Patient Entry Form

Username *

Select KIT * --SELECT--

Patient Name *

Patient Mobile

Patient Email

Patient's Gender * --SELECT-- Male Female

Patient Age (in years)

Patient's Father/Husband Name

Patient Address with Pincode *

Patient Aadhar ID

Body Temperature

Oxygen Level (SpO2)

Chest CT Scan Value (if available)

Any Other Symptoms

Recommended By

Recommended Mobile

Remark (if Any)