International Patient Department

Please complete and return admission form and patient history to Laleh hospital.




Reason for the admission and history of present illness.

Medical and Surgical History: List the medical condition / operations performed and date


Current Medications:

Please list all medications including complementary medications and bring these to hospital in their original containers.

please fill out the blank by this format: Drug Name - Dose - Frequency / Time

آمار بازدید

امروز
414
دیروز
4494
ماه جاری
414
ماه گذشته
44926
امسال
247716

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