Beruflich Dokumente
Kultur Dokumente
2
3
Registration No.
Patients name and her religion, income& age :
Total: 2
5.
Husbands/Fathers name -
Mr Shailendra Sonavale
6
.
7
.
dt : 13/10/12
20/07/13
8
9.
10
11.
12
13.
Male: 1
Female : 1
wk: 24
EDD:
Not Applicable
Not Applicable
Not Applicable
Ultrasound
NO
NO
NO
NO
NO
NO
NO
2 Abortion {VESICULAR MOLE}
NO
NO
Not applicable
Dr Rajendra Prakashey MMC reg No44552
Non-Invasive
YES
(1)Ultrasound ( specify purposefor which ultrasound is tobe done
During pregnancy) [ List of indications for ultrasonography of pregnant
Women are given in the note below]
Invasive
(ii)Amniocentesis
(iii) Chorionic Villi aspiration
(iv) Foetal biopsy
(v) Cordocentesis
(vi) Any other (specify)
Any complication of procedure please specify
Laboratory tests recommended1[3] ---
YES
YES
Result of
1
NO
YES
18.
(b) Ultrasonography
(specify abnormality detected, if any).
Date(s) on which procedures carried out.
Date on which consent obtained. (In case of
invasive)
The
result of pre-natal diagnostic procedure were
conveyed to
Was MTP advised/conducted?
19.
Date: 04/04/13
15.
16.
17.
Place : Nagpur
04/04/13
04/04/13
Mrs Sweety Yogesh Mandaogade on
04/04/13
NO
Dr Rajendra Prakashey.
Name and signature of the person conducting
ultrasonography/image scanning/ Director or owner of
genetic clinic/ ultrasound clinic/imaging centre.