Add Patient | DreamsEMR - Responsive Bootstrap 5 Medical Admin Template

Basic Information

Profile Image

Upload

JPG or PNG format, not exceeding 5MB.

ID

First Name*

Middle Name*

Last Name*

Blood Goup*

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*

Pincode*

Referral Doctor’s Info

Referred By*

Referred On*

Department*

Other Information

Notes If Any

Vitals

Temprature*

F

Pulse*

mmHg

Respiratory Rate*

rpm

SPO2*

%

Height*

cm

Weight*

Kg

BMI*

kg/cm

Waist*

cm

BSA*

M

Quick Notes

Medical History

Type

Date of Illness

Reason

Hospital Name

Assessment done if any

Notes

Documents If any

Xray_report_head

Size : 21.2 Kb

Blood_report_head

Size : 30.5 Kb

Type

Date of Illness

Reason

Hospital Name

Assessment done if any

Notes

Documents If any

Add New

Complaints

Patients Overall Health Condition

Does patient have any health Condition

Enter value separated by comma

Allergies if Any Before