Integrative Medicine Prescription

INTEGRATIVE MEDICINE PRESCRIPTION

Praina Institute of Yoga and Allied Sciences
...Wholistic Care, Naturally (An Initiative of Surajbai Sardarmull Navyas Trust)

Name

Spouse/Father

Reg. No

Mobile

Marital Status

UHID

DOB

Age

Sex

Qualification

Occupation

Allergies

Diet

Water

Motion/Mict

Sleep

BP / Pulse

Height / Weight / BMI

Hobbies/Habits

Assessment

Plan

Subjective / Objective

Management Protocol

Diet/Restaurant

Yoga + 10

Spa

Physiotherapy

Products

Naturopathy / Children Package

IP / OP / Others

Follow-up

Detox (Partial/Complete)

Investigations / Lab Tests

Date & Time

Remarks

Signature of Consultant

Signature of Doctor