Naimat Child Care Clinic

Bhutta Chowk, Khanewal | Ph: 065-2555111

ADMISSION FORM DISCHARGE FORM

Patient Name

Father Name (S/O, D/O)

Age & Gender

Consultant Physician

Date & Time of Admission

Date & Time of Discharge

Ward / Bed No.

Contact Number

Diagnosis / Clinical History

Discharge Advice & Medication

Total Charges (PKR)

Payment Status

Naimat Child Care Clinic

Bhutta Chowk, Khanewal | 065-2555111

Reg:

Date:

ADMISSION SLIP

Patient Name:

Age/Gender:

Father Name:

Ward/Bed:

Consultant:

Admission:

Discharge:

Diagnosis:

Medication:

Medicine	Timing

TOTAL:

STATUS: