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AI辅助中医线上咨询申请

AI-assisted Traditional Chinese Medicine Online Consultation Application

本问诊单目前以中文填写为主。如需英文协助，请通过 WhatsApp 联系我们安排。

This form is primarily completed in Chinese. For English assistance, please contact us via WhatsApp.

本平台提供 AI 辅助中医线上咨询资料收集服务。AI 只用于整理资料、生成摘要和协助随访，不替代合格中医师的判断。

This platform provides AI-assisted data collection. AI is solely for organizing information and generating summaries, and does not replace the professional judgment of a qualified TCM practitioner.

本服务不处理急症。如有胸痛、呼吸困难、严重腹痛、突然肢体无力、意识不清、持续高烧、呕血、黑便或其他紧急情况，请立即前往医院或急诊。

This service does not manage medical emergencies. If you have chest pain, breathing difficulty, severe abdominal pain, sudden weakness, confusion, persistent high fever, vomiting blood, black stool, or any emergency symptoms, please seek urgent medical care immediately.

安全筛查

Safety Screening

Do you currently have chest pain, chest tightness, or difficulty breathing?
Do you have sudden slurred speech, facial drooping, limb weakness, or numbness?
Do you have severe abdominal pain, persistent vomiting, or a rigid abdomen?
Do you have vomiting blood, black stool, bloody stool, or unexplained significant weight loss?
Do you have a persistent high fever, or fever with confusion?
Are you currently pregnant AND experiencing abdominal pain, bleeding, dizziness, or severe discomfort?
Do you have thoughts of suicide, self-harm, or harming others?
Are you under 18 years old?

基本资料

Personal Information

用于身份核对、预约确认和病历记录。For identity verification, appointment confirmation, and clinical record keeping.

Have you previously received services from our platform/practitioner?

咨询意向

Consultation Request

Urgency
Type of Service
Preferred Consultation Method

4. 期望预约时间 (意向)

Preferred Appointment Time (Intention)

以下时间仅作为预约意向，最终咨询时间将由医师通过 WhatsApp 确认。所有时间以马来西亚时间为准。
The selected time is only a preferred consultation time. The final appointment will be confirmed by the practitioner via WhatsApp. All times are based on Malaysia Time.

主诉

Main Complaint

What is the primary issue you want to address today?
How long have you had this problem? (Duration)
How did the symptoms begin? (Onset pattern)
Severity Score (0=None, 10=Most Severe)
5
When is it most noticeable?
What aggravates the symptoms?
What relieves the symptoms?

症状情况

Symptom Details

Gastrointestinal Issues
Pain Issues (Location & Nature)
Sleep & Stress
Women's Health (Leave blank if not applicable)

中医问诊资料

TCM Intake Information

既往史与用药

Medical History and Current Medication

Past Medical History
Current Medications / Supplements
Allergies
Surgical History
Recent Test Reports

生活方式

Lifestyle

资料上传提示

Upload Instructions

为保证资料传输的安全与隐私，本网页不直接接收图片上传。

To ensure the security and privacy of data transmission, this webpage does not directly receive image uploads.

请您在点击最后一页的「生成病历并发送至 WhatsApp」按钮后，直接在 WhatsApp 聊天框中发送以下资料给医师：

Please send the following materials directly to the practitioner in the WhatsApp chat box after clicking the "Generate summary" button on the final page:

  • 清晰的舌象照片 (自然光、无滤镜、不要刚喝咖啡后拍)
    Clear photo of tongue (natural light, no filters)
  • 近期的检验报告 (PDF或照片)
    Recent medical test reports
  • 目前服用的药物清单或照片
    Current medication list or photos
  • 疼痛部位的具体照片 (若有皮疹或肿胀)
    Photos of painful areas (if rashes/swelling present)

最终确认与协议导出

Final Confirmation and WhatsApp Submission