Bed Request

Bed Request

Patient Name *

Age *

Pin code *

City *

Patient at Home *

Covid positive or negative*

Symptoms *

Spo2 level *

Other medical issues/History *

Requirement: ICU/ventilator *

Current Doctor (Name & Number)

Current hospital if Any

Hospital preference

Family member name

Ambulance needed

Covid Vaccination done

HRCT scan if Any

Phone number (To receive OTP from SAKHAL NGO) *

Otp *

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