Patient Registration Form

Chief Complaint:
Examination:
Provisional Diagnosis:
Advanced Investigations
Treatment:
General Instructions:
Follow Up:
Gayathri Health Clinic

Dr.Gayathri Devi Lenka

MBBS, MD - General Medicine

1-64-18,SECTOR 2,MVP COLONY VISAKHAPTNAM-530017

Registration No: APMC/FMR/96802

Phone:9 222 444 777 | Email: care@doctorgayathri.com https://doctorgayathri.com

Date and Time:

July 27, 2024 at 03:33 PM

Name:

Age:

Gender:

Vital Signs:

WT:

BP:

PR:

Temp:

Consultation:

Chief Complaint:

Examination:

Provisional Diagnosis:

Advanced Investigations:

Treatment:

General Instructions:

Follow Up:

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