VEDICHOMYO HOSPITAL & INSTITUTE OF HOLISTIC MEDICAL SCIENCES
7C,7CA-7CB,Jagdamba Nagar-C,Bajrang Dwar,Kalwar Road, Jhotwara,Jaipur, Rajasthan-302012
Mobile No. : - +91-9772792004, Email : - vedichomyo@gmail.com, Web. : - www.vedichomyo.com
Date:- 07-12-2025
Patient Information Sheet
UHID No.- VH0
OPD – IPD –
OPD – IPD –
Patient Name – abc
Father/Husband Name –
Address – jaipur
Phone No. – 9858587888
Occupation –
E-mail –
Age - 35
Wt. -
B.P. - mm/Hg.
Sex - Male
Ht. - cm
PR. - /min
DIAGNOSIS -
Dr. By:-
Chief Complaint / Present Complaint
Chief Complaint / Present Complaint Chief Complaint / Present Complaint Chief Complaint / Present Complaint Chief Complaint / Present Complaint
Past History –
Past History / Present Complaint Chief Complaint / Present Complaint Chief Complaint / Present Complaint Chief Complaint / Present Complaint
Family History –
Family History / Present Complaint Chief Complaint / Present Complaint Chief Complaint / Present Complaint Chief Complaint / Present Complaint
Mental Generals –
Mental Generals / Present Complaint Chief Complaint / Present Complaint Chief Complaint / Present Complaint Chief Complaint / Present Complaint
Therapy
Physical General -
- Tongue -
- Tongue desc
- Thirst -
- Thirst desc
- Stool -
- Stool desc
- Abdoman -
- Abdoman desc
- Urine -
- Urine desc
- Hot / Chilly -
- Hot desc
- Prespiration -
- Prespiration desc
- Skin -
- Skin desc
- Menses -
- Menses desc
- Allergy -
- Allergy desc
- Sleep -
- Sleep desc
- Dreams -
- Dreams desc
- Others -
- Others desc
- Investigation -
- Investigation desc
Medicine -
AESCULUS 200
BACK-RS-DROP
C.P 6X/2D
S-SPONDYLYSIS DROP
S-CAD3
Next Follow Up Visit
Signature of Doctor
