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PATIENT APPLICATION FORM
PATIENT'S DETAIL
NAME: NURSID ALAM
FATHER NAME: SHAMIM
FATHER OCCUPATION: LABOUR
SEX: MALE
ADDRESS: JAGARNATHI, JHARKHAND, INDIA
DISEASE: CHEST CANCER
HOSPITAL NAME: AIIMS HOSPITAL
DEPARTMENT: MEDICAL ONCOLOGY
ESTIMATE COST: RS 2,50,000
J-l00, Shakurpur, Delhi-l10034 | Mob. : 8800364302Website : missionchildcaretrust.org I missionchildcaretrust.com
Email : i [email protected]
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BTfudr srrrfrq B{rErFd rr{Etrr, T$ ffi-!!oo?RALL INDIA INSTITUTE OF MEDICAL SC|ENCES, New Dethi-I10029
" mTrwf rf*rr {DISGHARGE SUMMARY
rFt/Name N UA\ J, R\q ft s*zase1
lazT(8-g {-Date of Admission/Discharge
\-;
S.ernrr.zc.R. No. rrsHq o.P.D.O.
Hospital Course, Treatment givenand Condition discharge
\il: --
PbF*/11 w{
Y<1
History and condition on admission
r KBLRelevant lnvestigation with Dates
DIAGNOSIS :
ADVICE :
To attend. ...Follow up Clinic/O.p.D. on
Registrar
irfr;ra $q frHra frcTrrrDEPARTMENT OF REPRODUCTIVE BIOLOGY
A.I.I.M.S., New Delhi- 1t00Tg3r. m. 3Tr. i., r$ R"dt_110029
UHID:
Name:
Ward Name:
Test Name
25 oh Mtamin D
Folate
Active B l2
OverAIl Comment :
Authorised Sienatory
DrSumbhi Gupta
I 027 I 8308
MI.NURSID ALAM, Male
Sample No:
Lab RefNo :
Verificatisn Time:
Report
Comment
RPB-031017372
395
04110/2A17 03:58 pm
Normal R.angeResult
10.8 ngiml
17-1 ng/ml
41.2 pmol/L
Verified Bvmarymathew
I of I
/.\:\05-10-2017 09:27
560 LPL - NOIDA 3
r,t ??, Se*l& CqHltl?e'rcial Complepq1tteat;
;i tta, m afket, No!d6,1 8}3.CI?.€-86 Bl }'t *tego':..rlUF
flkilr(Hoay) Brig. Dr. Anind I-d' M.E.B,S., D.oP.
@b"a.@*tFMRmolmffircruroiu ruuwor ruon
q"+*-* UlDr.VBdd@?LaIM'De[IO'Se,l,P
@*{d@$"tWIHIFOMNIAWARD MNNtr
l.lame
t-.ab No.
r: tc Status
: MT. NURSID
.. 138218642
.P
CsllectedReeeivedReported
i:':*':Units
q1u2a1'7
4t1012017
4110t2017
Final
7:36:00AM7:38:23AM5:57t24PM
Bio. Ref. lnterval
ALAM
Age: 14 Years Gender:
Ref By : A.l.l.M.S. HOSPITAL
Results
Male
iest Narne
! IVER PANEL 1; LFT,SERUM
L:rpectrophotometry)
llilirubin Total
itilirubin Direct
Ltilrrubirr lndirect
AST (SGOT)
\iT (sGPT)
r)(l TP
'.ri-.aline Phosphatase (ALP)
lotal Protein
\lburnin
A: G Ratio
0.54
0.10
0.44
34
30
131
650
7.88
4.194 44I. tt
mgidL
mgldL
mg/dL
U/L
U/L
U/L
U/L
g/dL
g/dL
0.30 - 1.20
<0.20
<1 .10
<50
<50
2-4274 - 390
6.00 - 8.00
3.80 - 5.40
0.90 - 2.00l
ijote : ln known cases of Chronic Liver disease due to Viral Hepatitis B & C, Alcoholic liver disease or Non
,:icoholic fatty liver disease, Enhanced liver fibrosis (ELF) test may be used to evaluate liver fibrosis.
