P A T I E N T D A T A S H E E T:

Name of Patient: Lacerna Romeo P. DATE: January 08, 2023

(full last name, First name.Middle Name)
Age/Sex:/ Date of Birth:
78 / MALE (DD/MM/YYYY) October 24,1944
Patient Location: ⃝ OPD RP# Hospital No:
⃝ REFERRAL RP#patients
⃝ INPATIENT Date of Admission:
(DD/MM/YYYY) RP# patients.

FINDINGS:

-Pleural Effusion, Right

-Diabetes Mellitus 11,poorly controlled -HASCVD
-DM11 Nephropathy

REMARKS:

Medications:
Empagliflozin linagliptin (GLYXAMBI) 25mg/5mg -Candesartan (Candez) 8mg -Levofloxacin
(Levox) 500mg Remarks: For Hospital Admission

Note: ALWAYS INDICATE DIAGONSIS/ PROCEDURE IN ORDER OF IMPORTANCE

I HAVE RECEIVED THIS RECORD AND FOUND IT TO BE CERTIFICATE

COMPLETE.

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SIGNATURE OF PERSON RESPONSIBLE ADMITTING PHYSICIAN