HA
Hashim Ahmed

Patient Registration Form

Export const GenderOptions = ["Male", "Female", "Other"]; export const PatientFormDefaultValues = { firstName: "", lastName: "", email: "", phone: "", birthDate: new Date(Date.now()), gender: "Male" as Gender, address: "", occupation: "", emergencyContactName: "", emergencyContactNumber: "", primaryPhysician: "", insuranceProvider: "", insurancePolicyNumber: "", allergies: "", currentMedication: "", familyMedicalHistory: "", pastMedicalHistory: "", identificationType: "Birth Certificate", identificationNumber: "", identificationDocument: [], treatmentConsent: false, disclosureConsent: false, privacyConsent: false, }; export const IdentificationTypes = [ "Birth Certificate", "Driver's License", "Medical Insurance Card/Policy", "Military ID Card", "National Identity Card", "Passport", "Resident Alien Card (Green Card)", "Social Security Card", "State ID Card", "Student ID Card", "Voter ID Card", ]; export const Doctors = [ { image: "/assets/images/dr green.png", name: "John Green", }, { image: "/assets/images/dr cameron.png", name: "Leila Cameron", }, { image: "/assets/images/dr livingston.png", name: "David Livingston", }, { image: "/assets/images/dr peter.png", name: "Evan Peter", }, { image: "/assets/images/dr powell.png", name: "Jane Powell", }, { image: "/assets/images/dr remirez.png", name: "Alex Ramirez", }, { image: "/assets/images/dr lee.png", name: "Jasmine Lee", }, { image: "/assets/images/dr cruz.png", name: "Alyana Cruz", }, { image: "/assets/images/dr sharma.png", name: "Hardik Sharma", }, ]; export const StatusIcon = { scheduled: "/assets/icons/check.svg", pending: "/assets/icons/pending.svg", cancelled: "/assets/icons/cancelled.svg", }; i want to add country name , states and cities data to it how to do give me a formate like India , Assam , guwahati like way i wano to add

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Register patients easily with our comprehensive form, including personal details, identification, and location data like country, state, and city for seamless healthcare management.

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Last updated 1 month ago