;{,IDNEY PANEL; KFT,SERUM
iSpecirophotometry, Indirect ISE)
1lrea
ireatinine
r lfic Acid
Calcium, Total
irhosphorus
Alkaline Phosphatase (ALP)
I otal Protein
, iibun.rin
;\ , G Ratio
Sodium
Potassium
rlhloride
28.00
0.70
2.10
9.16
3.29
650
7.88
4.19
1.14
134.00
4.42
103.00
mg/dL
mg/dL
mgidL
mg/dL
mg/dL
U/L
g/dL
g/dL
mEq/L
mEq/L
mEq/L
10.00 - 38.00
0.50 - 1.00
3.50 - 7.20
8.40 - 10.20
3.30 - 5.40
74 - 394
6.00 - 8.00
3.80 - 5.40
0.90 - 2.00
136.00 - 146.00
3.50 - 5.10
101 .00 - 109.00 r___-.--)
LahNo, :
AJc Status :
Mr. NURSID ALAM
13$21&$42 Age: 14,Y-.ears Gender;
P. ' Ref By : A-|J,M.E' HO'EFITAL
'' ''"'' 'a " ' '-T'i'1r"*:1 -"*''
Collected. ReceivedMale Reported
: 4t'1012017 7:35:00AM
: 4l'1012017 7:38:23AM
:, 41 10I2A1T 5:57-.24PNt
Test Name
CoMPLETE BLOOD COUNT (CBC)(DC Detection, Flow Cytometry & SLS)
r-iemoglobin
i'acked Cell Volume
RBC Count
1'/CV
[ICH
I..,'lCHC
'iled Cell Distribution W'lotat
Leukocyte Count
i ifferential Leucocyte
S eg rnented [,leutrophils
Lymphocytes
i',ionOcytes
L-osinophils
Fasophils
Absolute Leucocyte Cr
I'leutrophils
i ymphocytes
l,/lonocytes
l- osinophils
Basophils
irlatelet Count
Results
thou/mm3
thou/mm3
thou/mm3
thou/mm3
thsu/mm3
Bio. Ref, lnterval
2.00 - 7.00
1.00 - 3.00
0.20 - 1.00
0.02 - 0.50
0.01 - 0.10
3.17
1.14
1.18
0.00
0.02
ii ote
I As per the recommendation of lnternationalcouncilfor Standardization in Hematology, the differentialleucocyte counts are additionally being reported a6 absolute numbers of each cell in per unit volume ofblood
: Test conducted on EDTA whole blood
9,70 g/dL 13.00, 17.00
(PCV) 32.00 % 40.00 - 50.00
3.25 mill/mm3 4.50 - 5.50
98.50 fL 80.00 -'100.00
29.80 pg 27.0O - 32.40
30.30 g/dL 32.00 - 35.00
ion Width (RDW '17.90 To 11.50 - 14.50
Count (TLC) 5.51 thou/mm3 4.00 - 10,00
Count (DLC
Count
57 50 :o20.70 %
21.40 ln0.00 %
0.40 o/o
L
3 17 l,n
40.00 - 80.00
20.00 - 40.00
2.00 - 10.00
1.00 - 6.00
<2.00
150.00 - 450.00
Name
!-qb No,
A/c,Status
EXAMINATION
ihlicroscopy)
eolleeted, Received
Repo.ryed
Report$tatus
411012017
: 411OJ2Q1,7
: N1912O17
: Fihal
7;36.: AMzrif:2aepr
5157:24PM
Test Name Results UnitsBLOOD PICTURE; PERIPHERAL BLOOD SMEAR anisocytosis +,
microcytic hypoehrom ic RBCs+,There is monocytosisPlatelets are adequate.Followup and clinical correlation
Bio. Ref. Interval
[-^v*affi^ulry-f'Y
rjr. Ankur singhM.D. Pathology (GOLD lr/EDALIST)ilhief of Lab
il
o|-*tn ^-'Dr. Gaurav Jyoti Phukan
MBBS; DCP
Sr. Consultant Pathologist
@,ofreport
*#**..-'.
