The Transplantation of Human Organ Rules 1995 FORM 2

Email Print This Page
Font : A-A+

 

1[FORM 2

[To be completed by the concerned medical practitioner]

[Refer rule 4(1) (b)]


I, Dr. ……………………… possessing qualification of …………………………..

registered as medical practitioner at Serial No. …………………….. by the

…………………………… Medical Council, certify that I have examined Shri/Smt./ Km

……………….. s/o, w/o, d/o Shir ……………… aged ………………who has given in-formed consent about donation of the organ, namely (name of the organ ………………………….. to Shri/Smit./Km ………………………………….. who is a “near relative” of the donor / other that near relative of the donor, who had been approved by the Authorisation Committee / Registered Medical Practitioner i.e. In-charge of transplant center (as the case may be) and that the said donor is in proper state of health and is medically fit to be subjected to the procedure of organ removal.



Place …………………… ………………………….

Date ……………………. Signature of Doctor

seal




To be affixed (pasted) and attested by the doctor

concerned


The signatures and

seal should partially

appear on photograph and document without disfiguring the face in photograph.

To be affixed (pasted) and attested by the doctor

concerned


The signatures and

seal should partially

appear on photograph and document without disfiguring the face in photograph.












Photograph of the Donor Photograph of the Recipient

(Attested by doctor) (Attested by doctor)]

Post your Comments

Comments should be on the topic and should not be abusive. The editorial team reserves the right to review and moderate the comments posted on the site.
* Your comment can be maximum of 2500 characters
Notify me when reply is posted
I agree to the terms and conditions
Mukesh Yadav Monday, March 23, 2009

WHAT IS THE STATUS OF RECENT AMENDMENTS IN the TRANSPLANTATION OF HUMAN ORGAN ACT?
WHETHER THERE IS ANY CHANGE OR NOT?

Medindia Newsletters

Subscribe to our Free Newsletters!

Terms & Conditions and Privacy Policy.

Stay Connected

  • Available on the Android Market
  • Available on the App Store

Facebook