J M Diagnostic
ARCHANA ROHIT OWHAL
JM-20260904175056 · 2026-09-04 · 17:45
Completed
WA
PCPNDT · Form F — 2 separate prints
Pre-procedure (Pages 2 & 3)
Declaration + Disclaimer — patient signs this on arrival, before the USG is done.
Print Declaration + DisclaimerPost-procedure (Page 1 only)
ReadyUSG report captured — statutory Form F Page 1 is ready for the register file.
Print Form F Page 1Tests
| 1 | USG Early Pregnancy | USG | ₹1,200 |
| 2 | CBC | Routine | ₹300 |
| 3 | Urine Examination Routine | Routine | ₹200 |
| 4 | BSL R | Routine | ₹100 |
| 5 | Glycated Haemoglobin (HbA1C) | Routine | ₹600 |
| 6 | Thyroid Stimulating Hormone (TSH) | Routine | ₹300 |
| 7 | Blood Grouping and Rh Typing | Routine | ₹200 |
| 8 | HIV - Elisa | Routine | ₹550 |
| 9 | TVS 300 USG | USG | ₹300 |
Clinical
- LMP
- 2026-07-25
- Known case of
- —
- Seen
- —
- Advice
- —
- Staff
- Akanksha
- Account
- Cash
- Next Appointment
- —
- Reason
- —
- Next ANC
- —
- Next Consultation
- —
Category Charges
Routine
₹2,250
Special
₹0
USG
₹1,500
X-Ray
₹0
ECG
₹0
Doppler
₹0
Cardiac
₹0
Consultation
₹0
HSG
₹0