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It}o be Wipbble lel ftlowinici! | | 11 oy nia TELL L Jencon L111 101016 ALLEL eet alos) Phone No: (47% 11 : ; WO Ema Sparshjainl993 @ yahoo i in DETAILS OF INSURANCE HISTORY 2} arent coved ary her Medea Hea nasarce [Jee B)datecot commencement ot ft nsurance without reat LOE ye comes: Promo ELUTE by ‘Sur insured (Rs) Dave you been hake ne enlowensaeeicetonctieconran?|_is Nee ae Lolo) ubufLis LJ ‘Diagnosis 2) Previews covered by anyother Medclarm/Hrakhinsucance |_jves [Je A) Myes Company Name DETAILS OF INSURED PERSON HOSPITALIZED. ‘Nemeslite Pao BITAM RymAR RIN Dy MeatniO carton Pare eet eee ee SpoendecraieAfemate|_| 4 Age-yeus| 511] mors [2 ©) DaeotBeih|O16 | LOL) LLIMG 14) ‘)Reiatonshino! 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Deve (210 |OL4| (2/1211) “povectacmeso4 246 |10 |) [210 2) Jy reel DH) {1] spomecsosdrgd 916105) 2/012|) porme[ 118 L319) “name ol nesting cocter_Drra_EShan Shaxma____Dagnos Dirwun veces sel_| ntezed_| Ras ratte aceon subsance Abuse /NechelConampter|_| ptacteniegatres|_] Nel sReporedtopolce ved_| nol_] Geese ert omic fyel Jiseeneseatel —— A a Scanned by TapScanner Scanned with CamScanner Scanned with CamScannerDETAILS OF CLAIM 2) Oca of he veamenteape, nies Claimed i oe ae | Pre tespateaon tapenie, j ’ bob a: - we SUA lelo yj, Horptatsier tapences * (NLS 16/5) ete. m8 lsata 1} witli ec cos BL scr | * Arbulance Charges: fe 6. Others coe) ML Eat | Total % Uisieiz(e (sy | g Pete H Po dat 211 wPolopilivenseiod — ganlo lal | Z ©) Gain fr Doman Homptatsaion Yes] Nel | (es rove ceaisn ones) ; ODA I Limp I /eahbenelt camer + Hospal Dally cash BELLI esieseas MLL tit M. Chtca ness Genetic Bs i Corvalescence ttt tii) PrefPosthosptalsaton Rs wOthens RACE np sum benef, Teta sLLLEL I yy lai Documents Submitted - Check ist LF cai rermony sired Li tars iematon tary fet crina ospnat nisin (A ovoinat respi Bestop Bt | ongnal oslo Povment eceiet W1T Ongeat Hoot Ochaige SurnenaeyPhanicy Bi LL operation Theater Nones Uc Af orginal doctors Prexenptions Griginar Doctors request: Tor inves Pa ai lnk che at th payee name ported name o ‘he poyes inet printed onthe cheque lel please tach capped he fest. age ofthe bank passbook DETAILS OF BILLS ENCLOSED. (SiNo | BiiNo. opr Dye 2 D Da MW a m w DoT r o BT oTe Nor = Dpepepr DETAILS OF Prumany INSURED’ BANK accOUNT - tame of the Hole (As perant Account). BITAM KUMP) ANY “Sa Sra apse eer 9/5/1218 (56/0) © Sonnare: KOTAK _MAHINDRA Sar Name Bde: TANARPURL, 6 3 TewaWPuRL, MEWDELM~ Noose S)Accounctype:Sonng WF Girert.|_| Cash Geda}_| Mice Jolt ‘i OFSCCode: IKIKIB IK] O]0/0 [4 IS | nove BEB PERS EMH 9 orice eI Ny Kumes Jacn ae: [4|59)(0,7)/ajojaiy cH 2 eee Seereienad Scanned by TapScanner Scanned with CamScanner Scanned with CamScannerTO AE RILLEDIN BY THE HOSPITAL . ‘The ssue ofthis forms otto be taken as admission of aby Please include the orignal reauthorization request form ine of PARTA aN eters (abe ad ic ey 1b) oso. Secieat tn nae eee Abhishek SHAREM A anererstimcore _}, $\ san More OLY 7.7.34. 