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Emergency Guarantee Request
Issue an instant admission deposit voucher for hospital intake. Zero gas tokens required.
Member Account
Receiving Hospital
hospital1.admit-hack-6711fd.testnet
hospital2.admit-hack-6711fd.testnet
Deposit Amount (USDC)
Max: 400.00
MAX
USDC
Admission Reference
Hospital file/visit number, not the patient's name.
Service Date
Ref + date identify one admission everywhere.
Patient Initials (Optional)
Max 4 chars
Generate Emergency Guarantee