Admission

Hamedan Medical Group Boo-ali Hospital

Admission Summary Sheet

Name*

Family Name*

Father’s name*

untitled element

Sex*

Marital Status*

Passport Number*

Date Of Birth*

Nationality*

Admission Date*

Admission Physician

Address*

Phone*

The Medical History and Treatment Procedures*

Upload Medical Documents*

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+98-81-38381021-5
Boo-ali Hospital, above the Mardom park, Mahdieh street, Hamedan, Iran