Consent

My day Liyana Atiqah binti JamalMV-717854
Liyana Atiqah binti Jamal Draft NKA
53y · F · MV-717854 · 730611-07-9098 · Cataract Extraction with IOL Phacoemulsification · Left eye (OS)
Theatre
Eye OT 2 · 12.15 PM

A · Patient

MV-717854
Name (as per IC / passport)
Liyana Atiqah binti Jamal
MyKad
730611-07-9098
Date of birth
11/06/1973
Gender
Female
Age
53 years
Ward / bed
Daycare / 014
Allergy
No Known Allergy
ASA
ASA I

B · Next of kin

C · Operation or procedure

Cataract Extraction with IOL Phacoemulsification · Left eye (OS) · MPSN OPH-001

D · Type of anaesthesia

ISEC/OT-F03 · Rev. 02