Get Application Form For Assam Arogya Nidhi 2020-2025

This guide aims to assist users in completing the Application Form For Assam Arogya Nidhi online. The process is designed to be straightforward and accessible for all users seeking financial assistance for medical treatment.

Follow the steps to successfully complete the application.

1. Click the ‘Get Form’ button to download the application form and open it for editing.
2. Enter the patient's name in block letters as required in the first field.
3. Specify the patient's age accurately in the designated area.
4. Provide the permanent address in section 3(A) and the correspondence address in section 3(B). Make sure both addresses are correct and complete.
5. Input the name of the patient's father or guardian in the next field.
6. Indicate the gender of the patient in the appropriate section.
7. Select the patient's category from the options: General, Scheduled Tribe (ST), Scheduled Caste (SC), or Other Backward Class (OBC).
8. If the application is made by an individual other than the patient, provide the name of the applicant here.
9. Detail the relationship of the applicant to the patient in the next field.
10. Describe the disease for which treatment is required in the corresponding section.
11. State the name of the hospital where the treatment is currently being received.
12. Insert the monthly income of the patient or parent, ensuring it is certified by the relevant authority.
13. Specify the amount of one-time financial assistance required.
14. Indicate whether financial assistance for the same purpose has been received from any other government department; if so, provide the details.
15. Read and confirm the declaration by signing and dating the form.
16. Provide the hospital details: name, address, and the patient's hospital registration number.
17. List the important medical reports that are to be enclosed with the application.
18. Provide a brief diagnosis and present clinical condition in the designated section.
19. Detail the recommended amount of money needed for the treatment.
20. Include an itemized breakdown of the expenditure associated with the recommended amount.
21. Specify the names and costs of the consumables or medicines required for the operation or treatment.
22. Finalize the application by obtaining the signatures of the treating doctor, head of the department, and chief medical officer or superintendent along with their official seals.
23. Once all fields are complete, save the changes, and download or print the form as required.

Begin your application process for financial assistance by filling out the Application Form For Assam Arogya Nidhi online today.