medical re imbursement application forms,new hospitalsand full government orders

1. A.SHANAVAS CHITHARA
TALUK OFFICE
NEDUMANGADU

2. 1
FORM OFAPPLICATION FOR CLAIMING REIMBURSEMENT OF MEDICAL EXPENSES
OF GOVERNMENT SERVANTSAND THEIR FAMILIES
(Separate form should be used for each patient)
1. Name and designation of Government Servant :
(In block letters)
2. Scale of pay :
3. Office in which employed :
4. Place of duty :
5. Residential address :
6. Name of patient and relationship of the
Government servant to the patient :
7. Place at which the patient fell ill :
HOSPITAL TREATMENT
8. Whether hospitalised or not :
9. If hospitalised whether in Government hospital
or private (notified hospital and the name of :
hospital)
10. If hospitalised outside the State
i) Whether the patient was on duty :
ii) Name of institution :
11. If on special treatment outside the State-
i) Name of institution :
ii) Whether certificate of Director of
Health Services as contemplated in Rule 7
(a) is attached
iii) Whether prior sanction of Director of Health
Services has been obtained :
12. Last date of treatment :

3. 2
CHARGES:-
13. Details of amount claimed :
(List of medicines, cash memos and
essentiality certificate should be attached)
i) Treatment in Government hospital
Medicines
ii) Treatment in private institutions
(Bills to be certified indicating emergency
of the case)
1. Charges for medicines :
2. Charges for treatment :
3. Charges for accommodation :
4. Charges for laboratory services :
5. Charges for diet :
14. Total amount claimed
(in figures and in words) :
15. List of enclosers-
1. Essentiality certificate :
2. List of cash bills :
3. Certificate of medical officers :
Declaration to be signed by the Government Servant
I hereby declare that the statement given above are true to the best of my knowledge and
belief and that the person for whom medical expenditure has been incurred is wholly dependent on
me.
Place:
Date: Signature of the Government Servant.

4. FORMS AND CERTIFICATES
APPENDIX II FORM
APPLICATION FOR CLAIMING REFUND OF MEDICAL EXPENSES INCURRED
IN CONNECTION WITH MEDICAL ATTENDANCE AND TREATMENT OF
GOVERNMENT SERVANT AND THEIR FAMILIES
1. Name and Designation & Section :
(in Block Letter)
2. Office of the employee :
3. Pay of the Govt. Servant as defined in FRs
and other employments which should be shown :
separately
4. Place of duty :
5. Full Residential address with door No
And name of the Mohalla :
6. Name of the patient, his / her relationship
to the Govt. Servant. In case of children
state age also :
7. Place at which the patient fell ill :
8. Nature of illness and its duration :
9. Details of amount claimed, cost of
Medicines purchased from the Market /
List of medicines / cash memos, and the
Essentiality certificate should be attached
Each in duplicated signed by treatment doctors :
10. Total amount claimed : Rs.
11. List of Enclosures
i. Check List [ ] ii. Essential Certificate [ ]
iii. Emergency Certificate [ ] iv. Discharge summary [ ]
v. Consolidation Bills [ ] vi. Medical Cash bill [ ]
vii. Operation Notes
ix. Non-Drawal Certificate
[
[
]
]
viii. Dependence certificate [ ]
x Referral proceedings [ ]
xi Reports [ ]
xii Pension [ ]
xiii Others________________ [ ]
DECLARATION TO BE SIGNED BY THE
GOVERNMENT SERVANT / PENSIONER
I here by declared that the statement in the application is true to the best of my knowledge
and belief and that the person from whom medical expenses were incurred is a member of my
family as defined under the Government servant Medical attendance rules 1972 and wholly
dependent upon me.
Signature of Forwarding authority Signature of Govt. Servant / Pensioner
and office to which attested

