Get Arogya Karnataka Self Declaration Form Pdf

The Arogya Karnataka Self Declaration Form Pdf is a critical document used by beneficiaries to declare details related to medical investigations and hospitalizations. This guide provides clear instructions on how to accurately fill out the form online, ensuring a smooth and error-free submission.

Follow the steps to complete the Arogya Karnataka Self Declaration Form effectively.

1. Press the ‘Get Form’ button to access the Arogya Karnataka Self Declaration Form Pdf and open it in the editor.
2. Begin by entering the certification details regarding the amount collected for investigation charges. Fill in the blanks with the relevant figures and names of the patient who holds the Arogya Karnataka Card.
3. Complete the section that certifies the refund amount provided to the beneficiary. Include the refund method, whether it was through cash, cheque, or demand draft, and the preauthorization number.
4. Provide details about the travelling charges paid to the beneficiary, writing both the total amount and its equivalent in words.
5. Sign with a thumb impression or your signature in the designated area provided for the patient, and ensure the signatures of the Arogyamitra and the SAMCO are included.
6. Fill in the hospital and patient details sections accurately, which may include personal and treatment-related information such as date of request, hospital name, contact numbers, and diagnostic details.
7. Complete the sections requiring medical history, current complaints, and treatment plans as required. Input all information clearly and succinctly.
8. Review all entries for accuracy and completeness before saving changes. You may then choose to download, print, or share the completed form as necessary.

Start filling out the Arogya Karnataka Self Declaration Form online today for a hassle-free healthcare experience.