COCHLEAR IMPLANT - Patient Registration
Patient Name
Father's Name
Date of Birth (Child)
*
Age must be less than 5 years
Gender
Male
Female
Contact No.
Email
CNIC No. (Father)
Form B
Address
Province
Select Province
Punjab
Sindh
Balochistan
Khyber Pakhtunkhwa
Gilgit Baltistan
ICT
AJK
District
Select District
Select District
Abbottabad
Astore.
Attock
Awaran
Badin
Bagh
Bahawalnagar
Bahawalpur
Bajaur
Baltistan
Baltistan (At Skardu).
BANNU
Barkhan
Batagram
Bhakkar
Bhimber
BUNER
Chaghi
Chakwal
Charsadda
Chinot
Chitral
Dadu
Dera Bugti
Dera Ghazi Khan
Dera Ismail Khan
Diamir (At Chilas).
Faisalabad
Ghanche (At Khaplu).
Ghizer (At Gakuch).
Ghotki
Gilgit.
Gowadar
Gujranwala
Gujrat
Hafizabad
Hangu
Haripur
Harnai
Hattian
Haveli Kahuta
Heyderabad
Hunza.
Islamabad
Jaccobabad
Jaffarabad
Jamshoro
Jhal Magsi
Jhang
Jhelum
Jhelum Velly
Kacchi Bolan
Karachi
Karak
Kashmore
Kasur
Kech Turbat
Khairpur
Khanawal
Kharan
Kharmang.
Khushab
Khuzdar
Khyber
Kohat
Kohistan
Kohlu
Kotli
Kurram
Lahore
LAKKI MARWAT
Larkana
Lasbella
Layyah
Lehri
Lodhran
Loralai
Lower Dir
Malakand
Mandi Baha-ud-Din
Mansehra
Mardan
Matiari
Mianwali
Mirpur
Mirpur Khas
Mithi
Mohmand
Multan
Musa Khail
Mustung
Muzaffarabad
Muzaffargarh
Nagar.
Nankana Sahib
Narowal
Naseerabad
Nawab Shah
Neelum
North Wazirstan
Noushki
Nowshehro Feroz
Nowshera
Okara
Orak Zai
Pakpattan
Palandri
Panjgour
Peshawar
Pishin
Punch / Rawalakot
Qallat
Qamber Shahdad Kot
Qillah Abdullah
Qillah Saif Ullah
Quetta
Rahim Yar Khan
Rajanpur
Rawalpindi
Sahiwal
Sajawal
Sanghar
Sargodha
SHANGLA
Sheikhupura
Sherani
Shigar.
Shikarpur
Sialkot
Sibbi
Skardu
Sohbatpur
South Waziristan
Sudhnoti
Sukkur
Swabi
Swat
Tando Allahyar
Tando Muhammad Khan
Tank
Tharparkar
Thatha
Toba Tek Singh
Torghar
Umer Kot
Upper Dir
Vehari
Washuk
Zhob
Ziarat
Recommended By (Hospital/Board)
Submit
For further information and queries:
ad.it@pbm.gov.pk