Outpatient number: Hospitalization number:xxx
Patient name: xxxx Diao Gender: Female, Age: 83 years old
Home address: xxx, xxx Village, Jiangyan Town
Preliminary diagnosis: cerebral infarction, coronary heart disease
Whether need surgery: Amount of blood transfusion:
Disease rating: I
Advance payment: RMB 1000
Remarks: Agricultural cooperative medical service
Detail information Be hospitalized: area No. 9
Signature of the Doctor: xxxx Wang
Comment of the Hospital admission:
Staff of Handling procedures: xxxxx Yang
Date: Sep. 26, 2015