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SSSSOTN Medical Activities Report Form
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SSSSOTN Medical Activities Report Form
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1
Step 1
SSSOTN MEDICAL ACTIVITIES REPORT - FORMAT
Name of the Medical Seva Dal
(Reporter)
Contact number
of the reporting person
Email
of the reporting person
email
District
of the activity
Select An Option
Chennai East Coast
Chennai North
Chennai South
Chennai West
Coimbatore
Cuddalore
DHARMAPURI
Dindigul
Erode
Kanchi North
Kanchi South
Kanyakumari
Karur
Madurai
Nagai
Namakkal
Nilgiris
PUDUCHERRY
Salem
Sivaganga and Ramnad
Thanjavur Thiruvarur
Theni
Thiruvannamala
TIRUNELVELI
Tirupur
Tiruvallur
Trichy
TUTICORIN
Vellore Tiruvannamalai
VILLUPURAM
Virudhunagar
Date
of the activity
date_range
Venue
of the activity
Type of Camp /
Activity
Select An Option
General Medical Camp
Comprehensive Medical Camp
Diabetic Camp
Cardiac Medical Camp
Cancer Screening
Eye Camp
Dental Camp
Mental Health Check up
Gynaec Special Camp
Paediatric Camp
Ortho Camp
ENT Camp
Homeopathy Camp
Siddha Camp
Ayurvedic Camp
Blood Donation Camp
Veterinary Camp
No. of UG Doctors participated
Numeric please
No. of PG Doctors participated
Numeric Please
No. of Para Medical staff participated
Numeric Pls
No. of Sevadals participated
Numeric Please
No. of Beneficiaries
OP Patients
OP - Male
No. of Male patients
OP - Children
No. of Children patients
OP - Female
No. of Female patients
Special Tests / Treatments
Echo
ECG
No. of Male patients
Cataract Surgery
Ultrasonogram
X-Ray
Blood Test
Others
Please specify
Veterinary Camp
Animal
details
Approximate
cost for the camp
Please upload photos
(with Dress code Scarf and banner)
cloud_upload
Upload
Date submitted
the report
date_range
Comments
Feedback if any
0
/
Submit Form
I submit this activity at the Lotus Feet of our Beloved Bhagawan
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