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PREPARED BYENTER YOUR DETAILS HERE IN BLUE CELLS
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Name:VENKATESHAM CHOWKI
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Designation:SA(MATHS)
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Working PlaceZPHS RAMACHANDRAPURAM
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Dist:MEDAK
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Ph.No.9441216748
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NAME OF PATIENTP.Srininvas Kumar
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RELATIONSHIP WITH THE EMPLOYEEself
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NAME OF EMPLOYEEP.Srininvas Kumar
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DESINATIONSA(Social)
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OFFICE OF WORKZPHS R.C.Puram
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MANDALR.C.Puram
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DISTRICTMedak
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SCALE&PAY15280-40510
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HOUSE ADDRESSH.No.25-35/2/35
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Sri Sai Nagar, Ashoknagar
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R.C.Puram, Hyderabad
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INPATIENT / OUT PATIENTInpatient
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SPELL OF CLAIMFIRST
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NAME OF DISEASEPost Primary PTCA + Stent to load + IABP support (Driver 3.5X24 mm)
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HOSPITAL NAMECare Hospitals
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HOSPITAL ADDRESSRoad No.1, Banjara Hills, Hyderabad
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PERIOD OF TREATMENTFROMTOTO
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05-07-201110-07-2011
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AMOUNT49,952Forty nine thousand nine hundred and fifty two
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DDOHead Master
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OFFICE NAMEZPHS R.C.Puram
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MANDALR.C.Puram
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DISTRICTMedak
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TO ADDRESSBELOW 50000/-ABOVE 50000/-
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The District Educational Officer,The Director of School Education, A.P.,
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Medak District,Near Telephone Bhavan, Saifabad,
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HQ:Sangareddy.Hyderabad-500004
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ENCLOSURES1.Checklist
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2.Appendix-II
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3.Non Drawn certificate
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4.Dependant certificate
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5.Hospital Recognition G.O.
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5.Emergency certificate
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6.Essentiality certificate
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7.Discharge summary
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8.Original Medical Bills
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