🔒 Internal Appointment Management

Internal use only - Payment tracking and reference management for Ameelio Hospitals

⚠️ Internal Use Only: This form is for hospital staff to manage payment tracking, reference numbers, and internal appointment details. Not for public use.
💳 Razorpay Integration: Payment references will come from Razorpay payment gateway. Use the Razorpay Payment ID for tracking.

✅ Internal appointment data has been updated successfully!

❌ There was an error updating the appointment data. Please try again.

Patient Information

Patient Name *

Patient Phone *

Appointment Date *

Appointment Time *

Payment & Reference Information

Reference Number *

Payment Done *

Razorpay Payment ID

Amount

Payment Received Date

Created Date *

Created Time *

Staff Member

🔒 Internal Appointment Management

Patient Information

Payment & Reference Information

Internal Notes