&e : SANKARA EYE HOSPITAL, BANGALORE Pe GIFT OF Visi JS SANKARA EYE FOUNDATION Patient MRDNo. SEHBLRI722680/23 PatientName Harijana Venkateshulti Patient Age/Sex —§8 Year(s) / Male Guardian Name HARIJANA GANGaNNA RURAL OUTREACH EYE (Tulsi Trust, Sight Savers Pal Vi Patient Card = SSNo.70 fs SAN ead EDICALFITNESS: te | Camp No 3503 -A1 Camp Place ATMAKUR DisirievSimte - ANANTAPURVAndors Pesan KERATOMETRI- Admission; 20/04/2023 “ RE a DAE ELA TAME INITIAL ASSESSMENT Complaints: do ooh tz Any Allergies ( ‘Ocular Examination Right Eye 7 batt Eye | Visual Acuity 2/bo- ia aw Roplas =ve ‘SPECIAL INSTRUCTIONS, On or 7 Referral ‘CursEon:TION 5, eas, Ciera eer cama Model: SM ym gt Quris ¢ © biate suture 5) cavtory SS — Ci coment Ol timbat suP 7* oO =f [5 Emvotope (pe L_ te Capeulotomy J Canopener iridotomy oP Os tou Oo Oltis Fixated 7 ac Chamber formed ger lactate Air 7 suture Tl NeSutue 1 Continuous interrupted Suture materat —]-0vien! 10-0 Nyon Ne] | Others + i Brich Ne isco m= oR ay ! pura § aA i TRYPAN BLUE Box Ne A] v isupernert icamos . [1 susconjuctiva Decadan } Seneres ALG Phubine 1 + POST - OPERATIVE ORDERS 11 In). Decadan Stating Tab Diamex 250mg Oral Giycerot Tab Wysotona Tab, Ime} Plus ye oag a Atropine Dates akPOST OPERATIVE NOTES Br Mare evereie) Date: arlul fe Time Finaings Treatment a coll eonnmenvs WO... shot “ Comes is Sill ead ace sPLON DEAT KM rept Bp ted... HOMIDE €/D. NO Su inf eben Le Peetep rete revive! + OA calouD cu Pit Seal & Sign of Doctor or. ensTRY amy Nature of surgery Seal & Sign of Dactar : DISCHARGE NOTES Date of Surgery Surgeon DoT Tas II chargé Vision EpeSe Post-operative advice given ‘Condition on Discharge=—IST rmpraved Instructions on Discharge 8 OFLAGIN DX E/D 6 TIMES x 10 DAYS OFLACIN DX E/O 4 TIMES x £0 DAYS OFLAGIN OX E/O 3 TIMES x 10 DAYS ‘OFLAGIN DX B10 2 TIMES x 10 DAYS, OFLAGIN DX END 1 TIMES x 10 DAYS: aoe ] same) Worse. eviews DIETICIAN’S NOTES = i aPRE-OPERATIVE CHECKLIST _, Lab investigation (Yes467 NA} General consent (Yes7No INA) Keoratometry Resting 4*88/ No INA) AScan (yesT No NA} Pt identified with ID card ( Yes TNo / NA) Any allergy (Yes / NoTNA} Anaesthetist’s fines ( Yee TNo/ NA) 1OL Power available (YesTNo / NA) Consents obtained ees /No/ NA) Eye to be operated marked (Y¥se7No/ NA) Pupil alae = requitedINot required ae 7 Date: |, 93° Name of Staff / he ‘a \y ‘ \ OPERATIVE CHECKLIST IOL available,Power verified (Yes/No / NA) rid Any other consumables/Change in procedure... 00). \ Date : aA y \23, Name of Staff: | ae Sign POST-OPERATIVE CHECKIST Anaesthesia record competed {YesTNO) Surgery nates complete_(Yes No) / Post Op Instructions given (yes No ) x ‘ ere J Date :)\\ Name of Staff -" Dipffia /a Sign , a * MRD CHECKLIST Name of Sheet Yes No / NA No. Of Sheets Consent Sheet U f ‘Anaesthesia Record ti Nurses Recoros ty ‘Additional Sheets uo Gift of Vision | have been counselled about eye care and have received the copy of discharge summary. | sincerely thank Sri Kanchi Kamakoti Medical Trust-Sankara eye hospital far providing totally free eye care services Seis meetiot uf ne soamns chy iconic anew we, Katee. vous eng ag LEA mAROR CE, 3,¢ Sou matsB.oets chaser tit - deed erin uae uemoctnntA, Name of Patient / daca sixes Sion! Thumb imoreecion of Baliant /Maeneh wh. J atime em