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 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.
