehydration with drowsiness

 Level of Consciousness : drowsiness

Brief History of presenting complaint:- Neck rigidity (+) peantav decreased B/L pupils small neation

Vitals: HR: 78 /min Pulse Rate: 80min BP: 70/50mm Hg

RR: 18 /min SPO2 in Room: 96 % RBS: 113 mg/dl

Systemic Examination CVS: S1& S2 (N) RS B/L EAE CNS: Drossiness

Relative Investigation : As per requirement.

Remark by Doctor: Patient needs work up Low General Condition & management as per evaluation. As
such kindly facilitate the approval for Admission and Further management.

Doctor’s signature (Cont No 9935556699)

Hospital seal

Comment of the MO ECHS

Sign of the MO ECHS

Counter signature of the OIC ECHS