2. Mp DR ©) Qoicatons__ | : Mame 8.9000 8°042684 waco — 41 \ se ret Cee aor i 1) Matured Quahiy Assureice ands Ups ny Nanas Heat Promectnepwen Fk: PT IAY Kuri SAT i 8) Peegsrsonernee/2.02-1 26 11) cycancer side EF%rae(] ayrge-eas[S6) Monts LLY oa nora 8 Ty Oerctadmsson Q4Glojtyiai)| —gytmre (ILELLD JOM rj Osteotdnchage: [bistelsi} aft) 1 tem: twigisifn 1D WeetAdmimion tmergency [Fiennes] Say Care[_}yateriny"} KN Maerrity 9) Date o einvery joowtssae Ly 2 1 HnustiestiniveDitaeeienne | OGar canine rons) meses] mpsseret trot LL LLL LS DDETAKS OF ALMMENT DIAGNOSED (PRIMARY) » eDI0Cates Omnpeen co acon Fema Ore Ble Pnunennttis | reociver du Abies beara: \4 4 3 i) Comers ee 6 peepee tut ee 2 meaterevion tua Yo] ome xsternnn int So Py i 1) dameneston yearn mclaren Se ‘Dracuteien dieeipey teCTNe DSi preense Sic] Restate CL since tu acrrcnamoton C) OV nny ve stance: Kensanpten Tencandsesaenasan 6 eL] tach teais) Wheto est Ys Ne ytegeres race vs) nies “ier ope ge ek ns meen ily serie oto Gy Orgran Ashorztin eget SCIMPE eto ep 2) Gy! reameraon eae os eeene te eimesinabon 2 eeepc ol en vee by il ec § i tesutaninese amma, [orFamacys 5 Sos Cia crper trent é pelea [El ort caine oe hng ote late Do osprat brent uptat C1 Any tte pease soe AComONA DETALS IN ASE OF NON en Eo igact ae aE em ee eG nh Omers ‘DCLARATION By THEHOSPTAL (PASE READ VERY CARAULLY) ‘Weare deca tha tb nfo rare nthe Ga ferns rve and correc othe best ceurivande andl, Hoe nement supposin otcenceumeat olay rata fal. ou nghttaciamurde fs clarmshaltelreted =o a g poo Scanned by TapScanner Scanned with CamScanner Scanned with CamScannerSANT PARMANAND HOSPITAL Multi-Super Specialty Healthcare 150 9001 : 2008 CT SCAN & ANGIOGRAPHY CENTRE cr dealing Hand Dr. Rakesh Vohra, MD FORMERLY SENIOR CONSULTANT RADIOLOGIST SjR GANGA RAM HOSPITAL & DWAN CHAN AGGARWAL WMAGING CENTHE PATIENT'S NAME: BIJAY KUMAR JAIN. 56 M4 — 23.08.2074 AREA SCANNED: HRCT THORAX SCAN NO. 12403221 UHID NO. Pr 08e283 HRGT OF THE THORAX ‘rachea is central, Trachea! bifurcation is defined, Airway is patent Mediastinal vascular structures are defined and their fat planes are preserved. Hear mates are sen inthe pretracheal (9mm), preaortc (16 mm) & subcarinal 16 mn) regions, There is evidence of a 13 mim partially caleified precarinal node. No hilar mphadenopathy s See) lateral ploural thickening is present. No pleural effusion is noted on either side, ‘Heait appears normal in size. No pericardial effusion is seen ‘A calcific speck Is seen in the lateral basal segment of left lower lobe. A a ec rere ot ground glass opacities wit septal thichering & crazy paving involving all the lobes of both lungs. IMPRESSION: In view ofthe above mentioned CT findings, the possibility of? viral infection cannot be ruled out. CO-RADS CATEGORY -5. INTERPRETATION, Vor nh sucicion ot cow. 19nacton ETSEVERITY SCORE (serniquanttaive scoring system) ~11/ 25 - MODERATE ADVICE. RTPCR test. Lee we rn Rvp RADIOLOGIST (OR. RAKESH VOHRA) “sao