---): Place of Duty: Name of Patient: Relationship with Employee: Age: Nature of illness: Name of Doctor/Hospital: Period of treatment: From ------------- To-------------------(Certificate issued by the Medical Officer in-charge of the hospital as per enclosed proforma is to be attached) 12. Details of claim: (attach prescription, vouchers, etc. in duplicate) Voucher No. Amount Consultation: Diagnostics/Tests:.

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How to fill out the Hptr 6 online

Filling out the Hptr 6 form is an essential step for employees seeking medical reimbursement for indoor treatment. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to complete your Hptr 6 form online.

  1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
  2. Fill in the personal details: Enter your name, designation, registration number, and salary or pension as of 01-04. Provide your place of duty for identification.
  3. Input patient information: Write the name of the patient, their relationship to you, and their age.
  4. Describe the medical condition: Specify the nature of the illness the patient is suffering from.
  5. Provide details of the medical provider: Enter the name of the doctor and the hospital where treatment was received.
  6. Indicate the treatment period: Clearly mark the start and end dates of treatment, ensuring that you attach the necessary certificate from the medical officer.
  7. Detail your claim: List out all relevant expenses on the claim form, including consultation fees, diagnostics/tests, medicines/injections, appliances, room rent, charges for nurses, and any other applicable costs. Make sure to attach prescriptions and vouchers in duplicate.
  8. Calculate the total amount: Sum up all the expenses and write the total in the designated section of the form.
  9. Provide a declaration: Sign the declaration confirming that the information provided is true and that the patient is fully dependent on you.
  10. Final review: Double-check all the entered information for accuracy and completeness.
  11. Save, download, or print: Once you have completed the form, save your changes, or download and print a copy for your records.

Start filling out your Hptr 6 form online today to ensure your medical expenses are reimbursed promptly.

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