SL NO DOCUMENT LINK DOCUMENT TYPE

https://www.averoachmea.nl/-/medi
a/files/particulier/zorgverzekering/for
1 INSURANCE FORM
mulier/Health-Insurance-Application-
Form.pdf

https://www.hdfcergo.com/documen
2 ts/crosslink/Home%20Insurance- INSURANCE FORM
Proposal%20Form.pdf

https://insurance.kotak.com/assets/i
3 mages/uploads/how_do_i/Kotak_Sam INSURANCE FORM
poorn_Bima_Micro_Insurance_Plan_-
_Proposer_Addendum_020820.pdf

https://www.hdfcergo.com/documen
4 ts/downloads/claimforms/TravelInsur INSURANCE FORM
anceClaimform.pdf

http://www.southwestservicelife.com
5 /uploads/CorpToFran/SWSL1%20CLAI INSURANCE FORM
M%20FORM.pdf

6 https://www.ssa.gov/forms/ssa-16- INSURANCE FORM

bk.pdf

https://orientalinsurance.org.in/docu
7 ments/10182/1177126/PublicLiability INSURANCE FORM
ClaimForm.pdf/5c11e730-973c-4909-
9d5d-c8ec56fc6df4

https://www.hdfcergo.com/documen
8 ts/crosslink/Standard%20Fire%20and INSURANCE FORM
%20Special%20Perils%20Insurance-
Proposal%20Form.pdf
 https://axa-
prod.s3.amazonaws.com/axa-com-my
9 %2F18fcd911-13e0-448b-a2f5- INSURANCE FORM
002fa662f66a_personal-accident-
claim-form-gi.pdf

https://www.hdfcergo.com/documen
10 INSURANCE FORM
ts/crosslink/marine-claim-form.pdf

https://www.myopd.in/images/Sampl
11 e-Hospital-Software-Bill-MyOPD- Medical Bill
Beds.jpg

12 https://www.sharp.com/patient/billin Medical Bill

g/upload/Sample-Bill.pdf

13 https://pbs.twimg.com/media/EainhL Medical Bill

VU4AIns9T.jpg

14 https://pbs.twimg.com/media/EbGJ0 Medical Bill

USXkAAsMHQ.jpg

15 https://www.pdffiller.com/preview/2 Medical Bill

1/942/21942007/large.png

16 https://miro.medium.com/max/735/1 Medical Bill

*6Dxl4SV07d6ypVnF8hdqJQ.png

17 http://www.napervilledentist.com/wa Medical Bill

lkout.jpg

https://bloximages.newyork1.vip.tow
nnews.com/bendbulletin.com/conten
18 t/tncms/assets/v3/editorial/d/2a/d2a Medical Bill
440c7-8bc8-5f69-9c45-
2cbddde67687/5de99e5d53dfb.imag
e.jpg
 https://www.uwhealth.org/files/uwh
19 ealth/images/patient_guides/billing/i Medical Bill
mg_uw_health_billing_statement.jpg

https://gogetfunding.com/wp-
20 content/uploads/2019/02/5984656/i Medical Bill
mg/receipt.jpg

https://www.consumercomplaints.in/
thumb.php?
21 complaints=1105740&src=381821797 LAB REPORTS
.jpg&wmax=900&hmax=900&quality=
85&nocrop=1

http://2.bp.blogspot.com/-
st2u7xUQ8Sw/VAukK_2kDkI/AAAAAA
22 AAAmw/rVP8V7BaS_U/s1600/20_Uri LAB REPORTS
ne%2BRoutine%2BExamination
%2BUrine%2BR_M_E
%2B12%2Bmay.jpg'

