Current Medical Facility: {{managePatientCtrl.followUpFacName}}

Process
{{managePatientCtrl.model.reminderFollowUpTypeDescr}}

Date

Please enter a valid date! Date is required Date cannot be later than today {{managePatientCtrl.followUpDateMsg}}

Contact Name

Please enter valid Name. Contact Name is Required. Minimum 2 characters required Maximum 30 characters allowed

Activity

Activity is Required.

Disposition

Disposition is Required.

Contacted At: Address1

Address One is Required. Please enter a valid Address. Minimum 3 characters required Maximum 50 characters allowed

Contacted At: Address2

Address Two is Required. Please enter a valid Address. Minimum 3 characters required Maximum 50 characters allowed

Vaccine ID

Comments

Additional Comments Comments

Comment must not exceed 200 characters.