online payment

patient details

uhid *

enter uhid.

patient name *

payment details

hospital name *

select facility.

advance type

amount *

enter amount.

pan no/aadhar no *

payer details

payer name *

enter payer name.

mobile no *

enter mobile no.

email id

invalid email id

address *

enter address.

country *

enter county name.

state *

enter state name.

city *

enter city name.

zip/postal code *

enter zip/postal code.

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