Medical Summary jobs

Requisition Id: 15603

• To attend any new patient (admission) within prescribed time frame
• To examine & take a proper history of the patient (If he is in a position to give it on his own) or from his relative.
• Check any previous records, if available.
• Charts down all the details in the history sheet.
• Inform the respective consultant about the admission follow his orders.
• Instruct the nursing staff about the necessary orders to be carried out.
• If there’s a transfer in-patient from the ICU. Read the transfer summary/ clinical notes carefully and act accordingly.
• Inform the respective consultants whenever seems significant.

• To take rounds and examine individual patients at least once in every shift and as & when needed. Inform the respective consultant/ Registrars if any new findings.
• To put the notes in clinical sheet.
• To enter the relevant details of each and every patient accordingly.
• Attend rounds with the respective consultants and carry out the necessary changes in the order. Enter them in the treatment sheet.
• Fill the Medicine Card and Non Drug Order sheet
• To instruct the nursing staff about orders and follow them up
• To follow up with all the investigations to be seen and trace their results. Note down investigation results in the investigation sheet.
• To Document Verbal Orders correctly in clinical notes if given by consultants.
• To respond to emergency calls and to activate code blue if any medical emergency is encountered beyond your control.
• To identify the critical status of patient and shift him to critical care area in time.
• Always contact primary consultant if found necessary at any point of time.

• Prepare discharge summaries well in advance according to the policy.

• To follow pre-operative orders in the treatment sheet. To check whether the consents (Surgical, Anesthesia, etc) for the surgery has been taken from the patient. If not inform the respective person.
• To get the PAC done. To carry out all the pre-operative orders.
• Inform the consultant over phone during night shift about patient status who are scheduled for surgery next day.
• To attend patients complaints. To calm the patients if they are apprehensive. Inform the consultant if needed.

• To attend camps according to the policy.
• To work as per Policies and procedures of organization.
• To get the cross referral form filled abd call cross consultants according to the policy.
• Use capital letters for medicines (Generic Names/ Salt) and always put sign, name, date and time with every entry you make.
• To take care about completeness of records
• To act accordingly as per communicated by hospital management team.

• Verbal Ability/Communication Skill: Ability to comprehend verbal instructions given by the supervisor or head of the department.
• To give accurate and tactful explanations to patients. Problem solving/ Decision-making
• To think independently and exercise own judgment in consensus with the supervisor.