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

{{ $ActivityTypeName }}

{{ $ActivityName }}

@csrf
@if (isset(session()->get('doctor')['vCentralCode']))
Back
@else
@endif

Patient {{ $iPatientNo }}

Pro Merit II

Data Collection Form (DCF)

Doctor’s Details
@if(isset(session()->get('doctor')['vCentralCode']))
@else
@endif
@if (isset(session()->get('doctor')['vCentralCode']))
@else
@endif
Patient’s Details

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

If Former, how long ago did patient quit smoking?

General Examination Findings

Investigations *



Etiologic of HFpEF (Tick all applicable) *

Number of previous HF admissions in the last 12 months excluding current admission

If Yes, History of Myocardial Infarction (MI):

If Yes, Coronary Intervention done:

If Yes, Type of Intervention:

Heart failure Therapy Details *
Drug Class and Drug
(generic name only)		 Dose/Strength
(in mg unless specified) 		Frequency of dosing Duration in months
Ant- Diabetic Therapy Details *
Drug Class and Drug
(generic name only)		 Dose/Strength
(in mg unless specified) 		Frequency of dosing Duration in months
Anti-Hypertensive Therapy Details *
Drug Class and Drug
(generic name only)		 Dose/Strength
(in mg unless specified) 		Frequency of dosing Duration in months
Lipid Lowering Therapy Details *
Drug Class and Drug
(generic name only)		 Dose/Strength
(in mg unless specified) 		Frequency of dosing Duration in months
Anti-platelet / Aspirin Therapy Details *
Drug Class and Drug
(generic name only)		 Dose/Strength
(in mg unless specified) 		Frequency of dosing Duration in months
Anti-thrombotic Therapy Details *
Drug Class and Drug
(generic name only)		 Dose/Strength
(in mg unless specified) 		Frequency of dosing Duration in months
Investigations
Glycemic Profile
Lipid Profile
Renal Profile: