Form: IHS Field Patient Referral Initial.html,IHS Field Patient Referral Viewer.html

To: <var To_Name>
Subject: IHS Field Patient Referral-<var PatName>-<var Village>	
Msg:
From Team: <var Name>
Date/Time: <var time>

PATIENT NAME: <var PatName>

Patient Age: <var PatAge>
Patient Gender: <var PatGen>
Patient Village: <var Village>
Other: <var Other>

PATIENT COMPLAINT/PROBLEM: 

<var Prob>
--------------------------------------------------------

Care Already Given: 

<var PatCare>
--------------------------------------------------------

Meds Given Already: 

<var PatMed>
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Type of Care Requested: 

<var CareReq>
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Caregiver Contact: <var Contact>
--------------------------------------------------------

Additional Info or Comments:

<var Comments>