Patient is registering first time at SCTIMST Yes No AsX A√ Hospital No. : Bip-]{Xn \º¿ : 1 Name of the Patient with initial tcm-Kn-bpsS apgp-h≥ t]cpw C\n-jyepw (IN BLOCK LETTERS) 2 Completed age 3 Date of Birth DD MM YYYY 4 Gender]q¿Øn-bmb hb v P\-\-Xo-bXn 5 Scheduled Tribe 6 Religion/ 7 Nationality/]´n-I -h¿§w aXw tZio-bX.