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Person Registration Form
Basic Information
Generated ID
*
Auto-generated unique identifier
Generated ID is required.
Practice ID
*
Select Practice
Main Medical Center
Downtown Clinic
Westside Family Practice
Emergency Care Unit
Please select a practice.
Person ID
*
Unique person identifier
Please provide a valid person ID.
Person Type
*
Select Type
Patient
Healthcare Provider
Staff Member
Administrator
Other
Please select a person type.
Created By
*
User who is creating this record
Please provide the creator information.
Modified Timestamp
Auto-updated on changes
Additional Details
Status
Active
Inactive
Pending
Suspended
Priority Level
Normal
High
Urgent
Low
Department
Select Department
Cardiology
Neurology
Orthopedics
Pediatrics
Emergency
General Medicine
Surgery
Radiology
Notes & Comments
Notes
Tags
Use tags to categorize and organize persons
Reference Number
Access & Permissions
Can View Medical Records
Can Edit Records
Can Access Reports
Receive Notifications
Emergency Contact
Requires Approval
Cancel
Save as Draft
Create Person