Get Medical Reimbursement Form 97 In Word Format

The Medical Reimbursement Form 97 is essential for claiming refunds for medical expenses incurred by Central Government servants and their dependents. This guide provides clear, step-by-step instructions on how to complete this form effectively online.

Follow the steps to fill out the Medical Reimbursement Form 97 online:

1. Press the ‘Get Form’ button to access the Medical Reimbursement Form 97, then open it in your preferred word processing editor.
2. Begin by entering the name and designation of the Government servant in block letters, and indicate whether they are married or unmarried.
3. Input the office where the Government servant is employed and state their pay, including any other emoluments separately.
4. Provide the place of duty and the actual residential address of the Government servant.
5. Enter the name of the patient and their relationship to the Government servant, noting the age if the patient is a child.
6. Specify where the patient fell ill and detail the amounts being claimed for medical attendance or treatment.
7. Fill in the Medical Attendance section, detailing consultation fees along with the name and designation of the Medical Officer consulted, and the specific dates and fees for each consultation and injection.
8. Complete the charges related to pathological, bacteriological, and other tests, showing the name of the hospital or laboratory, and indicate if these were advised by the authorized medical attendant.
9. List the costs of any medicines purchased, ensuring to attach case memos and essentiality certificates.
10. Continue with the Hospital Treatment section by specifying the hospital name and itemizing charges including accommodation, diet, surgical operations, and nursing services.
11. Fill in the Consultation with Specialist section, providing details of any consultations, including the name of the specialist, consultation dates, and if prior approval was obtained.
12. Calculate the total amount claimed, deduct any advances taken, and provide the final net amount.
13. Compile a list of enclosures to attach for documentation.
14. Sign the declaration at the end of the form, confirming the accuracy of the provided information.
15. Once completed, save the changes, download the form, and print or share it as required.

Start filling out your Medical Reimbursement Form 97 online today!