Lucky Cement Limited, Site Office

Advance for Medical Treatment

Due to Industrial Injury/Sickness at Site
Designation: S.G Emp No. 90000188
Name: Mr. Yousaf
Department: A & S Date of Injury: 24-04-23
Regular Daily Wages Contractual Outsource Contractor Staff Visitor
Details of Accident
IP was working in loeshe mill cement mill line CD at Silo Bucket elevator L/D.Hot cement Accidently damaged the left
eye .borught to LCL dispensary with pain in is eye.
patient Shifted to DIKhan trauma center for further treatment.
Detail of First Aid Treatment at Site Dispensary by Medical Office.

MO LCL given first aid treatment inj Voren and other treatment.
Further Treatment Required from Some Other Clinic/Hospital (Give Detail)

After first aid treatment patient referred to trauma center DIKhan

Medical Officer
Estimated expense required on further treatment (give break-up if possible)
The Patient Back pain Sever condition. Ba cause some special
investigation like X-Rays and other treatment Rs . 5000/=
Medical Officer Head of Dept.
Approval of advance for medical treatment (Original bill should be submitted to Account Dept.)
I. For estimated expenses up to Rs. 20,000/- required for further treatment.
Remarks:

Approved by
Balance Amount Rs 1010/=
GM (A&S)
II. For estimated expenses up to Rs, 50,000/-required for further treatment.
Remarks:

Recommended by Approved by
GM (A&S) Director Operations
III. For estimated expenses more than Rs. 50,000/- required for first aid/further treatment.
Remarks:

Recommended by Recommended by Approved by

GM (A&S) Director Operations Executive Director
Distribution:
1. Executive Director
2. Director Finance