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.)

Name *

Registration No. *

Qualification *

Speciality *

Hospital/Clinic Address *

City *

State *

Name *

OPD/IPD Registration No *

Gender *

Male Female

Age(in Years) *

City/Town *

State *

Pulse(minute) *

Weight(in Kg) *

Height(in cm) *

Type of skin*

Normal Sensitive Acne prone

Suntan

Sunburn

Acne

Melasma

PMLE

Any other

If any other, please specify

Kindly fill the relevant information or tick, as appropriate.

Sunscreen given	Frequency of application	Duration in weeks
Photostable	OD BID Every 2 hourly
Any Other