Get Vrdl Requisition Form - Aiims Bhopal

Filling out the VRDL Requisition Form is an important step in ensuring accurate diagnosis and timely treatment. This guide will provide you with a clear and organized approach to complete the form online effectively.

Follow the steps to successfully complete the VRDL Requisition Form.

1. Click ‘Get Form’ button to access the form and open it for filling out online.
2. In section A, indicate the sample source by ticking the appropriate box for the category: outbreak/disease cluster referred by public health authorities, investigated by VRDL, or self-referred. Enter the relevant dates as prompted.
3. In section B, provide the patient's name, relationship (using S/o, D/o, W/o as applicable), age in completed years, and contact number. For infants, specify age in months and days. Select the patient's sex.
4. Complete the address details including House No/locality, Village/Town, Taluk/Tehsil, District, and Pin Code. Include the hospital OP/IP number and indicate the patient's type (in-patient, out-patient, or self-referred).
5. Enter the clinician's name and contact number, along with the referral hospital's name in the designated fields.
6. In section C, provide clinical details by entering the date of onset of illness and the duration of illness. Tick all relevant syndromes and associated signs and symptoms.
7. Specify any other necessary investigations requested in section E, by encircling the relevant tests.
8. In section D, answer the epidemiological details regarding the presence of similar cases in the household, village/locality, and provide information about recent travel if applicable.
9. Lastly, in the final section, fill in the name of the person completing the form, add any signatures if required, and check all entries for accuracy.
10. Once you have completed the form, you can save any changes, download, print, or share the form for submission as needed.

Complete the VRDL Requisition Form online now for efficient diagnosis and treatment.