KRANTII: Emergency Requirements Assistance
KRANTII is a not for profit voluntary group of like minded Indians focused towards collaborative contributions to strengthen nation building and national interest. We neither follow nor represent any religious or political interest group.

We are here to help you by sharing leads to emergency resources that you may need, although we are trying our best to verify them individually by our team member or through trusted sources, we request patients and their families to use their own discretion before availing any such services, especially if they include advance payments.The information you share will solely used for provide you assistance and not for any other purpose.

Thanks and regards
Team KRANTII
Sign in to Google to save your progress. Learn more
Purpose *
Full Name of Patient *
Age of Patient *
Gender *
AADHAR Card number ( To facilitate registration)
Date of first COVID Symptom
MM
/
DD
/
YYYY
Date of Covid +ve Report
MM
/
DD
/
YYYY
SPO2/Oxygen level *
Below 70
70 - 85
85 -94
More than 94
Do Not Know
Not Applicable
with Oxygen Support
without Oxygen Support
SPO2 Trends *
Stable
Fluctuating
Decreasing
Do Not Know
Not Applicable
With Oxygen
Without Oxygen
CT Score *
Current Address of Patient (Enter home address / Hospital Name if you are currently admitted)
House Number / Street name / Landmark *
City / Place *
State *
Pincode *
Need Home Care Service
Male
Female
Professional Home care Nurse
Care Taker
Clear selection
Medicine Requirement
Need assistance : Blood
A+
A-
B+
B-
AB+
AB-
O+
O-
ANY GROUP
COVID Plasma
Blood Normal
Platelets
Clear selection
Need assistance : Oxygen
Yes
No
Oxygen Cylinder
Oxygen Refill
Oxygen Concentrator
Oxygen Kit
Oxygen Can
Clear selection
Need assistance : Ambulance
Yes
No
Normal Ambulance
Covid Ambulance
Ambulance with Oxygen
Mobile ICU Ambulance
Neonatal Incubator Ambulance
Cardiac Ambulance
Mobile Dialysis Ambulance
Life support ambulance
ICU Ambulance with BIPAP
Trauma Ambulance
Cardiac Ambulance
Clear selection
Admission Preference *
Need assistance : Shift to Hospital
Yes
No
Oxygen Bed
ICU Bed
ICU with Ventilator
Normal Bed
Clear selection
Bed Type (If applicable)
Yes
No
Pregnant Women - ICU
Pregnant Women - Ventilator
Pediatrics - ICU for child ( age less than 13 years)
Pediatrics - Ventilator for child ( age less than 13 years)
Defence Personnel / Ex-service men / Dependent - Oxygen Bed
Defence Personnel / Ex-service men / Dependent - Ventilator
Nephrology - ICU
Nephrology - Ventilator
Neonatal ICU (NICU)
Clear selection
Comorbidity if any : *
Yes
No
Neurology
Nephrology
Cardiology
Diabetic
Cancer
Asthma
Others
None of these
Other Requirement if any?
Share you current Google location Link ( To help us make sure emergency support reaches your doorstep )
Attendant Name *
Attendant relation to Patient *
Attendant Phone Number ( Volunteers from Team KRANTII will contact you on this number. We request you to provide your whatsapp number and keep it active for further communication) Note : If you don't have or use whats app you can give an alternate number *
Referred by : Source *
Required
Name of the person referring
Referrer's Contact Number
Disclaimer: KRANTII is a not-for-profit, apolitical, self driven group of people who have volunteered to help and provide COVID-19 related support by collecting information and verifying resources to the best of our abilities. We expressly state to the user/ recipient of the information/resources provided by us hereby, that:The information provided by us is in an advisory capacity and does not constitute as medical advice and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. We will provide full-spectrum support to bring the case to a safe & logical conclusion but we do not deal with any commercial organisations. We request you to exercise caution when engaging with KRANTII and would like to emphasise that any support we provide is not to be considered as entitled or as a paid service. We urge that any final decision and/ or actions are taken in consultation with medical professionals, staff, and the family members of the patient. In this regard, KRANTII shall not be liable to face any legal action, civil or criminal, in any court of law. *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms