|
Ref. LHRC/CAS/ :
|
[REFNO]
|
|
Date :
|
[DATE]
|
Time :
|
[TIME]
|
|
| To |
| S. I. of Police , |
| Police staion |
| [PITO] |
| Sir, |
| Sub : | Intimation Regarding Medico-Legal Case |
|
| [PTNAME] Aged about [PTAGE] years said to be normally residing at the below mentioned address has come /has been brought to the casualty of this hospital with a history [INJUARYCAUSE] |
|
| The Patient |
| [OPTION1] |
| [OPTION2] |
| [OPTION3] |
| [OPTION4] |
| [OPTION5] |
| [OPTION6] |
| [OPTION7] |
| [OPTION8] |
|
| Kindly do the needful. | Patient's Residential Address |
| Yours Faithfully | [ADDR1] |
| [ADDR2] |
| [ADDR3] |
| [PHNO] |
| [CMO] |
| Name & Signature Of CMO |
| Intimation received by ............................... on.............................................. at ..................................... |
| Police Station............................................................................................................................................ |
| Seal Of Police |