23 http://www.jamesvaidyanhealing.co LAB REPORTS

m/images/1/medrep4.jpg

https://www.marham.pk/foru
24 m/urologist/urine- LAB REPORTS
complete-14299

https://mangalsushila.files.wordpress.
25 com/2014/06/report-of-sushila- LAB REPORTS
pradhan.jpg

https://s3.ap-south-
26 1.amazonaws.com/marham- LAB REPORTS
web/assets/files/8571-cbc-test-
diagnosis-marham-32.png

https://s3.ap-south-
27 1.amazonaws.com/marham- LAB REPORTS
web/assets/files/14299-urine-
complete-marham-38.jpg

https://sites.google.com/a/priyankat.
28 com/priyankat/documents/tabby-s- LAB REPORTS
medical-reports?overridemobile=true

https://www.scribd.com/document/4
29 38996231/R6218017-KUSHVITHA- LAB REPORTS
131119222310-pdf
 http://www.jamesvaidyanhealing.co
30 LAB REPORTS
m/images/1/CBC_261008.jpg

https://doctor.lybrate.com/img/maile
31 DOCTOR
r/prescription_5.png
PRESCRIPTION
FORM

http://www.dentalware.com/uploads
32 /1/1/5/7/11578872/1208565_orig.pn
g DOCTOR
PRESCRIPTION
FORM
https://pattersonsupport.custhelp.co
33 m/euf/assets/Eaglesoft/Prescriptions/ DOCTOR
Rx_patient_portion_a.png
PRESCRIPTION
FORM
https://www.abelmed.com/Content/a
ssets/images/abelmed/medical-
34 products/emr-
features/PrescriptionMar2014.jpg DOCTOR
PRESCRIPTION
FORM

35 https://www.heartlandrx.net/images/
EMAR-POS.jpg DOCTOR
PRESCRIPTION
FORM

https://image.slidesharecdn.com/pres
36 cription-150930065407-lva1-
app6892/95/prescription-10-638.jpg? DOCTOR
cb=1443596144 PRESCRIPTION
FORM

https://www.neurologyindia.com/arti
37 cles/2018/66/4/images/ni_2018_66_ DOCTOR
4_928_236960_f1.jpg PRESCRIPTION
FORM

38 https://www.usapharmacyexams.com DOCTOR
/ImageHandler.ashx?id=93 PRESCRIPTION
FORM

39 https://d27zlipt1pllog.cloudfront.net/
pub/media/wysiwyg/artboard_1.png DOCTOR
PRESCRIPTION
FORM
 https://www.myopd.in/blog/wp-
40 content/uploads/2020/02/myopd-
sample-rx-full-eng.png DOCTOR
PRESCRIPTION
FORM

https://www.myopd.in/images/sampl
41 Discharge Summary
e-discharge-summary.jpg

https://computalogic.zendesk.com/hc
42 /article_attachments/115004575014/ Discharge Summary
mceclip8.png

43 https://pbs.twimg.com/media/D00azi Discharge Summary

qU0AA8bnI.jpg

44 https://media.cheggcdn.com/media Discharge Summary

%2F2f9%2F2f95e7c2-fab5-4167-a625-
c469fde6d9b5%2FphpHHJj2k.png

45 https://d3i71xaburhd42.cloudfront.ne Discharge Summary

t/15c16ccac291316c6fa1dae269943e
cce554cc5f/2-Figure1-1.png

https://cdn.jotfor.ms/form-
templates/screenshots/pdf/425x575_
46 2090704644702050/hospital- Discharge Summary
discharge-template.png

https://i.pinimg.com/736x/ea/4d/84/
47 ea4d84e2187beda3bfade871032bc41 Discharge Summary
1.jpg
 https://reader015.vdocuments.mx/re
48 ader015/html5/0709/5b436275924b3 Discharge Summary
/5b436276a1f7c.jpg
https://www.signnow.com/preview/3
49 95/142/395142120/large.png Discharge Summary

https://images.template.net/wp-
content/uploads/2017/11/General-
50 Discharge Summary
Format-Discharge-Summary-
Template.jpg
PATTERNS

Initials,Infix,Last name,Date of Birth,Gender,Social Security No, Nationality,House

number,Postalcode,City,Country,Home phone number,Mobile telephone no,email, Apply
insuranse for yourself,Voluntarily chosen excess,Which family member,Other insured
person social security number,Plans (Basisverzekering, Aanvullend, Aanvulend Tand,
Income(Policy holder,Insured1,Insured2,Insured3), Account number, Premium payment,
Policy holder signature, Date of register

Branch Code, Agent Code, Name, Communication address, City, Pin, Mobile No, Tel,
email,occupation,aadhar card,insurance propsed address,year of construction,Built up
area of residence,sum insured,item insured,insurance company name,policy
number,period of insurance,salary,Bank account holder,Account Number,
Branch,date,signature.

