HOSPITAL TRAINING REPORT-1 BP509P

A
HOSPITAL TRAINING REPORT PART-1
Submitted
In Partial Fulfillment of the Requirements for the award of Degree
of
Bachelor of Pharmacy (B. Pharm) 5
th
Semester
Session- 2022-23
Submitted by
ADITYA CHAPRANA
(Roll No. - 2000680500005)
Under the Guidance of
Assistant Professor
Department of Pharmaceutical Technology
MIET, Meerut
Dr. A.P.J ABDUL KALAM TECHNICAL
UNIVERSITY, LUCKNOW
JANUARY, 2023

Dr. A.P.J ABDUL KALAM TECHNICAL UNIVERSITY, LUCKNOW(U.P)
DEPARTMENT OF PHARMACEUTICAL TECHNOLOGy
MEERUT INSTITUTE OF ENGINEERING & TECHNOLOGY, MEERUT
DECLARATION BY STUDENT
This is certify that the entitled “Hospital training Report” is a bonafide and genuine
training work done by me Mr. Aditya Chaprana (Roll No.-2000680500005)
B.Pharm 5th
Semester, session-2022-23 under the guidance of Mr. Ankit
Chaudhary.
Signature of Student
Date:- 23/01/2023
Place: - MIET, Meerut

DEPARTMENT OF PHARMACEUTICAL TECHNOLOGY
DECLARATION BY FACULTY INCHARGE
This is certify that the project entitled “Hospital training Report” is a bonafide and
genuine training work done by Mr. Aditya Chaprana (Roll No.-2000680500005)
B.Pharm 3rd
Year, V Semester, session-2022-23 under the guidance.
Mr. Ankit Chaudhary
Assistant Professor
Dept. of Pharmaceutical
Technology M.I.E.T. ,
Meerut
Date:- 23/01/2023
Place:- MIET, Meerut

MEERUT INSTITUTE OF ENGINEERING & TECHNOLOGY,MEERUT
CERTIFICATE
This is certify that the enttled “Hospital training Report” is a bonafied and genuine
training work done by me Mr Aditya Chaprana (Roll No.-2000680500005)
B.Pharm 5th
Semester, session-2022-23 under the guidance of Mr. Ankit
Chaudhary Assistant Professor, Department of Pharmaceutical Technology, Meerut
Institute of Engineering & Technology, Meerut.
Prof. (Dr.) Vipin K. Garg Dr. Garima Garg
Head Principal
Dept. of Pharm. Tech. Dept. of Pharm. Tech.
M.I.E.T., Meerut M.I.E.T., Meerut

ACKNOWLEDGEMENT
The training opportunity I had with Kailash Hospital, Meerut was a great chance
for learning and professional development. Therefore, I consider myself as a very
lucky as I was provided with an opportunity to be a part of it. I am also grateful for
having a chance to meet so many wonderful people and professional who led me
through this training period.
I am using this opportunity to express my deepest gratitude and special thanks to
Meerut Institute of Engineering & Technology, Meerut who gave us an
opportunity so that we could learn something so important.
I express my deepest thanks to Dr. Ravi Bhagat of Kailash Hospital & Maternity
Home for taking part in useful decision & giving necessary advices and guidance
and arranged all facilities to make life easier. I choose this moment to acknowledge
his contribution gratefully.
I perceive as this opportunity as a big milestone in my career development. I will
strive to use gained skills and knowledge in the best possible way, and I will
continue to work on their improvement.
Thanking You Aditya Chaprana
B. Pharm 3rd
Year
Roll no.: 2000680500005

VISION OF HOSPITAL TRAINING
The vision of the Hospital training is to study the organisation of various
departments, the working and development of the organisation, the present status
of the hospital & future prospects of the organisation. To promote civic sense and
shoulder the responsibilities with full potential by being a ultimate healthcare
Professional and a Responsible Pharmacist.
The overall objectives of the study:
• To study the Hospital structure.
• To know about its products and service activities.
• To know the different functions of all the departments.
• To know the responsibilities of top management and how to execute
responsibility.
• To analyse the working of Hospital using by analysis of various departments.

Department of pharmaceutical technology
Vision Statement of the Department
To be an outstanding department in the country that imparts high quality, need
based, value based and career based education with a strong research programme
to produce self-reliant competitive pharmacy professionals.
Mission Statement of the Department;
• To educate the graduate and undergraduates in the field of pharmaceutical
sciences. To fulfill the requirement of skilled human resources with focus on
sustainable quality education, training and research of students coming from all
socioeconomic levels.
• To convert students into socially responsible and self-reliant competent
professionals, to bridge the gap between the physician and patient and to improve
industry institution interaction.

Department of Pharmaceutical Technology
Meerut Institute of Engineering and Technology, Meerut
Program Educational Objectives (PEOs)
1. To produce pharmacy graduates who are able to apply principles of
pharmaceutical sciences utilizing modern tools and build their career in the
field of pharmaceutical and allied sectors.
2. To produce pharmacy Graduates who are able to demonstrate leadership
skill, problem solving skill and strong communication skills, along with
professional and ethical values.
3. To produce pharmacy graduates who are able to fulfill the needs of skilled
human resources to serve the health care needs of the society.
4. To produce pharmacy graduates who will pursue higher studies and involve
in research and development.

MEERUT INSTITUTE OF ENGINEERING AND TECHNOLOGY,
MEERUT
PROGRAM OUTCOMES (POS)
1. Pharmacy Knowledge: Possess knowledge and comprehension of the core and basic
knowledge associated with the profession of pharmacy, including biomedical sciences;
pharmaceutical sciences; behavioral, social, and administrative pharmacy sciences; and
manufacturing practices.
2. Planning Abilities: Demonstrate effective planning abilities including time management,
resource management, delegation skills and organizational skills. Develop and
implement plans and organize work to meet deadlines.
3. Problem analysis: Utilize the principles of scientific enquiry, thinking analytically, clearly
and critically, while solving problems and making decisions during daily practice. Find,
analyze, evaluate and apply information systematically and shall make defensible
decisions.
4. Modern tool usage: Learn, select, and apply appropriate methods and procedures,
resources, and modern pharmacy-related computing tools with an understanding of the
limitations
5. Leadership skills: Understand and consider the human reaction to change motivation
issues, leadership and team-building when planning changes required for fulfillment of
practice, professional and societal responsibilities. Assume participatory roles as
responsible citizens or leadership roles when appropriate to facilitate improvement in
health and wellbeing.

6. Professional Identity: Understand, analyze and communicate the value of their
professional roles in society (e.g. health care professionals, promoters of health,
educators, managers, employers, employees).
7. Pharmaceutical Ethics: Honour personal values and apply ethical principles in
professional and social contexts. Demonstrate behavior that recognizes cultural and
personal variability in values, communication and lifestyles. Use ethical frameworks;
apply ethical principles while making decisions and take responsibility for the outcomes
associated with the decisions.
8. Communication: Communicate effectively with the pharmacy community and with
society at large, such as, being able to comprehend and write effective reports, make
effective presentations and documentation, and give and receive clear instructions.
9. The Pharmacist and society: Apply reasoning informed by the contextual knowledge to
assess societal, health, safety and legal issues and the consequent responsibilities
relevant to the professional pharmacy practice.
10. Environment and sustainability: Understand the impact of the professional pharmacy
solutions in societal and environmental contexts, and demonstrate the knowledge of,
and need for sustainable development.
11. Life-long learning: Recognize the need for, and have the preparation and ability to
engage in independent and life-long learning in the broadest context of technological
change. Selfassess and use feedback effectively from others to identify learning needs
and to satisfy these needs on an ongoing basis

Table of contents
S.NO TITLE PAGE NO.
1. Introduction 1-4
2. First aid 5-15
3. Handling of prescription 15-18
4. Study of patient observation chart 19
5. Simple diagnostic 20
6. Dispensing 21-22
7. Different Routes of Injection 23-27

INTRODUCTION
A Hospital is a health care institution providing patient treatment with specialized medical and
nursing staff and medical equipment. The best-known type of hospital is the General hospital,
which typically has an emergency department to treat urgent health problems ranging from fire
and accident victims to a heart attack. A district hospital typically is the major health care facility
in its region, with a large number of beds for intensive care and additional beds for patients who
need long-term care. Specialized hospitals include trauma centers, rehabilitation hospitals,
children's hospitals, seniors' (geriatric) hospitals, and hospitals for dealing with specific medical
needs such as psychiatric treatment (see psychiatric hospital) and certain disease categories.
Specialized hospitals can help reduce health care costs compared to general hospitals. Hospitals
are classified as general, specialty, or government depending on the sources of income received.
Pathology is a branch of medical science primarily concerning the cause, origin and nature of
disease. It involves the examination of tissues, organs, bodily fluids and autopsies in order to
study and diagnose disease.
Here are some common tests performed during the hospital training in hospital.
1. Widal test
2. Pregnancy test
3. Glucose test
4. Blood group test
5. Urine test
1. Widal Test
Salmonella typhi and Salmonella paratyphi A, B and C cause enteric fever (typhoid and
paratyphoid) in human. Laboratory diagnosis of enteric fever includes Blood culture, Stool
Culture and Serological test. Widal test is a common agglutination test employed in the
serological diagnosis of enteric fever. This test was developed by Georges Ferdinand Widal in
1896 and helps to detect presence of salmonella antibodies in a patient's serum.

2. Pregnancy test
Pregnancy tests look for a special hormone —human chorionic gonadotropin (HCG) — that only
develops in a person’s body during pregnancy. These tests can use either your pee or blood to
look for HCG. At-home pregnancy tests that use your pee are the most common type. When used
correctly, home pregnancy tests are 99% accurate.
3:Glucose test

Both low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia) are of concern for
patients who take insulin. It is important, therefore, to carefully monitor blood glucose levels. In
general, patients with type 1 diabetes need to take readings four or more times a day. Patients
should aim for the following measurements:
• Pre-meal glucose levels of 70-130 mg/dL
• Post-meal glucose levels of less than 180 mg/dL
Different goals may be required for specific individuals, including pregnant women, very old and
very young people, and those with accompanying serious medical conditions.
Finger-Prick Test. A typical blood sugar test includes the following:
A drop of blood is obtained by pricking the finger.
• The blood is then applied to a chemically treated strip.
• Monitors read and provide results.
Home monitors are less accurate than laboratory monitors and many do not meet the standards of
the American Diabetes Association. However, they are usually accurate enough to indicate when
blood sugar is too low.

To monitor the amount of glucose within the blood a person with diabetes should test their blood
regularly. The procedure is quite simple and can often be done at home.
Some simple procedures may improve accuracy:
• Testing the meter once a month.
• Recalibrating it whenever a new packet of strips is used.
• Using fresh strips; outdated strips may not provide accurate results.
•Keeping the meter clean.
• Periodically comparing the meter results with the results from a laboratory
4: Blood group test
A test kit can be used to test blood type. It involves pricking finger and placing a drop of blood
on a card that will react to a serum on the card that contains antibodies. Now we will be given
the opportunity to test blood type using this technique.

In accordance with the original meaning of the word, hospitals were originally "places of
hospitality", and this meaning is still preserved in the names of some institutions such as the
Royal Hospital Chelsea, established in 1681 as a retirement and nursing home for veteran
soldiers. Some of the Training parts are as Follows:
 FIRST AID (wound dressing, artificial respiration) .
 HANDLING OF PRESCRIPTION
 STUDY OF PATIENT OBSERVATION CHART
 SIMPLE DIGNOSTIC
 DISPENSING
 DIFFERENT ROUTES OF INJECTION HOSPITAL TRAINING
FIRST AID
First aid is the first help or assistance given to any person suffering a sudden illness or injury,
with care provided to preserve life, prevent the condition from worsening, and/or promote
recovery. It includes initial intervention in a serious condition prior to professional medical help
being available, such as performing CPR while awaiting an ambulance, as well as the complete
treatment of minor conditions, such as applying a plaster to a cut. First aid is generally performed
by the layperson, with many people trained in providing basic levels of first aid, and others
willing to do so from acquired knowledge. Mental health first aid is an extension of the concept
of first aid to cover mental health. There are many situations which may require first aid, and
many countries have legislation, regulation, or guidance which specifies a minimum level of first