5. GOVERNMENT OF KERALA
Ahstrqct
INTEREST FREE MEDICAL ADVANCB TO GOVERNMENT EMPLOYEES -
MQDIFICATION TO APPLICATION TORM - ORDERS ISSUED.
FINANCE (LOANS) DEPARTMENT
G.O. (P) No.586/13 /Tin. Thiruvananthapuram, Dated, 03. f 2.20 l3
Read: - i. G.O.(P) No.l07ll0l/Fin dated 27 .09.2001 .
2. G.O.(P) No.358/07/Fin dated 10.08.2007.
QBD EB
As per the Government Order read above an application form for Interest Free Medical
Advance to Government employees was introduced. But now certain Lacunae have been noticed in
the application form. In the circumstances, Government are pleased to modifr the Application
form for Interest Free Medical Advance as appended to this order with immediate effect.
Necessary Orders will be issued later, to incorporate the form in K.F.C. Vol.II.
BY ORDER OF THE GOVERNOR
C.MARY
ADDITIONAL SECRETARY (FINANCE)
To
The Principal Accountant General (A&E/G&SSA) Kerala, Thiruvananthapuram
The Accountant General (E&RSA) Kerala, Thiruvananthapuram
- All Heads of Departments and Offices.
All Departments (all sections) of the Secretariat.
The Secretary, Kerala Public Service Commission (with C.L.)
The Registrar, High Court of Kerala, Ernakulam (with C.L.)
The Registrar, Kerala Agriculture University, Thrissur (with C.L.)
All Secretaries, Additional Secretaries, Joint Secretaries, Deputy Secretaries and Under
Secretaries to Government.
The Secretary to Governor.
The Director of Treasuries, Thiruvananthapuram.
The District Treasuries/Sub Treasuries.
The Director of Public Relations, Thiruvananthapuram.
/fn"Nodal Offi cer, Finance Department.
Stock file/Office copy.
Forwarded / By Order
WSection Officer

6. FORM OF APPLICATION FOR INTEREST FREE MEDICAL ADVANCE TO
GOVERNMENT EMPLOYEES
1 Name of applicant
2 Designation
3 Name of Institution/Office
4 District and Station
5 Date of Birth
6 Date of First appointment/Date of entry in Service
7 Dateofsuperannuation/retirement
8 Pay and Scale ofPay
9 Natureofappointment(Provisional/regular)
10 Length of service as on the date of application
11 Length of remaining seruice as on the date of
application
12 Whether the applicant is a Gazetted Officer or Non-
Gazetted Officer
13 The designation of the drawing :
offi cer/counters i gning authority
14 The name of the Treasury from which the amount is
proposed to be drawn
l5 Name, address and relationship with the patient
(i) Name
(ii) Age
16 Whether the patient is a Government Employee
l7 Whether the patient is a Service Pensioner
l8 Purpose for which it is required
(i) Name of Hospital
(ii) Date of Surgery
(iii) Name of Surgery/treatment .
19 Amount to be deposited
20 Approximate expenditure
2l Amount of advance required
22 Whether advance for similar purpose was obtained
previously and if so:-
(i) The No. and date of the Govemment Order
sanctioning it
(ii) Date of drawal of the Advance
(iii) Whether the amount of advance has been .
utilized. Details of adjustment made

7. 3
(iv) Balance if any outstanding, if so reason for non-
utilization of full amount sanctioned
23 In dependent case whether the patient has any other :
children other than applicant
(a) If yes, No. of children and their income profile
may be included (age, profession, annual income :
ofeach)
24 Speci$ whether they are wqrking
Private/Government/ Abroad :
25 The DDOs/HODs may countersign the bill and
certificate obtained from the party whom Medical
Reimbursement claim is released or IFMA adjusted
Certified that the information given abovo is complete and true and that I will comply with
the rules laid down in the case of Interest Free Medical Advance from the time to time.
Signature of the applicant:
Name:
Designation:
ENQUTNY CERTTFICATE
1. Certified that the applicant has no other means to raise the amount for meeting the
expenditure.
2. Certified that I have made enquiries about the purpose for which the advance is applied for
and have been satisfied myself with the genuineness of the facts attached to with this
application.
3. Certified that the applicant will continue in service till the complete repayment of the
advance as per existing Rules/Orders
Place:
Date:
Signature:
Name and Designation:

