Patient Registration Design

patient registration design desc c olu ripti mn on (lab el text )

label inpu input name t type type name

patient id

patie idlab nts id el

text box

first name

first name of the patie nt last name of the patie nt midd le name of the patie nt usern ame of the patie nt pass word provi ded by the

fnlab el

text box

lnlab el

mnla bel

last name

middle name

usern ame

passw ord

d efa ult val ue

idtxtb ox

t abl e ref err ed

data type store d

validati validati a ons or llo required name w /conditi nu on ll va lu es varch not idrequi no ar(20) empty red

b lan k fntxtb b ox lan k

p ati ent varch not p ati ar(20) empty ent

text box

lntxtb ox

b lan k

varch not p ati ar(20) empty ent

text box

mntxt

b b lan ok x

varch not p ati ar(20) mandat ent ory

fnrequi no red

lnrequi no red

ye s

unam text elabel box

unam b etxtbo lan x k

varch not p ati ar(20) empty ent

unamer no equired

pwdl abel

pwdtx b tbox lan k

varch not p ati ar(20) empty ent

pwdreq no uired

text box

addres s

city

state

zip

email id

home phone

mobile numbe r

day

mont h

patie nt addre ss of the patie nt name of the city name of the state. zip code

addre text sslab area el

addre sstxta rea

b lan k

varch not p ati ar(20 empty ent 0)

address no require d

cityla text bel box

citytxt b box lan k

varch not p ati ar(20) empty ent

cityreq uired

no

statel abel

text box

statet xtbox

varch not p ati ar(20) empty ent

statere quired

no

zipla bel

text box

ziptxt box

email id of the patie nt phon e num ber (land line) mobi le num ber of the patie nt day of dob

maill abel

text box

mont h of dob

mont hlabe l

b lan k

varch not ar(20) empty

ziprequ no ired

varch not ar(50) empty

mailre quired

b lan k mailtx b tbox lan k

p ati ent p ati ent

home text label box

homet b xtbox lan k

varch not p ati ar(20) mandat ent ory

ye s

mobil text elabel box

mobil b etxtbo lan x k

varch not p ati ar(20) mandat ent ory

ye s

dayla bel

daylis day p n selected daysele no tbox ati umbe cted ent r

drop dow n list box drop dow n

no

varch selected months no month mo p listbo nth ati ar(20) elected x ent

year

year of dob

yearl abel

sex

sex to whic h the patie nt belon gs marit al statu s of the patie nt

sexla bel

marita l status

list box drop dow n list box radi o butt ons( 2)

yearli stbox

y ear

p n selected yearsel no ati umbe ected ent r

maler adio, femal eradio

ma le sel ect ed

varch selected sexsele no p ati ar(10) cted ent

varch selected marital no marit drop marita s p allabe dow llistbo ele ati ar(20) selecte l n x ct ent d list one box