Download - OG Department Manual - NABH
P.S.G. HOSPITALS, COIMBATORE – 641 004
DEPARTMENT OF OBSTETRICS & GYNAECOLOGY
HOSPITAL MANUAL
1. DEPARTMENT ORGANOGRAM
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Head of the department
Unit chiefs
Professors
Associate professors
Assistant professors
Selection Grade Tutors
Resident Doctors
CRRIs
Support staffs
Secretary
Staff nurses
Counsellor
Nursing assistant
Technicians
Attenders
2. ACADEMIC FUNCTIONS OF THE DEPARTMENT
Teaching schedules are followed as per university regulation in both
undergraduate & postgraduate
The teaching consists for
1. Undergraduate
2. Postgraduate
3. CRRI
Undergraduates:
Teaching schedule preparation:
A maser chart is prepared by the department registrar consists the details
of all batches teaching schedule for a month in date wise manner. It
consists the time, topics and the faculty name for every session. The
chart is being displayed in the student’s notice board.
The format of the chart is as below:
Date Lecture topics Clinical teaching
Batch /
Phase
Time Topic Faculty Batch /
Phase
Time /
Sessio
n
Topic Faculty
Class conducting system:
The students are expected to see their schedule earlier.
Undergraduate’s timetable is divided as
Lecture classes
Tutorial session
Case presentation session
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Symposium
Small group teaching
Integrated teaching
Lecture classes:
This is a period of 1 hour and the topics are scheduled as per the list
recommended by the university. Students are attending the Obstetric &
Gynaec lecture class from 4th semester onwards. Every phase of students
is having one lecture class in a week for this subject.
Tutorial session:
In final year clinical teaching, students are having tutorial session which is
scheduled as each topic for a day from Monday to Friday. In Saturday
they are having General clinical session. (Some Mondays are scheduled
for internal assessment test)
Case presentation session:
All phase students except introductory phase is having case presentation
session on everyday (Monday to Friday) of clinical postings. Every batch is
divided in to subdivisions which may consists of 4 students and the each
subdivision is responsible for case presentation on that particular day and
they have to report to the faculty prior to 1 or 2 days. They will be given a
case for presentation by the faculty. The student observes and takes
notes of the history & presenting complaints of the case and they prepare
for presentation. The diagnosis & management of the case is discussed
on the case presentation session by the faculty & the students.
Symposium:
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The scheduled symposium topics are prepared by the concern students
group with the guidance of faculty and presented by the students. Each
student gets a chance of symposium presentation in the final year phase.
Small group teaching:
In final year clinical teaching, students are having small group teaching
session which is scheduled as Monday 2.00 pm to 4.00 pm & Wednesday
3.00 pm to 4.00 pm.
Internal assessment :
Theory test are conducted on Mondays for III MBBS part B students in
concern subjects by rotation. Test scheduled is prepared and display in
the notice board at prior time, the test notice consists of the topics, date,
time.
Clinical tests are conducted at the last clinical posting day of that
phase, and valuated mark details are sent to the Academic cell and
displayed in the student’s notice board.
Model exams are scheduled prior to the university exams and model
exams are conducted in the university’s question & marks pattern in both
theory and clinicals. Mark details are sent to the academic cell & students
notice board.
Final year student’s record note: Student’s has a faculty in-charge
for record note book and they get correction and signed from that faculty
by weekly in a regular manner. Friday 2.00-4.00 is the time schedule for
record note correction. At the finishing of the final year posting they
should get complete correction of the record note book and HOD’s
signature, and then submitted to the department. The record marks are
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given by record in-charge faculty of the student. Record mark awarded in
the format of
Case record perfection - 8 marks
Presentation - 4 marks
Regularity - 4 marks
Neatness - 4 marks
Total - 20 marks
The computerized student’s attendance report of every month is
verified by the head of the department and the checked statement is sent
to academic cell and student’s notice board.