Proposal Number, Name, ClientId, Nationality, Source of Earning, Address, City, State, Pin,
Contact No, Photo Id proof,Address Proof, Propser/Premeium, Amount, draftno,
date,drawn, place, date signature,Proposal Number.

Policy no, Passport No, Trip Destination, Periof From, Claims Ref No, Name, Date of Birth,
Sex, Address, Phone no, Name of Insurer, Date trip commenced, Schedule date of return,
Claimants Address, Place, Date, Signature, Place of Accident, Type of Insurance,Name of
common carrier, Flight no, Benificary name,Bank account No, Branch name, IFSC Code,
Signature

Insured Name, Social Security No, Date of Birth, Patients Name, Pat Social security No, Pat
DOB, Address, Phone No , Covered Person name, Disease, Symptoms, Date of Cause, Last
treatment, Date and time of accident, Accident city, Phone Number, Signature of patient,
Signature of spouse, Signature of dependent,Date of births of primary, DOB of Spose, DOB
of dependent

Name,Social Security Number,Gender,Date of Birth,Nationality,Martal Status,Spouse

name,Full name of all the children,Work began, Work ended, Total earnings, Illness,
injuries, blind or low vision,other disability benefits,remarks, signature, dateRouting
Transit Number, Account Number, Signature of witness

Policy No, Claim No,Name of Insured, Adresss, Policy No, Period of the Policy, Limit of the
Indeminity under the Policy, date of occurance , Time, Place of Accident,Adtess and
occupation, State of accident, Damage to property,.Claim,estimated amount of
claim,witness address, insured signature.

Customers PAN No, Name of the Insured, Address, Steet Name, Locality, City, Pincode,
State, Phonno, Fax No, Email, Business of Insured, Intermediary Details, Intemediary Code,
Client Type, Period of Insurance Form, Amount Rs, Salary, Business, Name of Bank
Account Holder, Name of the Bank, IFSC Code,Period of Insurance form, Basic Valuation of
Buildings, Risk ccupancy address,Risk details occupancy, Fire Protection, 24x7 security,
Date, Place, Signature.
Policyholder Full Name, Mobile No, Email, Policy Certificate No, Correspondence Address,
GST registration no, Date of registration, Claiment Full Name, Mobile No, Relationships,
Date and time of accident, Location of Accident, Type of loss/claim ,Description
of Accident,Description of Accident, Bank Name, Account No, Bank Branch , Bank Name,
Date, signature

Policy No,Declaration No, Name and address of the consignors,Name and address of the
consignees, Nature of goods, Number and date of the Carrier's Receipt, Place of despatch,
Place of destination, Date of arival, Date of despatch, date of taking delivery, Date when
loss or damaged noted, Duty payable on sound good, Original Insurance Policy and/or
Certificate duly Endorsed, Copy of the Bill of Lading, Carriers Certificate, Address,
Signature, Place, Date, Name of Insured , Policy Number, Claim number, Benificiary Name,
Bank Account Name, Branch Name , Account Number , IFSC code

Ref No, Mob no, Doc Name, Patient Details, Patient UID, Bill No, Age, Payer Details, Bill
Date, Admission No, Admission Date Discharge Date, Primary Code, Particulars, Amounts,
Total Bill Amount, Amount Paid, Rate, Staus , Receipt No, Method, Patient Signature

Name, Adress, Stament Date,Service Date, Type of Service, Account, Billed Charges,
Adjustments, Insurance Payments, Patients Payments, Balance Due, Account Number,
Insurance Payments, payable To, Statement print Date, Signature,Card Number.
PAN No, IPD No, UHID No, Patient Name, Class, Doctor in charge, Age , Final Diagonisis, Bill
No, Bill Date, Admission Date and Time, Discharge Date and Time, Discharge status, Bill
Amount, Sub Total, Total Amount, Less Deposit, Less Receipt, Balance Amount, Paid
Amount,GST no

MRNo, Patient Name, Bed No, Patient Category, Admitting Doctor, Admission Date, Bill
Date, Bill No, Company Name, Bed Category, Hospital Charges, Consultation, Sun store
Material, Radiology, Pathology, Gross Amount, Sur, Charges, Net Payable, Advance
Amount, Balance Amount,

Patient Name, Account, Address, Amount Due, Date of Service, Patient Service, Primary
Insurance Billed, Secondary Insurance Billed, Pharmacy, Emergency Room, EKG/ECG,
Total Charges, Total Payments, Total Adjustment, Card Number, Signature, Account
Number, Date of service, Invoice Date

Patient Name, Account name,Insurance information, Admitted Date of service, Vissit

number procedure code, service provider type of service, billed charges,paid by paln
adjustment,patient payment,due from the patients, account total due from , due date,
account numberstament date,card number,signatureshow amount paid

Account Name, Addresss, Patient, Code, Description,Th,Surf,Amount, EST.ins, Previous

Account Balance, Todays charge, todays Payments, New account balance, expected
insurance, balance, next appt, day, date, time,reason, date of service, account
number,doctors name, address

Date, Explanation of activity, Patient name, Debits, Pending, Credits, Balance, Statement
date, account number, current ,days, total, Ins pendins,patient balance, explanation of
activity,patient name, charges and debits, payment and credits, account number,statment
date, statment of account,amount enclosed
Name of patient, Account number, statement date, due date,account name, amount due,
amont paid, date, service description, status, charges, payments, patient balance,
professional sevices total, hospital clinic services total, total amount due, amount due

Patient name, Attending doctors, Patient address, guarantor name, company name, Soa
reference number, Admission number, Age, Admission date, Discharge, Room No, First
Class Rate, Second Class rate, Hostipal bill particulars, Charges, Pyments, Balance due,
doctors incharge, fee, discount, payment, balance, total professional fee, signature,
amount convered

Regn Date, Name, Reg No, Ref bY, Sample, Type, Sample Collection, Print Date, Age, Sex,
Regn Centre, Ref No, Test Name, Result, Biological Reference range, Differential count,
Peripheral smear, Signature, Refrenced Date

Receipt, PT name, Reffered By, Date, Age, Sex Sample, Del Date, Tests , Physical
examinatition, Qualntity, Color, apperance, Sediment, Microscopic examination, RBC, Pus
Cells, Chemical Examination, Reaction, Albumin, Sugar, Ex phosphate, Casts, RBC,WBC, On
request Bile salt, bile pigments,bile protein, Crystals, Urate, Uric acid, Cal oxcate, checked
by,technologist,report process

Name, UHID,Ref by, Gender, Bill no, Date, Age, Lab No, Time,Volume,colour,
apperance,specific gravity,ph,protein,sugar,urine keotene,bile salts,bile pigments,occult
blood,pus cells,RBC,Epitieliel cell,cast,crystal,Prescribed by
Patient Name, Age, Reffered by, Date, Ref No, Location, Test haemoglobin, result, Units,
Normals,Differential count,blood indices,palet count,blood group,RBC,WBC,Platelets, MP,
PS Conclusion,Report check, Pathologist
Invoice No, Nrl no,Patients name, Date of collection, Referred By, Date of registeration,
Age, Requestor, Date of Reporting, Test, Result, Unit, Reference range, Method, Total
leucocyte count, Haemoglobin, PCV, MCV, MCH, Paletes count, Reg no, Prescribtion agent

