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Rugency Hospital
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Patient Registration
Personal Information
First Name
*
Middle Name
Last Name
*
Gender
*
Male
Female
Date of birth
Mobile
*
Login Information
Email
*
User Name
*
Password
*
Address Information
Address
*
City
State
Country
Zip Code
Phone
Other Information
Blood Group
Select Blood Group
O+
O-
A+
B+
A-
B-
AB+
AB-
Symptoms
Anemia
blood loss
Dolor estomacal
fever
head pain
headache
Lower Back Pain
lower back pain
mathabetha
mathabetha
mental problem
mifupa inauma
mlm
mlm
nausea
nausea
Red Eye
Rosetia
sds
sucks
Swollen Toe
weight gain
Diagnosis Report
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