FORM-B

Vide Rule
ESSENTIALIh CERTIFICATE
I Certify that Sri.Kavana Sagar Gowda, R K. 1 Yrs Son or Sri.Krishna HC 8630 in
Rajagopalanagara police Station has under my treatment for Fever Decrese Blood
fmm 2S.os.2019 to 2Q052019€on Dated & 2506.2019 out patient treatment) at the
Hospital. Rajakumar Nagara. Rajaji Nagar in My consulting form and that the under
mentioned medicines
prescribed by me in this connection were essential for the recovery/ prevention of
serious deterioration in the
condition of the patient. The medicines are not stroked in the Suguna hospital for
supply to private patients
and do not include proprietary preparations for which cheaper substance equal
thereapeutle value are
available nor preparations which are primarily foods. toilers and disinfectants.
Name of the
Medical Shop
Date :
Name of the Medicines
List Enclosed Seperately
List Enclosed Seperately
Grand Total
c,csh Bill NO.
and Date
Price
27.843 82
Signature
esignation of
Authorised Medical Attendant
Dr. REKHA. G, MHA
Medical
•IVAL
Signature of th dical Officer
In charge ofthe Case of the Hospital
Dr. REKHA. G,
Medical Superin'endent
Ren No