Code of Ethics Regulations, 2002

APPENDIX-3

FORMAT FOR MEDICAL RECORD
(see regulation 3.1)

Name of the patient :


Age :

Sex :

Address :

 



Occupation :



Date of 1st visit :



Clinical note (summary) of the case:



 

Prov. : Diagnosis :

 



Investigations advised with reports:



 

Diagnosis after investigation:



 

Advice :





Follow up



Date:

Observations:



 

Signature in full ………………………….

Name of Treating Physician

Chapter 1, Chapter 2, Chapter 3, Chapter 4, Chapter 5, Chapter 6, Chapter 7, Chapter 8,
Appendix 1, Appendix 2, Appendix 3, Appendix 4