TE waLO20S met2b220%t wSbS420u otto.STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED STAR |. races Soa ie nse: pmeamugecnialy cent Resiv alagan ———— meen SL) aL) mi ve a] TG] mn] conven ODAR/TIPT armeetenione AEG tem] om] ree] Lr eer (ome Ese] eee eC | eee eee se oe Ee ieee tains /so/ ale PO IEOO Spee omens PSE /LO 2D eam soroem sel] ne] seine] itm AE] N]_ tenn CJ Os sttmctnmaens Ew Ee ent a etic al |p cee : mae fe ieee iS | i : : & ieen 78 MOLES ‘hey ce tt oraton ein ti ci Ae tay mata ty ite dn roan ‘eo cenaenecnra wor ay tsa Me owe (OE DIS ES os ELSON sre ana ns sondern pron agers so Me Pew ei mon cman am mt ; PRIMARY WUE nye aint erase tie mene | f ein a mi ire ne Se aa ese a oar one Toa an yo a “a ERE ST — | ie Seam [rama Tr. era Tak er a a SS Tae tr a ‘ken o— i tr operTea TORT TTS — | es cane mr RN INTENT | why Tern ee raver man ame Toe OE Sea SEn Gr WED PRON OSPTAED ote Fac eo Tena Fn roo Ear Suet omeee Seer pr onan aia sae o_o ca caplet ee a ees aa canton co Saori 3 hes eat ‘anemia Teri ethan ress mcrae Tete ien [operator Dae TORINO | arn we deen it [hee rotor ews ro oer tear ot rer coer Teciorgteor isi Taamtebe napa Tero Tate aio Fes ek mm nou09susie Star Health and Allied Insurance Co. Ltd. IRDA Regn.No.129 Reg & Corporate Office: 1, New Tank Stret,Valluvat Kottam High Road Nungambakkam,Chennal - 60034 ‘Phone: O44 - 28288800 Telefax O44 ~ 28260062 Wels: yw trhealth ip ‘CONPORATE CLAIMS DEPARTMENT: # No 15,1" 2b loo, Baa Complex Wits Lane Whites Rood oyapetsh Chena -600018 Phone 48260 695, CLAIMNo + OL9 R24-F09 toe PATIENT ADMISSION NO /1P'NO /MRDNo:__&F 4 To: (Name of the Hospital & Address) cpAS HospyrTal PLeT Alo 1 SETOK E+ Cues nent Mavyanin 122018 Dear Sirs, Re: AUTHORISATION TO STAR HEALTH AND ALLIED INSURANCE CO. LTD., Thave undergone treatment for from {O /{[© /2R° top S /~o fled inyour Hospital. Thereby authorize M/s. Star Health and Allied Insurance Company Ltd. and its representatives, who is my Health Insurer to seek any medical information/records from you or from the Medical Practitioners who have attended on me in connection with the above ailment and the treatment given. In case they seek any such information/records/indoor case papers, kindly oblige. ‘Thanking you, Yours faithfully, OP a (Sighatire of the Claimant) Aciitess ofthe tasuredi DATE: app btetef apple peadtslc PLACE: Sect 1% Pavey Tefen err Sper OuSTAR HEALTH AND ALLIED ED INSURANCE COMPANY LIMITED fc coo ‘San Lone en wee et ee comm AA P94 od 12. 4p Qo wet emer (SLO AZOD Onm FIT] cso 3} EI CIE] toma Asetimdeoee ae onarmneenrees [] ones ("] eee. OE) —— SCSoo see GoooooS |S vom GOS005, —_ = Soe — Haron in ma [ ommmmmewne w]e [] meen wn reeset itninieat te [Ju] (ae ea ea eas ee 1D opareetremr no Rigen nn pennant oa eet |G secon oA ARSED NC ©. ote aa han fons cretode iat a renin asi ‘Srvtecmnar tna Nea i ee er = ~US 06 2s | oh so sranevstsenmenney j ! 