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:- 15-11-2025
Patient Information Sheet
UHID No.- VH0
OPD – IPD –
OPD – IPD –
Patient Name – test
Father/Husband Name –
Address – test
Phone No. – 0123456898
Occupation –
E-mail –
Age - 28
Wt. -
B.P. - mm/Hg.
Sex - Male
Ht. - cm
PR. - /min
DIAGNOSIS -
Dr. By:-
Chief Complaint / Present Complaint
AESCULUS 200
BACK-RS-DROP
BC 21/2D
Therapy
Physical General -
- :- Tongue -
- :- Thirst -
- :- Stool -
- :- Abdoman -
- :- Urine -
- :- Hot / Chilly -
- :- Prespiration -
- :- Skin -
- :- Menses -
- :- Allergy -
- :- Sleep -
- :- Dreams -
- :- Others -
- :-Investigation -
Past History –
Family History –
Mental Generals –
Next Follow Up Visit
Signature of Doctor