Medical Reimbursement Form CGHS PDF

Medical Reimbursement Form CGHS PDF Download using the direct download link

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Medical Reimbursement Form CGHS PDF Download in for free using the direct download link given at the bottom of this article.

Medical Reimbursement Form CGHS

This is a Medical Reimbursement application form for a claim of medical expenses incurred by the insured person in cash for the treatment of the family.

Medical Reimbursement form PDF can be downloaded from the link given at the bottom of this page.

Medical Reimbursement Form CGHS PDF - 2nd Page
Page No. 2 of Medical Reimbursement Form CGHS PDF

Medical reimbursement is a facility where an employer reimburses uninsured general medicine or accident expenses incurred by the employee or his dependents.

Details to be Mentioned in Medical Reimbursement Form

  • Name and Designation of Government Employee
  • Office in which Employed
  • Place of Duty
  • Permanent Address
  • Name of Patient and his/her relation with Government servant
  • Details of amount Claimed
  • Hospital Treatment
  • And any other details

Document Required

  • Medical Reimbursement Application Form
  • Hospital Discharge Summary (Original)
  • Case receipts from hospitals or chemists.
  • Health Card Copy
  • If an accident happens, then FIR or medico-legal certificate(MLC)
  • And any other details

Central Government Health Scheme (CGHS) medical reimbursement form for serving government employees.

Medical Reimbursement Form CGHS PDF Download Link

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