aid provision in certain circumstances. This can include specific training or equipment to be
available in the workplace (such as an Automated External Defibrillator), the provision of
specialist first aid cover at public gatherings, or mandatory first aid training within schools. First
aid, however, does not necessarily require any particular equipment or prior knowledge, and can
involve improvisation with materials available at the time, often by untrained persons. First aid
can be performed on all mammals, although this article relates to the care of human patients.
AIMS OF FIRST AID
The key aims of first aid can be summarized in three key points, sometimes known as 'the three
P's'.
Preserve life: The overriding aim of all medical care which includes first aid, is to save lives and
minimize the threat of death.
Prevent further harm: Prevent further harm also sometimes called prevent the condition from
worsening, or danger of further injury, this covers both external factors, such as moving a patient
away from any cause of harm, and applying first aid techniques to prevent worsening of the
condition, such as applying pressure to stop a bleed becoming dangerous.
Promote recovery: First aid also involves trying to start the recovery process from the illness or
injury, and in some cases might involve completing a treatment, such as in the case of applying a
plaster to a small wound.
SKILLS OF FIRST AID
Certain skills are considered essential to the provision of first aid and are taught ubiquitously.
Particularly the "ABC"s of first aid, which focus on critical life-saving intervention, must be
rendered before treatment of less serious injuries. ABC stands for Airway, Breathing, and
Circulation. The same mnemonic is used by all emergency health professionals. Attention must
first be brought to the airway to ensure it is clear. Obstruction (choking) is a life-threatening
emergency. Following evaluation of the airway, a first aid attendant would determine adequacy
of breathing and provide rescue breathing if necessary. Assessment of circulation is now not
usually carried out for patients who are not breathing, with first aiders now trained to go straight
to chest compressions (and thus providing artificial circulation) but pulse checks may be done on
less serious patients. Some organizations add a fourth step of "D" for Deadly bleeding or
Defibrillation, while others consider this as part of the Circulation step. Variations on techniques
to evaluate and maintain the ABCs depend on the skill level of the first aider. Once the ABCs are
secured, first aiders can begin additional treatments, as required. Some organizations teach the
same order of priority using the "3Bs": Breathing, Bleeding, and Bones (or "4Bs": Breathing,
Bleeding, Burns, and Bones). While the ABCs and 3Bs are taught to be performed sequentially,
certain conditions may require the consideration of two steps simultaneously. This includes the
provision of both artificial respiration and chest compressions to someone who is not

breathing and has no pulse, and the consideration of cervical spine injuries when ensuring an
open airway
SPECIFIC DISCIPLINES OF FIRST AID
There are several types of first aid (and first aider) which require specific additional training.
These are usually undertaken to fulfill the demands of the work or activity undertaken.
Aquatic/Marine first aid is usually practiced by professionals such as lifeguards, professional
mariners or in diver rescue, and covers the specific problems which may be faced after
waterbased rescue and/or delayed MedEvac.
Battlefield first aid takes into account the specific needs of treating wounded combatants and
non-combatants during armed conflict.
Hyperbaric first aid may be practiced by SCUBA diving professionals, who need to treat
conditions such as the bends.
Oxygen first aid is the providing of oxygen to casualties who suffer from conditions resulting in
hypoxia.
Wilderness first aid is the provision of first aid under conditions where the arrival of emergency
responders or the evacuation of an injured person may be delayed due to constraints of terrain,
weather, and available persons or equipment. It may be necessary to care for an injured person
for several hours or days.
•Mental health first aid is taught independently of physical first aid. How to support someone
experiencing a mental health problem or in a crisis situation. Also how to identify the first signs
of someone developing mental ill health and guide people towards appropriate help.
CONDITION THAT OFTEN REQUIRE FIRST AID
• Altitude sickness, which can begin in susceptible people at altitudes as low as 5,000 feet, can
cause potentially fatal swelling of the brain or lungs.
•Anaphylaxis, a life-threatening condition in which the airway can become constricted and the
patient may go into shock. The reaction can be caused by a systemic allergic reaction to allergens
such as insect bites or peanuts. Anaphylaxis is initially treated with injection of epinephrine.
• Battlefield -This protocol refers to treating shrapnel, gunshot wounds, burns, bone fractures,
etc. as seen either in the traditional battlefield setting or in an area subject to damage by
largescale weaponry, such as a bomb blast.
• Bone fracture, a break in a bone initially treated by stabilizing the fracture with a splint.
• Burns, which can result in damage to tissues and loss of body fluids through the burn site.

• Cardiac Arrest, which will lead to death unless CPR preferably combined with an AED is
started within minutes. There is often no time to wait for the emergency services to arrive as 92
percent of people suffering a sudden cardiac arrest die before reaching hospital according to the
American Heart Association.
•Choking, blockage of the airway which can quickly result in death due to lack of oxygen if the
patient's trachea is not cleared, for example by the Heimlich Maneuver.
• Childbirth.
•Cramps in muscles due to lactic acid build up caused either by inadequate oxygenation of
muscle or lack of water or salt.
•Diving disorders, drowning or asphyxiation.
•Gender-specific conditions, such as dysmenorrhea and testicular torsion.
•Heart attack, or inadequate blood flow to the blood vessels supplying the heart muscle.
• Heat stroke, also known as sunstroke or hyperthermia, which tends to occur during heavy
exercise in high humidity, or with inadequate water, though it may occur spontaneously in some
chronically ill persons. Sunstroke, especially when the victim has been unconscious, often causes
major damage to body systems such as brain, kidney, liver, gastric tract. Unconsciousness for
more
than two hours usually leads to permanent disability. Emergency treatment involves rapid
cooling of the patient.
•Hair tourniquet a condition where a hair or other thread becomes tied around a toe or finger
tightly enough to cut off blood flow.
• Heat syncope, another stage in the same process as heat stroke, occurs under similar conditions
as heat stroke and is not distinguished from the latter by some authorities.
•Heavy bleeding, treated by applying pressure (manually and later with a pressure bandage) to
the wound site and elevating the limb if possible
•Hyperglycemia (diabetic coma) and Hypoglycemia (insulin shock).
•Hypothermia, or Exposure, occurs when a person's core body temperature falls below 45.7 °C
(92.6 °F). First aid for a mildly hypothermic patient includes rewarming, which can be achieved
by wrapping the affected person in a blanket, and providing warm drinks, such as soup, and high
energy food, such as chocolate. However, rewarming a severely hypothermic person could result
in a fatal arrhythmia, an irregular heart rhythm.
• Insect and animal bites and stings.

• Joint dislocation.
• Poisoning, which can occur by injection, inhalation, absorption, or ingestion.
• Seizures, or a malfunction in the electrical activity in the brain. Three types of seizures include
a grand mal (which usually features convulsions as well as temporary respiratory
abnormalities,change in skin complexion, etc.) and petit mal (which usually features twitching,
rapid blinking, and/or fidgeting as well as altered consciousness and temporary respiratory
abnormalities).
• Muscle strains and Sprains, a temporary dislocation of a joint that immediately reduces
automatically but may result in ligament damage.
• Stroke, a temporary loss of blood supply to the brain.
• Toothache, which can result in severe pain and loss of the tooth but is rarely life-threatening,
unless over time the infection spreads into the bone of the jaw and starts osteomyelitis.
•Wounds and bleeding, including lacerations, incisions and abrasions, Gastrointestinal bleeding,
avulsions and Sucking chest wounds, treated with an occlusive dressing to let air out but not in.
FIRST AID KIT
A first aid kit is a collection of supplies and equipment that is used to give medical treatment,
and can be put together for the purpose by an individual or organization or purchased complete.
There is a wide variation in the contents of first aid kits based on the knowledge and experience
of those putting it together, the differing first aid requirements of the area where it may be used
and variations in legislation or regulation in a given area. The international standard for first aid
kits is that they should be identified with the ISO graphical symbol for first aid (from ISO 7010)
which is an equal white cross on a green background, although many kits do not comply with
this standard, either because they are put together by an individual or they predate the standards.
First aid kits can be assembled in almost any type of container, and this will depend on whether
they are commercially produced or assembled by an individual. Standard kits often come in
durable plastic boxes, fabric pouches or in wall mounted cabinets. The type of container will
vary depending on purpose, and they range in size from wallet sized through to large rucksacks.
It is recommended that all kits are in a clean, waterproof container to keep the contents safe and
aseptic.Kits should also be checked regularly and restocked if any items are damaged or are
expired out of date.
CONTENTS OF FIRST AID KIT
•Commercially available first aid kits available via normal retail routes have traditionally been
intended for treatment of minor injuries only. Typical contents include adhesive bandages,
regular strength pain medication, and gauze and low grade disinfectant. Specialized first aid kits

are available for various regions, vehicles or activities, which may focus on specific risks or
concerns related to the activity. For example, first aid kits sold through marine supply stores for
use in watercraft may contain seasickness remedies. AIRWAY, BREATHING AND
CIRCULATION.
•First aid treats the ABCs as the foundation of good treatment. For this reason, most modern
commercial first aid kits (although not necessarily those assembled at home) will contain a
suitable infection barrier for performing artificial respiration as part of cardiopulmonary
resuscitation, examples include:
• Pocket mask
• Face shield
• Advanced first aid kits may also contain items such as:
Or pharyngeal airway
• Nasopharyngeal airway
• Bag valve mask
• Manual aspirator or suction unit
• Sphygmomanometer (blood pressure cuff).
• Stethoscope
• The common kits mostly found in the homes may contain: Alcohol, Band-Aids, Cotton Balls,
Cotton Swabs, Iodine, Bandage, and Hydrogen Peroxide.
TRAUMA INJURIES
• Trauma injuries, such as bleeding, bone fractures or burns, are usually the main focus of most
first aid kits, with items such as bandages and dressings being found in the vast majority of all
kits.
• Adhesive bandages (Band-Aids, sticking plasters) - can include ones shaped for particular body
parts, such as knuckles o Moleskin-for blister treatment and prevention.
Dressings (sterile, applied directly to the wound) o Sterile eye pads o Sterile gauze pads o Sterile
non-adherent pads, containing a non-stick teflon layer of Petrolatum gauze pads, used as an
occlusive (air-tight) dressing for sucking chest wounds, as well as a non-stick dressing
. Bandages (for securing dressings, not necessarily sterile) o Gauze roller bandages - absorbent,
breathable, and often elastic o Elastic bandages - used for sprains, and pressure bandages o

Adhesive, elastic roller bandages (commonly called 'Vet wrap') very effective pressure bandages
and durable, waterproof bandaging. Triangular bandages - used as slings, tourniquets, to tie
splints, and many other uses. -
• Butterfly closure strips - used like stitches to close wounds, usually only included for higher
level response as can seal in infection in uncleansed wounds.
• Saline-used for cleaning wounds or washing out foreign bodies from eyes.
Soap - used with water to clean superficial wounds once bleeding is stopped.
• Antiseptic wipes or sprays for reducing the risk of infection in abrasions or around wounds.
Dirty wounds must be cleaned for antiseptics to be effective.
• Burn dressing, which is usually a sterile pad soaked in a cooling gel.
• Adhesive tape, hypoallergenic.
• Hemostatic agents may be included in first aid kits, especially military or tactical kits, to
promote clotting for severe bleeding..
PERSONAL PROTECTIVE EQUIPMENT
• The use of personal protective equipment or PPE will vary by kit, depending on its use and
anticipated risk of infection. The adjuncts to artificial respiration are covered above, but other
common infection control PPE includes:
• Gloves which are single use and disposable to prevent cross infection Goggles or other eye
protection
Surgical mask or N95 mask to reduce possibility of airborne infection transmission (sometimes
placed on patient instead of caregivers. For this purpose the mask should not have an exhale
valve).
● Apron
INSTRUMENTS AND EQUIPMENTS
• Trauma shears for cutting clothing and general use.
• Scissors are less useful but often included.
• Tweezers, for removing splinters amongst others.
Lighter for sanitizing tweezers or pliers etc.

• Alcohol pads for sanitizing equipment, or unbroken skin. This is sometimes used to debride
wounds, however some training authority'sadvice against this as it may kill cells which bacteria
can then feed on.
• Irrigation syringe - with catheter tip for cleaning wounds with sterile water, saline solution, or a
weak iodine solution. The stream of liquid flushes out particles of dirt and debris. • Torch (also
known as a flashlight).
• Instant-acting chemical cold packs.
• Alcohol rub (hand sanitizer) or antiseptic hand wipes.
• Thermometer
Space blanket (lightweight plastic foil blanket, also known as "emergency blanket"). Penlight. .
Cotton swab
• Cotton wool, for applying antiseptic lotions.
• Safety pins, for pinning bandages.
MEDICATION
Medication can be a controversial addition to a first aid kit, especially if it is for use on members
of the public. It is, however, common for personal or family first aid kits to contain certain
medications. Dependent on scope of practice, the main types of medicine are lifesaving
medications, which may be commonly found in first aid kits used by paid or assigned first aiders
for members of the public or employees, painkillers, which are often found in personal kits, but
may also be found in public provision and lastly symptomatic relief medicines, which are
generally only found in personal kits.
LIFE SAVING:
• Aspirin primarily used for central medical chest pain as an anti-platelet.
● Epinephrine auto injector (brand name Epipen) - often included in kits for wilderness use and
in places such as summer camps, to temporarily reduce airway swelling in the event of
anaphylactic shock. Note that epinephrine does not treat the anaphylactic shock itself, it only
opens the airway to prevent suffocation and allow time for other treatments to be used or help to
arrive. The effects of epinephrine (adrenaline) are short-lived, and swelling of the throat may
return, requiring the use of additional epipens until other drugs can take effect, or more advanced
airway methods (such as intubation) can be established.
•Diphenhydramine (Brand name:-Benadryl) - Used to treat or prevent anaphylactic shock. Best
administered as soon as symptoms appear when impending anaphylactic shock is suspected Once

the airway is restricted, oral drugs can no longer be administered until the airway is clear again,
such as after the administration of an epipen. A common recommendation for adults is to take
two 25mg pills.
Non-solid forms of the drug, such as liquid or dissolving strips, may be absorbed more rapidly
than tablets or capsules and therefore more effective in an emergency.
PAIN KILLERS:
• Paracetamol (also known as Acetaminophen) is one of the most common pain killing
medication, as either tablet or syrup.
• Anti-inflammatory painkillers such as Ibuprofen, Naproxen or other NSAIDs can be used as
part of treating sprains and strains.
• Codeine which is both a painkiller and anti-diarrheal.
SYMPTOMATIC RELIEF:
Anti-diarrhea medication such as Loperamide - especially important in remote or third world
locations where dehydration caused by diarrhea is a leading killer of children
• Oral rehydration salts
• Antihistamine, such as diphenhydramine
Poison treatments
• Absorption, such as activated charcoal.
• Emetics to induce vomiting, such as syrup of ipecac although first aid manuals now advise
against inducing vomiting.
• Smelling Salts (ammonium carbonate).
ARTIFICIAL RESPIRATION
Artificial ventilation, also called artificial respiration is any means of assisting or stimulating
respiration, a metabolic process referring to the overall exchange of gases in the body by
pulmonary ventilation, external respiration, and internal respiration. It may take the form of
manually providing air for a person who is not breathing or is not making sufficient respiratory
effort on his/her own, or it may be mechanical ventilation involving the use of a mechanical
ventilator to move air in and out of the lungs when an individual is unable to breathe on their
own, for example during surgery with general anesthesia or when an individual is in a coma.
Pulmonary Anton ventilation (and hence external parts of respiration) is achieved through

manual insufflation of the lungs either by the rescuer blowing into the patient's lungs (mouth-to
mouth resuscitation), or by using a mechanical device to do so. This method of insufflation has
been proved more effective than methods which involve mechanical manipulation of the patient's
chest or arms, such as the Silvester method. It is also known as EXPIRED AIR
RESUSCITATION (EAR), EXPIRED AIR VENTILATION (EAV), MOUTH TO MOUTH
RESUSCITATION, RESCUE BREATHING or colloquially the KISS OF LIFE.
In some situations, mouth to mouth is also performed separately, for instance in near-drowning
and opiate overdoses.
The performance of mouth to mouth in its own is now limited in most protocols to health
professionals, whereas lay first aiders are advised to undertake full CPR in any case where the
patient is not breathing sufficiently.
Mechanical ventilation: Mechanical ventilation is a method to mechanically assist or replace
spontaneous breathing. This may involve a machine called a ventilator or the breathing may be
assisted by a registered nurse, physician, physician Associate, respiratory therapist, paramedic, or
other suitable person compressing a bag valve mask or set of bellows.
Mechanical ventilation is termed "invasive" if it involves any instrument penetrating through the
mouth (such as an endotracheal tube) or the skin (such as a tracheostomy tube). There are two
main modes of mechanical ventilation within the two divisions: positive pressure ventilation,
Where air (or another gas mix) is pushed into the trachea, and negative pressure ventilation,
where air is, in essence, sucked into the lungs. Tracheal intubation is often used for short term
mechanical Ventilation. A tube is inserted through the nose (nasotracheal intubation) or mouth
(orotracheal intubation) and advanced into the trachea. In most cases tubes with inflatable cuffs
are used for protection against leakage and aspiration. Intubation with a cuffed tube is thought to
provide the best protection against aspiration. Tracheal tubes inevitably cause pain and coughing.
Therefore, unless a patient is unconscious or anesthetized for other reasons, sedative drugs are
usually given to provide tolerance of the tube. Other disadvantages of tracheal intubation include
damage to the mucosal lining of the nasopharynx or oropharynx and subglottic stenosis. There
are two main types of mechanical ventilation: positive pressure ventilation, where air (or another
gas mix) is pushed into the lungs through the airways, and negative pressure ventilation, where
air is, in essence, sucked into the lungs by stimulating movement of the chest. Apart from these
two main types there are many specific modes of mechanical ventilation, and their nomenclature
has been revised over the decades as the technology has continually developed.
Mechanical ventilation is indicated when the patient's spontaneous ventilations inadequate to
maintain life. It is also indicated as prophylaxis for imminent collapse of other physiologic
functions, or ineffective gas exchange in the lungs. Because mechanical ventilation serves only
to provide assistance for breathing and does not cure a disease, the patient's underlying condition

should be correctable and should resolve over time. In addition, other factors must be taken into
consideration because mechanical ventilation is not without its complications
In general, mechanical ventilation is instituted to correct blood gases and reduce the work of
breathing.
Common medical indications for use include:
•Acute lung injury (including ARDS, trauma)
•Apnea with respiratory arrest, including cases from intoxication
•Acute severe asthma, requiring intubation
•Acute on chronic respiratory acidosis most commonly with Chronic obstructive pulmonary
disease (COPD) and obesity hypoventilation syndrome
•Acute respiratory acidosis with partial pressure of carbon dioxide (PCO 2) > 50 mmHg and pH
< 7.25, which may be due to paralysis of the diaphragm due to Guillain-Barré syndrome,
myasthenia gravis, motor neuron disease, spinal cord injury, or the effect of anesthetic and
muscle relaxant drugs
• Increased work of breathing as evidenced by significant tachypnea, retractions, and other
physical signs of respiratory distress[³]
• Hypoxemia 2) 2) = 1.0 with arterial partial pressure of oxygen and (PaO55 mm Hg with
supplemental fraction of inspired oxygen (FIO
•Hypotension including sepsis, shock, congestive heart failure
•Neurological diseases such as muscular dystrophy and amyotrophic lateral sclerosis.
HANDLING OF PRESCRIPTION
A prescription is a health-care program implemented by a physician or other qualified health care
practitioner in the form of instructions that govern the plan of care for an individual patient. The
term often refers to a health care provider's written authorization for a patient to purchase a
prescription drug from a pharmacist. Prescriptions may be entered into an electronic medical
record system and transmitted electronically to a pharmacy. Alternatively, a prescription may be
handwritten on preprinted prescription forms that have been assembled into pads, or printed onto
similar forms using a computer printer. In some cases, a prescription may be transmitted from
the physician to the pharmacist orally by telephone; this practice may increase the risk of
medical error. The content of a prescription includes the name and address of the prescribing
provider and any other legal requirement such as a registration number (e.g. DEA Number in the
United States). Unique for each prescription is the name of the patient. Each prescription is dated
and some jurisdictions may place a time limit on the prescription. In the past, prescriptions
contained instructions for the pharmacist to use for compounding the pharmaceutical product but

most prescriptions now specify pharmaceutical products that were manufactured and require
little or no preparation by the pharmacist. Prescriptions also contain directions for the patient to
follow when taking the drug. These directions are printed on the label of the pharmaceutical
product.
The word "prescription", from "pre-" ("before") and "script" ("writing, written"), refers to the
fact that the prescription is an order that must be written down before a compound drug can be
prepared. Those within the industry will often call prescriptions simply "scripts".
'Rx' is a symbol meaning "prescription". It is sometimes transliterated as "Rx" or just "Rx". This
symbol originated in medieval manuscripts as an abbreviation of the Late Latin verb recipe, the
imperative form of recipe, "to take" or "take thus". Literally, the Latin word recipe means simply
"Take...!" and medieval prescriptions invariably began with the command to "take" certain
materials and compound them in specified ways.
Contents
In some countries, drug companies use direct-to-prescriber advertising in an effort to convince
prescribers to dispense as written with brand-name products rather than generic drugs. Many
brand name drugs have cheaper generic drug substitutes that are therapeutically and
biochemically equivalent. Prescriptions will also contain instructions on whether the prescriber
will allow the pharmacist to substitute a generic version of the drug. This instruction is
communicated in a number of ways. In some jurisdictions, the preprinted prescription contains
two signature lines: one line has "dispense as written" printed underneath; the other line has
"substitution permitted" underneath. Some have a preprinted box "dispense as written" for the
prescriber to check off (but this is easily checked off by anyone with access to the prescription).
Other jurisdictions the protocol is for the prescriber to handwrite one of the following phrases:
"dispense as written", "DAW", "brand necessary", "do not substitute", "no substitution",
"medically necessary", "do not interchange". In other jurisdictions they may use completely.
Different languages, never mind a different formula of words. In some jurisdictions, it may be a
legal requirement to include the age of child on the prescription. For pediatric prescriptions some
advice the inclusion of the age of the child if the patient is less than twelve and the age and
months if less than five. (In general, including the age on the prescription is helpful.) Adding the
weight of the child is also helpful. Prescriptions often have a "label" box. When checked, the
pharmacist is instructed to label the medication. When not checked, the patient only receives
instructions for taking the medication and no information about the prescription itself. Some
prescribers further inform the patient and pharmacist by providing the indication for the
medication; i.e. what is being treated. This assists the pharmacist in checking for errors as many
common medications can be used for multiple medical conditions. Some prescriptions will
specify whether and how many "repeats" or "refills" are allowed; that is whether the patient may
obtain more of the same medication without getting a new prescription from the medical
practitioner. Regulations may restrict some types of drugs from being refilled. In group practices,
the preprinted portion of the prescription may contain multiple prescribers' names. Prescribers
typically circle themselves to indicate who is prescribing or there may be a checkbox next to
their name.

Who can write prescriptions (that may legally be filled with prescription-only items?)
National or local (i.e. state or provincial) legislation governs who can write a prescription. In the
United States, physicians (M.D., D.O., or D.P.M) have the broadest prescriptive authority. All 50
states and the District of Columbia allow licensed certified Physician Associates (PAS)
prescription authority (with some states, limitations exist to controlled substances). All 50 states
allow registered certified nurse practitioners and other advanced practice registered nurses (such
as certified nurse-midwives) prescription power (with some states including limitations to
controlled substances). Many other healthcare professions also have prescriptive authority
related to their area of practice. Veterinarians and dentists have prescribing power in all 50 states
and the District of Columbia. Clinical pharmacists are allowed to prescribe in some states
through the use of a drug formulary or collaboration agreements. Florida pharmacists can write
prescriptions for a limited set of drugs. In all states, optometrists prescribe medications to treat
certain eye diseases, and also issue spectacle and contact lens prescriptions for corrective
eyewear. Several states have passed RxP legislation, allowing clinical psychologists (PhDs or
PsyDs) who are registered as medical psychologists and have also undergone specialized training
in script-writing to prescribe drugs to treat emotional and mental disorders. Chiropractors may
have the ability to write a prescription, depending on scope of practice laws in a jurisdiction.
LEGIBILITY
Prescriptions, when handwritten, are notorious for being often illegible. In the US, illegible
handwriting is at least indirectly responsible for the deaths of 7,000 people annually, according
to a July 2006 report from the National Academies of Science's Institute of Medicine (IOM).
Historically, physicians used Latin words and abbreviations to convey the entire prescription to
the pharmacist. Today, many of the abbreviations are still widely used and must be understood to
interpret prescriptions. At other times, even though some of the individual letters are illegible,
the position of the legible letters and length of the word is sufficient to distinguish
The medication based on the knowledge of the pharmacist. When in doubt, pharmacists call the
medical practitioner. Some jurisdictions have legislated legible prescriptions (e.g. Florida). Some
have advocated the elimination of handwritten prescriptions altogether and computer printed
prescriptions are becoming increasingly common in some places
Conventions for avoiding ambiguity
Over the years, prescribers have developed many conventions for prescription-writing, with the
goal of avoiding ambiguities or misinterpretation.
These include:
•Careful use of decimal points to avoid ambiguity:
• Avoiding unnecessary decimal points: a prescription will be written as 5 mL instead of 5.0 mL
to avoid possible misinterpretation of 5.0 as 50.
• Always using zero prefix decimals: e.g. 0.5 instead of .5 to avoid misinterpretation of .5 as 5.

