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12+ & 15+ JAN 2022 COVID VACCINATION FORM - PP UNIT GH KOTTAYAM
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SESSION SITE
*
വാക്സിനേഷൻ സെന്ററിന്റെ പേര്
GH KOTTAYAM 15+
DATE OF VACCINATION
*
വാക്സിനേഷൻ തീയതി
MM
/
DD
/
YYYY
PHONE NUMBER
*
ഫോൺ നമ്പർ
Your answer
NAME OF CLIENT
*
വ്യക്തിയുടെ പേര്
Your answer
AGE
*
വയസ്സ്
12
13
14
15
16
17
18
Other:
GENDER
*
ലിംഗഭേദം
Female
Male
Others
NAME OF SCHOOL
*
CMS HSS CHUNGAM
NSS HSS UNION CLUB
LOURDE PUBLIC SCHOOL
EXCELSIOR
MD SEMINARY SCHOOL
BAKER VIDHYAPEEDAM
OTHERS
ST. JOSEPH SCHOOL
ST. ANNES SCHOOL
MOUNT CARMEL GHSS
GIRIDEEPAM SCHOOL
MT SEMINARY SCHOOL
BAKER SCHOOL
CHINMAYA VIDHYALAYAM
GOVT HSS KARAPPUZHA
HOLY FAMILY HSS KANJIKUZHI
MODEL HSS VAYASKARA
MOUNT CARMEL VIDHYANIKETHAN
VIDYADHIRAJA SCHOOL
DOSE
*
എത്രാമത്തെ ഡോസാണ് എടുക്കേണ്ടത്?
dose-1
dose-2
VACCINE
*
covaxin
corBEvax
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