社區臨時藥物補充計劃 CIMRS
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病人中文姓名 *
病人英文姓名 *
HKID *
聯絡電話 *
出生日期 *
MM
/
DD
/
YYYY
性別 *
已預約醫管局覆診日期 *
MM
/
DD
/
YYYY
已預約醫管局覆診醫院／診所 *
已預約醫管局覆診專科 *
是否已啟用醫健通 *
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