No.F.5-38/2001-Chief (H) Government of Pakistan ; Mi ith / mee eel 7 Wilk. Islamiabad the Maré, 2006 Subject: GUIDELINES FOR SUBMISSION AND. SCR’ UTINY OF THE MEDICAL CLAIMS. Only the attactied prescribed application form be used. Proper prescriptions bearing O.P.D. No, ‘name,: a and -diséase--of the’ acinssion/dls fe ip (in case of indoor treatment) be'attached in support of the claim. jatient_and Names and quantity of the medicines purchased by tlevelaininnt be enclosed with the epplication for reimbursement. Application must be countersigned by any.one of thé: following officers: For Federal Government Officers authorized to-egiintérsign. the application form servants treated at: 5 7 + 2) Islamabad iv Medical Superintendenit, Federal Govt, Services Hospital, Islamabad. sat ii, Ditector, Clinical Services, FGSH, Islamabad: ili, Executive Director/Joint Execiitive Director/Deputy: Executive Director, Pakistan Institute of Medical Sciences, Islamabad. iv, Joint Executive Director, Children Hospital (PIMS), Islemabed. V. Head of the department of coticerned ‘specialty. >) Rawalpindi i, Civil'Surgeon (Federal Govt.) ii, | Medical Superintendent, T:B Centre, Raivaipindi c) Peshawar/Quetta i, Civil Surgeon (Fedetal Govt:) 4) Karachi i,. Civil Surgeon Federal Govt). if, Besa Director, Jinnaly Postgraduate Medical Centre, : iii, Executive Director, Natiotial Institute of Cardiovascular Diseases, Karachi, * iv. Director National Institute.of Child Health, Karachi, V. Head of the department. of concemed' specialty. ¢) Lahore i. Civil Surgeon (Federal Govt, : ii, Chairmani/Administrator/Head of concerned speciaity, Sheikh-Zayed Hostal Lahore. fee 5). Other places where i, Medical Superintendent/Officér lacharge or Head of the there is no Federal Provincial Govt. Hospitel/Dispensary concemed, Govt. Hospital’ Dispensary Contd-----/P-2wv a In case the patient is referred to some other. ho: hhis authorized Medical Attendant, a copy of other hospital by | such referral letter/move sanction, as the case may be, be attached with the cl Cost of treatment taken from the un-authorized hospital/private clinic of the doctor (even if he/she is serving in any Government hospital) is not admissible. Only the receipts written on the proper hospital printed forni/prescription slip duly stamped is to be accepted. Cash memos must be on proper printed form with licence No, of. the: chemist and’ signed by the Authorized Medical Attendant. Cost of Unani; Ayurvedi¢ and Hoieopathic medicines will not be reimbursed, Transportation charges of the patient are not'to be reimbursed. Cost of laboratory tests taken from authorized/unduthorized hospital/iaboretory are admissible on the basis of reference by.the Authorized Medical Attendant only. < ‘The cost of Vaccine (8), blood and blood products is admissible: The cost of following items is not reimbursable: i, Cost of organs and tissues in cases-of traisplants ii Soaps and detergents iii, Food supplements iv, Toilet and cosmetic goods v. , Thermometer vi, Expenses incurred on medical treatment abroad The cost of following items is reimbursable: Antiseptic liquids as prescribed i, Disposables as prescribed “Dental treatment” includes teatment-of alveolar (gum and jaw bone) disease, extraction of teeth, Seatment for dental caries, gingivitis, pyorrhoea and filling (temporary ot permanent) of dental cavities including root canal treatment, scaling, but does not include dental implants, orthodontic appliances, bridging, crowning and provision‘of dentures: In addition to above,’ if any patient’ has to get médical ‘treatment from any un-authorized/private Rospitalimilitary bospita/clinic, in emergency, he is required to produce emergency certificate from treat : wuntersigned by the nearest orized Mei ed: in para 4 of the guidelines. This supercedes th try of Health's Circular No.F.1-1/2005-MR-I dated 17" November, 2005. it ht! 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