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  • Sample Registration

    Uploaded by

    Shaikh Nilofar
    4 views1 page
    This document is a patient registration form containing information such as the patient's name, ID number, contact details, department, tests ordered, and billing information. It lists the patient's name as Shabina Khan and includes fields for details like patient category, center, consultant, pregnancy status, tests ordered, total cost, payment received, and balance due. Payment and billing details are also provided, including discount amounts and who approved them.

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    This document is a patient registration form containing information such as the patient's name, ID number, contact details, department, tests ordered, and billing information. It lists the patient's name as Shabina Khan and includes fields for details like patient category, center, consultant, pregnancy status, tests ordered, total cost, payment received, and balance due. Payment and billing details are also provided, including discount amounts and who approved them.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    4 views1 page

    Sample Registration

    Uploaded by

    Shaikh Nilofar
    This document is a patient registration form containing information such as the patient's name, ID number, contact details, department, tests ordered, and billing information. It lists the patient's name as Shabina Khan and includes fields for details like patient category, center, consultant, pregnancy status, tests ordered, total cost, payment received, and balance due. Payment and billing details are also provided, including discount amounts and who approved them.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

     Home  Front Desk  Sample Registration

    REG. ON:       VISIT ID : 

     PATIENT INFORMATION 

    Pt Unique ID : BMCM230700259375

    Pt Name : SHABINA KHAN    


    24
     

    Years

    F
    Cont. Number : 9819554760

    Patient Category

    IPD
    Default PRN    Yes  No *
    PRN / TRF No.

    CL9065-2061

    Billing Type

    Regular

    Centre

    OLD KHAR DISPENSARY POLYC ( CL9065 )


    Consultant Dr / 2nd Opinion

    OLD KHAR DISPENSARY POLYC

    Instruction to Lab

    Regular
    Preganancy Status

    No

    Reference No

    Billing Category

    CREDIT

    Patient History

    Corporate

    --Select--

    Patient Special type

    --Select--
    Marketed By

    --Select--

    ICMR - SRF ID

    Temperature

    BP

    SPO2

    Patient Department

    --Select--

    TESTS / PROFILES

     pt

    Type fewESTIMATION
    characters of
    OFthe Test / Pro"les
    PROTHROMBIN you( PT
    TIME want
    ) (PTto
    select TUBE) - P128410 - KDPL2874

    ESTIMATION
    Add Tests OF PARTIAL THROMBOPLASTIN
    / Pro"les
    TIME (APTT) ( APTT ) (PT TUBE) - P128411 -
    KDPL2873
    Test Code Test Name Price O!er Price
    ANTISTREPTOLYSIN - O (ASO) ( ASO ) (PLAIN) -
    T129721 - KDPL1349

    LEPTOSPIRA IGM AND IGG (SERUM) - T129762 -


    KDPL3422
    Showing 0 to 0 of 0 entries
    ANTI CCP ( CYCLIC - CITRULINATED PEPTIDE) (
    Total Cost
    ACCP ) (PLAIN) - T129765 - KDPL1001
    0
    Discount Type

    Amount

    Discount

    0
    Discount Remarks

    Discount Approved By

    Select

    Grand Total

    0.00

    Paid Amount

    0
    Balance Payable

    0.00

     Save Patient Info

    New Registration     Invoice      

    | A product of Techjivaa Software Pvt. Ltd. | Session Auto Logout


    in : 44 Mins : Seconds : 35 seconds.
    !

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