Emergency Patient Registration
Scheme:
{{currentERPatient.SchemeName}}
PriceCategory:
{{currentERPatient.PriceCategoryName}}
First Name
Alias Name
*
:
First Name is required
Alias Name is required
First Name must be less than 40 characters
Alias Name must be less than 40 characters
Middle Name
:
Last Name
*
:
Last Name is required
Last Name must be less than 40 characters
{{GeneralFieldLabel.Caste}}
*
:
Gender
*
:
--select--
Male
Female
Other
Gender is required
Age
:
Years
Months
Days
Age is required.
Date Of Birth
:
Country
:
{{Country.CountryName}}
{{GeneralFieldLabel.DistrictState}}
:
{{GeneralFieldLabel.Municipality}}
:
Ward Number
:
Address
:
This is a Police Case
Contact number
:
Primary Phone is not proper
Referred By
:
Condition during arrival
:
Mode of arrival
:
Care Of Person
:
Care Of Person Number
:
Brought By
:
Relation With Patient
:
Please Select Triage Code
X
Death
Critical
Moderate
Mild
Case
:
--select--
{{case.Name}}
0">
{{c.Name}}
Biting Address
:
{{Country.CountryName}}
Name of Animal
:
Date of Bite
:
Bitten on
:
{{part.DisplayName}}
Biting Snake
:
{{type.DisplayName}}
First Aid
:
{{type.DisplayName}}
Add Unknown ER-Patient
Reset ER-Patient
Register
Update