Exit - 6 - Screening_2_04082023 Serial No * Phone * Patient Health History Background: Chief Complaint Height (Cm) Weight (Kg) BMI=(I5/(H5/100)/H5/100)) BP(mmHg) Investigation: Blood: X-Ray: Urine: CT Scan: ECG: USG: Sugar: Angiography: History of Jaundice Yes No Oral Cancer Signs Yes No Anti-HTN drugs Yes No Anti DM drugs Yes No Refer To Department * Amniotic sac surgery Angioplasty Ayush Bone grafting Bone surgery Brain disorders Bypass surgery Cancer Dental disease Dialysis Diseases and surgeries of children Ear-Nose-Throat Eye surgery Gastric and intestinal surgery General Medicine General Surgery Gynecology / Pediatrics Heart disorders Kidney disease Kidney transplant Mental health Obesity Plastic surgery Pulmonary disorders of infants Respiratory disorders and tuberculosis Serious injury in accident Skin diseases Spine surgery Surgeries of eardrums Orthopaedics Other Upload - Investigation Report Drop a file here or click to upload (Max 10 files) Choose File Maximum file size: 10MB Discription (Optional) <p><br></p> If you are human, leave this field blank. Register Wanted To Add New Fresh Form Click Button Below: Add Another / New Form Entry
