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Details of the Patient
Name
Date of Birth
*
required
Gender
Phone Number
Email
Patient diagnosis details (In brief)
Is patient on Ventilator
*
Yes
No
If patient is on ventilator, specify the number of days
Is patient on Vasopressor
*
Yes
No
Noradrenaline (ml/hr)
Methylene blue (ml/hr)
Vasopressin (ml/hr)
Adrenaline (ml/hr)
2D Echo Findings
Details regarding patient status/condition
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