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Patient Report Details

Patient Information
Name John Doe
NRIC 900101-14-5678
IC Image View Image
MRN No 12345678
Email john.doe@example.com
Phone +6012-3456789
Payment Deposit
Deposit Price RM 50.00
Estimate Price RM 150.00
Payment Method Online
Requestor Information
Name Sarah
NRIC 880909-10-1122
IC Image View Image
Requesting for Father
To Pro Office Sdn Bhd
Delivery Address
No 4811-1-43A Jalan Perdana CBD2
Persiaran Flora Cyber 12, Cyberjaya,
63000 Cyberjaya, Selangor
Purpose Insurance claims
Delivery Method Prooffice@Demigroup.com (via email)
Supporting Document View Document
Review Before Send Yes
Digital Consent & Signatures
Accept
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