8. 1) The cases of Medical Reimbursement claims in which treatment is undergone in
Government approved private hospitals can be settled by the AD themselves as
per KGSMA rules, 1960, in consultation with DHS and Finance Department, as
per the ceiling limit fixed in this regard if the patient is referred by an Authorized
Medical Attendant .
2) Only those proposals for which special sanction is required for reimbursement
(ie. for the treatment in unapproved private hospitals with or without proper
It has been brought to the notice of Health &Family Welfare Department that
many Administrative Departments in Government Secretariat recommend and forward
proposals for medical Reimbursement in respect of Government employees to this
Department even though the hospital where treatment was undergone is a recognized one
by the Government and the patient has been referred by an Authorized medical
Attendant. Such a procedure results in undue delay in settling the Medical
Reimbursement Claims even in deserving cases. In order to reduce the Administrative
delay and to make the procedure much easier the Administrative Departments in
Government Secretariat including Law, and Finance are directed to examine the cases of
Medical Reimbursement claims properly on the basis of the following before forwarding
the files to Health and Family Welfare Department for concurrence:-
Sub:- Medical Reimbursement - Further instructions - Issued - Regarding.
CIRCULAR
Health and Family Welfare (G) Department
Dated Thiruvananthapuram, 11.07.2012
No.24623/G2/12/H&FWD
GOVERNMENT OF KERALA

9. Fo~rder
Section Officer
All Departments including Law,Finance and Legislature.
All Head of Departments.
Information and Public Relations Department
(For publishing in the official Website)
To
V.V.VINAYAKUMAR
Special Secretary to Government
A list of approved hospitals and list of diseases for which Medical
Reimbursement is admissible is appended herewith. Which is available in the Website
of this department also.
reference ) need be forwarded to this Department. In such cases specific
recommendation at the level of Secretary is required.

10. 1 zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA
SI.No Name of Centre Name of Disease Government Order by which
the centre is approved by Govt.
1 Alshifa Hospital, Perinthalmanna Orthopaedics G.O(Rt)No.2175/03/H&FWD
dated 21.07.2003
2 AKG Memorial Co-operative Hospital, l)Cardiology and G.O(P)No.126/2007 /H&FWD
Kannur Cardiovascular Disease dated 02.06.2007
2)Neuro Medicine
3)Neurosurgery
4)Urology
5)Paediatric Medicine
and surgery
6)Plastic Surgery
?)Oncology
8)0bstetrics and
Gynaecology
9)0rthopaedics
10) ENT
ll)Dermatology
12)General medicine
13)0phthalmology
14)General Surgery
3 Amala Cancer Hospital, Thrissur Cancer G.O(MS)No.195/84/HD dated
25.07.1984
4 Amrita Institute of Medical Science and Cardiology and zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLCardio G.O(P)No.230/2000/H&FWD
Researach Centre, Kochi Vascular Surgery dated 18.08.2000
1. Gastro Intestinal G.O(P)No.263/2002/H&FWD
Diseases and Surgery dated 21.10.2002
(Gastro enterology)
2.Orthopaedic
3.Renal Transplantation
and Dialysis
4.Neurology and
Neurosurgery
5.Investigations in Radio
Diagnosis
Department(Including CT
Scan, MRI, Ultra Sound
etc)
6.All types of Laboratory
investigations
7.Urology including
Lithotripsy
8.Paediatric cardiology
9.Nuclear Medicine
Department

11. 2
Medical Oncoloy G.O(P)No.182/2009/H&FWD
Radiation Oncoloy dated 19.06.2009
Surgical Oncology
5 August Nursing zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA& Homeopathic Undergoing treatment in G.O(Rt)No.3911/84/HD dated
Research Centre, Kalamassery the institution 12.12.1984
G.O(Rt)No.2929/85/HD dated
16.09.1985
6 Caritas Hospital, Kottayam Cancer G.O(P)No.524/2011/H&FWD
dated 24.10.2011
7 Cosmopolitan Hospital, Orthopaedics G.O(P)No.45/97 /H&FWD
Thiruvanantha puram dated 18.02.1997
8 EMS Memorial Co-operative Hospital & 1) Cardiology G.O(P)No.126/2007/H&FWD
Research Centre, Perinthalmanna 2)Neurology dated 02.06.2007
3)Neuro surgery
4)Nephrology
5)Gastroenterology
6)Urology
7)Andrology
8)Inf ertility
9)Paediatric surgery
Investigation facilities
MRI Scan
CT scan
Echo Cardiography
TMT
EEG
Nerve Conduction studies
1) General Medicine G.O(P)No.316/2009/H&FWD
2)General Surgery dated 09.09.2009
3)0rthopaedics
4) Gynaecology and
obstertrics
5) Paediatrics
6)ENT
?)Radiology
8)Dental and
Maxillofacial
9)Cardiothorasic and
Vascular Surgery
lO)Interventional
Cardiology
11) Interventional
Neurology
Investigation facilities
1) Cardiac Catherization
Laboratory (Cath Lab)
2) Bronchoscopy
3)Upper Gastro Intestinal