Avoiding trailing zeros on decimals: e.g. 0.5 instead of .50 or 0.50 to avoid misinterpretation of
.50 as 50.
•"mL" is used instead of "cc" or "cm³" even though they are technically equivalent to avoid
misinterpretation of 'c' as '0' or the common medical abbreviation for "with" (the Latin "cum"),
which is written as a 'c' with a bar above the letter. Further, cc could be misinterpreted as "c.c.",
which is a rarely used abbreviation for "take with meals" (the Latin "cum ciao")
• Directions written out in full in English (although some common Latin abbreviations are listed
below).
• Quantities given directly or implied by the frequency and duration of the directions.
• Where the directions are "as needed", the quantity should always be specified.
• Where possible, usage directions should specify times (7 am, 3 pm, and 11 pm) rather than
simply frequency (three times a day) and especially relationship to meals for orally consumed
medication.
• The use of permanent ink.
• Avoiding units such as "teaspoons" or "tablespoons."
• Writing out numbers as words and numerals ("dispense #30 (thirty)") as in a bank draft or
cheque.
• The use of the degree symbol (°), which is commonly used as an abbreviation for hours (e.g.,
"q 2-4°" for every 2 4 hours), should not be used, since it can be confused with a '0'. Further, the
use of the degree symbol for primary, secondary, and tertiary (1°, 2°, and 3°) is discouraged,
since the former could be confused with quantities (i.e. 10, 20 and 30, respectively).
• The use of apothecary/avoirdupois units and symbols of measure - pints (O), ounces (3), drams
(3), scruples (3), grains (gr), and minims (m) -- is discouraged given the potential for confusion.
For example, the abbreviation for a grain ("gr") can be confused with the gram, abbreviated g,
and the symbol for minims (m), which looks almost identical to an 'm', can be confused with
micrograms or meters. Also, the symbols for ounce (3) and dram (3) can easily be confused with
the
numeral '3', and the symbol for pint (O) can be easily read as a '0'. Given the potential for errors,
metric equivalents should always be used.

STUDY OF PATIENT OBSERVATION AND RESPONSE CHART
In medicine, monitoring is the observation of a disease, condition or one or several medical
parameters over time. It can be performed by continuously measuring certain parameters by
using a medical monitor (for example, by continuously measuring vital signs by a bedside
monitor), and/or by repeatedly performing medical tests (such as blood glucose monitoring with
glucose meter in people with diabetes mellitus). Monitoring and documenting physiological
observations is a key component of recognition and response systems. An observation and
response chart is a document that allows the recording of patient observations, and specifies the
action to be taken in response to deterioration from the norm. The purpose of these charts is to
support accurate and timely recognition of clinical deterioration, and prompt action when
deterioration is observed. The way in which observation charts are designed and used can
contribute to both the poor recording of observations and failure to interpret them correctly.
Observation and response charts should:
• Be designed according to human factor principle.
• Have the capacity to record the core physiological observations specified in element 1.6 of the
National Consensus Statement (respiratory rate, oxygen saturation, heart rate, blood pressure,
temperature and level of consciousness).
• Specify the physiological parameters and other factors that trigger an escalation of care.
• Specify the actions require when care is escalated.
Prototype general observation chart section

SIMPLE DIGNOSTICS REPORTS
Many mental health professionals use the manual to determine and help communicate a patient's
diagnosis after an evaluation; hospitals, clinics, and insurance companies in the US also
generally require a DSM diagnosis for all patients treated. The DSM can be used clinically in
this way, and also to categorize patients using diagnostic criteria for research purposes. Studies
done on specific disorders often recruit patients whose symptoms match the criteria listed in the
DSM for that disorder. An international survey of psychiatrists in 66 countries comparing use of
the ICD-10 and found the former was more often used for clinical diagnosis while the latter was
more valued for research A diagnostic test is a procedure performed to confirm, or determine the
presence of disease in an individual suspected of having the disease, usually following the report
of symptoms, or based on the results of other medical tests. This includes posthumous diagnosis.
Such tests include
• Utilizing nuclear medicine techniques to examine a patient having a lymphoma.
• Measuring the blood sugar in a person suspected of having diabetes mellitus, after periods of
increased urination.
• Taking a complete blood count of an individual experiencing a high fever, to check for a
bacterial infection.
The Diagnostic Report resource is a suitable for the following kinds of diagnostic reports:
• Laboratory (Clinical Chemistry, Hematology, Microbiology etc.
•Pathology / Histopathology / related disciplines.
• Imagine Investigations (X-Ray, CT scan, MRI etc.)
• Other diagnostics - Cardiology, Gastroenterology etc. The Diagnostic Report resource is not
intended to support cumulative result presentation (tabular presentation of past and present result
in the resource). The Diagnostic Report resource does not yet provide full support for detailed
structured reports of sequencing; this is planned for a future release.

DISPENSING
Remote dispensing is used in health care environments to describe the use of automated systems
to dispense (package and label) prescription medications without an on-site pharmacist. This
practice is most common in long-term care facilities and correctional institutions that do not find
it practical to operate a full-service in-house pharmacy.[citation needed] Remote dispensing can
also be used to describe the pharmacist controlled mote prescription dispensing units which
connect patients to a remotely located pharmacist over video interface to receive counseling and
medication dispensing. Because these units are pharmacist
controlled, the units can be located outside of typical healthcare settings such as employer sites,
universities and remote locations, thus offering pharmacy services where they have previously
never existed before.
A typical remote-dispensing system
A typical remote-dispensing system is monitored remotely by a central pharmacy and includes
secure, automated medication dispensing hardware that is capable of producing patient-specific
packages of medications on demand. The secure medication dispensing unit is placed on-site at
the care facility or non-healthcare locations (such as Universities, workplaces and retail
locations) and filled with pharmacist-checked medication canisters. [Citation needed] When
patient medications are needed, the orders are submitted to a pharmacist at the central pharmacy,
the pharmacist reviews the orders and, when approved, the medications are subsequently
dispensed from the on-site dispensing unit at the remote care facility. Medications come out of

