π Please fill-in the Registration Form.
β
Existing patients records
Please use the Patient Number πππ to find the patient information.
| Patient Number/α ααα½α α’ααααααααΊ | 80 |
|---|---|
| Gender/αααααα | Female |
| Are you pregnant/α’αααααΆαααααααα? | no |
| Family Name/ααααααααα½ααΆα | Sa Chhonhan |
| Age/α’αΆαα» | 69 |
| Contact Phone Number/s (If any) | 086267730 |
| Present Address/From: | |
| Province/ααααα | Kampong Cham |
| Kampong Cham Districts | Krong Kampong Cham |
| Village/ααΌαα· | Preak dom chΓ’n |
| Commune/αα»ααααααΆα | Sombour meas |
| Reason for visit/α ααα»α’αααΈααΆα ααΆα’αααααΆααααααΆ αα ααΈααααα ααααααα | She has been the High blood pressure, diabetes, palpitations , she has already to check the eyes blurry last year ago and now she wanted to check again |
| Date | 20/10/2024 |