Dr. Saloni Khera
MD (Pathology)
Chief of Lab
DT. B. R. AMBEDKAR INSTITUTE ROTARY CANCERALL INDIA INSTTTUTE OF MEDICAL SCIENCES NEW DELHI
DISCHARGE SLIP
lndoor Reg Nr
Consultant Name
Patient Name
1987 14
Combo6
NURSID ALAM
IRCH NO 1987 14 Ward DAYCARE
Sex MAge 14
AdmissionFor CHEMOTHERAPY Admission Date l1/10/2017 Discharged Date 1111012011
Diagnosis
Chemo. Protocol: Cemcitabine-carboplatin q 3 wkly Cycle/Day: wk20dl
Druss Administered
PREMEDICATION GIVENInj Ondansetron 8 mg
Inj Dexamethasone 8 mg
inj fosaprep 150 mg in 100 mlns dl
IVP
IVP
CHEMOTHERAPY/IMMUNOTHERAPY GIVEN
Drug Name
lnj Carboplatin AUC 5 D1
lnlDoxorubicin Dl-D3
Advice Attend OPD for follow up assessment
Re-appointment in on lU1Al20I7
Final Dose
500mg
7Omg
Unit
500 m
250 m
Soln.
5%D
NS
lnfusion Time
2 hrs
l12 hr
Signature of PhysicianDr Susant
560 - LPL - NOIDA 3
N-27, Sec-18. Commercial Complex, Near.Atta market, Noida.120-3029866/3142530NOIDA
Natio.rraLl?efeI€nte lab: Se6oi. tg; Block:E" Rohii1L: AtewDethi : t 1 O 0A5re!0-two}"?.ry0$EdB,?*,l;1:, _ ---
"1x.,(;ln:p*ifi :n.l]i a*in
'ii:+'CAP .,ACCREDITED\/COLLEGE of AMERIcAN ETAotoGI(Is S,,
l$goot:2@ lrl
tso/rEc
- 127001
J*.{ ,/ ua.aener
N:rme
Lab No.
Aic Status
Ta,st Name
Segmenled Neutrophils
l,l"rrn phq6)/{sg
It4onocytes
Eosinophils
Basophils
Atrsolute Leucocyte Count
Nerutrophils
Lymphocytes
I\4onocytes
Ec'sinophils
Basophils
Platelet Count
Note
MT. NURSID ALAM
138217650 Age: 14 years
P Ref By : AIIMS
Gender: Male
67.10
16.50
15.40
0.20
0.80
Res ults
CollectedReceivedReported
Report Status
U NItS
o//a
%
/o
\
1O11O12017 9:46:00AM1O11O12017 9:47:31AM1011012017 11:46:44AM
Final
thou/mm3
thou/mm3
thou/mnr3
thou/mm3
thou/mm3
thou/mm3
Bio. Ref. lnierval
40 00 - 50.00
,l trn trtrn.J.JU - J. JU
80.00 - 100.00
27,OO - 32.00
32.00 - 35.00
11 .50 - 14.50
4 90 - 10100
40.00 - 80.00
20 00 .- 40.00
2 00 - 10.00
1.00 - 6.00
"<2.00t
200-700
1.00 - 3.oo
0.20 - 1.00
0.02 - 0.50
0.01 - 0.10
'150.00 - 450.00
coMPLETE BLOOD COUNT (CBC)(Eiectrical lmpedence & Flow)
9.1 0 g/d LHe,n roglobin
Packed Cell Volume (PCV) 28.60 %
Rllq Coilt 2.88 mlymmsMCV 99.30 ,L
MCH 31 60 ps
MCHC 31.90 g/dlRe,d cell Distribution width (RDW) 19.40 o/a
Tctal Leukocyte Count (TLC) 6 11 thou/mm3Differential Leucocyte Count (DLC)
4ta
101
0.94
0.01
0.05
253.0
1. As per the recommendation of International council for Standardization in Hematology, the differentialleucocyte counts are additionally being reported as absoiute numbers of each cell in per unit volume ofblood
2. -lest conducted on EDTA whole blood
l llflil ilIlI 1ilil flit lllil il]t llil iltil ilIil liti lllt
ll la i,tij.r,jll.i ':|.{l;;.']tltit-ri[* *r lI
,Fage 1 of 2
;i::i:: ll'11t1
,i.: :.:,. -.:
: Mr. NURSID ALAM ;^,,**_: 138217650 Age: 14years Gender: Mate l"r"ly"l :1ohat2o.t, ;;;;;;;;: 138217650 Age: 14years Gendbr: Male Received :1OhAt2A17 9:47:31.AM
: P Ref By : AIIMS Report Status : Final
Tebt Namel._l _..
- Results Units, SREA, s;;u'r- - --+: Bio. Rer.lnterval
l_lueq.rlLvl rv'uu rngidL 1o.oo - 38.00, -'--", 19.00 .^^^ --I (urease uvt I r'uu mgidl 10.00 - 38.00 I
itRa 0.65 mg/dl 0.50 _ 1.00 Irc ,rg/uL
_-__l
w*-Dr. P@t Kau.MD (Pathology)Chief of Lab
I IflIl flililIili ilflt fiilt till tillt lllil ilill illl lfll Page 2 of 2
Results Units
Test Name
i ,-rvi* PANEL 1; LFr'sERuM
i (Spectroptrotometry) 0.40 mg/dl o'30 - 1'20
<0 20Bilirubin Total 0.10 mg/dl ),-nn i
Bilirubin Direct 0.30 mg/dl <1'10 i
Bilirubin lrrdirect 28 U/L <50
r<50 I
AST (sGoT) 30 u/L
ALT (sGPT) eo u/L 2 - 42
GGTP 38s u/L 74 - 390
Alkaline Phosphatase (ALP) 7.?7 gidL 6'00 - 8 00
rotar Protein 3.6s g/dl lll -i|lAlbumin 1.01
A:G Ratio
N,.:ts : ln known cases of chronic Liver disease due to Viral Hepatitis B & c' Alcohoric liver disease or Non
;ric,;iir:ilc faity iive i C,.r,,L"]"E,-na.,cse iiver ''n"'ln '*"i test rna)/ be used to
lvaluate
I ver fih osis
KIDNEY PANEL; KFT,SERUM
(ip".troPnotometry' lndirect ISE)36'00
0.51
1'80
8.61
5.J L
385
l,zt
3.65
1'01
132.00
a a'7
103.00
I c!i9ll{"- ----
rx:ffigf UFI, *g*v''{ ''*r*r*rcrcBn l, fl.r, @ ii,ll;!1i;J3'|oDi"n3",,i,rc"-rr"..::"-:, \ i.*i"il#*+6i'r . *"r'"*r*' -, j
;;;;; *"ida.12o'302e866t314253o ' I
NOIDA
161812017 9:35:00AM
Name : r,/rr. NURSTD ALAM i::::J:l "
)i'iii" s:36:36AM
LabNo."137g44gg7Age:l4YearsGender:MaleReported"'1618i2017'2:43:30PM: Final
AJ,; Status ; P Ref By : A't'l'M'S' HOSPITAL
Bio' Ref' lnterval
Urea
Cr-eatinine
Uric Acid
Calcium, Total
PhosPhorus
Alkaline PhosPhatase (ALP)
Total Protein
Albumin
A: G Ratio
Sodium
Potassium
+f.iie-$i'
mg/dl 10'00 - 38 00
mg/dL 0'50 - 1'00
mg/dL 350-720
mg/dL B'40 - 10 20
mg/dl 330-540
U/L 74 - 390
g/dl 600-8'00
g/dl 3'80 - 5'40
0.90 - 2.00
mEq/L 136'00 - 146'00
mEq/L 350-5'10
mF-qt 10!99 qeoo
@Tj€st5ii
1'effi ffi ilii\\tlrti$llllllililtil\t\illll\lPage '1 of 3
560 - LPL - NOIDA 3N-27, Sec-1E, Commercial Complex, Near.Atta market, Noida. 1 20.3029 8$6t 31 42530NOIDA
.l.lI l+";rkI Glonv) Bne*Dr.*4rvind Lali M.B.B.Sf{,.C-+-I il lrrnrlrri... 1)l. r).\;nrj i . l
, / .\rflN\t"W1l,:1" . \:r^r. q1v-4\-o !. fu-.rr\ .-.,;a
I
ACGftEDITEDBJio'q$* a* "^**** ffi,lffi
Name :
Lab No. i
A/c Status :
Test Name
Mr. NURSID ALAM
137944997 Age: '14 Years Gender:
P Ref By : A.l.l.M.S. HOSPITAL
Collected : 161812017 9:35:00AMReceived :'161812017 9:36:36AMReported : 161812017 2:43:30PM
Report Status : Final
Units Bio. Ref. lntervalResultsI
COMPLETE BLOOD COUNT (CBC)(Electrical lmpedence & Flow)
Hemoglobin
Packed Cell VoJume (PCV)
RBC Count
_gtuLYn
]mill/mm3 _
rfL
1s.00 - 17.00
40.00 - 50.00
MCV
2.77
otr an
MCH 30.00 ps 27.AO - 32.00
