UHID - OPD No./FileNo/REGISTRATION NO.

BanglaName - Village /Estate/ResidentialNAme

Guardian Name/ Next of kIN
ID/PASSPORT NO
MOBILE NO.
FOR ADDITIONAL INFO: check for other kenyan systems/ rx sheet etc
MLC????=======

PAYMENT INFORMATION/DETAILS
PAYMENT TYPE: CASH /CHEQUE/ CREDIT CARD ETC

24mu / 3 = 8mu after 8hrs daily

ADDRESS

aapointment / booking /

UHID Date = > Registration Date

UHID No. => Registration Date /

Sponsor =>?
Pat. Name=> Patient name

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temperature (Fahrenheit) - Celcius
meter - metre
(BMI)
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FAX NO. => KRA PIN NO.
CODE=>MFLCODE
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CONSIDER CHANGING THE TICK ICON ON THE LIST