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The Transplantation of Human Rules - 1995 - new

 

1[FORM 3

[Refer rule 4(1) (c)]



I, Dr./Mr./Mrs.. ... working as at and possessing qualification of .. certify that Shri / Smt. Km. . S / o, D / o, Wo Shri / Smt. . aged .. the donor and Shri / Smt. . S / o, D /o, W/o, Shri / Smt .. aged the proposed recipient of the organ to be donated by the said donor are related to each other as brother / sister / mother /father /sons /daughter as per their statement and the fact of this relationship has been established / not established by the results of the tests for Antigenic Products of the Human Major Histocompatibility Complex. The results of the test are attached.







Place .

Signature

(To be signed by the Head of the Laboratory)


Date .

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