5 i i 3 4 0 0 i a ee eeNot tobe Faxed / Scanned “GUBRE FOR PLING Ca FOR PART To din a J BATA ‘bescnion roma | a essa Tre ot Tones > ron Er a oot Tiny s eT in eh ewe ae Tat None in be wane off ray Testor na z ot Onn En lens i erg owas lensairalaatone 1 Reon a wh Se ot rae eS UHR | seca ete Cues a Pere cau epee ane Toa [ ra 0 ae itn {ECT DETAR OF TE PATERTAGWTED oon Ere enews Tareas 2 Peper Erie soe np ‘Asay ree Tac Gr or tr Teka Foner ote Ei pf a Rare oy rd tae wan hr a aber Ui ett 1 tre iin toon Ue ome ota ona [eet ce ny Tie nn os eerie Te an ‘eto p Tt in ts ae fost ry Ty tesa cal ‘asta One ay To toa HLS neces aa vs ft ane hE “axe tien SEETON- DETALS OF ALNEXT ORGNOSED RRA) oe te z areca See Re OU Wo oa TIBI Troms oa grt ee oe | somal onal ncaa Ea te D1 Gs onan ot oninnt —| Sanaa Foro pao Be ores pe : Psa WPS pl a nm | Ba Fat an ] reason? are PES ac een ranged | Sina Foran Go Foxes rf EDS ws ection Ot sre | Sn Fora ooo Deis Pose En rset be pss oer Prana Capt oD ‘Se ee pe en FERIA TERE PR wyeoa @ Pana aed In ree nea Taveras = 8 Renown i aot nr ese oT ls eerie terete ein ms | cadre ria meee eanmaenmer stoma Gain a ay Tn palin sonny Tete ae Ins cue Te in Lees eee | ak ianiniscaa Taye ies ie eb Fa el avai Repetto Tee hr at Tere Tn pe a Te Seaton ‘isi wh ati ame SECTION E = DETARS CASE OF NON RETWORE TOTP s ar Ene eos Tele St Ow Cte iF Phone no Err shoe nner of sp ‘hie STO ce wihetorm arbor | serene ee iin seo ‘ay epi 3 Pa Er pena utr ‘tae rahe Te Nari di re nb pene Es 3 1) Fest on a Tn tier eli ag Leeman | SECON F-DECARATIN BY HE HOSTAL e Ped era cy mre ry eth es ps saan A‘awit way Enrolment No.: 0000/00552/15507 % Sion, mar Chaurasia ‘fo sundor al Chow eae Sanlay Colony Sect agar aryona 122001, smoniaaes | | arreenr girere water / Your Asdhaor No. 3963 9676 6876 “wo saa0 5262068 482 arr aren, AR Fear nay ea Government oft soe se ar chausia ‘eitisigon: oaror993 ouwate 3963 9676 6876 Senne, weeer he awn see ev arr, =v | fesse era A FP er HE | fave gu: eg a wre HT mirormanion mAadhaar isa proof of identity, notof citizenship ‘= To establish identity, authenticate online, 1 This Is electronically generated letter. se ye Ber ae ee | fe youre aren acetate Aearent ata | cre wow ort A sete | } f= Aaghagr ts valid throughout the country. | ‘Aadhaae wil be helpful in avaiing Government | | ‘and Non-Government services in future. | EEStor ai chourasi. C-43, 5a Cate pale apa reo ata aaa 122002‘Advanced Loparoscopy Dr. GAURAV BANSAL ‘MBBS, MS, (General Surgery) FIAGES, FMAS Consultant Surgeon Costrointetinel Surgeon ‘Anorectal Surgeon SWASTHYAM Formerly Consultant at Primos Hospital, Delhi 1699, Lower Ground Floor, Sector 52, Bes, ein DOU} Daly it edical Examiner peat aiseeciy Gara Nol Gian Reg NS DMC/R/34302, Email: gouray_cty@yahoo.com ‘Not Valid for medicolegal purposes ‘M: 9910031911 — AMAR. CH AUBAS I [m0] 88 Co Morbidities Drug Allergy ey ANIKRe I = NX 7 . 1, ZIFL Qoow = a ei Sey T DaAPLON SoD Dp - et cere dna Row © Reinier oes Noo HETROGNYL fs z ( ANOV ATE 2 peek Meee [wotth, Z Tab Qucco LAY ATR at Mig Lo: 2| jelly Llp bo n saro4dppic Surge! a Ventral, Incisional and Inguinal (groin) Hernia, Gall Bladder, Appendix, Intestinal & Colonie Surgery, Laparoscopic 6) Laser, Scarless Surgery ure, Pilonidal Sinus flop cover), Circumcision (2SR) Piles (MIPH/Loser), Fistula (LIFT),CENTER OF DIABETES & ALLIED SCIENCES Plot No.1 Sector-47, Gurugram. 