Digicon

@if (isset(session()->get('doctor')['vCentralCode'])) {{ session()->get('doctor')['vCentralCode'] }} @endif

@if (isset(session()->get('doctor')['vCentralCode']))

Logout

@endif

@csrf

@if (isset(session()->get('doctor')['vCentralCode']))

Back

@else

@endif

(Kindly fill in the relevant information or tick, as appropriate.)

@if (isset(session()->get('doctor')['vCentralCode']))

Name of Doctor*

@else

Name of Doctor *

@endif

Registration No. *

Qualification *

Speciality *

Hospital/Clinic Address *

City *

State *

Initials *

OPD/IPD Registration No *

Gender *

Male Female

Age (in Years) *

City/Town *

State *

Diagnosis of dry skin condition of face *

Drug Class and Drug (generic name only)	Dose/Strength	Frequency of dosing	Duration
		OD BID TID
		OD BID TID
		OD BID TID

Drug Class and Drug (generic name only)	Dose/Strength (in mg unless specified)	Frequency of dosing	Duration
		OD BID TID
		OD BID TID
		OD BID TID

Drug Class and Drug (generic name only)	Dose/Strength (in mg unless specified)	Frequency of dosing	Duration
		OD BID TID
		OD BID TID

Drug Class and Drug (generic name only)	Dose/Strength (in mg unless specified)	Frequency of dosing	Duration
		OD BID TID
		OD BID TID
		OD BID TID

Investigations (if available), please specify