32.00 - 35.00MCHC 31.40 g/dLIRed Cell Distribution Widih (RDW) 16.70 % 11.50 - 14.50
If le!!: q!q"y"-co unt (rLC )
Differential Leucocyte Count (DLC)
Segmented Neutrophils
Lymphocyies
Monocytes
Eosinophils
Basophils
Absolute Leucocyte Count
Neutrophils
Lymphocy.tes
Monocytes
Ecsrnophrls
Basophils
5.74
%i o/
/Q
o//o
%
'thou/mm3
thou/mm3
thou/mm3
thou/mm3
thou/mm3
| 4.00 - 10.00
40.00 - 80.00
20.00 - 4.0.00
2.00 - 10 00
.1 .00 - 6.00
<2.00
2.00 - 7.00
1"00 - 3.00
0.20 - 1.00
0.02 - 0.50
thou/mm3
' zo. i\
1.20
4.00
0.70
4.23
1.17
0.07
0.04
Platelet Count 221.0 - ;tno{mm]Note
1. As per the recommendation of lnternational council for Standardization in Hematology, the differentialleucocyte counts are additionally being reported as absolute numbers of each cell in per unit volume ofblood
2. Test conducted on EDTA whole blood
0.01 - 0.10
, 150.00 - 450.00
Il!ilfl lt!ff iiiilffiillliilililrtffitlill!flltlillitil Page 2 of 3
560 - LPL - NOIDA 3
N-27, Sec-18, Commercial Complex, Near.
Atta market, Noida.120-3029866/3142530
NOIDA
Name
Lab No.
A,/c Status
ffifi:x: ffi*;ffi,Hls9@1i 206 "
,,,..;;.," Fs6o411 l::..rilJlr'lritiLr!\iArrf,{'N'ER
Mr. NURSID ALAM
137g44gg7 Age:14Years Gender: Male
P Ref BY : A'l'l'M'S' HOSPITAL
-4.flt{F):r
--------End of rePort
CollectedReceivedReported
Report Status
units
: 161812017 9:35:00AM
. 1618,;12017 9:36:36AM
: 161812017 2:43:30PM
: Final
Bio. Ref, lntervalTest Name
;)l,) il.,ntL' '.
,I0,"", *u,,N1D (Paihology)
Chief of Lab
, .lf,tqqt lq5-_U_ltr,irrq:i
@ Tests eondurtedra
i ffi riil fi A$i illl i
,8+.r-f -r!-<.s
S60 - LPL . NOIDA 3
N-27, Sec-18, Commercial Complex, Near.
Atta market, Noida.l 20-3029866/3142530
NOIDA
ALAM
tttii
it
I
il**!,(Hony) Brie. Dr. Arvind Lat
- . M.B,B,S.;p.c.P.'llrj r\l i:i!:J.
' . rr'ir:41 l',;'
Results
0.40
0.1 0
0.30
aa
30
90
385
727
3.65
1.01
ffi*ffi'fr
Name
Lab No.
AJ,: Status
Mr. NURSID
137944997
P
14 Years Getrcler: Male
A.I.I.M.S. HOSPITAL
CollectedReceivedReported
Report Status
mg/dL
mg/dL
mg/dL
U/L
U/L
U/L
U/L
g/dL
g/dL
161812017 9:35:0OAM
16tgt2017 9:36:36AM
1618i2017 2:43:30PM
Final
Bio. Ref. lnterval
0 30 - 1.20
<0.24
<1.10
<50
<50
74 - 390
6.00 - 8.00
3.80 - 5.40
0 90 - 2.00
Test Name
LI\/ER PANEL 1; LFT,SERUM
(Soectrophotometry)
Bilirubin Total
Bilirubin Direct
Bilirubin lndirect
AST (SGOT)
Ar_T (SGPT)
GGTP
Alkaline Phosphatase (ALP)
Total Protein
Albumin
A: G Ratio
Ngte : ln known cases of Chronic Liver disease due to Viral Hepatitis B & C, Alcoholic liver disease or Non
;iir:,..i,i.:i c iatt'y li"ei ii:t;ilse, Ei.hanceC ii'.,ei'il,.rr--:is (El.F) lest rrrar/ he used to evaluate liverfihl'osis.