122018, Haryana @ ; ilo@edascom @) , wow edasin @ = 01244232196, 01244232005 @ DISCHARGE SUMMARY PATIENT'S NAME: Mr Amar Chaurasia IPD: 20/376 AGE : 27 YEARS/M CONSULTANT: DR. GAURAV BANSAL DATE OF ADMISSION: 10-10-2020 DATE OF DISCHARGE : 15-10-2020 ROOMBEDNO 102 DIAGNOSIS: Post-Operative Case Of MIPH + Anal Fissurectomy + Surgical site Infection. CHIEF COMPLAINT: Pus Discharge from Perianal Region, Painful Deification, Post-Operative Case OF MIPH + Anal Fissurectomy on 22 Sep 2020 HISTORY OF PRESENT ILLNESS: Patient came with above mentioned complaints PAST HISTORY: Nothing Significant CONDITION AT THE TIME OF ADMISSION: Pulse — 80/min RR- 18 /min ‘Temp — Afebrile BP —110/72 mmiig PROCEDURE DONE: Conservative Management, COURSE IN HOSPITAL: Patient was admitted with above mentioned complaints. Put on Inj Tazact 4.5Gm 1y, Inj Pantop 40 Inj Oflox 100m1 . Inj dynapar7Smg, inj Metrogy! 100ml. Inj. Monoeef? gm. Other supportive medication were started. Antibiotics were changed as per culture report, Now Patient is being discharged in stable condition, Patient is tolerated sof oral diet and discharged in stable condition with further follow up advice.a Emergency Number 0124-4545 450 & Plot no. 1, Malibu Towne, Sector- 47, Gurugram Haryana- 122018 Q Center of Diabetes and Allied Sciences 9124-4232805 01244232196 info@cdasin MEDICATIONS GIVEN: ~ Inj. Metrogy! 100 ml IV Thrice a day ~ Inj. Dynapar AQ 75mg UV thrice a day = Inj Pan 40mg 1/V twice a day ~ Inj Tazact 4.5 gm liv BD + Inj Offox 100 mi IV BD, ~ Cream Anovate L/A = Inj. Monocef2 gm i/v BD. MEDICATION ON DISCHARGE- DRUG COMPOSITION DOSE [ROUTE [FREQUENCY | DURATION ‘Tab. CETIL CV eRe P78 | Granty | Twiceaday ‘S days (after meal ) fanic Acid 25MG 2 ee Tab. Pantop D Pantoprazole + 40mg | Orally ONCE daily S days Domperidone (before meal) Tab. ZINASED i cenac + Ongaligalyr | Sos 5 days(after meal) Serratiopeptidase Tab, DULCOLAX [Bisacody! Orally NIGHT SITZ BATH WITH TWICE, S DAYS ETADINE LIQUID pe Q DAILY CREAM ANOVATE A 5 DAYS + METROGYL-PCENTER OF DIABETES & ALLIED SCIENCES Plot No. | Sector47, Guam 122018, Haryana ©) info@cdas.com Q worwedasin @) 0124-4232196, 0124-4232805 @ CONDITION AT THE TIME OF DISCHARGE, Patient is afebrile; itals are stable, accepting orally. Surgical wounds are healthy. FOLLOW UP ADVICE ~ ‘* HIGH FIBER NORMAL oral diet 3 days. © Rest at home for 5 days. A = Avoid oily and spicy food. ‘+ Review in Surgery OPD after 5 days with prior appointment WHEN TO OBTAIN URGENT CARES. If patient develops fever, recurrent vomiting, abdominal pain, abdominal distension, Jaundice and severe constipation. CONSULTANT SIGNATURE, RMO SIGNATURE,Center of Diabetes and Allied Sciences & Plot no. 1, Malibu Towne, Sector- 47, Gurugram, Haryana- 122018 & 0124-4232805, 0124-4232196 © www.cdasin rman dnsion dat Tne sores oeanaoen 21 ae eh Tne siocomeeaiaipt coroQss tits ttn, raze toasts ss ou mang ocr ouverte edn. caegoy eager rome rete ex | ret ane sa