WORC Doctor
Visit ID
Clinic
Clinic Name
Clinic Address
Clinic Phone
Clinic Email
Exam
Exam Date
ID Checked? (yes/no)
Known to Examiner? (yes/no)
ECG Done? (yes/no)
ECG Date
Medications (last 6 months)
Operations
Other Conditions
Doctor Info
Doctor Name
Doctor Reg No.
Doctor Email
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