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UHID
Name
Age
Sex
Mobile
Address
Temp(°C/°F)
RBS
BP (mm of hg)
SpO2
RR
Pulse(/m)
Height
Weight(kg)
Symptoms
Gen Examinations
Investigation Adviced
Select Treatment Type:
-- Select Treatment --
Teeth Cleaning
Dental Filling
Tooth Extraction
Root Canal Treatment
Braces / Orthodontics
Dental Implants
Crown & Bridge
Teeth Whitening
Dentures
Gum Treatment
General Checkup
Upper Layer Teeths
1
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2
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3
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4
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5
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6
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7
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8
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9
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10
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11
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12
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13
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14
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15
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16
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Lower Layer Teeths
32
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31
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30
Select
29
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28
Select
27
Select
26
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25
Select
24
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23
Select
22
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21
Select
20
Select
19
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18
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17
Select
Medicine
Frequency
Duration
Instrucation
Action
Frequency...
1-0-1
1-1-1
0-0-1
1-1-0
S-O-S
Once in a week
Twice in a week
Duration...
3 Days
5 Days
7 Days
10 Days
15 Days
1 Months
2 Months
3 Months
Diet Plan
Revisit Date
Test Details
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