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 *

@else

Name *

@endif

ID No. *

Initials *

Age(in Years) *

Weight(in Kg) *

Gender *

Male Female

Prohance™ Junior (Vanilla)

Prohance™ Junior (Chocolate)

Duration of treatment:

7 Days 14 Days 21 Days 30 Days

Assesment of immune status

Number of times child was sick.
Number of days child was sick.
Requirement of hospitalization (No/Yes)
Number of days in hospital

Assessment of satisfactions

Parameters	Very unsatisfied	Unsatisfied	Neutral	Satisfied	Very Satisfied
Taste of the product
Solubility of the product
Childs compliance to Product
Overall assessment