Medical Record No, Patient Name, Specimen ID,Clinical Information, Age, Gender,
Location, Requesting Physicial,Account#, Requested on, Collected on, Reported on, Test,
Result, Normal Ranges, Blood count, RBC,MCV,MCH,MCHC,WBC,Neutrophils,
Lymphocytes, Eosinophiles, Monocytes, Basophiles, Platelets, Methodology, Pheripheral
film

Physical Examination, Color, Specific gravity, Turbidity, Deposit, PH,Sugar, Keotenes,

Protein, Blood, Urobillnogen, Billrubin, Nitrate, Pus cell, RBC, Epithelial cell, Casts, Crystals,
Amorphus, Misc, Test system

Name, Peffered By, Lab no, Date of Collection, File No, Total Leukocyte count, Nuecleated
Erythrocytes, Correct Leukocyte count,Heterophils, Lymphocytes Eosinophil,
Monocytes,Haemoglobin, Dead cells, HCT,MCHC,RBC,MCV,MCH, Platelet count, WBC
Morphology, RBC Morphology, Vetinary Signature

Name,Age,UID,Gender, Contact No, Referring Doctor, Registeres, Reported, Report Status,

Testname, Test result,Biological Reference range, Sample, Haemoglobin percentage,
Packed cell volume, Total wbc count,Neutrophils, Lymphocytes, Eosinophils, Monocytes,
RBC count, Mean corpus volume, Mean corpus Hemoglobin, Mean corpus hb
Name,UHID,Ref by, Gender, Bill no, Date, Age, Lab no, Time, Test, HB,
RBC,PCV,MCV,MCHC,RDW,Total Leucocytescount, Results reference name, Neutrophil,
Lymphocytes EosinophilMonocytes, Platelet count, RBC Morphology, WBC Morphology,
ESR,Prescriber

Hospital name,Hospital address,City,Hospital pincode.Hospital contact number,Hospital

google link,Doctor name,Doctor Registration number,Doctor address,Patient
name,Age,Address,City,Country,Pincode,Phone number,Mail ID,Medical History,Medicine
name,Instruction,Frequency,Months to apply medicine.

Hospital name,Hospital address,City,Hospital pincode.Hospital contact number,Doctor

names,Hospital address in markham,Hospital address in Tornoto,Patient name,Date of
birth,Age,Address,City,Country,Date of visit,Medicine name,Patient Identification, Health
card expiry,Instruction,Frequency,Doctor registration number,Signature of the patient.

Hospital name,Date,Time,Rx ID,Doctor name,Telephone number, DEA Reg, Patient

name,Date of birth,Address,City,Country,Rx Date,Exp Date, Medicine name,Dispense, Rx
Instruction,Patient Instruction ,Refills.

Printed date, written date,printed time,written time,Doctor name,Doctor address,Phone

number,Doctor ID,Patient name,Age,Date of Birth,Gender,Address,City,Country,Phone
number,Business phone,Medication,Sig,Quantity,Duration,Start Date,Do not refill, Allow
substitution

Hospital name,Hospital address,Date,City,Hospital pincode.Hospital contact

number,Hospital google link,Doctor name,Doctor Registration number,Doctor
address,Patient name,Sex,Age,Address,City,Country,Pincode,Phone number,Mail
ID,Diagonosis,Allergies,guardian,Medical History,Medicine
name,Instruction,Frequency,Months to apply medicine.

DD Form No,Date ,Patient name,Patient address,Phone number,For under 12,give age,

Medical facility,Date, Superscription,Inscription,gm or ml,Signature,MFGR,Exp Date,Lot
No,Filled by,Rx number,Signature rank and degree,Edition number

Doctor name,Doctor qualification,Register number, Patient name,Age,Gender,Date of

visit, Diagnosis,description,additional comments,prescribed
medicines,dosage,instructions,blood test,Fasting test,ugi,endoscopy,follow up,doctor
advice,doctor signature.

