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Get Wbhealthscheme2008 Form

O : 2 Full Name of the Govt.employee with Designation In Block Letters) 3 Full Address:- ( : : (i) Office : (ii) Residence : 4 Name of the Patient & Relationship with the Govt employee : 5 Pay(Basic + Dearness Pay) : 6 Name of the Hospital with Address : (a) : (b) 7 OPD treatment & Investigation Indoor treatment & Investigation : Date of Admission:- Date of discharge:- (In case of Indoor Treatment Only) 8 : Total Amount Claimed : (a) OPD treatment : (b) Indo.

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