Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 ORTHOLOGY Williams
30/03/2012 ORTHOLOGY Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Addmission & Dicharge Record

Addmission & Dicharge Record

Addmission & Dicharge Record
Name : Date & Time :
Gender : Room / Bed :
DOB & Age : Bed Type :
Marital Status : Pat. Type :
[Relation] : Dep. & Unit :
Address :    
  :  
  :  
  :  
Pin code :    
Phone :    
Religion :    
Ref Doctor : [RefDoctor]
Occupation [Occupation] Doctor :

Admission Order

To : Nurse in Charge
Routine Urgent Emergency
Please Admit on [AdmitDate] At [AdmitTime]
Dept. [ADepartment] Unit [AUnit]
Consultent [ConsultantName]
Signature of Admitting Dr [AdmitDocName]

Discharge Order

Please Discharge on [DisDate] At [DisTime]
Dept. [ADepartment] Unit [AUnit]
Consultent [DisConsultentName]
Special instructions [SplInstructions]
[SplInstructions]
[SplInstructions]
Signature of Discharging Dr [DisDoctor]

NURSES

For Admitting office only

Sourse of Admission Out Patient Clinic Emergency Referral
Udmitted under Dr [AdmittedUnder] Dept [Depaartment] Unit [Speciality]
Date of Admission [AdmissionDate] IP No [IPNo] Time [AdmissionTime]
Choice of Bed/Room General Private Non A/C Deluxe Suit Intensive care
Allocated Room / Bed [BedNo]
Name & Signature of admitting officer [AdmoittingOfficer]
(CAPITTAL LETTER) DOCTORS (Fill within 24Hrs of discharge) International Code
Provisional Diagnosis
[ProvisionalDiagnosis]
Final Diagnosis
(Main & Additional )
[FinalDiagnosis]
Discharge Status [DischargeStat]

If expierd cause of death

 [CauseOfDeath]
Name & Signature of Doctor [DocSign] Date [DocDate] Name & Signature of Unit Head [UnitHeadSign] Date  [UnitDate]

Medical Records Department

No. of sheets in the Record Sorting & Assembling By Deficiency Check By Coding By

Addmission & Dicharge Record
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 ORTHOLOGY Williams
30/03/2012 ORTHOLOGY Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 ORTHOLOGY Williams
30/03/2012 ORTHOLOGY Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 ORTHOLOGY Williams
30/03/2012 ORTHOLOGY Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 ORTHOLOGY Williams
30/03/2012 ORTHOLOGY Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 ORTHOLOGY Williams
30/03/2012 ORTHOLOGY Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 ORTHOLOGY Williams
30/03/2012 ORTHOLOGY Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 ORTHOLOGY Williams
30/03/2012 ORTHOLOGY Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 ORTHOLOGY Williams
30/03/2012 ORTHOLOGY Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 ORTHOLOGY Williams
30/03/2012 ORTHOLOGY Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 ORTHOLOGY Williams
30/03/2012 ORTHOLOGY Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 ORTHOLOGY Williams
30/03/2012 ORTHOLOGY Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 ORTHOLOGY Williams
30/03/2012 ORTHOLOGY Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 ORTHOLOGY Williams
30/03/2012 ORTHOLOGY Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 ORTHOLOGY Williams
30/03/2012 ORTHOLOGY Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 ORTHOLOGY Williams
30/03/2012 ORTHOLOGY Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 ORTHOLOGY Williams
30/03/2012 ORTHOLOGY Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 ORTHOLOGY Williams
30/03/2012 ORTHOLOGY Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 ORTHOLOGY Williams
30/03/2012 ORTHOLOGY Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 ORTHOLOGY Williams
30/03/2012 ORTHOLOGY Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 ORTHOLOGY Williams
30/03/2012 ORTHOLOGY Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 ORTHOLOGY Williams
30/03/2012 ORTHOLOGY Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 ORTHOLOGY Williams
30/03/2012 ORTHOLOGY Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 ORTHOLOGY Williams
30/03/2012 ORTHOLOGY Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 ORTHOLOGY Williams
30/03/2012 ORTHOLOGY Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 ORTHOLOGY Williams
30/03/2012 ORTHOLOGY Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM ANASTHESIOLOGY AADHIL 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 Orthology Williams
30/03/2012 Orthology Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM Anasthesiology Aadhil 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 Orthology Williams
30/03/2012 Orthology Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM Anasthesiology Aadhil 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 Orthology Williams
30/03/2012 Orthology Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM Anasthesiology Aadhil 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 Orthology Williams
30/03/2012 Orthology Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM Anasthesiology Aadhil 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 Orthology Williams
30/03/2012 Orthology Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM Anasthesiology Aadhil 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 Orthology Williams
30/03/2012 Orthology Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM Anasthesiology Aadhil 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 Orthology Williams
30/03/2012 Orthology Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM Anasthesiology Aadhil 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 Orthology Williams
30/03/2012 Orthology Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM Anasthesiology Aadhil 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 Orthology Williams
30/03/2012 Orthology Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM Anasthesiology Aadhil 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 Orthology Williams
30/03/2012 Orthology Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM Anasthesiology Aadhil 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 Orthology Williams
30/03/2012 Orthology Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM Anasthesiology Aadhil 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 Orthology Williams
30/03/2012 Orthology Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM Anasthesiology Aadhil 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 Orthology Williams
30/03/2012 Orthology Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM Anasthesiology Aadhil 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 Orthology Williams
30/03/2012 Orthology Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM Anasthesiology Aadhil 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 Orthology Williams
30/03/2012 Orthology Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM Anasthesiology Aadhil 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 Orthology Williams
30/03/2012 Orthology Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM Anasthesiology Aadhil 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 Orthology Williams
30/03/2012 Orthology Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM Anasthesiology Aadhil 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 Orthology Williams
30/03/2012 Orthology Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM Anasthesiology Aadhil 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 Orthology Williams
30/03/2012 Orthology Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM Anasthesiology Aadhil 0000208747 10/03/2012 11:57:54 AM
Registration Form

 Registration Form

Name : Patient # :
Gender : Date : 10/03/2012
DOB & Age : Patient Type :
Marital Status : Nationality :
Father : EMP Id :
Address : Permanent Address :
  : :
  : :
  : :
Pin code : Pin code :
Phone : Phone :
Religion : Designation :
Ref Doctor : Payment mode :
Occupation : Medical coverage :

Outpatient consultations

Date Department Consultant
30/03/2012 Orthology Williams
30/03/2012 Orthology Peter John

Admission

Date Department Consultant IP No. Date of Admission Date of Discharge
10/03/2012 11:57:54 AM Anasthesiology Aadhil 0000208747 10/03/2012 11:57:54 AM