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MuR Muk;g Rfhjhu epiyak; bul;oahh;gisak;

jpUtz;zhkiy ( kh)
jha; nra; ey kUj;Jtg;gjpntL
Hsc name - OP no- Anc no-

Name- Age- Bloodgroup-

Husband name community B.P.L –yes / no

Occupation and income Addres

L.M.P EDD

GRAVIDA
PARA
ABORTION

Previous history Menstrual history VHN Ph no


Duration Emergency
Ph no 108
Regular/irrreular
Married since Allergy to drugs

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