Form: IHS Field Patient Report Initial.html,IHS Field Patient Report Viewer.html
To:
Subject: IHS Field Patient Report - -
Msg:
From Team:
Date/Time:
PATIENT NAME:
Patient Age:
Patient Gender:
Patient Village:
Other:
PATIENT COMPLAINT/PROBLEM:
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Care Already Given:
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Meds Given Already:
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Type of Care Requested:
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Caregiver Contact:
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Additional Info or Comments:
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Express Sender:
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