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Discharge Summary
NAME OF PATIENT:
AGE: SEX:
EG NO./ I.D.NO/MR NO.
ADDRESS:
DATE& TIME OF ADMISSION:
DATE& TIME OF OPERATION:
DATE& TIME OF DISCHARGE:
UNDER DOCTOR:
REASON OF ADMISSION
PROVISIONAL DIAGNOSIS
FINAL DIAGNOSIS:
ICD CODE
TREATMENT SYNOPSIS:
INVESTIGATION:
PATIENT” S CONDITION AT THE TIME OF DISCHARGE:
FOLLOW UP ADVICE:
MEDICATION ADVICE:
NUTRITIONAL ADVICE:
IN CASE OF EMERGENCY CONTACT NUMBER_____________
EMERGENCIES
LIKE_______________.(related to admission)
CONSULTANT SIGN
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