RAIL WHEEL PLANT

(Medical Department)
Occupational Health Centre
Shop Floor (Near Mould Room)
Rail Wheel Plant, Bela
Dist – Saran (Bihar)
Pin No – 841221
Date:
MD/Central Hospital/Patna
CMS/Div. Hospital /SSE
REFFERAL LETTER
The Undermentioned employee/employees, with details, is/are being referred to your
Hospital for necessary treatment please.
1. Name: ___________________________, Emp.No________________,Age___
_________________________________,Emp.No.________________,Age___
2. Complaints/Injuries (Type Abrassion, Bruise, Cut, Crushed or Burn)

3. Examination (General &Local Examination):Gen.Condition: Good/Failr/Bad

Pulse: BP: Chest CVS/CNS/Abdomen
Details of injury, if any: ______________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
4. Treatment Given. A.
B.
C.
D.
E.
F.
ON DUTY MEDICAL OFFICER