Medications on Discharge: (Medication / Dose / Frequeney / Route / Duration) Bp Soe Sasi me Gawd (8990 / EHH / GaefDunfai Que eb 5Ne= OMA) aieeaet/-erey/p.erevee!evptyenp ane) ODO. Coamex ter br wy eu nase! + Rect! 3 bl | Dicty. Na vo vy bd ban Dake / Rs 9 quent / me eB) Lectulee to at td eesti Fenris Fe eg RAS UES Baw mcm ot Ora oles glow! bf e800 acetn Satanran ag sorirema £.£Ganstereyib soe) Greig, Pinky RAIGASLICL Ger. grhacwen wars Please use prescribed medications as advised by the Physician. Discharge Plan: (Inclusive of Management plan, Advices, Diet, Life Style Behaviour) Sone OF emEENS BE BE ACIS (GET eicisd eadxo CoeEe/q=I5/8OD GO:D cra! MALE quictions) SerehDup Ours, PLD PO arrsg Bib, sipeyoos aen,2 ewray,anisann pep UIpassiect a cher sAhucon,) Rly to Gl 1 Wey a Uactiaee) j Follow up Details fog 8208 Sind / G59 smdanonteupanuneaeh Day ‘Type of Clinic Consultant's Name | es Becta, same Dosiae, 2: sexi Sift enn eoaisu Suc ted “instructions in Sinhala or Tamil (Optional) (Ex;- Disease Condition, Medication, Referrals) | eeee cake Bovoest ool obec! (e0an D B2m8) Prssent/gili pe a paipsacisc Chowssvosws) Referral Note / exe 8508 0024 / utbscoreu eu MLEF No. Date Be rea, aoa Name of BHO Bee de peeeees fora, - eelksddead myoozter n® 068 odio Bulbs oo g@lo3 nda abba gutoang abohnspDo Be hirer ceo sou! dorF. 0d s01.ojt this Diagnosis Gard al your next consultaion,1 Dv Metonidarsl spo es ttt yy ebsiees Oxto0 A fee. meaeq ete ’ &s : amexctay 1 nets. , wets rae “ 3 aie | wee- 13-4 rs 4. 0. Cormoncty 6 “J Hb -14 6 es tb. 0. Mibancteer 400 au fice pie - 13 ate 5. Ty Rembdin wo ay be ae Govtd CAT) bs Gv Mensa! 10 wae dds.) Ned AST OU pt. Peraceteme! 1 GH } Arr to 4 Lachilee 10 my te ** “ee ace- 54 eB tS ane ~ b Na - 03h eee ar Cr - 106 e Cue - FY er - Bo o09 ree — 10g ges - too ‘Special Investigations: (Eg. Histology Report, CT Scan) Bede cSaises Stim (c¢2- Sm Equa Bolin / BB céanet) eer UPlergener set (© gro eswib : SaeTussd -2/Sdens, CT ov@aet) uss COT sech) @ef tubal preqnergy a haome peabore vin C26 mm Hhickness of pele fied) es @ L [atreal haemonbegic 448 p enctomebiote ¢5}) Ne TUP. le ph 4 84-6) ——v 14 E49 Time of Discharge ad BP-%,, pet me