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  • MCW Shastri Nagar MCW Shastri Nagar

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    M&CW Center Shastri Nagar
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    The document contains records from a COVID-19 vaccination center in MCW Shastri Nagar on April 21st and 19th. It lists information such as the serial number, dose, date, vaccination center, beneficiary name and contact number, vaccination officers who verified and administered the doses of Covishield, and signatures of the beneficiary and exit officer.

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    The document contains records from a COVID-19 vaccination center in MCW Shastri Nagar on April 21st and 19th. It lists information such as the serial number, dose, date, vaccination center, beneficiary name and contact number, vaccination officers who verified and administered the doses of Covishield, and signatures of the beneficiary and exit officer.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    5 views1 page

    MCW Shastri Nagar MCW Shastri Nagar

    Uploaded by

    M&CW Center Shastri Nagar
    The document contains records from a COVID-19 vaccination center in MCW Shastri Nagar on April 21st and 19th. It lists information such as the serial number, dose, date, vaccination center, beneficiary name and contact number, vaccination officers who verified and administered the doses of Covishield, and signatures of the beneficiary and exit officer.

    Copyright:

    © All Rights Reserved
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    of 1

    S.NO - DOSE- DATE – 21/04/2022 S.

    NO - DOSE- DATE –-21/04/2022

    COVID-19 VACCINATION CENTRE - MCW Shastri Nagar COVID-19 VACCINATION CENTRE - MCW Shastri Nagar
    NAME OF BENEFICIARY …………………………………………………… NAME OF BENEFICIARY …………………………………………………..
    BENEFICIARY CONTACT NO ……………………………………………. BENEFICIARY CONTACT NO ………………………………………….
    VERIFY BY VACCINATION OFFICER -1 ……………………………….. VERIFY BY VACCINATION OFFICER -1 ………………………………
    VERIFY BY VACCINATION OFFICER -2 ……………………………… VERIFY BY VACCINATION OFFICER -2 ………………………………
    VACCINATED BY COVISHIELD VACCINATED BY COVISHIELD
    COMPLETE OF 30 MINUTES BY V O -3 ………………………………. COMPLETE OF 30 MINUTES BY V O -3 ………………………………..
    EXIT TIME BY VACCINATION OFFICER -4 ………………………….. EXIT TIME BY VACCINATION OFFICER -4 ……………………………

    SIGN. OF BENEFICIARY SIGN. OF EXIT OFFICER SIGN. OF BENEFICIARY SIGN. OF EXIT OFFICER

    S.NO - DOSE- DATE - 21/04/2022 S.NO - DOSE- DATE - 21/04/2022


    COVID-19 VACCINATION CENTRE - MCW Shastri Nagar COVID-19 VACCINATION CENTRE - MCW Shastri Nagar
    NAME OF BENEFICIARY …………………………………………………… NAME OF BENEFICIARY …………………………………………………..
    BENEFICIARY CONTACT NO ……………………………………………. BENEFICIARY CONTACT NO ………………………………………….
    VERIFY BY VACCINATION OFFICER -1 ……………………………….. VERIFY BY VACCINATION OFFICER -1 ………………………………
    VERIFY BY VACCINATION OFFICER -2 ……………………………… VERIFY BY VACCINATION OFFICER -2 ………………………………
    VACCINATED BY COVISHIELD VACCINATED BY COVISHIELD
    COMPLETE OF 30 MINUTES BY V O -3 ………………………………. COMPLETE OF 30 MINUTES BY V O -3 ………………………………..
    EXIT TIME BY VACCINATION OFFICER -4 ………………………….. EXIT TIME BY VACCINATION OFFICER -4 ……………………………

    SIGN. OF BENEFICIARY SIGN. OF EXIT OFFICER SIGN. OF BENEFICIARY SIGN. OF EXIT OFFICER

    S.NO - DOSE- DATE - 19/04/2022 S.NO - DOSE- DATE –21/04/2022


    COVID-19 VACCINATION CENTRE - MCW Shastri Nagar COVID-19 VACCINATION CENTRE - MCW Shastri Nagar
    NAME OF BENEFICIARY …………………………………………………… NAME OF BENEFICIARY …………………………………………………..
    BENEFICIARY CONTACT NO ……………………………………………. BENEFICIARY CONTACT NO ………………………………………….
    VERIFY BY VACCINATION OFFICER -1 ……………………………….. VERIFY BY VACCINATION OFFICER -1 ………………………………
    VERIFY BY VACCINATION OFFICER -2 ……………………………… VERIFY BY VACCINATION OFFICER -2 ………………………………
    VACCINATED BY COVISHIELD VACCINATED BY COVISHIELD
    COMPLETE OF 30 MINUTES BY V O -3 ………………………………. COMPLETE OF 30 MINUTES BY V O -3 ………………………………..
    EXIT TIME BY VACCINATION OFFICER -4 ………………………….. EXIT TIME BY VACCINATION OFFICER -4 ……………………………

    SIGN. OF BENEFICIARY SIGN. OF EXIT OFFICER SIGN. OF BENEFICIARY SIGN. OF EXIT OFFICER

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