DigiCon

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

Name of Doctor*

@else

Name of Doctor *

@endif

Registration No. *

Qualification *

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

Speciality *

@else

Speciality *

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

Hospital/Clinic Address *

@else

Hospital/Clinic Address *

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

City *

@else

City *

@endif @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

State

H/O Alcohol consumption: *

Yes No

General Examination Findings

Pulse(per minute)

Blood Pressure: Systolic (mmHg) *

Diastolic (mmHg) *

Weight (in Kg) *

Height (in cm)

Body Mass Index (BMI) (kg/m²)

History, Co-existing diseases and concomitant therapies

Family History *

Not Applicable (N/A)

Diabetes

Hypertension

Dyslipidemia

Coronary Artery Disease

Cerebrovascular Disease

Chronic Kidney Disease

Heart Failure

Any other (Please specify)

Obesity*

Yes No

Diagnosed since:

Less than 1 yr 1 to < 2 yrs 2 to <3 yrs 3 to <4 yrs 4 to <5 yrs 5 to <10 yrs ≥10 yrs

Dyslipidemia disease characteristics and Concomitant therapies *

Years since Dyslipidemia diagnosis:

Less than 1 yr 1 to < 2 yrs 2 to <3 yrs 3 to <4 yrs 4 to <5 yrs 5 to <10 yrs ≥10 yrs

Statin Utilization

Drug*	Dose/Strength (in mg unless specified)*	Frequency of dosing *
Atorvastatin	5 10 20 40 80	OD BID TID
Aspirin	75 150	OD BID
Ezetimibe	-	OD BID TID
Fenofibrate	-	OD BID TID
Bempedoic Acid	180	OD
Any Other

Investigations

Lipid Profile*

Total Cholesterol (mg/dl)*

LDL-C (mg/dl)*

HDL-C (mg/dl) *

VLDL-C (mg/dl)

Triglycerides (TG) (mg/dl) *

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Patient {{ $iPatientNo }}

Doctor’s Details

Patient’s Details

General Examination Findings

History, Co-existing diseases and concomitant therapies

Dyslipidemia disease characteristics and Concomitant therapies *

Statin Utilization

Investigations