SSSSOTN Medical Activities Report Form

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SSSOTN MEDICAL ACTIVITIES REPORT - FORMAT

Name of the Medical Seva Dal(Reporter)

Contact numberof the reporting person

Emailof the reporting person

Dateof the activity

Venueof the activity

Is this an adopted village

YesNo

Is this a Tribal Village

YesNo

Is this a SSSVIP Village

YesNo

No. of UG Doctors participatedNumeric please

No. of PG Doctors participatedNumeric Please

No. of Para Medical staff participatedNumeric Pls

No. of Sevadals participatedNumeric Please

No. of Beneficiaries

OP Patients

OP - MaleNo. of Male patients

OP - ChildrenNo. of Children patients

OP - FemaleNo. of Female patients

Special Tests / Treatments

Echo

ECGNo. of Male patients

Cataract Surgery

Cataract Screened for Male

Cataract Screened for Mahilas

Cataract Surgery done for Male

Cataract Surgery done for Mahilas

Free vision test done for school children Boys

Free vision test done for school children Girls

Free Spectacle issued:

Ultrasonogram

X-Ray

Blood Test

Blood donation Team From

Blood donors participated Male

Blood donors participated Mahilas

Blood Units collected from Male

Blood Units collected from Mahilas

Sai Protein distributedmention in Kilogram

OthersPlease specify

Veterinary Camp

Veterinary Camp Team Fromdetails

No. of Animals treateddetails

OTHER DETAILS

Approximatecost for the camp

Date submittedthe report

Please upload photos(with Dress code Scarf and banner)

Upload

CommentsFeedback if any

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I submit this activity at the Lotus Feet of our Beloved Bhagawan