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260802B132 · Neela
Edited 17 Aug 2026, 17:15 IST
form 612 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
Devakottai, Unjanai
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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
?
Hypertension
Asthma
Heart Disease
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Thyroid Disorders
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Others
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Previous Surgeries
hysterectomy before 1 year
Allergies
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Smoking History
Alcohol Use
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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
Test
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Result
Cbg
105
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)
knee & Joint Pain
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Diagnosis
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ICD codes
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Treatment Advice
Prescription Advice
Pregabalin 0-0-1,Tab. chymoralforte 1-0-1, orthogel 10A 1-0-0, syp Zincovit 10ml 1-0-0, inj. para 1m stat
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Referral: to Dr.
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Referral Department
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