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Basic Detail
Patient Name
Mobile Number
Mobile Number
Year
Month
Day
Patient ID
Male
Female
Clicnic
Clinic 1
Clinic 2
Clinic 3
Personal Information
Patient Avatar
Anniversary Date
Emergency Contact
Contact (Alternate)
Category
Category 1
Category 2
Category 3
Address
ICMR ID
Notes
Referred by
Dr.
Dt.
Mr.
Mrs.
Ms.
Practicing Categoriy
Categoriy 1
Categoriy 2
Categoriy 3
Categoriy 4
Legal Entity Name
Registration Details
Diet
Food
Drug
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