Contact

nu m bers

; ext; 2235, 2236, 223j

:021_35611349

021 -3 5 61107 I

Faxnumber

_7 S

E-mail address : health.services@niilife.com

24 hours Emergency tines: 0300-giaOeSl;

oSOUufBlet; 0333_3030553

Intimation Form
Important Instructions for the Hospital / Doctor
Patient Detail
Full Name of Patient

02.YEARS
33630-55 I 1924-9

0332-262s937
829-01-0065
0000266

tal Details

FATIMAMEDICAL CENTRE

Telephone & Fax No.

0616521410

0334-714s866

Treatment Particulars
07-09-16
412s-16

Bed No. / Room No.

NURSERY

Name of Surgeon / fhysician

DR.ARIF ZULQARNAIN

Diagnosis
Date of

Acute Gastroenteritis

frst con

NO

Withwhatcomplain@

Loose

Since wtren
complaints? please state the exact dite and vear
Past History of the

{hethel

fatie

FATIrY1A

NO

disease?

Ifyes, please sp
previous Surgery done? Ifyes, please

For Last 7 days

NO

the presen

whetherth"disea@

Motion,Vomittirrgg"v"- *rys

,p".i&

details.

NO

of Surgery/t
\l*"
ailment

Admitted

Estimated Length of stay foriurrent aGase

4..TO s-DAYS

Estimated Cost of trearment

Visiting Consultant

AttendingDoctor,@

LTAN.

NO

Rs.40,000/: appnOXUarBL
NO
DR.ARIF ZU.QARN,AIN