Patient Registration Hub
⌘K
Active Patients:
...
New Patient Intake Form
SYSTEM GENERATED UNIQUE UHID
UHID-2026-XXXXXX
1. Photo Documentation
Photo 1: Profile Pic
*
Upload Profile Image
Photo 2: ID Document
*
Upload ID Document
2. Patient Identity & Demographics
Full Patient Name
*
Guardian Name
*
Gender
*
Male
Female
Other
Age (Years)
*
Blood Group
*
A+
A-
B+
B-
O+
O-
AB+
AB-
Marital Status
*
Single
Married
Divorced
Widowed
Date of Birth
3. Contact & Address Details
Phone Number
*
Email Address
Residential Address
4. Patient Account Credentials
Username
*
Password (Default: 123456)
Cancel
Complete Patient Registration
Patient Roster Directory
Patient
Details
Phone
Action