CC desk
SREWS dashboard
Surgery Booking & Financial Counselling
Please collect name & age as per Aadhaar.
Patient
Patient name
*
UHID
*
Age
Sex
Select…
Female
Male
Other
Contact number
Clinical
Surgeon name
Surgical specialty
Proposed procedure
Laterality
Select…
Left
Right
Bilateral
N/A
Anaesthesia
Select…
Local
Regional
Spinal
GA
Urgency
Select…
Elective (Planned surgery)
Semi-emergency (Surgery needed within 24 hrs, patient hemodynamically stable)
Urgent/Immediate (Acute threat to life/limb/organ)
Pre-op risk & workup
Known co-morbidities
None
Hypertension
Diabetes
Hypothyroid
Heart Disease
Kidney Impairment
Respiratory Disease
Obesity / BMI > 35
Blood Thinners / Anti Coagulant / Anti Platelet Therapy
Active infection / fever > 100.4°F in the past 7 days
MI or stroke in the past year
Angioplasty / CABG in the past year
PAC status
Select…
Already done — video consultation PAC done
Already done — in person
Will do with blood reports within last 7 days
Will do with blood reports and imaging reports
Will do without any reports — work up at the hospital planned
Anaesthetist's advice
Select…
PAC not yet done
Fit for surgery
Provisionally fit for surgery
Needs further work up (tests only)
Needs further work up and specialist consultations
Need to discuss with the operating surgeon
Habits
None
Smoking
Alcohol
Any other recreational drugs
Logistics
Transfer patient?
Yes
No
Surgery date
Surgery time
24h. Operational window 06:30–18:30.
Admission date
Admission — arrive by
Special requirements (implants / consumables / equipment)
Financial
Payer
Select…
Insurance
Cash
Expected length of stay
Insurance details
Admission to
Select…
Ward
ICU
Daycare
Admission type
Select…
Package
Open Bill
Billing bed category
Select…
Single Room / Private
Twin Sharing / Semi Private
Suite Room
Daycare / Multi-bed
Staying bed category
Select…
Single Room / Private
Twin Sharing / Semi Private
Suite Room
Daycare / Multi-bed
Package amount (₹)
Enter rupees, e.g. 115000
Advance to collect (₹)
*
Enter rupees
Open bill line items
Counselled by
Auto-filled from your name; editable.
Admission done by
Prescription upload
Image or PDF, up to 15 MB. Must mention date & time of surgery and admission.
Remarks
This is a test submission (excluded from reports)
Submit booking