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CHECKLIST FOR MRMBS

GOVT. PRIMARY HEALTH CENTRE,


ELAVANASURKOTTAI
First Instalment :

a) PICME No
b) Passport Size Photograph
c) Mother Details, Address with Phone Number
d) AN Reg. Date, LMP,EDD, Community
e) VHN Signature with Seal
f) Bank Account Name, Account No. Branch IFSC Code
1.Application Form

a) Husbands Place of Residence Proof


b) Age Proof
c) MCP Card
d) Bank Passbook with Account No & Name
2.Xerox Particulars

a) PICME No with Photo Pasted on Card


b) Mother Address with Phone No
c) VHN Details
d) Gravid/Para/Live/Abortion
e) AN Reg. Date, LMP & EDD
f) TT immunization
g) Blood grouping and typing, Hb% Level, Weight, B.P
h) Testing for HIV/VDRL
i) Ultra Sonogram
j) Minimum 3 Visits
3.MCP Card Particulars

1. Delivery Particulars
2. Birth Certificate Xerox
3. First Instalment Availed?
Yes/No
Second Instalment :

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