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Get CENTRAL GOVERNMENT HEALTH SCHEME MODIFIED CHECK ...

Pensioners)& Entitlement 3. Full name of Card Holder (Block Letters) 4. Status (Govt. Servant/Pensioner/Other) 5. The following documents are submitted Please tick (-/) the relevant column (a) (b) (c) (d) (e) (f) (g) (h) : : from to . : Pvt. / Semi Pvt./General : : : Medical 2004 Form : Photocopy of CGHS card : No. of Original Bills : Copy of discharge summary : Copy of referral Specilaist/CMO : Whether the hospital has given breakup : for lab investigations Original.

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