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ROTTO Office, GMCH Complex, Near RIO (Regional Institute of Opthalmology)
Gauhati Medical College & Hospital, Pin: 781032

ORGAN(S) AND TISSUES(S) DONOR FORM

    Enter the Category:

    Regn No:

    Your Name:

    :

    Gender:

    Organ Name:

    Tissues:

    (Tissues can also be donated after the Brain Stem Death as well as Cardiac Death

    Blood Group:

    Date of Birth:

    City:

    State:

    Email:

    Mobile No:

    Choose Identity Proof:

    Enter Identity card No:

    Emergency Contact No:

    Details of witness

    Witness 1

    Name:
    Address:
    Mobile No:

    Witness 2

    Name:
    Address:
    Mobile No:

    We will contact you soon.

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