Fri, Sep 03, 2010 
 
 
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Name :
Age :
Sex :
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Female
Address :
 
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Your Present main complaints with Duration
History of Previous Disease

History of Previous / Present medication and Treatments Under Gone

Information of reports if any (X Ray, USG…)
           
Diet :
Veg
Non veg
Personal History :-
Alcohol Sleep :-
Normal
Abnormal
Smoking Bowel :-
Regular
Constipated
Appetite :-
Normal

Abnormal

High
Low
Do you want to say something more to help us in diagnosing your disease

 

 
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