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אישור
ביטול
Patient Registration
patient_message
First Name
Last Name
I am an Israeli citizen
I don't have israeli citizenship
Israeli ID Number
Passport Number (Not israeli)
Phone Number
Birth Date
01 - January
02 - February
03 - March
04 - April
05 - May
06 - June
07 - July
08 - August
09 - September
10 - October
11 - November
12 - December
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Kupa
Clalit
Leumit
Maccabi
Meuhedet
Private
TZAHAL
Gender
Male
Female
Residence City
Street Name
Street Number
Email
Receipt Number
**You must display original Receipt to staff**
I have a Receipt Number for cash payment
First Name
Last Name
ID Number / Passport
Phone Number
Birth Date
HMO
Kupa
Gender
cityCode
Residence City
Email
Receipt Number
Update
Delete
IDType
עב
عربيه
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