PATIANT APPOINTMENT
PATIANT DETAILS
1.PATIEANT DEATILS
1.1 Patieant Name:
1.2 father/husband/guardian name:
1.3 date of birth:
1.4 Gender:
female
male
1.5 occupation:
1.6 category:
cardiology
Dermatologist
ent
general doctor
Nueralogist
specialist
2.Residential Address
2.1 house number:
2.2 street no.:
2.3 landmark:
2.4 village/city:
2.5 district:
2.6 pincode:
2.7 state:
2.8 mobile number:
3.Documentation
3.1 Any Medical Reports:
yes
no
3.2 Nomminee:
yes
no
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