KIDNEY PANEL; KFT,SERUM
(Spectrophotometry, lndirect !SE)
Urea
Creatinine
Uric Acid
Calcium, Total
Phosphorus
Alkaline Phosphatase (ALP)
10.0c - 38.00
0.50 - 1.00
3.50 - 7.20
8.40 - 10.20
3.30 - 5.40
74 - 390
6.00 - 8.00
3.80 - 5.40
0.90 - 2.00
'1 36.00 - 146.00
3.50 - 5.10
101.00 - 109.00
Total Protein
Albumin
A: G Ratio
Sodium
Potassium
Chloride
36.00
0,51
1.80
8.61
3.32
aoc
7.27
3.6s
1.01
132.00
3.77
103.00
mg/dL
mg/dL
mg/dL
mg/dL
mg/dL
U/L
g/dl-
g/d L
mEq/L
mEq/L
mEq/L
I iffiilili!ffi llliliitriliililiiliiliiillilll IIill lllillEi Page i of 3
tf resr resutrs are atffilqi #i,ftllds t1,,?,#viEs# [o".,ggatsGt$1ffi,]trft&?re$efiM*.|f,?mBdjalelydsripJafis]E]le remedial action.
&:eF*/ #*ih: - 1 t* ,j#5
1&.eli,;'rlq!.iH+l:ali*{i }}J.a.*t?l,
- n
.\
\
DT. B. R. AMBEDKAR INSTITUTE ROTARY CANCERALL INDIA INSTITUTE OF MEDICAL SCIENCES NEW DELHI
DISCHARGE SLIP
Indoor Reg Nr
Consultant Name
Patient Name
1981 14
DR. SAMEER BAKHSH]
NURSID ALAM
IRCH NC 1987 14 Ward DAYCARE
Age Ml4
AdmissionFor CHEMOTHERAPY AdmissionDate 111912017 Discharged Date 111912011
Diagnosis
Chemo. Protocol: VPl6-lfosfamide D1-D-5 q 3 wkly Cycle/Day: Wk5d2
Druss Adminis
PREMEDTCATION GIVENInj Ondansetron 8 mg
Inj Dexar-nethasone 8 mg
IVP
IVP
CH E MOTHERAPY/IMMUNOTHERAPY GIVEN
ini fosaprep 150 mg in i00 rnl ns dl
Advice
Drug Name Final f)ose Unlt
inj Mesna D 1-D5 800mg
Inj Ifosfarnide D1-D5 ;frrf \4 ^ 1000 r NS
To attencl Daycare at 8.00 AM/2'00 PM tomorro* $' nt*'dose of chemotherapy
Infus io n
2 hrs
Signature of PhYsician
dr akash
Re-appointment in OfD--$ on I\1912011*H#*88#ffi -ffi
Prescribed Treatment
As Per OPD Card
TNEG NT'RSID AIAM
'a
4I
AdmissionFor CIIEMOTIIERAPY Admission Date 9l9DAl7 Discharged Dste 9/9DOl7
Diagnosis
Chemo. Frotocol: VPl6-Ifosfamide D1-D-5 q 3 wkly Cycle/Day: w5 dl
PREMEDICATION GIVENInj Ondansetron 8 mg
Inj Dexamethasone 8 mg
CHEMOTHERAPY/IMMUNOTHERAPY GIVEN
fosa 150
ErugName
Inj Ifosfamide D1-D5
lnj Mesna Dl-D5
carboPlatin
Adviee To attend Daycare at 8.00 AIW2.00 PM
800mg
6oo mg 5oo m so/oD
tomofllw for ne* dose of chemotherapy
Final Dose
4g
Unit
1000 r
Soln.
