Patient
Add Patient Info
Basic Info
Patient Category
Please select an option
Patient Name
Father's/Husband Name
Age/Birth Date
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Male
type="radio" class="ace">
Female
class="ace">
Others
Employee ID
Employer/Contractor
*
Division
Please select option
Department
Section
Please select option
Emp Cadre
Please select option
Designation
Please select option
Supervisor
Please select an option
Blood Group
Please select option
Is First Aider
Please select option
No
Yes
Joining Date
Aadhar No
Phone Number
Official Email
Is hazardous process
Please select an option
Yes
No
Dangerous process/operation
Raw materials or by-products to be likely exposed to
Nature of job
Status
Please select option
selected > Inactive
selected > Active
Is OHC Staff
Please select option
Yes
No
Identity Mark
OHC Location
Please select option
Address
Residing Village
Post
PS
Tehsil
District
State
Pin Code
Vaccination Details
S.No.
Vaccine Name
1st Dose
2nd Dose
3rd Dose
Remarks
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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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