Name of Doctor : * Qualification: * Detailed Address: * Pincode: * Tel No. (Clinic): * Mobile: Does our PSE meets you regularly: - Select - Yes No If yes, can you recall his name? Patient Name Age: Sex: - Select - Male Female Weight in Kg.: Sputum Test: X-ray Status: No. of Days Treatment Required: SCC 4+ Pouch SCC-4 Tablets SCC - 4 LW + POUCH SCC KIT Tablets SCC 3 POUCH SCC-3 Tablets SCC - 3 LW POUCH SCC-3 LW Tablets SCC - 2 POUCH SCC-2 Tablets

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