Venue of Camp
Camp Date:(required)  
Venue:(required)  City/Village:(required)
District:(required)  State:(required)
Camp Coordinator Information
Camp Coordinator Name:  Camp Sponsor:
Chief Guests Attended the Camp : :  Other Organizations Helped to Organize Camp:
Survey & Awareness
No.of people surveyed:  No.of people attended camp:
No.of people for 2nd checkup:  No.of people for 3rd checkup:
Number of Free Medicines given :  
Supporters
No.of Doctors Provided Services:  No.of Volunteers:
Names of Doctors:  Names of Volunteers with Mobile Numbers:
No.of Volunteer Hours Spent:  Paramedical Staff:
Tests Conducted
V.I.A:   Papsmear:
U/S:   Mammography:
Biopsy:   Breast Surgery:
Histeractomy:   Pre Cancer Data:
Biopsy Date :  FNAC Test Date :
No.of Breast Examinations Done:
Expenditure
Total Expenditure of Camp:  Cost of freely distributed medicines:
Expenditure for Equipment:  Expenditure for Tests:
Food Expenditure:  Other Expenditure:
Feedback
Patient Feedback:
Your Message: