Discuss Your Case


BASIC INFORMATION
HISTORY OF PRESENT ILLNESS
HISTORY OF PRESENT ILLNESS
GENERAL
NEUROLOGICAL MUSCULOSKELETAL ENDOCRINE
PAST MEDICAL HISTORY

Please list all current medical problems as well as major illness you have had in the past with approximate dates.

PAST SURGICAL HISTORY

Please list all operations you have had in the past with approximate dates.


Have you ever had a problem with anesthesia (If yes please explain.)

Have you ever had a blood transfusion? (If yes Why.)

Do you take aspirin or any medicines that contain aspirin, such as Ibuprofen or Motrin? (If yes please specify.)


MEDICATIONS

Please list all medications you are currently taking, including over the counter medications, with dosage.

ALLERGIES

Please list any known drug and food allergies.

ANY SIGNIFICANT

Family History :


SOCIAL HISTORY

Yes : No :

Yes : No :



The Department of Neurosurgery Center’s ("Department") Medical Second Opinion Program is provided as a resource for consultative medical advice and treatment recommendations for patients with neurological conditions and disorders of the head and spine including neurosurgery. We strongly suggest that you carefully read the following terms and conditions. Because this service is accessible via our web site, you agree to abide by our Legal Disclaimer posted there, as well as the Medical Second Opinion Program terms and conditions described below. These terms and conditions are subject to change at the discretion of Dr. Asheesh Tandon Medicine and the Department of Neurology & Neurosurgery. It is your responsibility to review them regularly as you will be held to any changes made to the terms and conditions up to the day you submit a request for a consultation from the Medical Second Opinion Program.

Stored Information

We will learn certain information about you if you visit Dr Asheesh Tandon’s website. You should know that we will store the following information from your web site visits: the IP address from which you access the Internet, the date and time, the Internet address of the web site from which you linked directly to our site, the name of the file or the words you searched, and the browser used to access our site. This information is used to measure the number of visitors to the various sections of our site and identify system performance or problem areas. We also use this information to help us improve features of the site and to make the site more useful. All data collected on our web site is protected from unauthorized access. Personal information is encrypted using SSL (secure sockets layer) technology.

Personally Provided Information

If you choose to provide us with personal information via email or postal mail/courier, or by filling out a form and submitting it through our web site, we use that information to respond to your request and to help us provide you with information or material that you request. We do not give, share, sell, or transfer any personal information to a third party unless required by law.

Links to Other Sites

Some Dr. Asheesh Tandon Medicine web sites provide links to other internet sites that provide health information. Once you link to another site, you are subject to the privacy policy of the new site. We do not share any individual personal information with any site to which this web site links.

For more information about Dr Asheesh Tandon’s Centre for Minimally Invasive Neurosurgery privacy policies and practices, and/or to exercise your privacy rights, please visit Our Notice of Privacy Practices.

Site Access and Licenses

The Department of Neurosurgery Medical Second Opinion web site access is permitted only for individual and private use by complying with the terms and conditions.

Consultative Service

The service provided through the Centre for Minimally Invasive Neurosurgery at Aditya Superspeciality Hospital Medical Second Opinion Program is different from the diagnostic services typically provided by a physician. The Center’s physicians providing this service will not have the benefit of information that would be obtained by examining you in person and observing your physical condition. Therefore, the physician may not be aware of facts or information that would affect his or her opinion of your diagnosis. Because this is a limitation on the accuracy of his or her opinion, and this is a risk to you, By deciding to engage this service, you acknowledge and agree that you are aware of this limitation and agree to assume the risk of this limitation.

Your participation in this program will be considered an indication of acceptance of:

  • The diagnosis you will receive is limited and provisional;
  • The Medical Second Opinion is not intended to replace a full medical evaluation or a face-to-face visit with a physician;
  • The Neurosurgical consultant does not have important information that is usually obtained through a physical examination; and,
  • The absence of a physical examination may affect the Dr. Asheesh Tandon Medicine physician's ability to diagnose your condition, disease or injury.
  • Results of the recommendations will be provided to your referring physician.
State Jurisdiction

This Agreement shall be governed by and construed in accordance with the laws of the State of Madhya Pradesh India without regard to its conflicts of laws rules. Any dispute shall be brought in the courts of Jabalpur India.


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