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DocPlus+ Rx
Lookup
Entry
Encounter
Exit
Billing
Configuration
Employee
Other details
Patient basic information
Vital information
Patient health history
Patient basic information
_id
Age
*
Please enter the patient age
Blood Type
*
Please enter the patient blood group
DOB
*
Please enter the patient date of birth
Email
*
Please enter the patient email
Is Patient's Father Alive?
NOT_ENTERED
Please provide patient father existence details
Patient Mother Name
Please provide patient father name
First Name
*
Please enter the patient first name
Does Patient has Insurance
NOT_ENTERED
Patient insurance details
Last Name
*
Please enter the patient last name
Martial Status
Provide patient Martial status
Middle Name
Please enter the patient middle name
Is Patient's Mother Alive?
NOT_ENTERED
Please provide patient mother existence details
Patient Mother Name
Please provide patient mother name
Next Kin Name
Please enter next kin name
Patient Notes
Patient notes
Add Item
Are parents living together?
NOT_ENTERED
Patient parents details
Patient Contact Info
Please provide patient primary contact info
Address Line1
*
Provide address line 1
Address Line2
Provide address line 2
City
city
Contact Type
*
Provide type of the contact primary, secondary..etc
Country
Provide country
Nearby Land Mark
Provide nearest landmark
State
Provide state
Telephone primary
*
Provide telephone primary
Telephone secondary
Provide telephone secondary
Zip
*
Provide zip code
Patient next Kin Details
Patient next kin details
Address Line1
*
Provide address line 1
Address Line2
Provide address line 2
City
city
Contact Type
*
Provide type of the contact primary, secondary..etc
Country
Provide country
Nearby Land Mark
Provide nearest landmark
State
Provide state
Telephone primary
*
Provide telephone primary
Telephone secondary
Provide telephone secondary
Zip
*
Provide zip code
Patient Profile Photo
Provide patient profile photo
Photo
Provide photo as upload
Profession
Provide patient profession
Gender
*
Please enter the patient gender
Patient Tax Code
Provide patient Patient tax code details
Submit