← Back to Main Documentation

Registration Form (Illustrative)

The Universal Patient Registration Framework standardizes the organization of patient registration information using Healthcare Data Elements. Rather than creating independent registration forms, the framework provides a consistent registration structure that can be adapted for different healthcare services while maintaining a common national information standard. The following example illustrates one possible implementation of the framework.

Collect permanent patient information once whenever possible, and record encounter-specific information for every visit.

Example Healthcare Organization

Patient Registration Form

PATIENT STATUS

018 ○ New Patient ● Existing Patient
001 UHID: XXXXXXXXXXXXXX
002 ABHA Number: YYYYYYYYYYYYYY

PATIENT IDENTIFICATION

003 First Name Example Name
004 Middle Name Singh
005 Last Name Reddy
006 Date of Birth 15th Aug 1975
007 Age 50
008 Gender Male
010 Blood Group B+
011 Nationality Indian
012 Marital Status M
013 Preferred Language Hindi -English

CONTACT INFORMATION

019 Mobile Number 0000000000
020 Alternate Mobile 1111111111
021 Email patient@goglol.com
022 Local Address 708 Swastika Apartment, Moonlight Road, Surat, Maharashtra 396325
024 Emergency Contact Example Patient Relative
026 Emergency Contact No. 2222222222

PATIENT HEALTH PROFILE

053 Chief Complaint
083 Past Medical History ▼ Hyper Tension, Thyroid
085 Current Medical Problems ▼ Hyper Tension
086 Current Medications ▼ aaa ddd
087 Drug Allergies ▼ None
096 Height ▼ 5.8 Ft
097 Weight ▼ 72 Kg
099 Smoking Status ▼ No
100 Alcohol Consumption ▼ No
Patient Health Profile

Only selected Patient Health Profile information is displayed during registration. The complete Patient Health Profile is displayed when the user selects the Patient Health Profile link/button, which opens with authentication.

PATIENT VISIT INFORMATION

033 Registration Date 11th July 2026
034 Registration Time 09:45 AM
035 Healthcare Facility Example Healthcare
036 Department General
038 Visit Type OPD
039 Consultant Dr. XXX YYY
042 Appointment Number 04
043 Visit Number Auto Generated
048 Payment Category Digital Pay (option in case of Insurgence)

The first four sections establish the patient's permanent healthcare identity and Patient Health Profile. The Patient Visit Information section records details specific to the current healthcare encounter.

AMDEES Framework Specification © 2026. All rights reserved.