Referral to Vaccine:

General Examination ☐ Yes ☐ No

File # ZF2774 Pts Name:  ‫حمده عيسى القرعلي‬ Date: 4/21/2020

Address 1 ‫ – منزل‬3 ‫ – شارع‬11 ‫مخيم الزعتري – قطاع‬

Phone 1 0790717669 Phone2 NA
Current Age 62
B.P  NA Temp  NA Health Education: ☒ PHC ☐ RH
H.R  NA Weight  NA
H.C  NA H.B  NA Nurse Procedure: Pt not present
F.B.S  NA R.B.S  NA

Hb1ac  NA     

Case is stable Yes

Chief Complain: HTN, Code: 99

7

☐ New Case ☒ Follow Up

History:
63 y/o woman with hx:
HTN

Physical Exam:

Patient not presented, but we were contacted with her by phone due to curfew, her vital sign on
last visit was normal, the patient status is stable, and no other issues according to her health
status.

Pt was sent many times to control bp but her bp still the same
Assessment & Work up: NCD – Lifestyle Advice
☒ Diet
Patient status is stable, medications are given, continue
☐ Exercise
home monitoring and refer to our clinic in case of ☐ Smoking
happening any problems. ☒ Other

Diagnosis:

HTN

Prescription ID Number E0002009

SN Code Medication Dose Quantity Notes
1. A13 Amlodipine 5mg 1*1 30
2. P2 Paracetamol 500mg PRN 24
3. E1 Enalapril 5 mg 2*1 60
Hydrocortisone acetate
4. H7 1% skin cream 1*1 1
15g
5. P2 Paracetamol 500mg 1*2 24
Miconazole 2% cream
6. M20 1*1 1
30 g
7.
8.

 
Referral ☐ Yes Cause of Referral with code: Referral to with code:
☒ No

Dr. Name: Hazem Signature:

Date: 21/04/2020