SRI GANGANAGAR HOMŒOPATHIC MEDICAL
COLLEGE,
HOSPITAL & RESEARCH INSTITUTE
( constituent College of Tantia University)
Recognized by Govt. of Rajasthan, & Deptt. of AYUSH, Govt. of India)
Tantia Higher Education Campus, Near RIICO Bus Stand, Hanumangarh Road
SRI GANGANAGAR – 335002, (RAJASTHAN) Ph. No.- 0154- 2494932, Fax: 0154-2494125
DEPT. – ORGANON OF MEDICINE WITH HOMŒOPATHIC
PHILOSOPHY
HOD/INCHARGE Name of Student:-
Roll No:-
Batch No:-
SRI GANGANAGAR HOMOEOPATHIC MEDICAL COLLEGE
HOSPITAL & RESEARCH INSTITUTE
Department of Organon of Medicine
O.P.D. CASE HISTORY SHEET
Name of the physician...............................................................................................Unit..........................
O.P.D./I.P.D. No....................................................................................................................Date.........................
Name: Socio Economic Status: Upper/ Middle/ Lowerclass
Father’s / Husband’s Name: Residence: Rural / Urban
Age: Dietary Habit: Veg. / Non-veg. / Eggitarian
Sex: Education:
Marital Status: Occupation:
Religion: Address:
DISEASE DIAGNOSIS:
MIASMATIC DIAGNOSIS:
PRESENT COMPLAINTS
HISTORY OF PRESENT COMPLAINTS:
PATIENT AS A PERSON:
Appetite:
Thirst:
Desires:
Aversion:
Stool:
Urine:
Menstrual History:
Thermal reaction:
Perspiration:
Sleep:
Dreams:
Addiction:
H/O Vaccination:
MIND:
SEXUAL HISTORY:
OBSTETRIC HISTORY:
PAST HISTORY:
S. No. Disease/ complaints Age/ year Treatment taken Outcome
FAMILY HISTORY:
PHYSICAL EXAMINATION:
General Examination:
Pulse: Sclera:
B.P.: Tongue:
R/R: Lymph nodes:
Temp: Oedema:
Conjunctiva: Nails:
Systemic Examination:
INVESTIGATION:
DIAGNOSIS:
ANALYSIS OF CASE:
EVALUATION OF SYMPTOMS:
TOTALITY OF SYMPTOMS:
SELECTION OF REMEDY / POTENCY/ DOSE:
DIET & REGIMEN:
PRESCRIPTION:
