YOUR ONLY DEFENCE IN THE COURT OF LAW IS YOURS RECORD.
SO THEY MUST BE UPTO DATE
MLC no: MEDICOLEGAL REGISTER
INDOOR/O.P.D. No: EXAMINATION DATE: TIME:
NAME & ADDRESS: -________________________________________________________________________
_________________________________________________________________________________________
___________________________________________ AGE: SEX:
BROUGHT BY: _______________________________________________________________________________
_____________________________________ CONTACT: ____________________________________________
I.D. MARK: __________________________________________________________________________________
HISTORY AND ALLEDGED CAUSE OF INJURY: _______________________________________________________
__________________________________________________________________________________________
DETAILS OF INJURY/ CLINICAL FEATURES (NATURE, EXACT SITUATION, DIMENTION, FREAH/HEALING CAUSE OF INJURY, AGE OF INJURY)
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
RADIOLOGICAL INVESTIGATIONS
SUMMERY OF TREATMENT
(ADDITIONAL SHEETS IF ANY)
CONDITION ON DISCHARGE & DIAGNOSIS
DATE OF ADMISSION DATE OF DISCHARGE
POLICE INFORMATION ON ADMISSION POLICE INFORMATION ON DISCHARGE
DATE: TIME DATE: TIME
PLICE STATION: PLICE STATION:
CONSTABLE’S NAME: CONSTABLE’S NAME:
BUCKLE NO. : BUCKLE NO. :
NAME OF INSTITUTION SIGN & NAME OF M.O.:
DESIGNATION: REG. NO.: