| | | CGHS beneficiaries availed indoor treatment / emergency procedures at Govt. hospitals / CGHS recognized hospitals / private un-recognized hospitals ( during emergency only ) required to submit his / her claim in the prescribed Performa (Med.2004) to his department / (to The Additional Director CGHS Trivandrum through CGHS Dispensaries in case of pensioners) within 90 Days from the date of discharge from hospital. (within one month from the date of discharge in case of treatment taken in emergency). | | | Documents required for submission of Medical Bill | | | | 1) Individual representation with Contact No: & Email Id. | 2) Med. 2004 | | 3) Prescription | 4) Xerox copy of the CGHS Identity Card | | 5) Distance from residence to the Private Hospital and to the nearest Govt. Hospital (in case of treatment taken in emergency) | | 6) Medical History sheet/Discharge summary | | 7) Legal Heir Certificate in case of death of Card Holder | | 8) Death certificate (in case of death of Card Holder) | 9) Bank Details (Bank Name, Branch Name, Complete Account No:, IFSC Code, MICR Code, Telephone No: of the Branch with STD code. | | | | | | | | | | | | | | | | | | | | |
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