First Name
Last Name
Mobile Number
Email
Insurance Type Medical InsuranceNSSFNo insurance
Has previously been admitted or visited Ain WiZein:
YesNo
Appointment Type OutPatientLaboratoryMedical ImagingEndoscopyPhysical TherapyRadiotherapy
Physician Name Anesthesia and ReanimationClinical CardiologyCardiac Catheterization Unit (Cath-Lab)Cardiac Care Unit -CCUCardiac Surgery Unit – CSUIntensive Care Unit – ICUNon Invasive Cardiac ServicesCardiology Step DownStroke UnitEmergencyDermatologyEndocrinologyGastroenterologyInfectious DiseaseCommunicable Diseases Evaluation & Management UnitMental HealthPulmonaryNephrologyNeurologyRheumatologyLaboratoryMedical ImagingObstetrics And GynecologyOrthopedic SurgeryPediatricsGeneral SurgeryOphthalmologyUrologyNeurosurgeryENTMaxillofacialPlastic SurgeryCardio-Thoracic and Vascular SurgeryClinical Research Unit- CRUInstitutional Review Board (IRB)
Prefered Date
Reasons
Type of Appointment
NewFollow Up
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