CityCare Multispeciality Hospital
14, Ring Road, Lajpat Nagar, New Delhi
Ph: +91-11-4567-8900
Clinical Reg. DL-CE-2019-04412
Type: PLANNED
Admission Sheet — IPD Case Paper
No: ADM/25-26/03210
Dt: 20-09-2026 09:30
Patient
Geeta Sharma · 48Y / F
UHID: UHID-2024-090112 · IPD: IPD/25-26/03210
B-44, Kalkaji
Bed: Ward 3B · Bed 12
Consultant: Dr. V. Kapoor (DMC-41028) · Gen Surgery Unit II
Ph: +91-98111-33445
Payer + Attendant
Cash (self)
Advance paid: ₹30,000.00 · Receipt DEP/25-26/012210
Attendant: Rajesh Sharma (Husband)
Dx: Cholelithiasis — for laparoscopic cholecystectomy [DC11.1]
Ph: +91-98111-77889
Consents
- ☐ General admission + treatment
- ☐ Anaesthesia + lap cholecystectomy
- ☐ Financial undertaking
Patient / attendant signature — admission consent
Attendant signature — financial undertaking received
Expected stay + tariff agreement
Expected stay: 4 days (planned discharge 24-09-2026)
Tariff: As per hospital tariff schedule v2026 — Ward 3B ₹6,000/day; package quote issued
Initial orders:
NPO after midnight; IV Ringer Lactate; pre-anaesthesia workup; antibiotic prophylaxis per protocol.
Risks/benefits explained in the local language; attendant sign mandatory.