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Swasthyasathi Complaint Form
Fill up this form if your Swasthyasathi card is being denied by Hospital or Nursing Home.
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* Indicates required question
Patient's name
*
Your answer
Age
*
Your answer
Blood group
*
Your answer
Contact number
*
Your answer
Address
*
Your answer
Swasthyasathi Card Number
*
Your answer
Cause of Admission
*
Your answer
Name of Hospital /Nursing Home
*
Your answer
Their explanation for swasthyasathi card refusal
*
Your answer
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