Case Record Form Name of the patient : Sex : Male Female Age* : Present Complaints and duration: 1. 2. 3. 4. * Previous major illness like Diabetes/ Hypertension/ Heart Disease/ Thyroid/ Asthma etc. Previous major operations * Allergies: * Any medication done for the above complanits Your E-mail * ( * )Marked Fields are compulsory, Please enter valid information.

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