Patient Registration Form
Patient ID :
Password :
*
Patient Name :
*
Age :
*
Sex :
Male
Female
Others
*
City :
Email :
*
Mobile :
*
Alcohol :
Tobacco :
Acidity :
Tuberculosis :
Exposure to Corona :
Thyroid :
Kidney Stone :
Prostate :
Kidney Disease :
Heart Disease :
Known Allergies :
Diabetes :
Hypertension:
Creatinine :
Blood Thinners :
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