Professional Documents
Culture Documents
Guardian’s Name :
(In case of a minor)
Organization :
Street Address :
City : Hanamkonda
State : Telangana
Country : India
Telephone : +91
Fax :
E-mail ID :
Alternate e-mail ID :
Age : 75 years
Sex : Male
Weight : 1Kgs
Structure
(Obese/Medium/Lean) : Medium
JOB DETAILS
Nature of work and whether it involves traveling:
Most of the work is done by sitting at office. Minimum journey in car.
PRESENT COMPLAINTS
List of present complaints with duration of each
Current Medication:
Normal, but facing severe pain in knees while walking
Allergies:
None
YES / NO
Inpatient Treatment Required
No
STATE OF DIGESTION
MENSTRUATION
Regular / Irregular
CYCLE
-
Normal / Less / More
FLOW
-
ASSOCIATED Pain / Clots / Muscle cramps
WITH -
Married / Unmarried
MARITAL STATUS
Married