{AJAXCONTENT}
Data Entry 00 00 00
Personal details
Prefix: FName: MName: LName:
CName: DOB: value="{DOBDD}" value="DD" name="dobdd" onfocus="this.value=''" onblur="if(this.value==''){this.value='DD';}else if(isNaN(this.value)){alert('It\'s not a valid integer'); this.value='DD';this.focus();} else if(! (this.value >= 1) || !(this.value <= 31)){alert('Day b/w 1 to 31');this.value='DD';this.focus();}" > value="{DOBMM}" value="MM" name="dobmm" onfocus="this.value=''" onblur="if(this.value==''){this.value='MM';}else if(isNaN(this.value)){alert('It\'s not a valid integer'); this.value='MM';this.focus();}else if(! (this.value >= 1) || !(this.value <= 12)){alert('Month b/w 1 to 12');this.value='MM';this.focus();}" > value="{DOBYYYY}" value="YYYY" name="dobyyyy" onfocus="this.value=''" onblur=" var d = new Date(); if(d.getMonth() >= 0 && d.getMonth() <= 11){cmonth = d.getMonth(); ++cmonth; } if(this.value==''){this.value='YYYY';} else if(isNaN(this.value)){alert('It\'s not a valid integer'); this.value='YYYY';this.focus();} else if(this.value.length <=3 || this.value.length >=5){alert('Year should be in YYYY format'); this.value='YYYY';this.focus();} else if(!(this.value >= 1800)){alert('Year must be greater than 1800');this.value='YYYY';this.focus();} else if(this.value > d.getFullYear()){alert('Invalid Year'); this.value='YYYY'; this.focus();} else if(this.value == d.getFullYear() && document.theform.dobmm.value > cmonth){alert('Invalid Month'); this.value='YYYY'; this.focus(); } else if(this.value == d.getFullYear() && document.theform.dobmm.value == cmonth && document.theform.dobdd.value > d.getDate()){alert('Invalid Date'); this.value='YYYY'; this.focus(); }" > ADate: value="{ADDD}" value="DD" name="addd" onfocus="this.value=''" onblur="if(this.value==''){this.value='DD';}else if(isNaN(this.value)){alert('It\'s not a valid integer'); this.value='DD';this.focus();} else if(! (this.value >= 1) || !(this.value <= 31)){alert('Day b/w 1 to 31');this.value='DD';this.focus();}" > value="{ADMM}" value="MM" name="admm" onfocus="this.value=''" onblur="if(this.value==''){this.value='MM';}else if(isNaN(this.value)){alert('It\'s not a valid integer'); this.value='MM';this.focus();}else if(! (this.value >= 1) || !(this.value <= 12)){alert('Month b/w 1 to 12');this.value='MM';this.focus();}"> value="{ADYYYY}" value="YYYY" name="adyyyy" onfocus="this.value=''" onblur=" var d = new Date(); if(d.getMonth() >= 0 && d.getMonth() <= 11){cmonth = d.getMonth(); ++cmonth; } if(this.value==''){this.value='YYYY';} else if(isNaN(this.value)){alert('It\'s not a valid integer'); this.value='YYYY';this.focus();} else if(this.value.length <=3 || this.value.length >=5){alert('Year should be in YYYY format'); this.value='YYYY';this.focus();} else if(!(this.value >= 1800)){alert('Year must be greater than 1800');this.value='YYYY';this.focus();} else if(this.value > d.getFullYear()){alert('Invalid Year'); this.value='YYYY'; this.focus();} else if(this.value == d.getFullYear() && document.theform.admm.value > cmonth){alert('Invalid Month'); this.value='YYYY'; this.focus(); } else if(this.value == d.getFullYear() && document.theform.admm.value == cmonth && document.theform.addd.value > d.getDate()){alert('Invalid Date'); this.value='YYYY'; this.focus(); }" > DDate / Time: value="{DISDD}" value="DD" name="disdd" onfocus="this.value=''" onblur="if(this.value==''){this.value='DD';}else if(isNaN(this.value)){alert('It\'s not a valid integer'); this.value='DD';this.focus();} else if(! (this.value >= 1) || !(this.value <= 31)){alert('Day b/w 1 to 31');this.value='DD';this.focus();}" > value="{DISMM}" value="MM" name="dismm" onfocus="this.value=''" onblur="if(this.value==''){this.value='MM';}else if(isNaN(this.value)){alert('It\'s not a valid integer'); this.value='MM';this.focus();}else if(! (this.value >= 1) || !(this.value <= 12)){alert('Month b/w 1 to 12');this.value='MM';this.focus();}"> value="{DISYYYY}" value="YYYY" name="disyyyy" onfocus="this.value=''" onblur=" var d = new Date(); if(d.getMonth() >= 0 && d.getMonth() <= 11){cmonth = d.getMonth(); ++cmonth; } if(this.value==''){this.value='YYYY';} else if(isNaN(this.value)){alert('It\'s not a valid integer'); this.value='YYYY';this.focus();} else if(this.value.length <=3 || this.value.length >=5){alert('Year should be in YYYY format'); this.value='YYYY';this.focus();} else if(!(this.value >= 1800)){alert('Year must be greater than 1800');this.value='YYYY';this.focus();} else if(this.value > d.getFullYear()){alert('Invalid Year'); this.value='YYYY'; this.focus();} else if(this.value == d.getFullYear() && document.theform.admm.value > cmonth){alert('Invalid Month'); this.value='YYYY'; this.focus(); } else if(this.value == d.getFullYear() && document.theform.admm.value == cmonth && document.theform.addd.value > d.getDate()){alert('Invalid Date'); this.value='YYYY'; this.focus(); }" > value="{DISCHARGETIME}" value="HH:MM am" onfocus = "this.value=''" onblur = " if(this.value==''){this.value='HH:MM am';}">
Phone: Mobile: HosRefNo: Weight:
Blood Group: Allergies:
Address details
Address:
Country:
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State:
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City:
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Locality:
Pincode: PhOffice: Fax: Email:
Referral doctor details
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Consulting doctor details
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Patient classification
Classification:
Others (If any): {HTMLEDITOR1}
Chief complaints
Complaints:
Others (If any): {HTMLEDITOR2}
Provisional / Probable Diagonosis
Diagonosis:
Others (If any): {HTMLEDITOR3}
Investigation done with report
Investigation:
Others (If any): {HTMLEDITOR4}
Final Diagnosis
Diagnosis:
Others (If any): {HTMLEDITOR5}
Treatment
{HTMLEDITOR6}
Condition on Discharge
{HTMLEDITOR7}
Advice on Discharge
{HTMLEDITOR8}
Followup
{HTMLEDITOR9}
Any Other Information / Other Findings
{HTMLEDITOR10}
Other Comments
{HTMLEDITOR11}
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