Name
Somchai Jaidee
Age
45 y
Sex
Male
DOB
12 Jan 1980
Visit date
15 Mar 2026  09:42
Dr. Wanchai Somsak
Back to Menu Proposal 1 – Full OPD EMR Form
Section 1 – Triage & Background
Chief Complaint (Triage)
"Chest pain, moderate severity, onset 2 hours ago."
Triage Score
2
Emergent
Assessed at 09:15 by Nurse Supaporn
Vital Signs (from Triage)
BP (mmHg)
148/92
PR (bpm)
102
RR (bpm)
22
Temp (°C)
37.2
SpO₂ (%)
96
Weight (kg)
72
Underlying Disease
Hypertension, Dyslipidemia
Allergy
NSAIDs Penicillin
Coverage
Universal Coverage (UC)
Rights verified – valid 2026
AIA Health Insurance
Policy No. AIA-23456789 – co-pay 300 THB
Note
Section 2 – Doctor Assessment
History
Physical Examination
BP (mmHg)
PR (bpm)
RR (bpm)
Temp (°C)
SpO₂ (%)
Weight (kg)
Section 3 – Diagnosis