FORM B
See rule 4 (2)
FORM B
See rule 4 (2)
From:
______ (Name, designation and address of the registered medical practitioner)
To:
______ (Name, designation and address of the Testing Officer.)
Dated ______ 20 ______.
Sir,
I forward herewith by post/with Shri * ______ of ______ a phial bearing serial No ______ containing ______ c.c. of venous blood collected by me on ______ at ______ a.m./p.m. of ______ who was produced before me for medical examination † and/or collection of blood from his/her body † by ‡ ______ and request you to test the blood and issue a certificate (in duplicate) regarding the result of the test.
Yours faithfully,
Signature and designation of the registered medical practitioner.
Facsimile of the seal or monogram used for sealing the phial containing the blood.
* Here specify the name, designation and address of the messenger with whom the phial containing the blood is forwarded for delivery to the Testing Officer.
† Strike off if these words are not required.
‡ Here state the name and designation of the officer by whom the said person was produced for collection of blood.