Change Doctor/ Department
X
Hospital No :
{{selectedVisit.PatientCode}}
Patient Name :
{{selectedVisit.ShortName}}
Age/Sex : {{selectedVisit.Age}}/ {{selectedVisit.Gender[0]}}
Address :
{{selectedVisit.Address}}
Contact No :
{{selectedVisit.PhoneNumber}}
Registration Date/Time
:
Registered Department
:
Assigned Doctor
:
Referred Department
*
:
Referred Department is Required
Referred Doctor
*
:
Referred Doctor is Required
Reason to Refer
: