Hospital Detail Questionaire

Case Id

Report Progress

Case Assigned to

Exact date and time of Admission as per hospital record

Exact date and time of Discharge as per hospital record

Presenting Complaint as per papers

Duration of complaints

Any previous Hopsitalization / Consultation

Any previous major illness including Surgical / medical

Substance Abuse / Alcohol

Previous consultations and Investigations

IPD register findings / OPD register

OT noting / OT Regster / Anaesthetia notes

Infrastructure Findings - if Any

Is the Hospital craeting any huddle to meet the patient

Room Number

Do you find anythig suspicious