HealthCure | Hospital Management and Information System

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Type of Patient

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Cash Entitle Corp/ Ins

Personal Information

Title *

Title Prefix

First Name*

Middle Name

Last Name

Marital Status *

Widow Single Married Divorced

Gender *

Male Female All

Blood Group

Emirates ID / Passport*

Emirates ID Passport No

Emirates ID* Other Emirates ID* Passport No*

Date of Birth *

Age *

Years

Months

Days

Password *

Confirm Password *

Reference ID

Upload Image

Contact Information

Country*

State/Province*

City *

Address *

Mobile No*

Telephone No

Email *

Occupation

Next of Kin

First Name

Last Name

Relation

Emirates ID

Mobile No