Doctor name,City name,Country,Zipcode,telephone number, DEA Reg,Licence number,

Patient name,Date of birth,Address,City,State,Country,Zip,Date of visit,Sex, Medicine
name,Dispense, Prescribed signature,Rx Instruction,maximum daily dose,Patient
Instruction ,Pharmacist test area,Dispense as written.

Doctor name,Doctor qualification,Regd No,City name,Country,Zipcode,telephone number,

DEA Reg,Licence number, Patient name,Age,Gender,DAddress,City,State,Country,Zip,Date
of visit, Diagonsis,Medicine name,Dosage, Prescribed signature,Instruction,maximum daily
dose,lab test,follow up, doctor advice,doctor signature
Hospital name,Hospital address,City,Hospital pincode,Hospital contact number,Hospital
Timing,Closed days,Doctor name,Doctor Registration number,Qualification,Doctor
address,Patient name,Weight,Height,Sex,Age,Address,City,Country,Pincode,Phone
number,Referred by,Medical history,Chief Complaints,Clinical
findings,Diagonosis,Procedures conducted,Medicine name,Instruction,Frequency,Months
to apply medicine.Follow up,Signature

Hospital name,Hospital address,Hospital contact number,Hospital TimingDoctor

name,Doctor Registration number,Qualification,Doctor phone number,Patient
name,Admission number,Admission date,Discharge date,Sex,Age,Address,Phone
number,Pateient UID,Primary Testing Consultants details,Discharge status,Other
cosultants,Provisional diagonsis at the time of admission,Final diagnosis at the time of
discharge,Complaints with duration and reason for admission,Summary of Presenting
illness,Key findings on physical examiniation at the time of admission,general
appearance,Summary of key investigation,Prescription and discharges,Advice on
discharge,In case of emergency,Follow up date,Treating Consultant,Declaration of
Patient/Attendant.

Hospital name,Hospital address,Hospital contact number,Patient name,Admission

number,Counselor,DOB,At admission,At Discharge,New Admission,services provided,
Discharged,Medication at admission,at discharge,Last observation dose,treatment
prognosis,substance use,medical,employment

UHID,Patient identifier,Name,Age,sex,Address,primary consultant,Date of admission,Date

of surgery,date of discharge,Allergies,Diagonsis,Surgery,History of present illness,Social
history,Clinical examination,Current medication,Weight,temperature

Allergies,Author Type,Filed,Note time,Patient name,DOB,Age,Medical record

number,Admission date, Discharge date,Primary physician,Principal diagnosis causing
admission,patient active,Discharge medications,Instruction to use medication,Consigned
by,patinent active hospital problem list.

Hospital name,Hospital address,Hospital contact number,Patient name,Admission

number,Counselor,DOB,At admission,At Discharge,LOS,UR number,principle
diagnosis,Comorbidities,Presentation/history,Examination,Operation/procedures,Alerts,Al
lergies, Medications on discharge,frequency,Reason for change
Date,Patient name,Patient I.D,phone number,attending physician,Facility name, date
services should end,Current medical condition,admission date, symptoms of disease,bill
paid,therapy notes,description of discharge plan,physician note

UHID,Patient identifier,Name,Age,sex,Address,IPNO,primary consultant,Unit,Date of

admission,Allergies,Diagonsis,Surgery,History of present illness,Social history,Clinical
examination,Current medication,Weight,temperature,Child,BP,Pupil,fundus
Hospital name,Patient name,Admission number,Age,I.P No,Counsultant,DOB,Date of
admission,Date of Discharge,Diagnosis,Donor Details,Pre transplant
assessment,BP,Pulse,PS,Chest,CVS,P/A,CNS
Hospital name,Patient name,Age,Ward,Sex,Hospital number,Admitted
on,MRDNo,Discharged on,Address,Diagnosis,History,on
examination,Investigation,Department name, Consultant telephone number,email id

Patient name,Medical record number,admission date,Discharge date,attending physician,

dictated by,primary care physician,referring physician,consulting physician, condition on
discharge, final diagnosis, history of present illness, discharge medication,discharge
instruction
Patterns