12. 3
Endoscopy, Colonoscopy
4)Pulmonary Function
Test
5) a)Clinical Laboratory
Investigations
b) Bio Chemistry
c)Micro biology
d)Histopathology
e) Clinical Pathology
f)Immunology
9 Emakulam Medical Centre, Ernakulam Orthopaedics G.O(P)No.45/97/H&FWD
dated 18.02.1997 zyxwvutsrqponmlkjih
10 Indian Institute of Diabetes, Diabetes G.O(P)No.169/04/H&FWD
Thiruvananthapuram dated 02.08.2004
11 Indian Institute of For treatment in the G.O(MS)No.14/96/H&FWD
Panchakarma,Cheruthuruthy, Shornur institution dated 11.01.1996
12 Kerala Co-operative Hospital Complex 1) Cardiology G.O(P)No.182/05/H&FWD
and Centre for advanced Medical 2) Cardio Thoracic dated 13.07.2005
services Ltd, Pariyaram, Kannur Surgery
3)Nephrology
4)0rthopaedics
1) Oncology G.O(P)No.113/2011/H&FWD
2) Surgery & Paediatrics dated 21.02.2011
13 KPM Hospital Malappuram Cardiology G.O(P)No.7l/200l/H&FWD
dated 15.03.2001
14 Komaranchanth Urology & Renal Renal trasnsplantation G.O(P)No.45/97/H&FWD
Transplantation Centre, Ernakulam Paediatrics dated 18.02.1997
15 Lakshmi Hospital, Aluva 1) Paediatrics G.O(P)No.29112011/H&FWD
2)0bstetrics and dated 30.04.2011
Gynaecology
16 Lakshmi Hospital, Ernakulam 1) Paediatrics
2)Cardiology
3)Neo-Natology G.O(P)No.136/02/H&FWD
4)Paediatric Surgery dated 15.06.2002
17 Lakhmi Hospital, Perumpavoor 1) Paedeatrics G.O(P)No.29112011/H&FWD
2)0bstetrics and dated 30.04.2011
Gynaecology
3)General Medicine
18 Lakhmi Hospital, Thrippunithura Obstetrics and G.O(P)No.29112011/H&FWD
Gynaecology dated 30.04.2011
19 Lakshmi Hospital, Udyogamandal, 1) General Medicine G.O(P)No.29112011/H&FWD
Emakulam 2)Paediatrics dated 30.04.2011

13. 4
20 Lisie Hospital, Emakulam 1) Cardiology G.O(P)No.291/2011/H&FWD
2)Cardiothorasic surgery dated 30.04.2011
3)Neurosurgery
4)0rthopaedics
5)Nephrology
6)Urology
21 Malabar Cancer Centre Society , Kannur Cancer treatment G.O(P)No.251/2002/H&FWD
dated 01.10.2002
22 Matha Hospital , Thrissur Orthopaedics G.O(P)No.45/97 /H&FWD
dated 18.02.1997
23 Medical Trust Hospital, Kochi Cardiology and Cardio G.O(P)No.340/97 /H&FWD
vascular surgery dated 09.12.1997
Orthopaedics
Paediatrics G.O(P)No.45/97/H&FWD
Renal transplantation for dated 18.02.1997
Renal Diseases
24 Moulana Hospital, Perinthalmanna Cardiology G.O(P)No. 71/2001/H&FWD
dated 15.03.2001
25 Msgr.Joseph Kandathil Memorial Cancer Cancer G.O(P)No.558/2010/H&FWD
Research Centre, Cherthala dated 21.08.2010
26 National Hospital, Kozhikkode Renal transplantation for G.O(P)No. 71/2001/H&FWD
renal diseases dated 15.03.2001
27 N.S.Memorial Institute of Medical Orthopaedics G.O(P)No.94/2011/H&FWD
Science, Palathara , Kallam dated 14.02.2011
28 NSS Medical Mission Hospital, Only for the patients G.O(MS)No.257/86/H&FWD
Pandalam referred by Authorized dated 22.12.1986
MedicalAttendentfor
better treatment
29 Panchakarma Hospital and Research For treatment in the G.O(P)No.20/2007/H&FWD
Institute of Oushadhi at institution dated 06.01.2007
Thiruvananthapuram and Thrissur
30 PRS Hospital, Killippalam, 1) Cardiology and G.O(P)No. 7112001/H&FWD
Thiruvananthapuram Cardiovascular surgery dated 15.03.2001
2)0rthopaedics
3)Urology
31 Doctors Diagnostics & Research Centre, For Clinical tests not G.O(MS)No.482/99/H&FWD
Thiruvananthapuram/Kottayam/ available in government dated 16.12.1999
Emakulam sector, at fixed rate as per
government order
32 Recognition of Devi Scans private Ltd, For Clinical testsnot G.O(MS)No. 70/2001/
Thiruvananthapuram available in government H&FWD dated 14.03.2001
sector, at fixed rate as per
government order
33 Samaritan Hospital, Aluva Complicated Heart G.O(MS)No.122/1985/HD

14. 5
Surgery dated 03.07.1985
34 Specialist Hospital, Ernakulam 1) Urology G.O(P)No. 71/2001/H&FWD
2) Orthopaedics dated 15.03.2001
3) Plastic Reconstructive
surgery
35 SP Fort Hospital,Thiruvananthapuram 1) Orthopaedics G.O(P)No. 71/2001/H&FWD
2)Thorasic surgery dated 15.03.2001
37 SUT Hospital, Thiruvananthapuram Cardiology and G.O(P)340/97/H&FWD dated
Cardiovascular surgery 1997
Orthopaedics G.O(P)No.45/97/H&FWD
(Fat embolisam cases dated 18.02.1997
requiring Ventilatory
Support)
Joint Replacement
Surgery for Knee and hip
38 Tellicherrry Co-operative Hospital, 1) Cardiology and G.O(P)No.126/2007/H&FWD
Kannur Cardiovascular Disease dated 02.06.2007
2)Neuro Medicine
3)Neurosurgery
4)Urology
5)Paediatric Medicines
and Surgery
6)Plastic Surgery
?)Oncology
8)0bstetrics and
Gynaecology
9)0rthopaedics
lO)ENT
11 )Dermatology
12)General Medicine
13)0phtalmology
14)General Surgery
Endocrinology G.O(P)No.316/2009/H&FWD
dated 09.09.2009

22. All Departments in Secretariat including Law zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA& Finance.
All Heads of Departments.
To
Dr. K. Ellangovan
Secretary Lo Government
It has come to the notice of' Governrneut that undue delay is occurring in
settling the Medical Reimbursement Claims in respect of Government Servants zyxwvutsrqponmlkjihgfeI
Teachers suffering from Cancer and I< idney cl iseases and other diseases affccti ng vi ta I
organs. It is necessary that such claims are to be settled in a time bound manner.
Therefore, it is hereby instructed that Medical Reimbursement Claims in respect of
Government Servants I Teachers suffering from Cancer and Kidney diseases and other
diseases which affect the vital organs should be settled within a maximum period of
one month from the date of receipt of such applications.
These instructions shal I be complied without fai I. zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHG
Sub:- - Health & Family Welfare Department- Time bound settling of
Medical Reimbursement Claims in respect of Government
Servants zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBAI Teachers suffering from Cancer and Kidney diseases
- Instruction issued - Regarding.
Dated Thiruvananthapuram , 29 .10.2014No.49329/G2/14/H&FWD
Health and Family Welfare (G) Department
CIUCULAR
GOVERNMENT OF KERALA
_II S:i.L;
Lt/11114 -
' )

23. Section Officer
Forwarded zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQP/By Order
The Stock File/Office zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBACopy.
The Secretary, Legislature Secretariat (with C/L)
The Registrar, High Court of Kerala, l·'.rnakulam (with C/L)
The Director of Health Services,Thi ruvananthapurarn
The Director of Indian Systems of Medicine , Thiruvananthapuram
The Director of Homoeopathy,Thiruv<manthapuram
~nformation and Public Relations Department
(For publishing in the official Website)
'·• 'I

