Encounter Form With Vital Signs
Demographics
Medical Record Number:
Family Name:
Given Name:
Middle Name:
Gender:
...
Male
Female
Date Of Birth:
Encounter Details
Encounter Location:
*
Encounter Location
*
...
Provider Name:
*
Provider system-id:
*
Encounter Date:
*
Patient Vitals
Weight (kg):
Height (cm):
BMI (KG/M
2
)
*
Temperature (
o
C):
Pulse(bpm):