Healthwise Diagnostics Ltd

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Test Details
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Full Name Random ID
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Full Name *
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Gender *
Type of Sample specimen *
Referral Facility/Hospital *
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Referral Name *
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Department *
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Type of Test Regular
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Preview of submitted tests:


ID: HW-000   Full Name:    Age:    Gender:
Phone Number:    Email Address:

Tests:


Laboratory:    Type of specimen:

Customer Type:    Total price:

Type of payment:   
Advance:    Balance:   
Debt Status:
;
Payment mode:   
Amount paid in cash:    Amount paid cashless:

Referral Name:    Commission:

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Laboratory
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Test
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Organism Isolated
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Antibiotic Sensitivty Repeater
Patient ID
Patient Name
Patient Age
Years/Months/Days *
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Female Min
Female Max
Child Min
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Only Min. Male
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