FORM VI
(See Rule 24)
Proforma of case record

Name of the hospital/nursing home …………….. Patient's Name …………. Age …….. Sex ……. Date of admission ………. Date of  discharge ……….. Mode of admission ……… Voluntary Reception order.
Complaints (report from relatives/other Sources)
Mental State Examination
Physical examination
Laboratory investigations
Provisional diagnosis
Initial treatment
Treatment and Progress notes
Date                                                                              Clinical State and side effect Treatment
Final diagnosis
Condition at discharge
Follow-up recommendations.