Page 716 - The Central Motor Vehicles Rules, 1989

688 THE CENTRAL MOTOR VEHICLES RULES, 1989 ANNEXURE-XIII

ii. In Patient/Out Patient
iii. Time of Arrival

iv. Patient Name
v. Patient Age
vi. Patient Contact Number
vii. Gender Male
Female
TG
viii. Injury Severity Fatal
Grievous Injury
Simple Injury Hospitalized
Simple Injury Non Hospitalized
ix. Relation (if Male/TG) Father
Guardian
x. Relation (if Female) Father
Mother
Guardian
xi. Father Name
xii. Patient Address
xiii. Accident Register Number
xiv. ID Proof Voter ID
PAN Card
Aadhaar Card
Driving Licence
Others
ID Proof Unavailable

xv. ID Proof Number
xvi. Identification Mark 1
xvii. Identification Mark 2
xviii. Informant Name
xix. Informant Address
xx. Contact Number
xxi. Doctor Name

xxii. Doctor Regn. Number
51. Treatment details
i. Injured Part of Body Back Injury
Buttocks Injury