NS
Infusion
2 hrs
IV Bolus 0,4,8 hr
al-k*
Re-appointment in MSignature of PhYsicianmukesh
_--
iET E
Admission Date SlenOlT Diseharged Date 8/E2017
CHEMOTHERAPY
Diagnosis
Chemo. Protocol: CDDP-DOXODl-D3q3wklYw9 Dr
PREMEDICATION GIVEN- Inj Ondanseffon 8 mg
Inj Dexamethasone 8 mg
FOSA I5O MG
CHEMOTHERAPY/IMMU NOTHERAPY GIVEN
Drug Name
lnj Doxorubicin D1-D3
To attend Daycare at 8'00 AN{/2'00 PM tomorrow for next dose of chemotherapy
lnfusion
l12ht
Signature of PhYsician
mukesh Patekar
Final Dose
50 MG
Unit
250 m
Soln.
NS
t,\
Advice
Re-appointment inon 8l8l2}fi
gr. etem.q. v{€Trt ltrft +RT sr6qd6 MR-2Dischargesummarv
DT, B.R.A. INSTITUTE ROTARY cANcER HOSPITALeTfu-m qTrfrq stTgt+{rq Tirqril, r$ ffi-ttoo?s
ALL INDIA INSITUTE oF MEDtcAL sctENGES, New Dethi-I10029qqit El qrrrr H*q frDISCHARGE SUMMARY
W.3F-U.ZC.R. No. O.P.D.O. Date of Admission/Discharge
A{,!',. 1;ilrlzName if yl"..i,, I l:,,.tj*" sq,zAge frrrzsex
History and condition on admission
Hospital Course, Treatment givenand Condition discharge
ant lnvestigation with Dates
AGNOSIS :
VICE:
inin
frf!^ 'fu". .. lC i?i ?r, { ,,{_ ( ,,, { fr u *,
) , .ru.t'.j {, $ i .i\J *' "T, ' .,"
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;
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\ t"tt results are 5i#itiflr${bl'LhEffie&eU;"erldh}Is ad#iyeiffdrt6litattiha rrfUratofy:i,frfr.,eu6a",irl*ijoii.rrjte remediar a*ion. ,
'ts conducted at National Reference Lab, New Delhi, a cAP (717 lool),lso IFS 6o+t t) and NABL {M-0061} accredited taborarory
ilFL. NOIDA 3
Name
Lab No.
A/c Status
est Name
Segmented Neutrophils
Mr. NURSID ALAM
138210996 Age: 14 years
P Ref By : AIIMS
I
Gender:
Results
CollectedReceivedReported
Report Staius
.'n"t
Male{
H
Bio. Ref. lntervalt
Hat
-lLvmphncr4es s'+ 1a
%40.00 _ B0.ooI rr,ronocytes i 7'E()
,%l Ecsinophiis 28'10
,,/o 2a'00 - 4o'a0
I Basophirs o'oo i* r
2 oc 10 oo
o.oo I 1'00-600
Neutrophirs t <z'ao
Lymphocytes 6i5 Jihou/mmi
2.A2 :?.00-7u0lvlonocytes thou/rnm3
a 4^ liruu/irrrrrr
1 oo - 3.ooi
I Eosinophits ::: thou/mm3 o.2o _ t.oo
r Basophils ' o'oo
thou/mm3i o.oo 0'02 - 0 50
prateret count u.uv thou/mm3
44.o 0.01 _ 0.10Giant platelets seen thouimm3 luo uo - ouo.ooplatelets are reduced. :
lAdvised:
I 4.00 - 10.00
Page .l of 2
I Follow up and Review.Resuit rechecked
Note
' fiJ"";l["":r"""rTmendation of lnternational councir for sta,dardization in Hematoiogy, the differentiarbrood
additionally being reported as absolute .r;;; of each ce, in per unit vorume of
2. Test conducted on EDTA whole blood
ilrfffi ll,tu til$t firu ffi fl i/fl/ ilff /ilit lflffi $t# fi$t
E --snF.iEea"*EE HEffi,''.'{F,i. 'i. CAP: accEEorreo
*'-=:i..-,:.-,r,, c.,eti,esh@ffis$-0c61
S*ffi*rirraarr- trcaes
.ffi,,*ffi*r
. 27 19t2017 10:23:0041\1'. 27l9lZ01T tO:24:27 A?,4: 27 19l20it 5:44:06piVl
Final
o4 1nuu, I (/ 1 :' 1' " 4.50 _ 5.50MCH rr' ru fr: lfl o^_ ,^^^.
