Get Revision Of Medical Reimbursement Claim Form For Cghs ...

Filling out the Revision of Medical Reimbursement Claim Form for CGHS online can be a streamlined process if you follow the appropriate steps. This guide aims to provide clear and concise instructions to assist users in completing the form accurately and efficiently.

Follow the steps to successfully complete the claim form.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred digital editor.
2. Enter the name of the principal CGHS card holder in the designated field, ensuring to use block letters for clarity.
3. Input the CGHS Ben ID number, followed by the CGHS wellness centre to which your card is attached.
4. Specify the validity of your CGHS card and the ward entitlement, choosing from options of private, semi-private, or general.
5. Provide your full address, along with a mobile telephone number and email address if available.
6. Fill in the patient's name, CGHS Ben ID number, and their relationship to you, the principal card holder.
7. Indicate your category as a pensioner beneficiary, selecting from the options provided.
8. List the name and address of the hospital, diagnostic centre, or imaging centre where treatment was received.
9. State whether the hospital or diagnostic centre is empanelled under CGHS.
10. Specify the treatment for which reimbursement is being claimed, indicating whether it is for outpatient treatment, tests, investigations, or indoor treatment.
11. Mention if you availed credit facilities, and if not, provide reasons if necessary.
12. Indicate whether the treatment was taken in an emergency situation.
13. Confirm whether prior permission was obtained for the treatment.
14. Disclose if you are subscribing to any health or medical insurance scheme, including any amounts claimed or received.
15. Fill out the total amount claimed for OPD treatment, indoor treatment, and tests or investigations.
16. Complete the bank details section, including your bank name, branch MICR code, account number, and IFSC code.
17. Review your entries for accuracy before signing the declaration stating the truthfulness of the information provided and your agreement to the reimbursement conditions.
18. Finally, save your changes, download or print the completed form, and share it as needed.

Complete your medical reimbursement claim form online today for a hassle-free experience.