Appendix 'A' (Refer to Para 7(a) of letter No B/49774 ... - Indian Army
Appendix 'A' (Refer to Para 7(a) of letter No B/49774 ... - Indian Army
Appendix 'A' (Refer to Para 7(a) of letter No B/49774 ... - Indian Army
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Vide <strong>Refer</strong>ral Serial <strong>No</strong> ………………………………….. the above named is referred for<br />
(a) Admission ………………………………………………. (Specify)<br />
(b) Investigation ………………………………………………. (Specify)<br />
(c) Consultation for ………………………………………………. (Specify)<br />
<strong>Refer</strong>red <strong>to</strong> ……………………………………………………………………………………<br />
(Specify Hospital, Nursing Home, Diagnostic Centre)<br />
Place : Signature <strong>of</strong> Med Officer<br />
(with stamp)<br />
Dated :<br />
OIC POLYCLINIC<br />
* Travel reimbursement allowed (Yes/<strong>No</strong>).<br />
* Attendant reimbursement allowed (Yes/<strong>No</strong>).<br />
Place :<br />
Dated :<br />
16<br />
Part II
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