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Patient Registration
Patient Intake Gateway & Clinical Registration Module
The sex field is required.
The address field is required.
The ownership field is required.
The site field is required.
The notes field is required.
The animal field is required.
The contact field is required.
The dateBite field is required.
The exposure field is required.
The fullName field is required.
Select Registration Type:
Animal Bite Patient
General Consult Patient
Medical Certificate
Visit Classification
Visit Type
New Patient / Day 0
2nd Shot / Day 3
3rd Shot / Day 7
4th Shot / Day 28
Booster Patient
🔍 Search Previous Patient Name to Load Old Info
-- Type patient name to search --
Selecting a patient will auto-fill their previous records.
Patient Information
Last Name
First Name
PhilHealth PIN
Address
Age
Sex
-- Select --
Male
Female
Blood Pressure
Temperature (°C)
Weight (kg)
Height (cm)
Contact No.
Exposure Information
Date of Exposure
Animal Type
-- Select --
Dog
Cat
Others
Ownership
-- Select --
Owned
Stray
Wild
DOH Patient Type Classification
PEP Eligible Primary
PEP Eligible Booster
Exposure Type
-- Select --
Bite
Scratch
Lick
DOH Classification
PEP Eligible Primary
PEP Eligible Booster
Exposure Site / Body Part
Remarks / Booster Source
-- Select Remarks / Patient Source --
External Booster (Finished primary series at another clinic)
Returning Clinic Booster (Finished primary series here)
Standard Initial Animal Bite Case
Selecting an external booster option automatically routes the patient for doctor consultation.
Save Record