DIVYA JYOTI AYURVEDIC MEDICAL COLLEGE & HOSPITAL NIWARI ROAD, MODINAGAR (GZB.) Under Graduate Department of Shalakya Tantra INDEX : LONG CASE PROFORMA - Name of the patient = | Date Sign. i ankay Ruma ha | Qo}slay : 2 | devyonshy Rumary ar et — 3 | Tyo sroraaay alt = 4 | seema ; a 3 | kisRno Bh aia 6 sa SETAE Ty To sag - aust Seay 09} 2]24 pbinav Jorn eae 70] 6124 Sita _Rhaw y | lylay omy RumayDIVYA JYOTI AYURVEDIC MEDICAL COLLEGE & HOSPITAL NIWARI ROAD, MODINAGAR (GZB.) DEPARTMENT OF SHALAKYA TANTRA DEPARTMENT OF SHALAR ror LONG CASE PROFORMA: SS ae Name; fANRAZ Kumar pure: 245)24 Age: ea|m OPDNo: (©QEC Religion: ind U PDNo: J&I9- Education: Dao St Occupation: Dacofadmiein 20/5124 Marital Status; - Marnicel Date of discharge: 29 [6]44 Pradhan vedana Avadhi Sahitam (Chief Complaints With duration): flushy growth in Lat Gye 4 x3 Months muld sud hug, : mild getign bod eensaion Marr ban Boje plomodic having normal vision Jo months 90° Re graduol diveloped opprorence Hy gown i” LE eye & war Vy aries i HK at an epthal yyist ~ Bey inielironce . han Be camt fo Hyamctgor gut dy: Poorvasyadhivrutta (History of past illness): H[pfo~ HTM 19m] ThyaordVyaktignvratta (Personal history) 4 1 Abmesanistiastih) Tedd ‘2 Nidra(Steep) bee oma ewes 4. Mutrapravrutti(Urination) 5 aly oe 6 Asatmya/Allergy —_— 7. Vyayama(Exercise) — 8. Vysvasaya( Occupation) a Kulavrutts (Family History) HAD Ashtavidh pariksha (General examination) 1. Nadi(putse) 48 bpm 2. Mutra(Usinary system) — 3. Mala(GI System) = 4. Jihva(Tongue) al 5. Shabda(Voice) = & Spanha(Temperature) — JQP a Poe) ~Fleshy grows in be ye Aderuti “stead if ‘Netra pariksha (Examination of eye) ——wsteararatete set) |° Required instruments: satay «eee a ) SA ay RT, hay RL ART nave ta | 9 age ar ore a a ee ——+) ses 6 Sigs 7, 5 4) ah dy gh me aT HL Yorn NTE) ae - ra? A wReRT AL So a ore gh a aa FS | ~FR aheg eR nar) HHT Weed | aha flr ary rel) site STEN THR Fa wr TL) - Fao fey ay | ; coh ashe ome eary 1 THT AE | “astrction Infeedion —ciplox egednep C11.) Sol Signature of aadent Recccuntnee — Repeat the Pincedese again to excise th Pregl m, sigoate of techeta DIVYA JYOTI AYt S 2 4 RVEDIC MEDICAL COLI EGE & HOSPITAL NIWARI ROAD, MODINAGAR (GZB.) DEPARTMENT OF SHALAKYA T ANTRA LONG CASE PROFORMA: : : iene Sevganshu Runtar ra : asym e ! OPDNo: | 0026 Hihdu WoNo: — 6 1 F Diagnosis: — HHOPLATY Date of admission: ©] JOU J tty Occupation Marital Status: Date of dischage: ©} fou) ay Address: Wusals WardNo. SHMO3 Pradhan vedana Av adhi Sahitam (Chief Complaints With duration}: asdieky discharge th Reay - - aiffFcatly ty Rearing Jrorm J fos Mecig wit> 20 Vedanavrutta (History of present illness): M@ To Polverds Re was, va a&-3mombhy back . thin gradually duveloped shicky discharge from Ri ean f Aiffrcuths tes Fearing gem His Rt ear. He way pridtalay 40K muditabion but got ro vuleh 60 fun Re Com de fgamcH shalakya OPD Jer duty tacaimune. illness): Poorvayyadhivrutta (History of past n]AJo- HTH Jom] Thyroidip Re AP1 aera Ary Col (AO) ‘Tympanic Membrane Tuning Fork Examinti Rinne Fest Weber Test tar [ABC Yet ‘Acatahe Dantamool Tawa ho i : ‘Samanya chikitsa V yavastha(samanya chikitsa sidaihant PRequi' ‘aur al erate ma | aes ary sdtorg : “Sica a yy I papa ee eee Tes tl] ion): ies i wma, pa cx] ety asc Sia! Pr : e al rot ssugu eal Vishishta Chikitsa Vidhi: = Required medicines: =| = fyory say |Se Date: Be 3 $ | E OPD Ne ; ee: » Hindu = ee i PpNo; 312 Education; aren anf Occupation: = — . Marital Stars; Marrred i i sed ne ' 4 ate of discharge: J] 5) 2! Address: Rugnath puy 1 4 WardNo. § LK Foy AY Pradhan vedana Av adhi Sahitam (Chief Complaints With duration): Granule Swetling Grit Bivching Path & fuses | w Lhegex Uday To y THs mild i ‘clanavrutta (History Sema ioe back - thor sud Re davelep wat asymioma ih ‘A wikh Gel) ee gensahion jadually Swell = ay pe rues: thi swell ny Haid wc t ey. pu a petanieg fain: sal aad Sea 1 bub did not gee mort Rav opD at DJAMCH: hy “tics wou Re canw shalshya