KSCT ( Konaark Sampoorn Chikitsa Tantr )
|
Registration
|
|
Particulars ( of Patient ) :
Name : ..
Gender : .. ..
Age : ..
Date of birth : .. ..
Place of birth : ..
Time of birth : ..
Weight : Complexion : Height : ..
Prognosis / diagnosis of the latest medical expert :
. ..
Final verdict / opinion ( if any ) of the latest medical expert :
.. .
|
Description of illness from patients perspective : ..... ...
Brief History of ailment(s) and ongoing treatment : .
Drugs taken :
Family history of ailments ( if any ) : .
|
|
Personal information ( Habitual & Preferences ) :
Smoking ( ), Drinking ( ), Tobacco chewing ( ), Paan Masala ( ),
Khainee ( ), Drugs ( ), Vegan ( ), Vegetarian ( ), Junk Food ( ),
Non Vegetarian ( ), Egg ( ), etc.
Quantity & Frequency : . ..
Duration :
Allergic to : ..
Complete Address : ..
Contact Numbers : ..
Name & Sign : .
Place : ...... . Date : .
|
Categorized Ailments :
( KSCT - A ) Acidity, Acne & Boils, Anemia, Blood Pressure, Gastritis, General Indigestion, Haemorrhage, Hair fall, Injuries, Leucorrhea, Viral Fever, Skin & General Allergies, etc.
( KSCT - B ) Appendicitis, Arthritis, Constipation, Diabetes Type II, Edema ( Water retention ), Gaseous-Cardiac pain, Gout, High & low Cholesterol, Insomnia, Joint pains, Leucoderma, Menstrual ( Periodical ) disorder, Obesity, Piles, Rheumatism, Sleep disorder, Thyroid, Urosis,
( KSCT - C ) Ageing, Depression, Diabetes Type I, Discolouration, Epilepsy, Gen. loss of vital energy ( Gen. Improvement in Immune system ), Infections : Bacterial & Viral, Impotence, Jaundice, Respiratory problems, Skin disease, Spondylitis, Varicose veins, etc.
( KSCT - D ) Alzheimer's Disease, Cerebrosis, Genital warts & Cervical cancer, Hepatitis ( B & C ) , Heart Problems, Hunter's syndrome, Interstitial Lung Disease ( ILD ), Kidney Failure, Low sperm count (Oligospermia), Memory loss, Meningitis, Mental Disability and motor & milestone skills problems, Neurological & Nervous disorders, etc.
( KSCT - E ) All cancers including Liver, bone and Blood Cancer ( Leukemia ), Autoimmune Diseases, Juvenile Diabetes, Blood Clotting, Multiple Sclerosis, Cirrhosis of liver, Drug Abuse and Addiction ( Reactions, side & after effects.), HIV+ and Aids, Hydrocephalus, Osteoporosis, Thalassemia, etc.
|
|
For all purposes with regards to this treatment, KSCT stands for Konark Sampoorn Chikitsa Tantr.
In case of any dispute :
Jurisdiction with regard to any dispute arising in all matters including medicine, dispensing and sending of medicines, payments or remittance of fees, etc., only the Courts and Tribunals having jurisdiction over Bangalore and not over any other place, shall have jurisdiction for the purpose of filing a suit or preferring complaint under the Consumer Protection Act or any other law for the time being in force or taking any legal proceeding against the KSCT or the Dispenser of the medicine.
The KSCT or the Dispenser of the medicine is not responsible for the loss of or the delay in the delivery of medicines - postal or couriered articles sent by the Dispenser of the medicine or by any designated person on behalf of KSCT .
|
Ailments (suffering) : ( To be filled by the KSCT personnel. )
( KSCT - A ) .. .. .....
( KSCT - B ) . ......
( KSCT C ) ... ...................
( KSCT D ) . .
( KSCT E ) . .
|