Kindly fill up the Cadaver Form with availability of Cadaver organ,we will get in touch with you to confirm the same.

Name :

Age :

Gender * : Male Female

Weight :

Blood Group :

Indian Citizen : Yes No

Address :

Patient Contact Number * :

E-mail id * :

Diagnosis * :

Fluid in Abdomen : Yes No

Leg swelling : Yes No

History of loss of Consiousness : Yes No

Bilirubine :

Albumin :

INR :

Creatinine :

Sodium :

AFP :

Date of Ultra sound last done :

Date of Ct Scan last done :

Upload Files :
(allowed file type - jpg/png/word/pdf)

Send Reset