Provisional Gate Pass

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Gate Pass Information

Valid Date is required
Patient Information
Patient Name Relation
Address Bed Number
Gate-Pass Information
Valid Date & Time Remark
Issued Date Issued By

Gate -pass

Checklist For Discharge

IP No {{ admission.admissionNo }} C R No Bill No
Patient Name {{ admission.fullName }} Bed No. {{ admission.bedNumber }}
Age {{ admission.age }}Y Sex {{ admission.gender === 'F' ? 'Female' : 'Male' }} Floor {{ admission.floorName }} / {{ admission.locationName }}
Father/Husband Name {{ admission.fatherOrHusband }} Category {{admission.bedNumber }}
Address {{ admission.fullAddress }} DOA {{ admission.admissionDate }}
Issue Date {{ record.createdDate | date: 'dd-MM-yyyy' }}
Issue Time {{ record.createdDate | date: 'h:mm:ss a' }}
Phone {{ admission.mobile }} Valid Upto {{ record.validUpto | date: 'dd-MM-yyyy' }}
Ref By Valid Time {{ record.validUpto | date: 'h:mm:ss a' }}
Checked By
Authorized By
Payment Made
Room Linen
Room Inventory
NOTE To be retained by staff nurse.
Issued  {{page.userAccount.fullName}}