Referring patients to the Outpatient clinic

* Only to be completed by doctors.

[[[["field29","equal_to","Yes"]],[["show_fields","field30"]],"and"],[[["field31","equal_to","SKGH"]],[["show_fields","field15"]],"and"],[[["field31","equal_to","RCDR"]],[["show_fields","field33"]],"and"],[[["field31","equal_to","SKHM"]],[["show_fields","field34"]],"and"],[[["field31","equal_to","SKHWC"]],[["show_fields","field32"]],"and"]]
1
Referred By
Doctor Name
License number
Specialty
Hospital / Cllinic
Telephone
Patient details
Patient Name
Nationality
Emirates ID
DOB
Insurance
Insurance Listpick one!
Gender
Fileupload
Attach
Reference to
Hospital / Clinicpick one!
Department-skhm
Department-rcdrt
Specific Clinic
Department-skhwc
Reason for Referral
Referral Reason
0 /
Clinical Data
Clinical Data
0 /
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