Senta ssiombonwom Prwgioame noc ae 1 ey vo 2 soi0 omen ee aan 10 zam0 soo 2 spteamo set cupes pasos saan oo 4 soamo —_sederones ne sso 30009 rao 2 mom owcrwes oe 10 ta emo a cs rote Pr) 70200 7 tus0see eae aie ico 7a re # sina oeemenpe foare 10 som sow aa comstaton +0102 orcavartne ane 1 10% so0 1 eros orcarevtot ae 1 som 1009 2 mem orca ond ose 12000 0 32 mtgame——orcasar ta ase 1m some 0 a am 20 10m ssoCenter of Diabetes and Allied Sciences % Plot no. 1, Malibu Towne, Sector- 47, Gurugram, Haryana- 122018 G 0124-4232805, 0124-4232196 = info@cdas.in © www.cdas.in cy ramber rae amar Chavasia ‘Admission Date Tine 130.200 44040 Ps 2M Discharge Date Tie 140-2070 053121 PA house no 985849 bal urs uno, wreazae staibadManabadiar at oae Tine ss r0-2020 0655407 ‘aiting Doctor Dr cau torel Bed No 10ting Category 00a Ta SHARING ‘Treating Doctor brava bana Payertype ah Payer tame ser ‘Settoment Dae 15.10202005:3540 PM 1 T0200 Or Gavray basal esine 200000 200000 18 110.2000 orcauartansal one am 140000 1,000.00 7 astoaa —_orGarav team Poatne 100000 xa00 oso 2000 complete loos courtcoc—Rauine 100000 san.00 Pramacy 39 tox0zo20 ws em queLe) 200M, . mee wa.9 tases 1010202 VENELOWIveaNNuLAz06 100 18800 1940 Issued 30102020 _TEGADERW FAM EVA6230N 1007200 nm saves scwren 22 rou SET (ROMEONS) 11°CS a 25 5 Issued 22 so19000 sy ro ML OM. 500 azs00 125.00 ese 2% oie aeerionTAZACT asin 300 La7ao saroco tees 220M. S009 28 aioe pantoP NT 7 woo amwecrioneveser 2m 7 om DDYNATROY A IND Ar.Center of Diabetes and Allied Sciences 9 Plot no. 1, Malibu Towne, Sector- 47, Gurugram, Haryana- 122018 & 0124-4232805, 0124-4232196 a © www.cdasin pear Conan ‘nisin Ot Tine onan t4040 PM se 9 5552 i, 1weazas stereasnunacaser ea. tmng category oa rw ssn ‘woming Decor ar oral Pave tne can Proertane sa Setement te seinema0e5a5s0eM 2 swivam —_ouamanovare 20 on 1 mu ma sued 2% seo sakaon BETADNELOTION 10 te ons eine 70 90089 2 swine weTRogM. seetea 1 u “ tse 32 roto pavTOP IL 1 on an eset ‘4 siamo nuecnoneueser2ut 10am ne sued 3 swieame —voveranmasaae, 100 mss ss wee 37 ros02020 aNouermcwouT 1 so tcone woo tee ‘2m anzero —puecmiow TazACT Asn 300 sarom areca sso 900m aoa wermooyLiw te 10 ase ae sot 41 wasam —panopnus 300 seus a)Center of Diabetes and Allied Sciences Plot no. 1, Malibu Towne, Sector- 47, Gurugram, Haryana- 122018 & 0124-4232805, 0124-4232196 it © wwww.edas.in ear Cn ‘asin Date Tene tosorematansoru 27 charge at Tine ss02m20083121 Pu sstoamoiasaorn ‘ng Doeter orca bared ‘ea ne. suing cago, a TaH SHARING ‘honing Decor aur basal Payer type cae Payer name sa Setement te ssi9zm0059540eu Hiealiiimmcemmeete thiozom— ENESETNWGMO Yan, 2 SSE a oe aan aE 44 uaoame seme ouLassrovay eT 00 tees trom NS omomUrD ro0m a som sour owe 47 wtoao —_syamcesmospoun 00 sao as ven 4 suaozemo —syance sou oseovan S00 saan en sued som s0 tniwwa— WECTONTAZACT AS IND 4 0 0 vend taocm srr suascauze aoe) 5 we 0 mt 200.2009 St szoza> —puTocO Nin VAR, 2 ‘sue 5 sztmama —_SyRAGELOML ASeOVaN 200580 as uma sso ae purconextas 6 5 ss sa vendss1o220059540 0M Center of Diabetes and Allied Sciences ‘Adnission