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New Patient Confirmation Form - RCM
Code:
Patient Name:
CM:
RCM:
Hospital:
Training Start:
Catheter Date:
Training End:
Mobile:
Doctor:
Tr.set Date:
RCM Remarks:
Patient Basline Data
Blood Parameters
Primary Disease:
HB:
Comorbid Disease:
S.Creatinine:
Previous Theraphy:
B.Urea:
Urine Output:
Duration of Previous Theraphy:
Blood Sugar:
S.Protein:
S.Albumin:
S.Sodium:
S.Potassium:
S.Calcium:

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