Shadeed Monsur Ali Medical College

Hospital
Plot No – 26 & 26/A, Road No – 10, Sector No – 11, Uttara Model Town, Uttara, Dhaka – 1230. Bangladesh.
Telephone:- PABX: 88-02-8918058, 8921291, 8964051, Mobile No: 01915431834 (Emergency Dept.) Fax: 8917978
E-mail: Smamc_bd@yahoo.com; Website: www.smamedicalcollege-bd.com

DEATH CERTIFICATE
Date: 12/04/2013 Patient ID: 1169/13
Name: Nazia Ahmed Moon Age: 30 yrs.
Father’s Name: Nazim Ahmed Religion: Islam (Sunni)
Address: 41, Kazi Abdur Rouf Road, Kalta Bazar, Sutrapur, Dhaka-1204.
Date and Time of Admission: 08/04/2013
Date and Time of Death: 11/04/2013

Cause of Death: The Patient was admitted to the hospital with progressive
right lower quadrant pain of several weeks duration. The patient had lost
approximately 20 kgs, with progressive weakness and malaise. On physical
examination, the patient had an enlarged liver span that was four finger
breadths below the right costal margin. Rectal examination was normal and
stool was negative for occult blood. Routine laboratory studies were within
normal limits. A chest x-ray and barium enema were negative. Her ECG
showed a right bundle branch block. CT scan showed numerous masses within
both lobes of the river. A needle biopsy of the liver was diagnostic of
moderately differentiated hepatocellular carcinoma and the patient was
started on chemotherapy. Three months after the diagnosis, the patient
developed sharp diminution of liver function as well as a deep venous
thrombosis of her left thigh, and she was admitted to the hospital. On her third
day, the patient developed a pulmonary embolism and died 30 minutes later.

Medical Officer/ Registrar

 Shadeed Monsur Ali Medical College Hospital
Plot No – 26 & 26/A, Road No – 10, Sector No – 11, Uttara Model Town, Uttara, Dhaka – 1230. Bangladesh.
Telephone:- PABX: 88-02-8918058, 8921291, 8964051, Mobile No: 01915431834 (Emergency Dept.) Fax: 8917978
E-mail: Smamc_bd@yahoo.com; Website: www.smamedicalcollege-bd.com

Treatment Sheet for Specialist Clinic

Date: Patient ID :

Name:

Age:

Address: Gender :

Date Chief Complaints & Findings Treatment And Advice

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