Patient Registration
Visit Type
  Out Patient
  In Patient
  OTC

  MRN  

Name  
New IC No. Old IC No.

 



 
Patient Particulars
 
Sex
Male   Female
Date of Birth
Age
Privilege
Referred by External Clinic


 
Visit / Admission Details
 
Attending Doctor
Add Another Doctor
Selected Doctors
Estimated Time
Patient Type
Patients Ahead
Patients Ahead
OTC Type

 
Emergency Contact Details
 
Contact Person
Relationship
Tel (H)
Tel (O)
Tel (M)


 
Remarks

     

 






 
Reprint Options

Patient Label
Inpatient Wristband