Get Application For Financial Assistance Under Umbrellaschme Rastriva Agroa Nidhi

This guide provides detailed instructions on how to accurately complete the Application For Financial Assistance Under Umbrellaschme Rastriva Agroa Nidhi online. By following these steps, you will ensure that all necessary information is included for a successful application process.

Follow the steps to complete your application effectively.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. In the first section, fill in the patient's name and age. Ensure this information is accurate and up-to-date.
3. Next, enter the name of the hospital where the treatment will take place.
4. Provide the OPD number or registration number of the patient, which is essential for identification.
5. Complete the section listing the father or partner's name to establish the patient's identity.
6. Fill in the patient's residential address accurately to ensure all communications are directed correctly.
7. Detail the diagnosis of the disease or condition being treated. This information is crucial for evaluating the application.
8. Indicate the total financial assistance required in Indian Rupees. Be realistic and provide detailed estimates where necessary.
9. Include an attested photograph of the patient as required by the hospital's medical superintendent, ensuring it adheres to all guidelines.
10. If an operation is planned, describe the operation details and expected expenses.
11. For cyclical treatments like chemotherapy or dialysis, indicate monthly or per cycle expenses and detail the specific costs anticipated.
12. Provide any additional expenditure details that may be relevant to the financial assistance request.
13. Obtain the necessary signatures from the treating doctor and the head of the department to certify the accuracy of the information provided.
14. Finally, ensure the form is signed by the medical superintendent of the hospital or medical institution, including the official seal.
15. Once all fields have been filled, save changes, and choose the appropriate option to download, print, or share the form.

Take the next step towards securing financial assistance by completing your application online.