Fill Report (One Page) — v9.9.2
Institute Header
PNG/JPG
Report Text
140px
100%
160px
100%
Page Margins (mm):
6mm
10mm
8mm
10mm
on print
Doctor's Signature & Seal
90%
10px
4px
Upload Images (Top: Right 1–3 | Right column: Left 1–3)
Top row shows Right 1–3; Right column shows Left 1–3.
Footer (screen & print)
Helper
Institute / Clinic Name
Address line, city, country
NASAL ENDOSCOPY (NASOENDOSCOPY) REPORT
Patient Name:
Patient ID:
Age:Y
Date of Birth:
Gender:
Address:
Mobile Number:
Referred by:
Right 1![]()
Right 1
Right 2![]()
Right 2
Right 3![]()
Right 3
RIGHT SIDE:
LEFT SIDE:
DX:
Notes:
Left 1![]()
Left 1
Left 2![]()
Left 2
Left 3![]()
Left 3
Doctor's Signature & Seal:
Date:
Developed and designed by MD OMAR FARUK
Developed and designed by MD OMAR FARUK [www.advancedhearingbd.com]