Reset Patient
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Reset Patient
Another booking has already been registered for this patient. Reference No.: 20160101-0001 Do you want to add a new booking?
Emergency IFT and HealthNET Booking System
Another booking has already been registered for this patient. Reference No.: 20160101-0001 Do you want to add a new booking?
Repeat Booking
Repeat Dates
Reference No.
Select Patient
PMI
HIS: *
CMX Database: *
ID
Name
Surname
PMI
Age
Address
Page No
Select Control Centre
Control Centre :*
*
Reallocate Patient
Reference No
Patient Name
Surname
Age
Collection Point
Phone Number
Transport Reason
Referring Clinican
Destination Facility
Destination Ward
Receiving Clinician
Mobility
Escort
Page No
Alternate Dates:
1. Collection Details
2. Patient Particulars
3. Destination Details
4. Preview
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Collect From:
Home
Collection Point
Facility
Facility: *
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*
*
Ward/Clinic: *
*
Phone Number:
*
Referring Person: *
*
Address:
*
Collection Point: *
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District Municipality: *
*
*
*
Local Municipality: *
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Town: *
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Suburb: *
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Street Address: *
*
Latitude:
*
Navigation Notes:
*
Longitude:
*
Facility: *
*
*
*
Ward/Clinic: *
*
Phone Number:
*
*
Referring Person: *
*
*
Address:
*
*
Discharge Destination Details
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Drop At:
Home
Drop Point
Facility
Facility: *
*
*
*
Ward/Clinic: *
*
Phone Number:
*
Receiving Person:
*
Clinician:
Address:
*
Drop Point: *
*
District Municipality: *
*
*
*
Local Municipality: *
*
Town:
*
Suburb:
*
Street Address: *
*
Latitude:
*
Longitude:
*
Navigation Notes:
*
Discharge Requirements
Patient Mobility: *
*
Transport Date: *
*
Fit for Air Transport:
Reason:
*
Communicable Disease:
Reason:
*
Medical Requirements:
Escort:
Reason:
*
First Time Visit to Facility:*
*
Transport Reason: *
*
Special Considerations:
Transport Medical Reason: *
*
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Requester Name: |
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Requester Phone Number: |
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Select an alternate date:
View Bookings
Patient Particulars
ID Number:
N/A
PMI:
Name:
Surname:
Gender:
Age:
DOB:
Phone Number:
District Municipality:
Local Municipality:
Town:
Suburb:
Street Address:
Next of Kin:
Next of Kin Phone Number:
Collection Details
Control Centre:
Reference No.:
Facility:
Ward/Clinic:
Phone Number:
Referring Person:
Clinician:
Address:
Collection Details
Control Centre:
Reference No.:
District Municipality:
Local Municipality:
Town:
Suburb:
Street Address:
Collection Point:
Longitude:
Latitude:
Navigation Notes:
Destination Details
Facility:
Ward/Clinic:
Phone Number:
Referring Person:
Clinician:
Address:
Destination Details
District Municipality:
Local Municipality:
Town:
Suburb:
Street Address:
Drop Point:
Longitude:
Latitude:
Navigation Notes:
Patient Requirements Details
Patient Mobility:
Escort:
First Time Visit to Facility:
Fit for Air Transport:
N/A
Reason:
Communicable Disease:
Reason:
Transport Date:
Transport Reason:
Transport Medical Reason:
Requester Name:
Requester Phone No.:
Select Collection Point
Collection Point
*
Collection Point
Subrub
Town
Local Municipality
District Municipality
Page No