Initial evaluation sheet-OPD 2/Emergency
Patients Name…………………………. Age………… Sex……………. Ht/Wt………...……
OPD/IPD No……...UHID No………………. …………….….…….…Date/Time……..……
Brief History of Illness:-
General Examination
Systemic Examination
GC-
RS-
P-
CNS-
BPRRTemp-
CVSAbdomen/Pelvis-
SpO2Nutritional Status:Plan of care:Treatment advice:-
Pain assessment:-
Signature of consultant
Date & Time:-………………..
Follow up:-