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260802J098 · Sr. Jaleel
Edited 18 Aug 2026, 18:07 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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E
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G
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H
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I
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J
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K
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L
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The scanned form
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
Meenakshi puram, Kkdi
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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
?
past 3 years taken medicine
Hypertension
?
Etfor pearysphosgrec
Asthma
Sinus Problem
Heart Disease
?
History of Heart dises
Thyroid Disorders
?
Others
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Previous Surgeries
Allergies
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scinallerqy
Smoking History
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Alcohol Use
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Family History
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Camilhistory c Dnn E u
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
Test
Done
Result
Cbg
135
Hba1C
Haemoglobin
Thyroid
Ecg
8nuisNks
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
Dccytcad
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ICD codes
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Treatment Advice
Prescription Advice
Tab. climp BD Tab. Janvemen, BD Tab. montec Lc
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Referral: to Dr.
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Referral Department
Dermatogy
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! Not read
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