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Patient ID :
Name :
Age :
Gender :
Weight : KG
Height : CM
BMI :
(Body Mass Index)
Mobile Number :
Address :
E-Mail Address :


VikrutiPrakriti
Vata
Pitta
Kapha


Other Observation


Blood Pressure:
Systolic      Diastolic    

Blood Suger:


Pulse Rate:


Cheif Complaints





Medical History





Investigation Report





Diagnosis





Patient's Lifestyle







Yoga & Meditation





Medicine Prescription





Suggested Diet