Dr. Muhammad Abbas Ali - Patient Admission Slip

Patient Name:

Age / Sex:

Date & Time:

IPD / Reg No:

Ward / Room No:

Bed No:

Admitting Consultant:

Referred From: (OPD / Emergency)

Provisional Diagnosis (داخلے کی وجہ):

MLC Status: (Yes / No)

Initial Management Plan / Nursing Orders (داخلے کے وقت ضروری ہدایات)

Estimated Package/Day: ___________

Advance Deposited: ___________

Patient / Attendant Signature

Admitting Medical Officer (Stamp & Sig)

DR. MUNEER ABBAS