ST HEFERMAL , GOveRnMENT OF MIZORAM DIRECTORATE OF HOSPITAL & MEDICAL EDUCATION, ae MIZORAM: aIZAWL Vike OFFICE ORDER NO. 576/2023 PROVISIONAL PERMISSION Sint. Lalremruati Chhangte, 40yrs, Lecturer, Govt. region HSS, LawngUal is allowed 10 undergo tne ‘necessary Medical Examination and Trestment at NOVA IVE Centre, Kolkata with one attendant due to ner lines from Sccondary Infertility with B/L Tubal Block, Mode of Travelling Air Travel is recommended, “The Final Permission arder for the treatment vill be sued on production of Discharge summary of the Hospital where the treatment was receive along with other documents 4s per notification vide No.D.12015/1/02-FEA dt 14" august,2017 and ©,M No.D.12015/1/2018-FEA Dt entitlements shall be Iimited to Entitlement on Roor re intitlements per Night (in Re) inside Mizoram [Outside Mizoram 33 R above 00 J6co0 n0to 12 2000, les00 509 000, 000) tos 750 2000) to2 [400 [sco [sino |pay levet inthe pay matrix Entitlement on diet charges: (i) Rs. 125/- per mest with o maximum of two meals per day or actual charge whichever i lss. (i) Forspectal diat (Therapeutic Diat) duels prescribed ay Medical Gticer- Rs. 350/- per day or actual charge whichever i less Any extra expenditure beyond the entitement(s) wil be borne by the patient themselves even if they are boing treated on credit basis, Sdj- Dr. LALMALSAWIMI SAILO Director of Hospital & Medical Educa ‘Mizoram : Alzawi "Meme No.B.1017/ 10 /2020 - DAME/MIRS Dated Aizawl 26 uly, 2023 Copy to 1. The Medial Superintendent NOVA IVE Centre Kolkata He is informed that the patient is eligtote/ nat etiGible for treetment on credit. The Director of Hospital & Medical Education does not undertake any responsibilty forthe cost of any treatment unless» separ ares ssued to this effect. This Provisional Persson is valid only for tee (3) months from the date of ssue, Ary expenditure above the enttlement ul ot be paid by the Gavernmment of Mizoram. Deputy Director of Accounts, School Education, Aizawl with reference to his No.6.27033/1/2023-Se(Ace) of 27.72023 fo information and necessary action The patient eiibe/not sible for Credit Faulty, For _setiserven of Sie: Charges Gort. Notation mentioned in Sk NO2 wil Be foloued AC Paason Concerned nase of Cycle Therapy eg Radiation, Chemotherapy, et, his advised to eroin inthe snowined Cay tl completion ofthe course 4. Office Order ook FINAL PERMISSION Dit TURTE TANA HRIATUR PAWVAWH TE 1 Forwarding Letter (Heas of Desartrnenlatangic 2 Discherge Cord (rial lon Xerox copy) 3. Provisional Permission copy 41 Medien Refer zag zany ai 2ng case ah pawh Screening Board ioh Medial Board patlng vex tran Ovo? Consultant Hopptal & Medical Education [o_Mitorgm Azo