This patient is Visited / Discharged Already!!!!

This patient is Closed /Delivery from out side of SRMS!!!!

Doctor ID

Department

Qualification

Name *

Mobile No.*

Age*

Sex *

Address

City

Sr. No	Disgnosis	IP Count	Hospital Amount	Hospital Billed	Hospital Concession	Hospital Settlement	Pharma Amount	Pharma Billed	Pharma concession	Pharma Settlement

Visit ID

Patient No

Patient Name

Doctor Name

Department

City

Phone

Registration date

Last Visit date

Followup Date

EDD Date

Heath Worker

Scheme

POG

Trimester Cycle

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Delivery Date:

Status:

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S No.	Visit ID	Patient No	Patient Name	Age	City	Phone	Doctor Name	Department	Last Visit date	Followup Date	Next Followup Date	New EDD Date	Remark	Delivery Type	Reason	SubReason	Delivery Date	Status

Sr. No	Patient No	IP No	Patient Name	Ward Name	Admit Date	Discharge Date	Doctor Name	Disgnosis	Amount	Concession	Settlement	Pharma Amount	Pharma concession	Pharma Settlement

SNo.	Checked In	Patient No.	Patient Name	Appt. Time	Had Admitted	Visit Type	Last Visit

CLINIC WISE ODM COMPLIANCE SUMMARY

Department Name	Appointments	Checked In	% Checked In	Medicine Prescribed	% Medicine Prescribed	Billed	% Billed

Packing Size

Medicine Code	Medicine Name	Frequency	Frequency Code	Dosages code	Dosages	Quantity	Remarks	storecd.	selprice	pkgsize

Medicine Code	Medicine Name	Frequency	freq code	Dosages	dosage code	Quantity	Urgent	Remarks	Store	Store cd	selprice	othpkgmed	Delete

Test Description/Test Date/Lab No.	Observed Values	Reference Values

ID	Doctor Id	Doctor Name	Clinic Name	Selected Date:	Time Slot	Rate Code	Online Available/ Not Available	Slot Code	OPD Available/ Not Available

Patient No. :
Appointment Details
Appointment Status : __________				Appointment ID :
Appointment Date : ________________________				Appointment Day : ________________________
Appointment Time : ________________________				Consultant Name : ________________________
Appointment Description : ss

S.No	Cln Code	DoCode	OPD Description	Doctor Name	Checked In	Medicine Prescribed	Investigation Prescribed
		TOTAL

Medicine Name	Frequency	Frequency Code	Dosages code	Dosages	Days	Remarks	Meal	ROA

Medicine Name	S.No	Frequency	Frequency Code	Dosages	Days	Remarks	Meal	Delete

Medicine Code	Medicine Name	Frequency	Frequency Code	Dosages	Days	Remarks	Storecd	Meal	ROA

Click on Template Name to Add Medicine in existing templates

Medicine Code	Medicine Name	Frequency	Frequency Code	Dosages code	Dosages	Days	Remarks	Storecd	Meal	ROA	Delete

investigation Code	Investigation Name	Unit	Remarks	Delete


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Payment Details

Amount (Rs.) : __________

Payment ID : __________

Payment Date : __________

Personal Details

Patient Name : __________

Date of Birth : __________

Age/Sex : __________

Mobile : __________

Email-ID : __________