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For free transport 0 to 1 year sick infant under JSSK
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S.NoName of the BeneficiaryMobile NoGenderAgeCategory
(SC/ST/OBC/EBC/SBC/GEN)		Hospital NameDistrictBlock/ Urban Local BodyGP/WardMonthYearTransport (from home to facility or facility to higher ficility or facility to home)Date pf ReferralAmount Reimbursed (In Rs.) only if other than 104 and 108
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