ees a ages. a atc aes, CT Sean sho as ets Cr aoa at npr cren wer 6 parc tage ‘8 Sam am ag Chains De 110054 ‘PH ect 2982 2806 9571119941 Hanna :23994401-10 Ext 526,527 ‘Hebets: wwa spe. Era | coaackbsphdohi ow Scanned by TapScanner Scanned with CamScanner Scanned with CamScannerseron42t +86 Yro /M Hae en oes sg oom Scanned by TapScanner Scanned with CamScanner ‘Seanned with CamScannerx [%[20.0| DELHI ASTHMA & DIABETES CENTRE 22 GAGAN VIHAR, DELHI © Ph. > 22510851, 22527499 © 00.00 AMM-12 NOON® 6.39 PALA 50 nA Mob, ; 1313108718 Dr. Anita Sehgal fag. OMG thao WORD MeCN nee ee Cy Mor Bigtiy ey Tas fe 0 Trngly wae sp — Shs aL AvalosM SY, Owey n FREES ot Rakes hevs Pee she Couple 1 oT Tughynce 2 mee Nee at “aH 1 z ’ Spe. Ak / PY. be » Race es] vut aT: Vetter a * Teuup lea° wees a 4 tek —— Indulat. Barat + Urns ai Ss Scanned by TapScanner Scanned with CamScanner Scanned with CamScannerDr. Bijay Patni Maes SCCRFOLDg m Dabo cm Dabwclogy.P Diploma in Crdogy abacioge Seroocreattnal com Diabetes Wellness Care. S04 Sarat Bore Roud Notata-700025, West Bengal © 03324550002 Mon-sat Name: Bijoy Kumar Jain Date: Fri Apr 23 2021 10:50:25 ‘Age: 56 years/Male Mobile No: 8178410149 H/O: Diabetes () Chief Complaints: Fever [5 Days], Cough [3 Days}, Loss of smell Findings: Tele consultation, History given by patient Investigation: None Diagnosis: T2DM, Fever for investigation, ? Covid (history), ‘Advice: + Maintain strict advice regarding Social distancing, handwashing and wearing of mask. +» Home isolation + Check So2, temperature every 6 hrs . If So2 is consistently less than 94 and/or istent temp inform immediat + Self monitoring of blood glucose as advised *# Plenty of liqui Calpol if temp more than 100 or body ache + Proning as suggested and explained in slide sent + Fabify 400mg -4and half tb twice daly xtst day, followed by 2tab twice dally x next + Metmectin 12g once daily after food X § days * Doxycycline 42 mg twice daily after food X 7 days + Vitamin C dai : k once daly x5 days + Zinconia 50mg once daily {Ttajenta smg once daly afte inch * Getapin XR twice daily after food + Rosuvas 20mg - once after + Ecosprin 75mg once after dinner * Veloz-D once before breakfast * Budecott inhaler 200meg twice daily followed by mouth wash LabTest: CRP, CBC, D-Dimer, RT PCR test for Covid19, HRCT SCAN OF CHEST Notes:Teleconsultation consent given. History of contact with Covid19 positive patients. If oxygen saturation is unable to maintain around 94percent with all medications and physical methods, you shail need institutional management Followup: Visit after 3 Days (Mon Apr 26 2021) h Or. Bijay Patni Reg no:49475 West Bengal Medical Council Diabetes Wellness Care ‘SOA Sarat Bose Road Kolkata-700025 (© 03324550002 Scanned by TapScanner Scanned with CamScanner Scanned with CamScanner& Paytm Paid Successfully = 1000 Bijay Patni’s Paytm Wallet linked to 9830089267 Transaction ID: 33768995154 12:30 PM, 23 Apr 2021 Scanned by TapScanner Scanned with CamScanner Scanned with CamScannerDELHI AST HMA & mee ES CENTRE . ie: ee "OT Monfae ce —! 