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

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

Ultrasonogram

X-Ray

Blood Test

OthersPlease specify

Veterinary Camp

Animaldetails

Approximatecost for the camp

Please upload photos(with Dress code Scarf and banner)

Upload

Date submittedthe report

CommentsFeedback if any

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