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  • Hospital Cash Treating Doctors Certificate

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    smallik3
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    This document is a hospital certificate from SBI Life Insurance Company Ltd providing details about an insured member's hospitalization. It includes the insured member's name, age, occupation, hospital admission and discharge dates and times, the treating doctor's name and hospital details, and a certification from the doctor confirming the insured member received treatment based on hospital records.

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    doctor

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    This document is a hospital certificate from SBI Life Insurance Company Ltd providing details about an insured member's hospitalization. It includes the insured member's name, age, occupation, hospital admission and discharge dates and times, the treating doctor's name and hospital details, and a certification from the doctor confirming the insured member received treatment based on hospital records.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    155 views1 page

    Hospital Cash Treating Doctors Certificate

    Uploaded by

    smallik3
    This document is a hospital certificate from SBI Life Insurance Company Ltd providing details about an insured member's hospitalization. It includes the insured member's name, age, occupation, hospital admission and discharge dates and times, the treating doctor's name and hospital details, and a certification from the doctor confirming the insured member received treatment based on hospital records.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    of 1

    Without Prejudice

    SBI Life Insurance Company Ltd


    HospitalcumTreatingDoctorsCertificate

    Insured
    Members
    recent
    photograph

    PartAInsuredMembersHospitalizationDetails
    NameofthePatient(InsuredMember):
    AgeofthePatient:
    Occupation:
    AddressasperHospitalrecords:

    IPNO:TotalNoofdaysofHospitalization:
    InNonICUDateandtimeofadmission: Date andtime ofdischarge:
    InICUDateandtimeofadmission:Date andtime ofdischarge:
    ExactHistoryreportedbythepatientatthetimeofadmission:

    *DidthepatienttaketreatmentearlierintheHospital?Ifyespleaseprovidetreatmentdetails:

    *Ifthespaceprovidedisnotsufficientforexacthistoryorprevioustreatmentdetails,pleaseattachsheet.
    PartBTreatingDoctorandHospitalsDetails
    NameofthetreatingDoctor:
    AddressoftheHospital:

    Telephonenumber:EmailID:
    RegistrationNumberoftheHospital:
    DateofRegistration: Validupto:
    Numberofbedsinthehospital:
    Tickwhatisapplicable
    Fullyequippedoperationtheatreavailable YesNo
    Fullyqualifiednursingstaffunderemployment24hoursperdayYes
    No
    Supervisedbyafullyqualifiedphysician24hoursperday Yes
    No
    DailyrecordforhospitalpatientsmaintainedYes
    No
    Hospitalisregisteredforallopathictreatment
    Yes
    No

    CertifiedthattheaboveInsuredMemberwasundergoingtreatmentinourhospitalandtheaboveinformationis
    basedontherecordsmaintainedintheRegisterNo:______________EntryNo___________dated___________.

    Date:_________________Signature:_____________________
    NameoftheDoctor:______________________
    StampoftheHospital:_____________________

    VersionI

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