Get Medical Reimbursement Form Appendix Ii

Filling out the Medical Reimbursement Form Appendix Ii online can streamline the process of claiming reimbursements for medical expenses incurred by Central Government servants. This guide provides clear, step-by-step instructions to help users navigate each section of the form efficiently.

Follow the steps to complete the form accurately and effectively.

1. Press the ‘Get Form’ button to access the Medical Reimbursement Form Appendix Ii and open it in your preferred online editor.
2. Begin by entering your name and designation as a Government servant in the designated fields. Indicate your marital status and provide information about your partner's employment if applicable.
3. Fill in the office where you are currently employed, including your pay details and any additional emoluments, ensuring each component is shown separately.
4. Provide your place of duty and actual residential address to establish your current location.
5. Enter the name of the patient for whom you are claiming the reimbursement, along with their relationship to you. If the patient is a child, be sure to indicate their age.
6. Specify the location where the patient fell ill, which may be necessary for processing your claim.
7. Detail the amounts being claimed in specific categories, starting with medical attendance. Include consultation fees, the name and designation of the Medical Officer consulted, and indicate the details of any injections received.
8. For pathological, bacteriological, or radiological tests undertaken, specify the name of the hospital or laboratory and confirm whether the tests were performed on the advice of the Authorized Medical Attendant. Attach relevant certificates as necessary.
9. List any costs for medications purchased, ensuring that cash memos and essentiality certificates are attached for verification.
10. If applicable, provide information related to hospital treatment, including accommodation details, diet, surgical operations, and any special medical services used. Attach appropriate certificates where mentioned.
11. Finally, calculate the total amount claimed, subtract any advances taken, and indicate the net amount claimed in the designated fields.
12. Compile a list of all documents and enclosures that support your claim, ensuring they are referenced accurately in your submission.
13. Read and complete the declaration section, affirming the accuracy of your statements and that the patient is wholly dependent on you. Include your signature and the date.
14. Once all fields are completed, review your form for accuracy. Save your changes, and then download, print, or share the finalized form as needed.

Start completing the Medical Reimbursement Form Appendix Ii online to expedite your claims process.