the dispensing machine printed with the patient's name, medication name, and other relevant
information. If the medication stock in a canister is low, the central pharmacy is alerted to fill a
canister from their bulk stock. New canisters are filled, checked by the pharmacist, security
sealed, and delivered to the remote care facility.
Perceived Advantages
In theory, access to dispensing services 24 hours a day in locations previously unable to support
full pharmacy operations. Advocates for remote dispensing additionally claim that the service
provides focused, uninterrupted and personalized time with a pharmacist as the system manages
the physical dispensing process while the pharmacist simply oversees it. Certain prescription
dispensing units can carry over 2000 different medications [citation needed] tailored to the
prescribing habits of local healthcare providers? Furthermore, remote dispensing terminal
manufacturers state that this technology can facilitate patient continuity of care between
prescriber and pharmacist.
Disadvantages
While some may purport that travel time to pharmacies is reduced, this point has been negated
by an Ontarian study published in the journal Healthcare Policy as over 90% of Ontarians live
within a 5 km radius of a pharmacy. [1] Remote dispensing also places a physical barrier
between the patient and pharmacist, limiting the pharmacist's ability to detect a patient's
nonverbal cues. A patient with alcohol on his or her breath would go undetected via remote
dispensing, increasing the risk for dangerous interactions with drugs such as tranquilizers,
sleeping pills, narcotics, and Warfarin to name a few. This problem may be amplified through
telecommunication service disruptions, which were reported in previous studies examining the
utility of remote dispensing technology.

DIFFERENT ROUTE OF INJECTIONS
1:Parental routes of administration
An injection is an infusion method of putting fluid into the body, usually with a syringe and a
hollow needle which is pierced through the skin o a sufficient depth for the material to be

administered into the body.
1. Intradermal injection
Intradermal injection of small amounts of material into the corium or substance of the skin, done
in diagnostic procedures and in administration of regional anesthetics, as well as in treatment
procedures. In certain allergy tests, the allergen is injected intracutaneously.
2. Intramuscular injection
Intramuscular injection injection into the substance of a muscle, usually the muscle of the upper
arm, thigh, or buttock. Intramuscular injections are given when the substance is to be absorbed
quickly. They should be given with extreme care, especially in the buttock, because the sciatic
nerve may be injured or a large blood vessel may be entered if the injection is not made correctly
into the upper, outer quadrant of the buttock.
3. Subcutaneous injection
Subcutaneous injection injection made into the subcutaneous tissues. Although usually fluid
medications are injected, occasionally solid materials such as steroid hormones may be injected
in small, slowly absorbed pellets to prolong their effect. Subcutaneous injections may be given
wherever there is subcutaneous tissue, usually in the upper outer arm or thigh.

5. Intravenous injection
Intravenous is a term that means "into the vein". Intravenous medication administration occurs
when a needle is inserted into a vein and medication is administered through that needle. The
needle is usually placed in a vein near the elbow, the wrist, or on the back of the hand. Different
sites can be used if necessary.
List of Injections
Various injections and vaccines are used in department of pharmacy, some of them are:
Vaccines
Tetanus
Anti-rabies vaccines (ARV)
Anti-snake venom (ASV
Hepatitis

Injections
Antibiotics ( Gentamycin 80mg, Ampicillin 500mg, Monoceff 500mg, Ciprofloxacin 500mg.
Metrogyl 400mg, Tetracycline 500mg, etc )
Steroids (Dexamethasone Sodium Phosphate Injection 4mg. Betamethasone injection)
Hydrocortisone Sodium Succinate injection 100mg
Antiemetic (Metoclopramide HCL Injection 10mg. Ondem 10mg)
Gastritis (Ranitidine HCL Injection 150mg, Omeprazole 20 mg. Pan tab 20mg, Homotidine
20mg)
Anti-allergic ( Phenaramine maleate 25mg )
Injection pain
The pain of an injection may be lessened by prior application of ice or topical anesthetic, or
simultaneous pinching of the skin. Recent studies suggest that forced coughing during an
injection stimulates a transient rise in blood pressure which inhibits the perception of pain.
Sometimes, as with an amniocentesis, a local anesthetic is given. The most common technique to
reduce the pain of an injection is simply to distract the patient. Babies can be distracted by giving
them a small amount of sweet liquid, such as sugar solution, during the injection, which reduces
crying.
Injection safety
40% of injections worldwide are administered with unsterilized, reused syringes and needles, and
in some countries this proportion is 70%, exposing millions of people to infections .Another risk
is poor collection and disposal of dirty injection equipment, which exposes healthcare workers
and the community to the risk of needle stick injuries. In some countries, unsafe disposal can
lead to re-sale of used equipment on the black market. Many countries have legislation or
policies that mandate that healthcare professionals use a safety syringe (safety engineered
needle) or alternative methods of administering medicines whenever possible. Open burning of
syringes, which is considered unsafe by the World Health Organization, is reported by half of the
non-industrialized countries. According to one study, unsafe injections cause an estimated 1.3
million early deaths each year. To improve injection safety, the WHO recommends:
1. Changing the behavior of health care workers and patients

2. Ensuring the availability of equipment and supplies.
3. Managing waste safely and appropriately a needle tract infection is an infection that occurs
when pathogenic micro-organisms are seeded into the tissues of the body during an injection.
[Such infections are also referred to as needle stick infections.]

CONCLUSION
The project Hospital Training is the working in a hospital. The process takes care
of all the requirements of an average hospital and is capable to provide easy and
effective storage of information related to patients that come up to the hospital.
It generates test reports; provide prescription details including various tests, diet
advice, and medicines prescribed to patient and doctor. It also provides injection
detail and billing facility on the basis of patient's status whether it is an indoor or
outdoor patient.
The system also provides the facility of backup as per the requirement. Patients
who are non-local language speakers or come from migrant populations or ethnic
minority groups often are not able to communicate effectively with their clinicians
to receive complete information about their care. At the same time, clinical staff is
often not able to understand the patients' needs or to elicit other relevant
information from the patient.
Professional interpreter services should be made available whenever necessary to
ensure good communication between non-local language speakers and clinical
staff.
The task force brings together practitioners, managers, scientists and community
representatives with specific expertise and competence in policy-relevant
knowledge in the field.
Aditya Chaprana

HOSPITAL TRAINING REPORT-1 BP509P

More Related Content

What's hot

Similar to HOSPITAL TRAINING REPORT-1 BP509P

Recently uploaded

HOSPITAL TRAINING REPORT-1 BP509P