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(no id) · Niamala S.
Edited 13 Aug 2026, 12:43 IST
form 165 of 1542 · 1542 reviewed, 0 left
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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
Block No:506,Kurinji 6th street,Sudamanipuram ,kkdi-630002
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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
She having DM for past 2 years,she is under medicine
Hypertension
Asthma
Heart Disease
Thyroid Disorders
She having thyroid issues
Others
Previous Surgeries
She underwent surgery for heart
Allergies
Smoking History
Alcohol Use
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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Result
Cbg
140
Hba1C
Haemoglobin
Thyroid
Ecg
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)
Breathing problem,knee pain,back pain
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Diagnosis
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ICD codes
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Treatment Advice
Prescription Advice
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Referral: to Dr.
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Referral Department
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