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Md. Mostafizur Rahman
Personal Information
- Name: Md. Mostafizur Rahman
- Date of Birth: 04/09/1989
- Street Address/PO Box: Chatmohar, Pabna
- Organ Donor: No
- Smoker: Yes
- Gender: Male
- Blood Type: AB+
- Street Address/PO Box: Chatmohar, Pabna
- Dentures: No
Emergency Contacts
| Name | Relationship | Home Phone | Cell or Business |
|---|---|---|---|
| Sabila Zara | Daughter | 67890 | 98765 |
| Sadia Islam | Wife | 678900 | 5432 |
Physicians
| Full Name | Specialty | Business Phone | Cell Phone |
|---|---|---|---|
| Nusrat Jahan | Mental Peace | 36378 | 7463738 |
| Hasina | Manus Mara | 38373 | 763728 |
Allergies / Sensitivities
| Drug | Details | Food | Details |
|---|---|---|---|
| altrol | 0-0-2 | Hilsha Fish | Khaua Jabe na |
| Deslor | 0-0-5 | Pui Sakh | jabe na |
Advanced Directives
- Full Code: Yes
- Life Support: No
- Do Not Resuscitate (DNR): No
Medication List
| Medication Name | Dosage | Frequency | Details |
|---|---|---|---|
| Napa | 100 | 1-0-1 | Khauar pore |
| alben | 5 | 0-0-1 | ghumanor por |
Implant Devices
- Device ID: 420
- Manufacturer: skf
- Model Number: 840
Diabetic
- Type I: Insulin dependent, Non-Insulin dependent
- Type II: Insulin dependent, Medication Controlled, Diet Controlled
- Other: nai
- Other: ase
Immunizations – Flu, Pneumonia, Tetanus, ETC
| Date | Immunization Type | Date | Immunization Type |
|---|---|---|---|
| 7/2/1991 | Besi nai | 4/9/1989 | olpo |
| 7/2/1992 | besi besi | 7/2/1993 | kom kom |