24. APPENDIX – II
THE KERALA GOVERNMENT SERVANTS MEDICAL ATTENDANCE RLES 1960
(Proforma to be filled up by the Authorized Medical Attendant when a patient is referred to other hospitals
within/outside the state)
1. Name and address of patient :
2. Whether employed if so
(a) Pay & Scale of pay :
(b) Office in which employed :
3. Residential address of the patient :
4. Place at which the patient fell ill :
5. Whether hospitalized or not :
6. If hospitalized whether in government
Hospital/Private hospital with name of
the hospital :
7. If advised hospitalization outside the state, the
hospital where the patient is admitted first.
State the reason for outside Hospitalisation. :
8. Details of permission granted for outside
treatment :
Signature of authorized Medical Attendant
(i). Remarks of unit chief/ Head Of Department
(ii) Remarks of Superintendent of Hospital
Counter Signature of DME/DHS

27. ജീവനകാ‍ുള മെഡിക‍ റീ ഇംമേഴ് മെനിുള അമേഷ ന‍ുമോ‍ രദിമകട കാരയങ‍
........................................................................................................................................
1.അമേഷമയാമടാപം,എസ‍ഷയാലിറി സ‍ടിഫികറ്(ഒറിജിന‍)
2.ഡിക്ളമറഷ‍( ഒനി‍ ൂൂത‍ ചികിതാ സരദായം സസീകരിചിടില എലതിന്)
3.ഒറിജിന‍ കയാഷ് ബിുക‍
4.ഗവ അംഗീൃത സസകാരയ ആുേതി ആമെങി‍ ഡി എം ഒ മെമലാപ് മവച അപ‍ഡിക് 2( ഒ േി
ടികറ് സഹിതം)
ചികിത കഴിഞ് ൂു ൊസതിനകം അമേഷ സെ‍പികെം
ചികിത ുടുന മകുകളി‍ ോ‍ട് ബി‍ സെ‍പികാം,എനാ‍ അവസാനബിലിമന തീയതി കഴിഞ്
ൂു ൊസതിനകം അമേഷ സെ‍പികെം
എലാ കാഷ് ബിലിമനയം േിറക് വശത് ചികിതിച മഡാട‍ മേ‍ മരഖമപുതിയ സീമലാുൂടി
ഒപിടെം
prescribed and administrated to the patient by me എന് മഡാട‍ ഒപിു ുമന എുതി മച‍കെം
എലാ കയാഷ് ബിുകളം paid by me എമനുതി അമേഷക‍ ഒപിടെം
എലാ കയാഷ് ബിലിമനയം ആദയമേജി‍ മരാഗിയമട മേും,മഡാടുമട മേും ഉടാകെം.തിുത്
ോടില.
ഒു ലഷം ൂേയ് ുകളിുള മെയിം ആമെങി‍ അതത് വുപിമന മെലധികാരി വഴി മവരിഫിമകഷന്
മവടി ആമരാഗ്, വുപ് ഡയറടമററി‍ അയമയടതാെ്
രധാനമപട അുഖങ‍ ആമെങി‍ മകസ് സമറിയമട മഫാമടാമകാപി അയയെം
എസ‍ഷയാലിറി സ‍ടിഫികറി‍ താമഴ േറയനവ ഉടായിരിമകടതാെ്
1.എലാ മേജിും മഡാടുമട മേര്,രജിറ‍ നേ‍,എനിവയമട സീമലാുൂടി തീയതി മവച മഡാടുമട
ഒപ്,,,,,,,,,,,,,ആുേതിയമട ഓഫീസ് സീ‍
2..മരാഗതിമന മേര്,മരാഗിയമട മേര്,ചികിതാകാലയളവ് എനിവ മരഖമപുതെം
3,ബിലിമന നേും തീയതിയം, കടയിമല മേര്,െുനിമന മേര്,ഫാ‍െമകാളജിക‍ മേര്,
4.തിുതുക‍ മഡാട‍ സാഷയമപുതെം
5,ബിുക‍ തീയതി രെതി‍ നേരിട് ആ നേ‍ രകാരം എസ‍ഷയാലിറി സ‍ടിഫികറി‍
മരഖമപുതെം
6.ലാബ് ചാ‍ജ്,മെഡിക‍ചാ‍ജ്,മഫാസിറ‍ ചാ‍ജ് എനിവ ഒുെിച് കാെികുത്.അതിമന ുക
തരം തിരിച് മരഖമപുതെം,അതുസരിുള കയാഷ് ബിും മവെം

28. A.SHANAVAS CHITHARA
TALUK OFFICE
NEDUMANGADU