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260802I045 · Jemy Neghalac
Edited 11 Aug 2026, 12:15 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
3/1775, Subsamaniyapuram , 10th street, Alagappapuram, karaikudi
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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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Diabetes
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Heart Disease
Thyroid Disorders
Others
Previous Surgeries
Allergies
Smoking History
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Family History
Screening Vitals
Height
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Weight
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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
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Cbg
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Hba1C
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Ecg
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Purpose of Visit / Department Needed
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OrthoPaedics
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OBG
Pediatrics
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Others
Ophthalmology
Diabetology
Cardiology
Neurology
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Urology
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Gastroenterology
Pulmonology
Doctor's Consultation
Chief Complaints (C/O)
wheezing, Irregular Periods
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Diagnosis
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ICD codes
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Treatment Advice
Prescription Advice
I- Acedopada Tab. pan Vizcal Orthogel
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Referral: to Dr.
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Referral Department
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