Patient Request User Manual

User Manual

Patient Request Form

Form Module 1

1. New Patient Form

Step 1: Click the new patient request button on the website under the patient request tab.

Step 2: Fill the form by filling mandatory fields.

Patient Details

  • First Name
  • Last Name
  • Date of birth
  • Gender
  • Email
  • Phone
  • Health card. Must be in this formate xxxx-xxx-xxx-AA
  • Address
    • Street
    • City
    • Province
    • Postal code
    • Country

Primary Health care provider details

  • Family Doctor’s Name
  • Office Phone Number
  • Fax Number

Step 3: Click the consent

Step 4: Submit

Step 5: Fill the mandatory details

  • Patient ID
  • Health Card Number
  • Postal Code

Step 6: Click Submit button to view all the pharmacy list in the pharmacy

Step 7: Select nearest pharmacy

Step 8: Registered successfully

2. Existing Patient Form

Step 1: Click the existing patient request button in the website under the patient request tab.

Step 2: Fill the form by filling mandatory fields.

  • Patient Id
  • Health Card Number
  • Postal code

Step 3: Click to see the pharmacy list

Step 4: Select nearest pharmacy

Step 5: Registered successfully