Patient Name *

Gender * Select Male Female

Date of Birth

Age *

Unit Years Months Days

Area / Mohalla *

Guardian

Phone

Address / Landmark

Emergency Contact

Emergency Phone

Weight (kg)

Height (cm)

Blood Group Unknown A+ A- B+ B- AB+ AB- O+ O-

Allergies Registration Notes

Register Patient Register & New Visit

Select a patient, then choose whether this is a routine/follow-up OPD encounter or an emergency ER encounter.

Patient *

Severity

Routine Follow-up Emergency

Encounter source: OPD

Complaints *

Fever Cough Diarrhea Vomiting Rash Pain Breathing Seizure Poor Feeding Wheeze

Attendant Name

Attendant Phone

Encounter Notes

Weight (kg)

Height (cm)

MUAC (cm)

Temp (°F)

HR

SpO2

RR

BP Systolic

BP Diastolic

CBG (mmol/L)

Focused OPD Examination Diagnosis Treatment Advised

Follow-up Date

Linked Admission Consultant

ER Encounter

Condition at Presentation Select Stable Serious Critical

ER Outcome Select Improved Static Deteriorated

Provisional Examination Other Systems Note ER Management Provisional Diagnosis

Admit from OPD

Saving this visit will create or update a linked admission record that opens on the Admissions page.

Ward / Bed

Admission Reason

Initial Admission History

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