اسم المريض :	{$name}	رقم الملف :	{$statusNo}
النوع / السن :	{$age} / {$sex}	القسم :	{$deptName}
السرير / رقم الغرفة :	{$bedNo} / {$roomNo}	تاريخ دخول القسم :	{$visitDate}

Wt :

{$exmination.weight} KG

Ht :

{$exmination.height} M

Diagnosis :	{$pre_diagnoses}
Proposed Operation :	{$operations}
History :	{$pre_anaesthetic.pre_history}

Drug Therapy before surgery :

{assign var=m value=1} {foreach $drug_therapy as $drug} {capture assign=m}{$m+1}{/capture} {/foreach}

No	Drug	Dose	Duration
{$m}	{$drug.drug}	{$drug.dose}	{$drug.duration}

Physical Examination :

Investigation :

General Condition :	{$pre_anaesthetic.general_cond}
Airway Assessment :	{$pre_anaesthetic.airway}
Blood Pressure :	mmHg
Heart Rate :	{$exmination->pulse} /min
Temperature :	{$exmination->temp}
Chest and heart :	{$exmination->chestandheart}
Abdomen :	{$exmination->abdomen}

ECG :	{$pre_anaesthetic.ecg}
Chest X-ray :	{$pre_anaesthetic.chest_xray}
Abdomen Ultra sound :	{$pre_anaesthetic.abdomen_ultra}
Echocardiography :	{$pre_anaesthetic.echo}
Angiography :	{$pre_anaesthetic.angiography}
Carotid Duplex :	{$pre_anaesthetic.carotid_duplex}
Radial Duplex :	{$pre_anaesthetic.radial_duplex}
Comments :	{$pre_anaesthetic.comments}

The patient is safe candidate for anaesthesia type :

{$exmination->anaesthesia_type}

Signature :

Date :

{$date}