27. MeBeiseloe lew. 3. Budecot Sep é Sapte a’ ct cat tap» py apy 4 Tal, Cofurenusnse 500 ie Ox cagplonaatites | P05 BY ie i co ae k Gat Pavncefasurl 0 ~~€ ‘So¢ Q * cesonuenare ne * Better eS sig patient education cig te Bary® Paytm Paid Successfully = 1400 Anita Sehgal’s Paytm Wallet linked to 9313168718 Transaction ID: 33736130941 05:17 PM, 20 Apr 2021 Scanned by TapScanner Scanned with CamScanner Scanned with CamScannerName of Payment Receiver BITAY KUMAR address. M~H[2lt, BRD FLOOR , DELHL DELHI. State. City. Telephone No. tick the relevant document in the lst Below) Ga Peano [PAN cara D Voter's identity Card — [2 Unique identity Carey Adhar Card fo Driving License MODEL “Town - = Bank Account Statement Photograph of Payment Receiver TAIN ns Pin Code...LOOOF MobiteNo 43122648 Telephone Bil Land Line/Mobie) |B Letter fom a recognized Publ Authority TO Electricity ail £ Ration Card C1 Letter from a recognized Public Authority (wenrrxo) | CI Valid lease agreement ] G1 Insurance Policyholder |-card/Certificate (wi hove) | Employers Certificate Ta ic Bank Letter for identification & proof of residence 0) Bank Letter for identification & proof of recent photograph above, Date 10-G- 202) place DELHI The documents provided as proof of identity and proots of address have been self-attested. | have also attached my Sato Allene General insurance Company Lid GE Pia, Arpat Runa Yerawada, Pune 911 O06 Ter 31 O20) COOIRTTT Fax [aN GO) BANIOTAT Set rete etapa ert residence } Ray Kerman a, ‘Signature of the Declarant Scanned by TapScanner Scanned with CamScanner Scanned with CamScannerScanned by TapScanner Scanned with CamScanner Scanned with CamScannerScanned by TapScanner Scanned with CamScanner ‘Seanned with CamScannerScanned by TapScanner Scanned with CamScanner Scanned with CamScannerScanned by TapScanner Scanned with CamScanner ‘Seanned with CamScannerScanned by TapScanner Scanned with CamScanner ‘Seanned with CamScannerScanned by TapScanner Scanned with CamScanner ‘Seanned with CamScannerScanned by TapScanner Scanned with CamScanner ‘Seanned with CamScannerScanned by TapScanner Scanned with CamScanner ‘Seanned with CamScanner= we 7 ‘re cis euanmee ee aoa nero Vara ~ Sop ane eae Soy at eee Tee oe (ea eo woe So 2 eee a tt <= Tee oa, Se ‘ sit 1 taiwan! 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NIMS HOSPITAL, DELHI ROAD, JAIPUR DL NOD Na NAOHNAONNNS _EASH Memo viss7ies? “NIAY RUMARIATN ‘ratent Nae Bill No i ba 12 ices SALE “COUNTER Age aiden Pees SRO” TENE, BA ie FACk GIY «RATE DIG. AMOUNT Osim ' 108234 Ora? IMMUVIRTABIVITAMINCA ZH 111830, si a0 oe 2 sah 821002 1282 ORILINCTUSSYP 10M {10 + nam 1190 me 2 soos 20442004 as) DABICLO 110 NG.CAP 0 8-30 m180 ms 2 TAXON COST CCST AMT 000 900 000 800 Boo 00 #335 800 4332 at 5.00 Sea 00 #800 obo Ai subject wo iaipar ey jurisdiction only ERO, Remark CASH Claim uatth Bajo pet, ALL CARE PLUS PHARMACY NIMS HOSPITAL, DELHI ROAD, JAIPUR NOsOAAAMPRaRENIZ DUNO:DL Nana nuns CASH Memo cast yo-seansrrtauizr Fas Nang WAY KUMARTARE Sikora sae “ETB SA COUNTER Apel Gmiirs Neb: fee Sho WNC WATCH Sr Dips Fie Ge ATE ORT ; ppc OU RAVAMLENO 10 vo MM a 3 + war Begorne aaa} RAPPOLDBRCAP moos} ts as 5 ee raion ons3RESTMONT Lc TABLET Tessie me {ke Me oa curruMso 1h fms wns wes $F Nezootos has TELMASOMGTAB foo ae tae ot sus ora ae incon coms caSTAMT © «SGSTE SOSTAMT ocr mi 5 Oe <8 fst te ie = ot = =9B Re he ir ‘Soe mi 8 ie RET ANT: nites ce Thm kan at Bee aAAeE ANT ‘ae ‘Ai eco ipa 9 jure oly EAL OE. = a ‘cra CASH UseR HAE MUSTAQ AL choim with Bajaj Muang Scanned by TapScanner Scanned with CamScanner Scanned with CamScannerScanned by TapScanner Scanned with CamScanner ‘Scanned with CamScanner[NIMS HOSPITAL Shoda Nagar: abu Det Hiway ‘Sana - 300 121, $5114) 238965 ia sunnersity og cr | Name: BUAY KUMAR JAIN Sex: 56 Y/Male 30-04-2021 Reg No: 202104260771 Accession 10430750 Opditpa: {PD + Multifocal patchy irregular air space alveolar consolidations associated _ with ground glass haziness noted in bilateral upper, right middle and lower lobes. r severity scoring system: “Lung Lobes ight upper lung lobe CORADS ~ 6 (CTSS = 14/25). The heart & mediastinum are central. ‘The trachea & major bronchi are patent ‘There is no evidence of obvious lymphadenopathy. , There is no evidence of pleural effusion on either side. Bony cage & chest wall are normal. te clinico pathologically.Mims HoserTAL Shes Nag. pen wih, Sapa -300 12, Erermcy sah far ees 0 Infowhoxptal emeunnarsty oF Wests gncteranresiy ong BLUAY KUMAR JAIN Reg No: 202104260771 : 56 Y/Male Accession No.:202| 0427102 27-04-2021 Opdaipa: PD. H.R.C.T. SCAN OF CHEST: Moderate ground glass opacity noted. Multifocal air space consolidations noted in bilateral upper, middle and lower lobes predominantly peripheral and basal distribution. Minimal crazy paving pattern noted. scoring system: sty soot lee je lung lobe ight lower lung lobe sft upper lung lobe lower lung lobe ol Poi ‘upper lung lobe 2 i 4 4 2 4 CORADS - 6 (CTSS = 16/25). ‘The heart & mediastinum are central ‘The trachea & major bronchi are patent. ‘There is no evidence of obvious lymphadenopathy. ‘There is no evidence of pleural effusion on either side. Bony cage & chest wall are normal. 2 us nO int uno Fase olate clinico pathologically. ante js H i r, Rajesh Yadav cham with bap MA sate Dept. Of Radio Diagnosis & Imaging Not for medico legal purposes Scanned by TapScanner Scanned with CamScanner Scanned with CamScanner~ +t ee emeorraL KERB, NIMS HOSPITAL (A Unit of Nims UI 16 JAPURDEL WHMAY saPuRontENPA osTyeM wo eau laes Ont the Specren ested ane shout be Co laadCicaly ten rue Cov 199 ANLNIMIR ‘su does mre the posal of Cov 8 fect Presence of tier, matin art RNA soci SARS-CoV 2can ees ont Kn corel he resis WEN inal Mage Anagaive re & engi noe ear ct ere dome ole SARS- ion. Hence sh caves repeat sample soe be ei. Lome fesaeaoy ac sabes Ike Svs BAL ET asa ar porn apes RESIDENTS: Scanned by TapScanner Scanned with CamScanner Scanned with CamScannerNIMS HOSPITAL (A Unit of NIMS UNIVERSITY) 14-C, JAIPUR DELHI HIGHWAY, -JAIPUR-303121 (RAJASTHAN), INDIA PH :0141-2308065. wourviumar | REGNO oa aver mo Accession No 21eosose 04-05-2021 Beer re - ner. oy a ‘a: 0408202 8:28:29 PM AL-G4.05202) BaP ADVANCE MOLECULAR BIOLOGY REPORT \RYNGEAL SWAB ‘Status Result Unit Biological Reference interval NEGATIVE 10 (€ Gene) UNDETERMINE - jave (N Gene) UNDETERMINE jo (INTERNAL CONTROL), 30 3 TA Spcte SARS Govt na Scio SARS COV 2 Not Ded tet eoncaie. Re Sarpe @ Reson an Ree On he Specter inland sos on Covet Cray nomen tr Cor 19 AMS eat crtm ponoy of Cot 8 net Prtaon of ibis mato nesta NA soe SARS-GHV 2c esa Ky cont eat eth cnet ans Areata i ge ne ety esr ns rt ot SARS re et Soe pan eae phan wet Lampert se ie Ste BAL ET apo apron Ni ‘ AIP ITAL NH, GHWay R303328 DR. YOGESH SINGH Scanned by TapScanner Scanned with CamScanner Scanned with CamScannerNIMS HOSPITAL Init of NIM: "sae Ey unas WO Me BUAY KUMAR 58 Mae 102052031 1 RUPESH ( 8102279268) RESIDENTS fiscal —— Scanned by TapScanner Scanned with CamScanner Scanned with CamScannerPH 0141. REG.NO maarverorr) Recession No 20210430000 NIMS HOSPITAL (A Unit of NIMS UNIVERSITY) ‘116, JAIPUR DELHI HIGHWAY, JAIPUR-20312 (RAJASTHAN), OIA 1-2388005 NOLOGIST. RESIDENTS: Fomor gonarted vapor. Usum ith Bahay pian, NIMS. HOSPITAL, ” JNPUR-D HIGHY nH 1 e.0A x OR RUPESH ( 8102271268) Authorised Signatory Scanned by TapScanner Scanned with CamScanner Scanned with CamScannerNIMS HOSPITAL (A Unit of NIMS UNIVERSITY) 176, JAIPUR DELHI HioHWay, APU + JAIPUR-09121(RAIASTHAN), DIA PH :0141-2388905 : - ‘Ue BUAY KUMAR, JAN 56 Nie 0-04-2001 02 a ui 10-50 eet) 2 un 14.63 LINE PHOSPHATASE 61 a 45-145 OTAL PROTEIN 68 gt e080 BUMIN L 20 gal ass2 OBULIN 4 48 od 2338 } Dimer TEST BLOOD IN 1036 Agim SEE BELOW TECHNOLOGIST RESIDENTS computer generated roport. Scanned by TapScanner Scanned with CamScanner Scanned with CamScanner“samalnt NIMS HOSPITAL ) ple Cottocted at 27/0402 1.0018) AN NIN PITAL JAIPUR DECH HIGHWAY “Ane MANCHA atid 422 (Reg.No 9942) TECHNOLOGIST RESIDENTS Authorised Signatory con Pier Generated report, Scanned by TapScanner Scanned with CamScanner Scanned with CamScannerNIMS HOSPITAL (A Unit of NIMS UN 16, JAIPUR DELHI HIGHWay, sAPUR Sa claus INDIA ied at. 270472035 +08.21 AM in Baat:27-042021 tooan Cum with Boyoy ot DR RUPESH ( 8102271268) pMNoLocisr RESIDENTS Authorised Signatory Scanned by TapScanner Scanned with CamScanner Scanned with CamScannerNIMS HOSPITAL (A Unit of NIMS UNIVER: V6, JAIPUR DELHI HicHWay, JAIPUR-3031211 PH :0141-2380066 MRAJASTHAN), INDIA re MeBUAY KUMAR | REG.NO. 2oavon2007r4 oPonPD 0 JN with AccessionNo 20210427015 DEPARTMENT —comoig BILLIONS, 2 une wr 2108200 her. ny sat LOCATION cov@ eure ‘Test Authoncated at: 1/042001 F401 PM Nondiabetic: 4.5.5.8 % Prediabetic: 5.8-6.5 DENTS TECHNOLOGIST RESI Ws computer generated report. Scanned by TapScanner Scanned with CamScanner Scanned with CamScannerNIMS HOSPITAL eat of NIMS UNIVE! HIGHWAY, JAIPUR-03121(RAJASTHAN), INDIA PH :0141-2308065 REG.NO 202104260775 AccessionNe == 20212715 BILLIPDNO. 2 er. ay er ‘oPDAPD Po DEPARTMENT — como uni nr LOCATION S000 102 Tost Authestcated a 7704203" 2a ht Result | ‘Unit Biological Reference Interval NON-REACTIVE TO REACTIE on neice |_| vente eer ee enna = een ie cr poorer ent ie ccifenuaa eet tad etna Chaim wath Goyoy ey DR KANUPRIYA TIWARE (REG.MP 16352) TECHNOLOGIST RESIDENTS: ‘Authorised Signatory compute generat report Scanned by TapScanner Scanned with CamScanner Scanned with CamScanner14-6, JAIPUR DELHI Ha) NIMS H (A Unit OSPITAL of NIMS UNIVERS|TY, HWAY, JAIPUR 20542 PH 01412390008 | V/ASTHAN) moa = Me BIJAY KUMAR JAIN 56 Y Male 27-04-2021 (Collected at: 2770872021 1:08:21 AM 0 A REG.NO 20210826077; | oppnpD (Po Accession No 20210427015 DEPARTMENT — covio.tg BILLAPD No. 2 onrr s UNIT compte generated report INVESTIGATION RESULT METHOD, Clot Determination PRIVARY SAMPLE TYPE _| Citrated Plasma TEST RESULT TEST I 403 Sec Norma! 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JPR/2017/€3500-3501 Scanned by TapScanner Scanned with CamScanner ‘Scanned with Cam:Scanned by TapScanner Scanned with CamScanner ‘Seanned with CamScannerScanned by TapScanner Scanned with CamScanner ‘Scanned with CamScannerMinistry of Health & Family Welfare Government of india Final Certificate for COVID-19 Vaccina Beneficiary Details Beneficiary Neme / ATi rar ARUNA GARG Age! 37 46 Gender) fet Female ID Verified / gerry oe ereenter PAN Card # AHNPG1621K Unique Health 1D (UHID) Beneficiary Reference ID 1416202476048 Vaccination Det Vaccine Name / deni rapt COVISHIELD Date of Dose / eof erent areter 02 Apr 2021 (Batch no. 4121Z021) Date of 2© Dose / af erem after Vaccinated by / dest err’ ate 1 TH Vaccination at / Ehesresxor er $2174 07 Jul 2024 (Batch no. 41212077) Preeti Fortis Hospital Shalimarbagh 3, North West Delhi, Delhi + Together, India will defeat COVID-19” (tm cerDatiet mmunizte a -eard t atk wets it! cote Haine No. 1075 “dare ea feat wit en ee eee aa we ere ante TET 1075 TEE COWIN fi % ae ‘ais Os cov + @ This centicate can be vested by scar the GF code ot Scanned with CamScanner Scanned with CamScannerMinistry of Health & Family Welfare Government of india Final Certificate for COVID-19 Vaccina Beneficiary Details Beneficiary Name / oInreff er ary Age! 3 Gender) fet ID Verified / year aa Herta Unique Health ID (UHID) Beneficiary Reference ID Vaccination Det Vaccine Name / dena rare Date of f Dose / age are & artar Date of 2© Dose / af erem after Vaccinated by / dest err’ ate 1 TH Vaccination at / Ehesresxor er $2174 Ritesh Garg 47 Male PAN Card # AHOPG1256F 2514692243612 COVISHIELD 02 Apr 2021 (Batch no. 41212021) 07 Jul 2021 (Batch no. 41212077) Preeti Fortis Hospital Shalimarbagh 3, North West Delhi, Dethi + Together, India will defeat COVID-19” (tm cerDatiet mmunizte a -eard t atk wets it! cote Haine No. 1075 “dare ea feat wit en ee eee aa we ere ante TET 1075 TEE COWIN fi This ceticate can be vested by scare GF code ot Scanned with CamScanner Scanned with CamScanner