Smart Adaptive Intake v2.3.0

Child Smart Case Record

Less typing, more intelligent selection. Required fields are marked with *.

Draft saves automatically on this device

1 / 7 · Starting your smart case record

Personal Information

Basic contact details help doctor and clinic team connect with you correctly.

Full Name * Date of Birth Age * Gender * Email *

Mobile Number *

☘ WhatsApp linked with same number ✈ Telegram linked with same number Alternative WhatsApp number (Optional) Alternative Telegram username/number (Optional)

Present Illness & Complaint Builder

Choose what applies. Each complaint has its own duration, severity, better/worse factors, and cause.

General Health Pattern

These selections help the doctor understand your constitution.

Thermal state

Fill information only if it is related with you.

Appetite

Fill information only if it is related with you.

Thirst

Fill information only if it is related with you.

Food desires / aversions

Fill information only if it is related with you.

Mind, Mood & Sleep

Select only if related with you.

Mind / emotional state

Fill information only if it is related with you.

Sleep pattern

Fill information only if it is related with you.

Mind/sleep details Optional

Past & Family History

Select if any of these are related to you or your family.

Past illness / medical history

Fill information only if it is related with you.

Family history

Fill information only if it is related with you.

Child Specific Details

Fill information only if it is related with you.

Child behaviour / development

Fill information only if it is related with you.

Birth, growth or behaviour details Optional

Review & Smart Doctor Summary

Please review. You can go back to change anything before submitting.