EnsoMed

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Philhealth ID Number
Type
Last Name *
First Name *
Middle Name
Suffix
Birthday *
Gender *
Blood Group

House No. / Street *
Village
Barangay *
City *
Province *
Mobile No.
Landline No.
Email Address
Password
Confirm Password

SSS Number
TIN Number

ID Photo'sADD

Philhealth Employer Number

Verify

As of	PEN	Employer Name	Address

Patient Name:
Concern:

Pain Site:
Illness History:
Findings:
Physician's Advice:
Other Findings:

Vitals

Pulse Rate	Heart Rate	Respiratory Rate	Blood Pressure	Temperature	Height	Weight

Signs & Symptoms

Management

Notes

Prescriptions

Lab Works

Date	Test Name	Description	Remarks
NO LAB WORKS TO DISPLAY

Triage Assessment History

Date	Type	Category	Questions	Answers
NO TRIAGE HISTORY TO DISPLAY

NCD Assessment History

No.	Date	Questions	Answers
NO NCD HISTORY TO DISPLAY

Date

Lab Work

Is Physician's Recommendation

Yes

Remarks

Referral Facility

Patient Remarks

Attachment

Lab Tests:

Name	Result	Range

Pre-Appointment Screening Questionnaire.

Patient Information
Search Item 1

Patient ID:		Patient Name:

Triage/FPE Date

Questionnaire
NO QUESTIONNAIRE TO DISPLAY

Patient Information
Search Item 1

Patient ID:		Patient Name:

Assessment Date

NCD Questionnaire
NO QUESTIONNAIRE TO DISPLAY

Patient Name
Date:
Remarks

HISTORY

Schedule	Remarks	Status
NO LIVE CONSULT HISTORY TO DISPLAY

Patient Name:
Concern:
Remarks:

Vitals

Pulse Rate	Heart Rate	Respiratory Rate	Blood Pressure	Temperature	Height	Weight

Signs & Symptoms

Management

Notes

Prescriptions

Lab Works

Date Time	Test Name	Description	Remarks
NO LAB WORKS TO DISPLAY

Triage Assessment History

Date Time	Type	Category	Questions	Answers
NO TRIAGE HISTORY TO DISPLAY

NCD Assessment History

No	Date	Questions	Answers
NO TRIAGE HISTORY TO DISPLAY

Consultations

Search

Date

Date Time	Patient Name	Gender	Age	Concern	Doctor In-Charge	Type	Status