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Mediciti Healthcare Services Private Limited

Format Ref. - MHSPL/OPD/003-Rev 0.0


Service Report
SRNo: MHSPL0320
Work Order Number
Hospital Type GH/MCHL CH/SDH PH
wO Date & Time
M-k2c)-O-6doR
Hospital Name
SDH SDDeie b3 0 20 S:22 fm
ME No 2pARCHoLPl063wo Responded Date &Time 64 03.2D 00le
P
ME Name
Make Customer Signature for

Model Respond
NA
Serial Number
NA
Under Service Provider Under Warranty AMC
|WO Completed Date & Time
o63:20 Kd /am
||Downtime
Problem Reported |Functioning Goodd Reimbursable Work
UProposed for Condemnation
Action Taken

Cht And otrsawa Un hale LLnsmal


min
min pholem. vectlid it . Jtk V

Material Used Stand By Equipment Details


No Item Description
QtyEquipment No
Equipment Provided Date
Equipment Condition Good Damaged
Equipment Returned Date
Customer Acceptance for Stand By Equipment

Breakdown Execution details


Engineer Name Date Start Time End Time

Kldepp Kadds o4: 2040DkZ0 Pm|\

Customer Remarks

Engineer Signature Customer Signature for Wo Completion

Name Name

Designation<
Stamp
For Internal Use only
Verification by In Charge

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