Tanla Covid Task Force
Please provide the following info to get
Tanla Covid Task Force
support
EMPLOYEE DETAILS
Name*
Mobile*
Company Email Address*
Employee ID*
Select Department*
Engineering
Product
Sales
Operations
HR
Marketing
Finance
Legal
Other
Other department name*
PATIENT DETAILS
Who is the patient?*
Self
Parents or Family
Relation*
Date of Covid Positive test result*
LOCATION OF PATIENT
Pincode*
Select City*
Mumbai
Gurgaon
Chennai
Bangalore
Hyderabad
PATIENT TREATED
Where is the patient being treated now?*
Home Quarantine
Admitted to Hospital
Admitted in ICU
HELP
What help do you need?*
Hospital Bed
Change Hospital
Assistance at hospital
Medicine
Oxygen
Insurance Support
Financial Assistance
Emergency
Other
CONTACT
How do we contact the patient?*
Self
Contact my Relative / Friend
Relation*
Contact Mobile Number*
COMPLETE
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HR TEAM
Name
Email
Mobile
ADMIN TEAM
Name
Email
Mobile