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Hospital Based Cancer Registry 
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Registration Form to be completed by Potential Participating Centers
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1.Name of the Institution :  * 
Postal Address:
 
State:
City: *  
Telephone:
Fax:
Email:  
2.Name of Head of Institution:
3.Name and Designation of
      Principal Investigator: * 
       Co-Principal Investigator:
       Faculty in Charge:
4.Brief profile of the Institution:
Year
Number of In-Patient Beds:
Total Out-Patient attendance:
Total Registrations:
Total Proved Malignancies:
2014 2015 2016
     
     
     
     
5.Department of Pathology:
Number of Specimens/Biopsies/Smears (non-malignant and malignant) reported during the year 2016 :
Total
(Malignant & Non-malignant)
Malignant
Histopathology Specimens/Biopsies
Cytology Smears including FNAC    
Haematology Smears
(including Peripheral Smear/Bone Marow)
   
Total   
 

        
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