Hospitalization Details
Reporting Time in OHC:
Date:
Name Of Patient:
Employee ID:
Age of Patient:
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Sex:
Individual Contact No.
Designation and employment status
Name Of Supervisor and Contact no
Reporting Time in OHC[24 Hrs format]
Details
Referral:
Referral Reason:
Ambulance Out Time:
Ambulance In Time:
Entry Time:
Additional Details :