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FTR Registration Form 'Kannada' Latest
FTR Registration Form 'Kannada' Latest
FTR Registration Form 'Kannada' Latest
A.
1 2a 2b 2c 3a 3b 3c 4
Patient Details
Name DOB TOB POB Phone LL Mobile 1 Mobile 2 E Mail ID 5b 5c 5d 6 7 City State Pin Code Ref by Qual / Profession 5a Address
B. No
Details of Ailments (latest First) (Use Reverse Side / Separate sheet if required) Disease Name Treated Where Medicines Taken Dosage Present Status
All above data are given at my free will and I approached the ashram on my own for my ailment.