Adroit - Data Report Entry

Adroit Consultancy Medicolegal Services PREINSURANCE HEALTH CHECKUP MEDICAL EXAMINATION REPORT PART - A : PRELIMINARY DATA : SR NO :

1

REPORT NO: ACM/01/2006

CLIENT NAME:

Singh Shyam Narayan

DATE :

13/11/2006

AGE:

51

PART - B : INSURANCE COMPANY DETAILS : NAME OF INSURANCE COMPANY : UNITED INDIA INSURANE CO LTD

DIVISIONAL OFF :- DO- 04

PART - C : MEDICAL EXAMINATION : - ( Filled by the medical Examiner ) POSITIVE HISTORY :

B.P.: - NO / DIABETES : NO / THYROID DISEASE: NO / ASTHMA: NO / HEART : NO

PART - D : GENERAL EXAMINATION : BODY WEIGHT :

84

Kgs

HEIGHT :

168

PULSE :

78

/ min

BLOOD PRESSURE : 120/80

RIGHT EYE :

CATARACT : NO / GLAUCOMA : NO / REFRACTIVE ERROR : YES

LEFT EYE :

CATARACT : NO / GLAUCOMA : NO / REFRACTIVE ERROR : YES

Cms mmHg

PART - E : SYSTEMIC EXAMINATION : RESPIRATORY SYSTEM

No Abnormality

CARDIOVASCULAR SYSTEM

No Abnormality

PART- F: INVESTIGATIONS : BLOOD-HB :

15.6 gm %

gm%

BLOOD - TC :

8700 / cumm

DC-N/L/M/B :

N: 68 / L:16 / M: 14 / B: 0 / E : 2

GLYCOSYLATED HB :

6.1 (NORMAL RANGE : 5.0 to 8.0) (Normal Range :)

SERUM CHOLESTEROL :

175mg% (NORMAL RANGE: 152 to (Normal 60) Range :)

X-RAY CHEST :

NORMAL

ECG :

NORMAL

USG :

NORMAL

STRESS TEST :

NORMAL

X-RAY BOTH KNEE :

Osteoarthritis changes in both knees, Calcification posterior to femur.

PART-G EXCLUSION : 1) Osteoarthritis of both knees. 2) Calcification posterior to femur. With regards

(Dr M D Gupta) MBBS, MD, DNB, PGDHA Reg No.: 79197 (Adroit Consultancy Medicolegal Services)

SR NO :

REPORT NO:

DATE :

CLIENT NAME:

AGE:

1 ACM/01/2006

13/11/2006 Singh Shyam Narayan

51

1 ACM/01/2006 2 ACM/01/2006 3 4 5 6 7 8 9 10 11 12 13 14 15

13/11/2006 Singh Shyam Narayan 13/11/2006 Singh Shyam Narayan

51 51

NAME OF INSURANCE COMPANY :

DIVISIONAL OFFICE :

UNITED INDIA INSURANE CO LTD

DO- 04

UNITED INDIA INSURANE CO LTD UNITED INDIA INSURANE CO LTD

DO- 04 DO- 04

POSITIVE HISTORY : B.P.: - NO / DIABETES : NO / THYROID DISEASE: NO / ASTHMA: NO / HEART : NO B.P.: NO / DIABETES : NO / THYROID DISEASE: NO / ASTHMA : NO / HEART : NO B.P.: - NO / DIABETES : NO / THYROID DISEASE: NO / ASTHMA: NO / HEART : NO

BODY WEIGHT :

HEIGHT :

PULSE :

BLOOD PRESSURE :

84

168

78 120/80

84 84

168 168

78 120/80 78 120/80

RIGHT EYE : CATARACT : NO / GLAUCOMA : NO / REFRACTIVE ERROR : YES CATARACT : NO / GLAUCOMA : NO / REFRACTIVE ERROR : YES CATARACT : NO / GLAUCOMA : NO / REFRACTIVE ERROR : YES

LEFT EYE : CATARACT : NO / GLAUCOMA : NO / REFRACTIVE ERROR : YES CATARACT : NO / GLAUCOMA : NO / REFRACTIVE ERROR : YES CATARACT : NO / GLAUCOMA : NO / REFRACTIVE ERROR : YES

RESPIRATORY SYSTEM

CARDIOVASCULAR SYSTEM

No Abnormality

No Abnormality

No Abnormality No Abnormality

No Abnormality No Abnormality

BLOOD-HB :

BLOOD - TC :

DC-N/L/M/B :

15.6 gm %

8700 / cumm

N: 68 / L:16 / M: 14 / B: 0 / E : 2

15.6 gm % 15.6 gm %

8700 / cumm 8700 / cumm

N: 68 / L:16 / M: 14 / B: 0 / E : 2 N: 68 / L:16 / M: 14 / B: 0 / E : 2

GLYCOSYLATED HB :

SERUM CHOLESTEROL :

6.1 (NORMAL RANGE : 5.0 to 8.0)

175mg% (NORMAL RANGE: 152 to 60)

6.1 (NORMAL RANGE : 5.0 to 8.0) 6.1 (NORMAL RANGE : 5.0 to 8.0)

175mg% (NORMAL RANGE: 152 to 60) 175mg% (NORMAL RANGE: 152 to 60)

X-RAY CHEST :

ECG :

NORMAL

NORMAL

NORMAL NORMAL

NORMAL NORMAL

USG :

STRESS TEST :

NORMAL

NORMAL

NORMAL NORMAL

NORMAL NORMAL

X-RAY BOTH KNEES : Osteoarthritis changes in both knees, Calcification posterior to femur.

1 1) Osteoarthritis of both knees.

Osteoarthritis changes in both knees, Calcification posterior to femur. Osteoarthritis changes in both knees, Calcification posterior to femur.

1) Osteoarthritis of both knees. 1) Osteoarthritis of both knees.

PART G : EXCLUSION 2 2) Calcification posterior to femur. 2) Calcification posterior to femur. 2) Calcification posterior to femur.

3

PART G : EXCLUSION 4

5

6