MOU signed by Dr. Johnson. P. John, President, KFK with Metropolis Management & Kochi Office.
Patient Name
Aadhar Number of Patient
Mobile Number of Patient
Care Taker Number
Your email ID
District AlappuzhaErnakulamIdukkiKannurKasargodKollamKottayamKozhikodeMalappuramPalakkadPathanamthittaThiruvananthapuramThrissurWayanad
PRESENT ADDRESS
PERMANENT ADDRESS
You are a Tx (TRANSPLANT PATIENT)Di (DIALYSIS PATIENT)Do (Donor)
Name of the Hospital
Hospital ID Number
Donor Name and Relationship
Date of Transplant (DD/MM/YYYY)
Upload Doctor Letter
Upload Aadhaar Card
I confirm that the above information provided by me are True and Correct YesNo