翔暘復健專科診所 初診病歷
基本資料
1. 姓名 *
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2. 性別 *
3. 身份
4. 身高(cm)
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5. 體重(kg)
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6. 生日(範例:1999/11/11) *
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7. 身份證字號 *
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8. 市內電話 (範例:07-1234567)
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9. 手機 *
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10. 住址
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11. Email
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12. 職業
13. 是否有藥物過敏 *
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