
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
- 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