Blood Donor and Patient Data

Viswa Rajbanshi Unnayan Mancha

Reg. No. S0011005 of 2019-2020

Blood Donor and Patient Information

(Data Collection Form)

Responsibility: Branch/Unit IT Cell

Blood Donation Date

VRUM Branch

Blood Donor Name and Address

Blood Group

Blood Unit Donated

Patient Name and Address

Purpose/Disease

Hospital Name

Remarks/Comments

Donor Photo (Size 50kb max.)

Data Provider Name

Data Provider Email