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To,

Dated:
The Additional Director,
CGHS, Sector 8, R.K.Puram
New Delhi-110022

Subject: Request for regularisation of emergency admission in Fortis


Hospital, Vasant Kunj and
reimbursement of bills.
Sir,
My earlier request to Joint Director, (Grievances) dated 01/02/15 enclosed in
original explaining the difficulties and emergency circumstances under which my wife
Smt. Harbanso Devi (CGHS Ben Id: 951782) was admitted in Fortis Hospital, Vasant
Kunj on 29/01/15 may kindly be seen. Because of his kind help and telephone to Saket
city Hospital, Saket, I approached them on the same day with case summary from Fortis
Hospital. Since they had no bed available in the I.C.U. there and have recorded the
same in writing on the enclosed application itself. I approached Rockland Hospital,
Qutab Institutional Area at 10:30 P.M. on the same day and a bed was available there. I
immediately went to Fortis Hospital and got my wife discharged and admitted her in
Rockland Hospital, Qutab Insititutional Area at about 12:30 P.M. and since then she
continued her treatment there in I.C.U
A copy of the emergency and ambulance certificate from the Fortis Hospital is
enclosed. As it was a question of life and death for my wife and I was forced to seek
admission in Fortis Hospital because no bed was available in the above mentioned
CGHS panelled Hospital.
I request that under the circumstances explained by me the entire expenditure of
Rs. 1,22,882/- (One lakh twenty two thousand eight hundred and eighty two rupees
only) incurred by me at Fortis Hospital, Vasant Kunj (Copy enclosed) may kindly be
regularised for this emergency admission as an exceptional case. I am unable to bear
this heavy expenditure at this advanced age of 80+ years. Hence the entire
expenditure of Rs. 1,22,882/- (One lakh twenty two thousand eight hundred and eighty
two rupees only) may kindly be reimbursed to me.
Eventually my wife expired on 7/3/15 in the I.C.U. of Rockland Hospital (Death
Certificate enclosed).
Yours faithfully,
Encl:
1.
2.
3.
4.
5.

Photocopy of CGHS Card holder.


Emergency certificate by Fortis Hospital, Vasant Kunj
Copy of Discharge Summary
Copy of bill from Fortis Hospital, Vasant Kunj.
Copy of Death Certificate.
( Narendra Kumar)
(Retired Under Secretary, Cabinet
Secretariat)
CGHS Ben. ID 951781
BD/14-H, DDA Flats, Munirka
New Delhi110067
Tel26109345/9868027726

To,

The Chief Medical Officer


CGHS Dispensary No. D-69,
Sector 3, R.K.Puram
New Delhi-110022
Subject: Request for forwarding the bills for reiumbursement
towards treatment of
my wife Smt. Harbanso Devi (Ben.ID 951782).
Madam,
With reference to above I request that my application for reimbursement
towards treatment of my wife may kindly
be forwarded to Addl. Director,
(Grievances), CGHS,
Sector - 8, R. K. Puram, New Delhi-110022.

Yours
faithfully,
Dated:
( Narendra Kumar)
CGHS Ben. ID 951781
BD/14-H, DDA Flats, Munirka
New Delhi110067
Tel. 26109345/9868027726

To,

Dated:
The Additional Director,
CGHS, Sector 8, R.K.Puram
New Delhi-110022

Subject: Request for reimbursement of bills for 2 Albumin H 20% Inj.


and 3 units of blood and 2
units of Platelet recharge.
Sir,
This is to inform that my Smt. Harbanso Devi (CGHS Ben Id: 951782) was
admitted in the ICU of Rockland Hospital, Qutab Institutional Area from 2/2/15 till
7/3/15. She was being treated for CKD-V and on the advice of Doctors in Rockland
Hospital she was administered 2 Albumin H 20% Inj. on different dates and 3 units of
blood and 2 Platelet Recharge .
Please find enclosed the biils for 2 Albumin 20% injection which were
administered on different dates as per the prescription enclosed. (The said injection
were not available with Rockland Hospital). A bill for 3 units of blood transfusion and 2
platelets recharge are also enclosed which were purchased form Indian Red Cross
Society, Parliament Street, New Delhi for reimbursement is also submitted.
I request that Rs. 7794/- for Albumin 20% injection and Rs. 4710/- for blood
transfusion and platelets recharge may kindly be reimbursed to me.
Eventually my wife expired on 7/3/15 in the I.C.U. of Rockland Hospital (Death
Certificate enclosed).
Yours faithfully,
Encl:
1.
2.
3.
4.

Photocopy of CGHS Card holder.


Copy of bills for purchase of Albumin H 20% Inj.
Copy of bills for 3 blood units & 2 platelets recharge.
Copy of Death Certificate.
( Narendra Kumar)
(Retired Under Secretary, Cabinet
Secretariat)
CGHS Ben. ID 951781
BD/14-H, DDA Flats, Munirka
New Delhi110067
Tel26109345/9868027726