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260802H004 · Sundaranve
Edited 19 Aug 2026, 17:13 IST
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Patient Information
Full Name
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Gender
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Marital Status
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Mobile Number
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Address
16/4, Sundaravilas, Kv, Kkol
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Register Number / UHID
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Age
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Father / Spouse Name
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Blood Group
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Aadhar Number
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Insurance Name/No
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Medical History
Condition
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Notes
Diabetes
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for past 10years have taken
Hypertension
Asthma
Heart Disease
Thyroid Disorders
Others
Previous Surgeries
Allergies
Smoking History
Alcohol Use
Family History
Screening Vitals
Height
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Blood Pressure (BP)
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SPO2
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Pulse
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Temperature
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Screening Tests
Test
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Cbg
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Hba1C
Haemoglobin
Thyroid
Ecg
Xray
Bmd
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Purpose of Visit / Department Needed
General Medicine
General Surgery
OrthoPaedics
Dermatology
Dental
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ENT
OBG
Pediatrics
Oncology
Others
Ophthalmology
Diabetology
Cardiology
Neurology
Psychiatry
Urology
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Doctor's Consultation
Chief Complaints (C/O)
Back Pain
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Diagnosis
Lumbae Disc Dim
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ICD codes
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Treatment Advice
Prescription Advice
L4-L5 Tab. Aceclopara 1-0-1 Tab.para 40mg 1 Tab.pregledim 1-0-0 Orthogel(L/A) -3
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Referral: to Dr.
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Referral Department
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