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260802J028 · V. Parvathi
Edited 18 Aug 2026, 17:53 IST
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No ID
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Batch 2
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A
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B
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C
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D
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H
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Patient Information
Full Name
✎ Edited
Gender
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Marital Status
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Mobile Number
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Address
Vengees Apartments, Subramaniya puram 5 th street 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
Present
Notes
Diabetes
?
for 10 years tab,telsan,T.tonact,IEZterica
Hypertension
?
for 10 yearsT.Alprax
Asthma
?
Heart Disease
Thyroid Disorders
?
Others
?
Previous Surgeries
?
stent
Allergies
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Smoking History
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Alcohol Use
Family History
?
F/H of Hypertension
Screening Vitals
Height
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Weight
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Blood Pressure (BP)
? Check
SPO2
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Pulse
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Temperature
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Screening Tests
Test
Done
Result
Cbg
220mg/dl
Hba1C
Haemoglobin
12.2
Thyroid
Ecg
Done
Xray
Bmd
Biothesiometry
Purpose of Visit / Department Needed
General Medicine
General Surgery
OrthoPaedics
Dermatology
Dental
Physiotherapy
ENT
OBG
Pediatrics
Oncology
Others
Ophthalmology
Diabetology
Cardiology
Neurology
Psychiatry
Urology
Nephrology
Gastroenterology
Pulmonology
Doctor's Consultation
Chief Complaints (C/O)
General Checkup
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Diagnosis
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ICD codes
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Treatment Advice
Prescription Advice
Clopilet Atrocentin 70 RUN-D zincovit syrup
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Referral: to Dr.
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Referral Department
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