NVCAdmin
| Photo |  |
| First Name | PRABIN |
| Middle Name | . |
| Last Name | BAJGAIN |
| Age | 24 |
| Gender | MALE |
| Accomadation | N-3 |
| Hall Seat No | D1 |
| Application No | MD1 |
| Foreinger (Y/N)? | |
| Monk (Y/N)? | |
| Student Type | NEW |
| This Center Student | OLD |
| Phone | |
| prabinbajgain111@gmail.com | |
| District/Country | |
| Profession | |
| Case Type | Referral |
| Severity | 9 |
| Reason | MENTAL DISTURBANCE-MINOR |
| Deprature Day | 1 |
| Case Description | left on day 1 5pm, due to anxiety problem not mentioned in the form. used to take drugs in the past. |
| Remarks |