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Prescription
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Vitals
B.P.
Pulse
Temp °F
SpO₂ %
Height cm
Weight kg
Clinical assessment
Chief complaints (with duration)
Prakriti (V–P–K)
Vikriti (V–P–K)
⚠ Past illness / drug / allergy
Systemic examination
Provisional diagnosis
Investigation plan
Panchakarma / Therapy plan
Procedure
Dravya(s)
Duration
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Adv. Day Care / IPD
Internal medicines · Aushadhi
Formulation
Dose
Anupana
Time
Days
Qty
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Anupana = vehicle (jal / madhu / dugdha / koshna jal). B/f = before food · A/f = after food · HS = bedtime.
Advice
Diet advice · Pathya–Apathya
Preventive aspects · Yoga / lifestyle
Review after (days)
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Vata
Pitta
Kapha
Vata-Pitta
Pitta-Kapha
Vata-Kapha
Sama (Tridoshaja)
Vata predominant
Pitta predominant
Kapha predominant
