Service Description
Application Form
Grievance Policy Description
Apply For Service
Application Form For Different Cards For TVCC Hospital system
Card Type
Section
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Gynaecology
Medicine
Surgery
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Sub unit
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APPLICANT DETAILS
Name of the Applicant
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Mobile Number/Whatsapp No.
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E-Mail
ADDRESS OF OWNER/AUTHORISED REPRESENTATIVE
State
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ANDAMAN AND NICOBAR ISLANDS
ANDHRA PRADESH
ARUNACHAL PRADESH
ASSAM
BIHAR
CHANDIGARH
CHHATTISGARH
DELHI
GOA
GUJARAT
HARYANA
HIMACHAL PRADESH
JAMMU AND KASHMIR
JHARKHAND
KARNATAKA
KERALA
LADAKH
LAKSHADWEEP
MADHYA PRADESH
MAHARASHTRA
MANIPUR
MEGHALAYA
MIZORAM
NAGALAND
ODISHA
PUDUCHERRY
PUNJAB
RAJASTHAN
SIKKIM
TAMIL NADU
TELANGANA
THE DADRA AND NAGAR HAVELI AND DAMAN AND DIU
TRIPURA
UTTARAKHAND
UTTAR PRADESH
WEST BENGAL
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District
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ANUGUL
BALANGIR
BALESHWAR
BARGARH
BHADRAK
BOUDH
CUTTACK
DEOGARH
DHENKANAL
GAJAPATI
GANJAM
JAGATSINGHAPUR
JAJAPUR
JHARSUGUDA
KALAHANDI
KANDHAMAL
KENDRAPARA
KENDUJHAR
KHORDHA
KORAPUT
MALKANGIRI
MAYURBHANJ
NABARANGPUR
NAYAGARH
NUAPADA
PURI
RAYAGADA
SAMBALPUR
SONEPUR
SUNDARGARH
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House/Plot No
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Village/Town/Address
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Patient's Details
Patient Name
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Species
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Buffalo
Cat
Cattle
Chicken
Dog
Duck
Goat
Horse
Pig
Sheep
OTHERS
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Breed
Please Select
Sex
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Male
Female
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Age(in Years)
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01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
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23
24
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26
27
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30
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Age(in Month)
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01
02
03
04
05
06
07
08
09
10
11
12
00
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Weight(in Kgs)
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Species(if Others)
Breed(if others)
Camera
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Image
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