Patient
Add Patient Info
Basic Info
Patient Name
Father's/Spouse Name
Surname
Age/Birth Date
">
>
Male
type="radio" class="ace">
Female
class="ace">
Others
Employee ID
Department
Blood Group
Please select option
Designation
Please select option
Joining Date
National Identity
*
Client Name
Please select option
Client Location
Please select option
Phone Number
Official Email
Status
Please select option
selected > Inactive
selected > Active
Is OHC Staff
Please select option
Yes
No
Identity Mark
OHC Location
Please select option
Passport Number
Address
Residing Village
Post
District
State
Vaccination Details
S.No.
Vaccine Name
1st Dose
2nd Dose
3rd Dose
Remarks
// end of while
Contact
Email
Personal Phone
Emergency Contact
Primary Contact Person
Primary Contact No
Secondary Contact Person
Secondary Contact No
Family Members
Sr
Name
Age
Gender
Relation Type
1
--Select Gender
Male
Female
Others
--Select Relation--
Spouse
Son
Daughter
Mother
Father
Known Health Advices And Health Risks
Known Health Advices
Known Health Risks
Sr
Question
Answer
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Upload File:
Uploaded Documents
S.No.
Document Name
Uploaded Date
Download link
Edit/Delete
No Files Found
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