^//\u^ 30.40 I Bo'00 - -ioO oo
,v,\/r ru i pglt: ,27.00_3Z.Oo
i 1eo ce1 Distrrburion wdpL(RDw) 32 90 ] n^t --_rat^,, - 'lrl ll?vl _ 16.10 i^. , !2.00-35.90Toiar Leukocyte count (TLc) liilu )I: 11 <.n .1 /-
, ," _""r r '
LUl 11.50 - 14.50Differentiat Leucocyte aorni roaai 11:36 i1"r,nra
o oo _ r..""
\\Ntest results are srbitit-'r'rgrtiu&rerfa#e6/rffir#i##li-iiliilf;j:#llll:,::::::,1!;,+r;:+:;rt".i*11::*.$i.ii,..{!,qn
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mfli-j*n*s'rtHa*ruari###eii,#ffi ffiil r e: rn e d, ata *ion,ts conducted at National R"feren." LaJ, NewDelhi, a CAp (7 17
--'-''"''j i,r"r.LJldte[yror:pussffilE remedial action.
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{OSPITAL PREMISES
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';i:iii' CAP .,accnrotteo\y'.,,.....,....'.......,"i;r.,'.,..COLLEGE of AMERICAN PAEPLOGI5TS
, bsi.'-.t
tso/lEc27001
560 - LPL - NOIDA 3
N-27, Sec-18, Commercial Complex, Near
Atta market, Noida.l 20-3029866/31 42530
NOiDA
CollectedReceivedReported
Report Status
Units
lso 9001:2008
2511O12017 9:25:0OA,M
2511012017 9:28:14AM2511012017 3:30:49PM
Fi nal
Narme
Lab No.
A/c Status
MT, NURSID ALAM
139102925 Age: 14 Years
P Ref BY : A.l.l.M.S
Gender
HOSPITAL
Male
Test Name
coMPLETE BLOOD COUNT (CBC)
(Eleclrical Impedence & Flow)
He,moolobtn
Packed Cell Volume (PCV)
Results
7.30
21.80
g/ciL
Bio. Ref. Interval
13.00 - 17.00
40.00 - 50.00
2.26 mill/mm3 4.50 - 5.50RBC Count
tvtt, v
MCH
MCHC
Red Cell Distributicn Vlicrh (RDW)
Tolal L e.lkocyte Cru^t --C
DiYerential l-eucocyte Count (DLC)
Segmenteo Neutrophils
i-,.,ii1p i13;yl3.r
Nlc;t ror;vtes
E: srnophils
Ba sophlls
Atrsolute Leucocyte Count
N eutrophils
Lymphocytes
Monocytes
Ecsinophils
Basophils
96.50
32.30
33.50
16,50
455
55.40
2,1 .3C
22.60
0.70
0.00
pg
.. )41v "*l
thou/mm3
ya
/o
o/o
/o
thou/mm3
thoU/mm3
thou/mrn3
thou/mm3
thou/mm3
tfroulmmg
80.00 - 100.00
27 .00 - 32.00
1t-50 - 14.50
4.00 - 10.00
40.00 - 80.00
:10 0c - 40.00
2.00 - i c.00
1.00 - 6.00
.< 2.0 0
:t.00 - 7 00
1 00 - 3.00
0.20 - 1.00
0.02 - 0.50
0.01 - 0.'1 0
2.52
0.97
1.03
0.03
0.00
PlateleI Count
Giant platelets seenF'latelets are reduced.Advised:Follow up and Review.Flesult rechecked
Note'1 .l\s perthe recommendation of lnternational council for Standardlzation in Hematology, ihe differential
leucocyte counts are additionally being reported as absoiute numbers of each cell in per unit r,'olutne of
trlood
2. Test conducted on EDTA whole blood
I ifillr ilffi iirillflliliillilllI lilll lilll lllfl llil iIIl Page 1 of 3
rr resr resurcs ara H$tntiifiYt5i' u *'Ulii*A,ifi€i5"bB#t#$iil*?li'd6i#ai;'mf' li6t6'i'ifn"oiur action I
58.0 150.00 - 450.00
@ Tests conducred at NarionalReference Lab, New Delhi, a CAP 1717lO01), MBL {MC-Zl l3) and ISO (FS 604l llaccredited laboratory
