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Name Of Patient
Sex
Male
Female
Age
I am the Patient?
Yes
No
Phone No
Alternate No
WhatsApp No
Email Id
Address
Short Case History(Upto 150 words)
Duration of illness
Symptoms
Previous treatment if any
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Upload available investigations & tick Yes/No after uploading:
Blood investigations
Yes
No
Any other lab investigation
Yes
No
X Ray film with report if available
Yes
No
MRI film with report
Yes
No
CT scan film with report
Yes
No
Bone scan with report
Yes
No
Biopsy report
Yes
No
Prescription of previous ortho doctor
Yes
No
others
Yes
No
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