MBBS students semester wise clinical posting details:
II MBBS students are attending clinical posting for a period of 10 weeks
3RD SEMESTER - 2 weeks - Introduction to OG
The introductory posting topics are taught by the facultyDAY 1 Introduction to Obstetrics . Fertilisation & ImplantationDAY 2 Duration of pregnancy I + II + III trimesters. AN care.DAY 3 Few complication in pregnancy in I + II + III trimestersDAY 4 Outcome of pregnancy.
Abortion, Labour :Preterm, Term & Post termDAY 5 Causation & Stages of labourDAY 6 Modes of delivery
Complication in labour. Puerperium – duration, problems
DAY 7 AN History taking, AN CaseDAY 8 Introduction to Gynaecology
Menarche, Normal menstrual cycle, MenopauseDAY 9 Common problems in adolescence, reproductive age group and
menopauseDAY 10 Gynaec history taking, Gynaec casesDAY 11 Infertility
DAY 12 LucorrhoeaDAY 13 Descending PV, Mass abdomenDAY 14 Post menopausal bleeding
4TH SEMESTER - 4 weeks - 3 weeks - AN history taking,
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Obs palpitation,Gyn. History taking , cases4th week - Family Planning
Family planning
Day 1 - Natural family planning & Barrier methods
Day 2 - IUCD
Day 3 - OCP
Day 4 - Other hormonal contraceptives
Day 5 - Injectable
Day 6 - Female
Day 7 - Male sterilisation
5TH SEMESTER - 4 weeks - Clinical assessment & Management in brief
III A MBBS students are attending clinical posting for a period of 6
weeks
6TH SEMESTER - 6 weeks - Clinical assessment Peripheral centers postings
III MBBS Part A students:
In OPD 2 students are posted by rotation and they are taught
interesting OP cases by faculty.
In peripheral maternity centers 2 students are posted by rotation and for witness of deliveries
The III B MBBS students are posted for a period of 8 weeks
8TH SEMESTER - 8 weeks - Clinical teaching P.S.G.Posting – LWCase discussion, Tutorials, SGT, IT
III MBBS Part B students postings:
o Two students of III MBBS Part B are posted for Labourward by rotation
for witness of deliveries conducting in labourward and caesarean
sections and other gynaecological procedures in Operation Theater.
o One student of III MBBS Part B students is posted in OPD Ultrasound
room
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The III MBBS Part B students are attending clinical classes from 9.00 am
to 1.00 pm.
Postgraduate teaching:
Postgraduates are posted in OPD, Labourward, Antenatal ward,
Gynaec ward & Postnatal ward, peripheral posting by rotation as per
university regulations.
The postgraduate students are posted under a particular faculty in
an unit by rotation.
Attendance register is maintained and the monthly attendance
report is sent to the academic cell.
Postgraduates are mainly involved in examining patients, following
up, management and progress of the patient.
They are also involved in bed side teaching & OMP
They see OP cases with a faculty presiding.
Complicated cases are shown and discussed by the postgraduate
with unit faculties.
They are trained to perform minor procedures like D & C, puerperal
sterilization, IUCD insertions assistance in all major and minor
Obstetric and Gynaec procedures.
They perform caesarean section, hysterectomy and other
gynaecological procedures with consultant assistance.
A separate logbook is maintained by each postgraduate student for
recording academic activities
Classes scheduled by monthly and displayed in postgraduate’s
notice board. The monthly teaching schedule consists of class topic,
time and the faculty name.
A journal club is arranged monthly once
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Perinatal care unit meeting is arranged to discuss the
complicated & high risk pregnancy cases. Postgraduate
discusses about the cases with the various specialty
consultants like Newborn, Paediatrician, Paediatric surgeon,
Pathologist.
Every postgraduate student presents an interesting case by
weekly
Each MD(OG) postgraduate student is guided by a faculty for their
thesis work and scheduled for thesis work as follows
o After 6 months from the joining they will guided to do the
following before completion 1st year
Decide topic of thesis
Presentation of review of literature and methodology
Submit title of thesis
Presentation of questionnaire (Proforma) and finalization
o In 2nd year
Finish data collection
Data analysis to be completed and presented
o 3rd year
Thesis book (hardcopy & softcopy) to be prepared
To be submitted
o Postgradautes are expected to attend CME programmes and
conferences (in a minimum of 3 programmes they should attend)
and guided for paper presentations.
CRRIs teaching:
They are posted for a period of 3 months in the department of Obstetric &
Gyanec. They are posted under a unit and guided by the corresponding
unit’s faculty.
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Their postings is scheduled as follows
2 weeks - Labour ward
2 weeks - Newborn
2 weeks - Elective posting
The rest of period they do OPD, ward, Operation Theater and intensive care
areas duty.
In OP posting CRRIs are taking history and doing preliminary examination for
new cases. Subsequently the cases are followed up with the consultant. The
case will be thoroughly examined by the consultant and disposed.
They are attending the ward rounds taking by the unit chief and faculty and
follow the chief consultant orders. Ward CRRIs monitor the ward patient’s
progress and inform the patient’s status and reports to the consultant.
They are expected to perform procedures like starting IV line, dressing,
suturing, suture removal and intensive care monitoring.
They are trained up in assisting and doing minor surgeries in Operation
Theater. In labourward posting they conduct deliveries, perform episiotomy,
assist for caesarean section & monitor patient in labour.
3. CLINICAL / PATIENTS RELATED FUNCTIONS OF THE DEPARTMENT
The clinical work in the department of Obstetric & Gynaecology broadly
divided under the following categories:
1. Antenatal care
2. Intra partum and post partum care
3. Operative and emergency Obstetrics
4. Gynaecological and operative Gynaecological care
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a. Screening for cervical cancer
b. Basic and special investigations of Infertility
5. Urogynaecology
6. Family planning
Antenatal care protocol:
1. Diagnosis of pregnancy
2. Monitoring of the health status of mother and fetus
a. Upto 6th month - monthly checkup
b. 7th month & 8th month - 15 days once
c. from 9th month onwards - weekly monitoring
3. Identification of risk factor
4. Detection of associated medical, surgical disorders
5. Screening for the woman for infections
a. Tamilnadu Aids Control Society project – PPTCT program for
counseling & educating the woman about HIV infection and
preventing methods and screening.
6. Antenatal investigation includes the following
a. Blood group
b. Heamoglobin
c. Urine routine
d. VDRL
e. GCT
f. HIV
g. HBsAg
h. Ultrasound at early diagnosis of pregnancy to rule out intra
uterine pregnancy and fetal viability
i. Ultrasound at 18-20 weeks to rule-out structural fetal anomalies
which can be detected by ultrasound.
j. Ultrasound at term to assess fetal growth & AFI
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7. Educating the woman about the effect of health, nutrition, drugs etc.,
on pregnancy
8. Preparing the woman for labour, breast feeding.
Outpatient department
1. At patient entry, they register at the Medical Record Department
depending on the complaints is registered to the concerned
department
2. Once the registration is made the OP file (medical record) of the
patient is transferred to the outpatient department by the MRD
attender. The OP file is checked weather the file is transferred to
proper department or not and then received by the department
secretary.
3. The patients are called in the order of registration time and a token
is placed for every attended patient’s file serially. If the called
patient is not in the OP waiting hall, it will be informed to the MRD
and checked up for proper registration.
4. The called patients are checked for Height & Weight by the staff
nurse.
5. Patient is asked to wait till their turn comes. If the patient condition
warrants immediate treatment, she will be consulted by a
Gynaecologist immediately.
6. The patient’s history & presenting complaints will be entered in the
file by the junior doctor. The patient history includes:
1. Presenting complaints
2. Menstrual history
3. Marital history
4. Obstetric history
5. Previous gynaecological history
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6. Medical & Surgical history
7. Family history
8. Personal history
7. A general examination is done by the junior doctor and recorded on
the case sheet. The general examination includes the following: BP,
Pulse, pallor, edema, CVS, RS and temperature.
8. Then the patient will be consulted by a consultant Gynaecologist.
9. The patient is thoroughly examined by the consultant and a
provisional diagnosis arrived at.
The examinations are:
Abdominal examination
Vaginal examination
Speculum examination
10. The required investigation to substantiate the diagnosis is
recommended after counseling the patient & their attender.
11. After the sample collected for the investigations the patient is
advised about the probable time taking for investigation report and
the report copy will be available on the patient’s file at all. The
probable time taken for investigation report is 2-3 hrs from, some
investigation report takes few days like culture takes 3 days, for
histopathology 7 days, etc.
12. The patient is advised about the review date and if any medication.
13. On report review, if any procedure is indicated by the investigation,
patient & the attender is explained about procedure & its risks. Date
is fixed for the procedure if the patient is willing to undergo the
further procedure. If the condition warrants and immediate medical /
surgical treatment, she is counseled regarding the treatment and
admitted. The admission orders written by the Gynaecologist in the
case sheet.
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14. The admission patient is shifted from the outpatient area to the
ward by the OPD attender with the OP file and the patient attender
is informed for wait in the IP patient attender area.
15. Day care procedure which do not warrant admission and deal with in
the OPD and the patient discharged on the same after when she is
stable.
Inpatient department
1. Following admission to the ward, the patient is assessed and if
intensive care is necessitated the patient is admitted to the critical
care units of ward & monitored intensively.
2. If the patient is admitted for a major / minor procedure the required
investigations which were ordered by the consulted Gynaecologist
are sent results are collected by the ward staff. Pre-op protocol
followed.
3. If the patient is admitted for observation, the results of the
investigations and the patient status are followed and informed by
the concerned ward interns & resident doctor to the consultant.
4. All nursing as well as medical work is supervised by the unit
concerned in a standard manner which includes conventional ward
rounds taken, thrice a day, in the morning, after noon and late
evening
5. If any complaints encounteded during the night is handled by
consultant & resident on duty.
4. JOB SPECIFICATIONS
Head of the department:
The HOD will function as the administrative head of her/his
department in addition to the professional responsibilities
To supervise punctuality and regularity in reporting
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Professors:
To effectively administer his/her unit in all aspects
To ensure smooth co-operation from his/her unit members
To implement effectively the policies laid by the HOD
To train the students and CRRIs posted under him/her
To actively contribute to uplift the academic standard of unit
as well as the department
To supervise the quality of work done by the Assistant
professors and Residents
Co-operate with the HOD in all aspects so as to maintain the
smooth functioning of the department
To shoulder all the responsibilities of the HOD during his/her
absence
To supervise the work done by the other category staff in the
maintenance of the professional zones of the institution
Plan and implement protocols for clinical work as well as
academic activities for junior staffs to update and keep alert of
recent development in the field
Associate professors:
To render adequate help and co-operation to the HOD and
Professors in the smooth functioning of the department
To perform all the duties allotted by the institution administrative
heads and the HOD regarding patient care and academic activity
To extend sufficient professional help to the Assistant Professors
whenever required
Assistant Professor:
To carry out the work responsibilities allotted by the HOD
To do stay in duties as per schedule
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To get actively trained in the respective specialties under the
supervision of senior faculty member
Gain teaching experience by vigorous participation in the academic
activities
To adequately guide the Residents and CRRIs and help them gather
enough practical skill
To pay attention to the maintenance of outpatient, inpatient zones
and special areas
To maintain absolute harmony in the unit/department by full co-
ordination with all members of the department
To ensure a very smooth public relationship
5. LIST OF REGISTERS
List of registers maintained in Outpatient department
1. Daily OP Patient register
2. Papsmear & Biopsy specimen register
3. Colposcopy register
4. Ultrasound register
5. Scan appointment register
6. Cu-T insertion register
7. Family planning progamme – sterilization register
8. MTP register
9. OP Things stock account register
10. High risk cases register
11. Interesting cases register
12. Perinatal care unit meeting register
13. Departmental library books register
14. Department staffs & faculty leave register
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15. Letters & communication dispatch register
16. Postgraduate attendace register
17. Undergraduate attendance register
18. CRRI – Intensive care areas attendance register
19. OPD daily Statistics
All register’s format enclosed in separate sheets
List of registers maintained in Labourward
List of registers maintained in Daycare room
List of registers maintained in OG ward
6. Format of work instruction (operational instruction)
Out Patient department:
1. Patient registeration at MRD
2. File (Medical record) arrival to OP waiting area by MRD attender
3. Patient is called by the staff nurse and checked for patient presence
in OPD. If patient not present at OPD waiting area verification is
done by OPD secretary.
4. Patient is checked for Height & Weight by the staff nurse
5. Patient is first seen by Resident doctor and the patient’s history with
presenting complaints is taken by the Resident doctor.
6. Subsequently the patient is consulted, examined and diagnosed by
a Gynaecologist
7. Advised for the investigation required, proposed line of treatment.
8. Explained for probable charges and duration stay if any
hospitalization required.
9. Procedures done in OPD:
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a. USG – Pelvis, Obstetrics
i. Patient takes a prior appointment, pays the bill on that
particular day & get USG done
ii. It is done on the same day depends on the urgency
iii. Explained consent obtained for obstetric scan
b. IUCD insertion
i. Patient is advised for IUCD
ii. Patient purchases IUCD at pharmacy
iii. IUCD is inserted by the consultant and advised about
medication and followup
iv. The patient has to pay the insertion procedure charge
and the miscellaneous charges
c. Colposcopy & cervical biopsy
i. Usually done by Papsmear result’s indication.
ii. Colposcopy directed biopsy is taken. If Colposcopy is
normal, no need for cervical Biopsy
iii. After the procedure the patient is advised for medication
and report review (Histopathology report processing time
- 7 days)
d. Cryo cautary: following the histopathology report, if indicated
patient is offered cryocautery in post menstrual phase.
10. Inpatient :
Admission requisition sent by the consulting doctor
Patient & patient’s relation is accompanied by the OP attender to
the admission counter
According to the patient choice the ward / room is allotted for the
patient
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Patient & patient’s relation is accompanied by the admission
counter attender to the allotted ward
The concern unit ward resident doctor and CRRI are informed by
the ward staff nurse who is receiving the admission patient.
The consultant orders are followed by the ward, CRRI and the
staff nurse
The ordered investigations requisition to the lab is written by the
ward Resident doctor
Blood samples are collected by the ward staff and sent to the lab
by the ward attender
Routine blood & urine investigation processing takes 3 hrs for
reporting
Some special investigations like CT, Ultrasound, MRI are done by
a prior appointment. The appointments are made by the ward
staff nurse.
In case of any emergency, urgent requisition can be made and
the results can get ready within 2 hr as soon as possible. It is
informed to the unit faculty by the CRRI immediately after the
result obtained
The results are collected by the ward attender
The results are review in the next ward rounds by a consultant
and decided for further treatment.
Pre-procedure protocols are followed for the case who got
admitted for certain procedures.
Proper consent for all procedures and surgeries is obtained by the
Resident doctor & staff nurse
7. Protocols for Surgical procedures
Pre-procedure:
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The indication for the surgical procedure and its risks involved are
explained to the patient & patient attender by the treating doctor.
A written informed consent is obtained from the patient & patient
attender.
Patient will be investigated for fitness for the surgical procedure
either as an outpatient or inpatient depending on the patient
decision.
The patient is admitted 2 days prior to the surgical procedure if the
patient wants to do all investigations and fitness opinion as an
inpatient.
If high risk, patient will be admitted earlier depending on the risk.
General Physician opinion and Anaesthethic fitness will be sought
prior to the surgical procedure.
Instructions given pre-op includes
1. Preparation of the surgical site and site of locoregional
anaesthesia by the ward staffs
2. Enema is given night prior to and the morning of the surgical
procedure by the ward staffs
3. Xylocaine and antibiotic test dose given on the morning of
the surgery.
4. Patient is kept nil per-mouth from previous midnight and also
pre-anaesthetic medication is administered
5. IV hydration is maintained.
6. The patient is shifted to pre-op room half an hour before the
surgical procedure
7. The patient attender is informed when the patient has shifted
into the theater block.
8. During the process of shifting the _______ standards are
adhered to
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Per-operative :
In the pre-op room the anaesthetist re-examines the patient to
ascertain the fitness for the surgical procedure.
Inside the operation theatre, the full dose of antibiotic is
administered during induction of anaesthesia.
The patient is placed in the required position (dorsal/lithotomy) for
the surgical procedure
The patient is intensely monitored during the surgical procedure.
Strict aseptic precautions are followed during the surgical
procedure.
After the surgical procedure is completed the patient is shifted to
the post-operative care ward for monitoring.
The patient attender is explained & informed about the patient
status and the procedure done by the surgeon.
Post-operative instructions:
Patient is monitored for vitals half an hourly still stable, then two
hourly for a minimum of 6 hours to 24 hours in the post-operative
ward.
When the patient is stable, shifted to the ward and informed
The patient is monitored by team of intensives, interns and staff
nurses.
The patient who is presently on IV hydration will be started on oral
hydration 4-6 hours after the surgical procedure.
Broad spectrum antibiotics are administered for minimum period of
48 hours
DVT prophylaxis started 6 hours following the surgical procedure for
patient at risk for the same.
Post-op analgesia is maintained with parenteral or epidural opioids
Post-op physiotherapy and early ambulation is advised.
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If there is deterioration of patient status, will be retained in the post-
op ward, treated further and then shifted to ward once stable.
8. Protocols for Day care procedures
List of day care procedure
1. Fractional curettage
2. 1st trimester MTP
3. Medical abortion
4. Vulval biopsy
5. Cervical biopsy
6. Suction evacuation
Pre-procedure instructions:
a. The indication for the procedure and its risks involved are
explained to the patient & patient attender by the treating doctor.
b. Patient is examined & investigated for fitness of the day care
procedure. The routine investigations are as follows:
Haemoglobin
Urine routine
Blood grouping & typing
HIV & HBsAg
Blood sugar
USG if required
c. If the patient is fit for the procedure, a written informed
consent is obtained from the patient & patient attender and the
patient is shifted to the day care room by the OPD staffs
d. The following orders will be instructed by the doctor
Preparation of parts
Verify for NPO from the previous day night
Xylocain test dose
Inj. TT 1 dose
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Per-procedure instructions:
a. For Fractional curettage & Suction evacuation:
IM sedation – Fortwin or Pethidine 1 amp with 12.5 mg
Phenargan given by the day care room junior doctor
After ½ hr from the IM sedation given the patient will be
placed in the required position
b. For Vulval / Cervical biopsy no sedation required, only local
infiltration of 1 % of xylocaine at biopsy site applied
c. For Medical termination of pregnancy / abortion 2 doses of
Cytotec of 400 micro gm 4 hours apart to kept in posterior
fornix. In case of missed abortion Tab. Cytotec 400 micro gm
kept vaginally followed by Suction evacuation after 4 hrs under
IM sedation and paracervical block.
d. The procedure will be done by a Gynaecologist and a junior
doctor.
Post-procedure instructions:
e. After the completion of procedure the patient will be
monitored for vitals & bleeding p/v by the team of day care
room junior doctor & staffs.
f. The Biopsy specimen / curettage specimen will be sent for
Histopathology lab with requisition of doctor.
g. After 5 hrs from the procedure, if the patient is stable the
patient is shifted out from the day care procedure room and the
patient attender is informed for the same. If the patient has any
complaints or not stable, get admitted for observation and
treated further.
h. The patient is advised for the review date in the outpatient
department, medication and the report follow up.
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9. Test SOP (Standard operating procedure)
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