Add Patient | Dreams EMR - Responsive Bootstrap 5 Medical Admin Template

Basic Information

Profile Image*

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ID

First Name*

Middle Name*

Last Name*

Blood Group*

Age*

DOB*

Patient Type*

Gender*

Company Name with Location

Martial Status*

Contact Information

Mobile Number*

Emergency Number*

Guardian / Person Name*

Address Line 1*

Address Line 2

Country*

City

State

Pin Code

Referral Doctor’s Info

Referred By*

Referred On*

Department*

Other Information

Notes if any

Vitals

Temperature *

F

Pulse*

mmHg

Respiratory Rate*

rpm

SPO2*

%

Height*

cm

Weight*

Kg

BMI*

kg/cm

Waist*

cm

BSA*

M

Quick Notes

Medical History

Type

Reason

Date of Illness

Hospital Name

Assessment done if any

Notes

Type

Reason

Date of Illness

Hospital Name

Assessment done if any

Notes

Add More

Complaints

Patients Overall Health Condition

Does patient have any health Condition

Allergies if any Before

Save & Confirm

Notifications

Patients