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India Aeromedical Services Pvt Ltd, is reachable round the clock. Please note our specific telephone numbers in order to reach us in case of an emergency. You can contact us round the clock, 365 days a year on our hotline numbers: 98200 43432 & 98210 21255.

CONTACT ADDRESS

INDIA AEROMEDICAL SERVICES PVT. LTD.
(Emergency Medical & Rescue Service)

Malkani Chambers,Off Nehru Road,
Near Domestic Airport, Mumbai - 400 099. INDIA
Operations
  Tel : +91-22-26134411
Cell : +91-9821021255
  Fax : +91-22-26113627

24 Hours
+91-98210 21255, +91-98200 43432, +91-98213 27232
Fax : +91-22-26058586
        +91-22-28370152

E-mail: ias@iasindia.com

AIR  AMBULANCE REQUEST AND MEDICAL INFORMATION FORM

Patient Name:

Family Name/Other Name

Nationality

  Male    Female

Age

Address:

City:

  Zip:

State:

Country:

Phone:

Passpot No. :

Casualty's Doctor:

Doctor's Tel No.:
Doctor's Fax No.:
Provisional Diagnosis:
Is the disease contagious or infectious in any form: YES:       NO:
Clinical Details:(Please mention if on any monitoring equipment)
Pulse: /min
BP:
Resp.Rate:
State of Conciousness:
State of Urine Output:
E.C.G.

Other Clinical Details:

Treatment given at present:(Please mention about any blood transfusion and blood group if known)
Details of investigation if any:
Destination Hospital:
Name of the Doctor to be Contacted at the Destination Hospital: