Blood Request :
| Patient Name | |
| Patient Blood Group | |
| Age | |
| Date when blood is required | 01-Jan-1970 |
| Units Required | |
| City | |
| Mobile Number | |
| Land Line Number | |
| Hospital Name | |
| Address | |
| Purpose |
The blood you donate is separated into components. Thus by donating one unit, you save three lives.