De Tne Anti Doe ‘eating oe aye am & Plot no. 1, Malibu Towne, Sector- 47, Gurugram, Haryana- 122018 & 0124-4232805, 0124-4232196 it ir © www.cdas.in sssoame osanai pu 7 szisam0 ss nioame 50 szi02m susozteo © wioan0 SyRnce-sm. osovaN su comprare) 209m METROGML sooMcrceM veces mu aaron m2 sro sy {is nowt) 130048 SYRINGE 1DML o1seOVaN rio, ‘TeoaDe Fun Lysez0¥0 vscuereBed NoitngCaegery Pere ‘extent so B53 ba atwnadAatdin Center of Diabetes and Allied Sciences & Plot no. 1, Malibu Towne, Sector- 47, Gurugram, Haryana- 122018 & 0124-4232805, 0124-4232196 rea Gres ard SORES scemninemenie apm teen te ne desoze@ WCAMULAZZ G 3UCIRA Roare 20 71001 Iss 72 teto2020—_venrLoNIvcaNNULA 206 pure 300s 00 sso tad 72 setoane—oocer sem na aA rowne 200 sae ‘soma 74 suso209 gyre toML sou rote 35080 aa sno Proctdine 7 10102009 cameatin Prose 1 x0 200 71030200 win ase 190. e000 > —ausoame NM camdaon ruse 00 an000 20000 © waedas inCenter of Diabetes and Allied Sciences & Plot no. 1, Malibu Towne, Sector- 47, Gurugram, Haryana- 122018 & 0124-4232805, 0124-4232196 ar Cea amsion Ox Tine sosm220oe4040 Pu ervaae Discharge ox Tne sein. cs21 Pe se 25649 ba ned ‘ino. roe sibstwlnnsas ss s2m2005540 PM Adniting Dor Gouae bars eH, Cae no7) 10a rom ANG ‘neaing Boer rasan mete aah Pave mane sw Paso Aton snare Pres 8y cise roCenter of Diabetes and Allied Sciences % Plot no. 1, Malibu Towne, Sector- 47, Gurugram, Haryana- 122018 & 0124-4232805, 0124-4232196 © info@cdasin © wwwedasin tne ere re apa sn ee pier cree ci os me ee aucocee ae aa Balan pene ae ue es = coe on Se RT ce wteure a ane im (MRD Charges Routine: : fe = Jae ere eae pais — Lge foe elie ert eS ee iii eee pen oe ues =. i ee er ee sues i. Macnee atiee em fw zs cs nie ieee tints Ce, nnte pee ee eae a, ome eee ain oe fe op gatas oe nat Zriueee CGvowemomu ne am kame101162020 tcoromstneiaann motes htps:imal.google.com/mailuo/?tab=rmB&ogblisent? project IMG-20200921-WA0008.jpq wnCenter of Diabetes and Allied Sciences “ym. Emergency Number meee (0124-4545 450 Plot no, 1, Malibu Towne, Sector- 47, Gurugram Haryana- 122018 0124-4232805 0124-4232196 = info@edasin MeAmar Chaurasia — HID 9952 order Dato 10-10-2020 052125 Pm 2YMale Payer Name set Collection Date 10-10-20200052740 PM PacIPa Patient TypeMisitNo, (P1373 Report Date 10-102020 0591.59 PM Blood Ordering Doctor __OrTrd Pato Wiarsfoed 1st FLOORI068 Haematology ‘Service Name Result) Unit "Ref. Range Method Complete Blood Count-CBC Haemoglobin(H) 15.4 git 12-46 Colorimetric Total Leukocyte Count 85 Kul 410 Electrical Impedance Pov 44.4 % 40-50 Electrical impedance RBC Count 5.35 miliors/eumm 3.5-5.5 Electrical impedance cv 53.0 f) 76-94 Calculated MICH 28.8 pa 21-32 Calculated MCHC 347H gill 31-34 Calculated Platelet Count 326 ul 150-400 Electrical impedance ROW-CV 118 % 11-15 Differential Leukocyte Count Neutrophils 87 % 40-70 Microscopy Lymphocytes 36 % 20-40 Microscopy Monocytes o4 % 240 Microscopy Eosinophils 03 % +6 Microscopy Basophils 00 % ot Microscopy \ithemeinitaettes Unattached kilinane Spr God Signed By: Dr Sapna Goel Pathologist Consultant