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Name Of Doctor Assistan (H.W.)



Father Name
Date of Birth


Gender
Category


Educational Qualification

Qualification
Board/University/Council
Roll No./Enrollment No.
Percentage/Grade

High School

Intermediate

Paramedical/Allied Health

Permanent Address-

Village/Mohalla
Post/House No.


Distt.
Pin


State
ID Details


Rural Telemedicine Health & Wellness Center Address-

Village/Mohalla
Post/House No.


Distt.
Pin


State


Mobile No.
Whatsapp No.


Center Building
Internet or Electric Facility Available at Your Center


If You have Experience with R.M.P.
How far is the Goverment hospital from your center (In kilometer).


Upload Your Photograph
Upload Your Aadhar Front/back Photograph


Upload Highschool Marksheet/Certificate Self attested
Upload Intermediate Marksheet/Certificate Self attested


Upload Paramedical/Allied Course Marksheet/Certificate Self attested


Experience
supervisor name/code


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