DigiCon

@if (isset(session()->get('doctor')['vCentralCode']))

Back

@else

@endif

Patient {{ $iPatientNo }}

CADAPT

Doctor’s Details

@if (isset(session()->get('doctor')['vCentralCode']))

Name of Doctor *

@else

Name of Doctor *

@endif

Registration No. *

Qualification *

Speciality *

Hospital/Clinic Address *

City *

@if (isset(session()->get('doctor')['vCentralCode']))

State *

@else

State *

@endif

Patient’s Details

Initials *

OPD/IPD Registration No *

Gender *

Male Female

Age (in Years) *

City/Town *

@if (isset(session()->get('doctor')['vCentralCode']))

State *

@else

State *

@endif

H/O Alcohol consumption: *

Yes No

Smoker *

Current Former Never

If Former, how long ago did patient quit smoking?

Unknown <6 months ago 6 months-1.5 years ago >1.5-2.5 years ago >2.5-3.5 years ago >3.5-5 years ago >5 years ago

General Examination Findings

Pulse (per minute) *

Blood Pressure: Systolic (mmHg) *

Diastolic (mmHg) *

Weight (in Kg) *

Height (in cm) *

Body Mass Index (BMI) (kg/m²) *

JVP *

Elevated Not elevated

Any Ventricular arrhythmia (VT/VF) *

Yes No

Medical History *

Diagnosis of Coronary Artery Disease (CAD) or Myocardial Infarction (MI)

Date of Diagnosis *

Type of treatment received *

Percutaneous Coronary Intervention (PCI) Coronary Artery Bypass Grafting (CABG) Others

Date of Diagnosis *

Current medications *

DAPT *

Yes No

Duration (In Months) *

DAPT therapy continued *

Yes No

Investigations *

Admission date *

Number of previous CAD/MI admissions in the last 12 months excluding current admission

Post CAD/MI Therapy Details *

Drug Class and Drug (generic name only)	Dose/Strength (in mg unless specified)	Frequency of dosing	Duration in months
		OD BID TID
		OD BID TID
		OD BID TID
		OD BID TID
		OD BID TID

Ant- Diabetic Therapy Details *

Drug Class and Drug (generic name only)	Dose/Strength (in mg unless specified)	Frequency of dosing	Duration in months
		OD BID TID
		OD BID TID
		OD BID TID

Anti-Hypertensive Therapy Details*

Drug Class and Drug (generic name only)	Dose/Strength (in mg unless specified)	Frequency of dosing	Duration in months
		OD BID TID
		OD BID TID

Lipid Lowering Therapy Details *

Drug Class and Drug (generic name only)	Dose/Strength (in mg unless specified)	Frequency of dosing	Duration in months
		OD BID TID
		OD BID TID
		OD BID TID

Anti-platelet / Aspirin Therapy Details *

Drug Class and Drug (generic name only)	Dose/Strength (in mg unless specified)	Frequency of dosing	Duration in months
		OD BID TID
		OD BID TID
		OD BID TID

Anti-thrombotic Therapy Details *

Drug Class and Drug (generic name only)	Dose/Strength (in mg unless specified)	Frequency of dosing	Duration in months
		OD BID TID
		OD BID TID
		OD BID TID

Investigations

ECG: findings * (new)

ECHO findings * (new)

Glycemic Profile

HbA1c (%)*

Fasting Plasma Glucose (mg/dl)*

Post-prandial Plasma Glucose (mg/dl) *

Lipid Profile

Total Cholesterol (mg/dl) *

LDL-C (mg/dl) *

HDL-C (mg/dl) *

VLDL-C (mg/dl) *

Triglycerides (TG) (mg/dl) *

Renal Profile:

Serum Creatinine (mg/dl)

Urine Albumin (mg/dl)

e-GFR (ml/min/1.73 m²)

Serum uric acid (mg/dl)

Peak Trop-T / Trop – I Positive Negative	BNP pg/ml At admission At discharge At follow up
ECG Rhythm SR AF Paced IVCD	NT pro BNP pg/ml At admission At discharge
QRS Complex Normal LBBB RBBB IVCD	Echo – EF (%)
LV diastolic dysfunction No Mild Moderate Severe	Echo – any other descriptive finding
Any Other investigation specify TSH/ HbA1c Electron-beam computed tomography (EBCT) scanning 64-slice CT angiography Carotid intima-media thickness (IMT) pulse wave velocity (PWV) ankle-brachial index (ABI)