                                                                       SSS | SHANTHI
MEDICAL CENTRE
                                                                                                  Social Services
S.F. No. 128/2 (2249), Trichy Road,
Singanallur, Coimbatore++41 005.                                             ( A Registered Public Charitable Trust )
Phone : 0422 - 2205500, Mobile : 84899 33133


                                           TREATMENT DETAILS PAD
                                                                                                       : 12.8/20
                                                                                           Date
 Doctor Name :
                            Shame
                                                                                           Reg No .:
Patient Name :
                                                                                             11 saus
                                                                                                -

 Age/Sex :


Particulars :




                                Non Ecoli Calle zu vr.




                  Ach




                                                   USU And Relió




                                                                        Dr.L. KARPAGAM MD (Pediatrica)
                                                                             Consultant Pediatrician
                                                                                    Reg.No : 64375
                                                                               Shanthi Social Services
                                                                                      Medical Centre
    Amount Rs :                                Bill Ref :                          Dr's Signature :

    I hereby accept for the above mentioned medical consultation, Prescribed treatments
     and medical tests to be conducted in Shanthi Social Services.




                                                                                                                   Signature

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