Directorate of Indian Systems Of Medicine (AYUSH) Jammu and KashmirMonthly OPD Report of AYUSH
Disp. _____________For the M/O _________
w.e.f. _________________ to _________________
Out Door Services ( age Group ):-
Male Female Total
0-5 years
5-16 years
16-45 years
45-60 years
60years & above
Total Out door
patients
[Link] Disease wise Outdoor patients :-
Fresh Followup Total No. Total Total Fresh Total OPD
cases cases for the Revenue for cases up to up to this
Month the Month this Month Month
Gastrointestinal
disorders
Urogenital
disorders
Sexual disorders
Neurological
disorders
Cardiovascular
disorders
Respiratory
disorders
Joint disorders
Skin disorders
Communicable
Disorders
Endocrinologica
l Disorders
ENT/
Ophthalmic
Disorders
Others
Total :
Total No. of cases referred to AYUSH Hospitals/ AYUSH Units ______________ Patients
Total No. of cases referred to Allopath/ other Hospitals __________________ Patients
OPD Slips Details:-
Opening Balance up to the previous Month ________________ Slips.
OPD Slips Received during this Month ________________ Slips.
OPD Slips Consumed during this Month ________________ Slips.
OPD Slips Balance ________________ Slips
HDF Account Detail :-
Revenue Deposited in HDF account up to 31.03.2021 Rs. _________________.
Revenue Deposited in HDF account during this Month Rs.________________.
Total Revenue Deposited in HDF account up to this Month Rs._____________.
No :- Dated:-
Submitted in original to District Medical Officer District (AYUSH) Officer Rajouri for
Information.
Medical Officer,
[Link] Disp.___________
OFFICE OF THE MEDICAL OFFICER [Link] DISPENSARY _________________
ATTENDANCE REPORT OF STAFF FOR THE MONTH OF _____________W.E.F. __________TO_________
S. Name of Officials Designa Leave Op. Leave Balance Days remain
N tion availed in balance availed present /
o this of CL during the Of CL Remarks
month month
CL/EL
6
No :- Dated:-
Submitted in original to Asstt. District Medical Officer District (AYUSH) Officer Rajouri for
Information.
Medical Officer,
[Link] Disp.___________
OFFICE OF THE MEDICAL OFFICER [Link] DISPENSARY ____________for the M/O
_________
Free Medicine & Awareness Camps :-
Venue Date of camp No. of No. of Revenue Subject of
persons patients realized awareness
participated examined
School Health Check-up programme:-
Vanue Date No. of School Subject of awareness
Children examined
Panchkarma Reporting for the Month of __________
[Link] Name of the Institution Total procedures Procedures in Total
up to the this month
previous month
No :- Dated:-
Submitted in original to Asstt. District Medical Officer District (AYUSH) Officer Rajouri for
Information.
Medical Officer,
[Link] Disp.__________
OFFICE OF THE MEDICAL OFFICER [Link] DISPENSARY ____________for the M/O
_________
Consolidated Patients detail for the month of _____________
[Link] Total No. of Total [Link] Total [Link] Aadhar card Mobile no. of
patients attended male Patients Female no. of total total
attended Patients patients. patients.
attended
No :- Dated:-
Submitted in original to Asstt. District Medical Officer District (AYUSH) Officer Rajouri for
Information.
Medical Officer,
[Link] Disp.___________
OFFICE OF THE MEDICAL OFFICER GOVT. Ayush DISPENSARY _________________
A/C Roll for the Month of ____________________________
[Link] Name of Officials Designation Month Amount Signature/
Revenue
stamps
No :- Dated:-
Submitted in original to Asstt. District Medical Officer District (AYUSH) Officer Rajouri for
Information.
Medical Officer,
[Link] Disp.___________