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No.

TALUKA HOSPITAL GHOTKI


Dated : To: ________________________________________

Date and hours of arrival Name_________________________________s/o _____________________________ caste _____________________ Age_________

Address___________________________________________ Occupation __________________________________Sex ___________

Name of relative of friend. Date of examination

No. and Date of police letter

Police constable

Date of Admission

Date of Discharge

Identification Marks

Probable Nature of injuries Kind of Weapon used

Poison Suspected
Medical Officer

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