S NO NAME OF THE HOSPITAL MOU SIGNED MOU NOT SIGNED SPECIALITIES

TO BE FILLED BY MITHRAS
KIOSK COMPUTER SCANNER PRINTER CAM WEBEX RAMCO/NO
HRAS
RAMCO MAIL-ID AMCCO/NO AMCCO MAIL-ID
MD OF THE HOSPITAL/NO MD MAIL-ID
 NAME OF BC/ST/SC/M
S.NO OP/IP NETWORK NAME OF THE PATIENT AGE SEX ADDRESS PHASE INORITIES /
HOSPITAL OTHERS

1 IP Government General Hospital, Guntur ALEAT CHINNAYEASULU 25 M PRAKASAM III SC

3 IP Government General Hospital, Guntur SHAIK KARIEM 40 M GUNTUR V MINORTIES

4 IP Government General Hospital, Guntur SHAIK KARIEM 40 M GUNTUR V MINORTIES

5 IP Government General Hospital, Guntur BANDARI PEDAVENKAYAMMA 55 F GUNTUR V BC

6 IP Government General Hospital, Guntur GOVATHOTI KOTAIAH 50 M GUNTUR V BC

7 IP Government General Hospital, Guntur I JAYAMMA 65 F PRAKASAM III SC

8 IP Government General Hospital, Guntur I JAYAMMA 65 F PRAKASAM III SC

9 P Government General Hospital, Guntur KOSURI LAKSHMI NARAYANA 34 M II BC

West Godavari
Government General
10 IP
Hospital, Guntur
PUNUGU NAGARAJU 18 M PRAKASAM III BC

11 IP Government General Hospital, Guntur DUKKIPATI PEDDIRAJU 18 M WEST GODAVARI II SC

12 IP Government General Hospital, Guntur KANTETI TIRUPATAMMA 80 F GUNTUR V BC

13 IP Government General Hospital, Guntur TEERATI BABY OF MALESWARI 1 F GUNTUR V BC

14 IP Government General Hospital, Guntur VALLAGI BAJIBABU 30 M GUNTUR V MINORTIES

15 IP Government General Hospital, Guntur MEKALA VENKATESWARLU 35 M GUNTUR V BC

16 P Government General Hospital, Guntur POTHURI SIVAKRISHNA 6 M/C GUNTUR V BC

17 P Government General Hospital, Guntur BURAGADDA SUSEELA 70 F GUNTUR V BC

19 IP Government General Hospital, Guntur BEJAVADA PEDA KOTAIAH 54 M PRAKASAM III BC

20 IP Government General Hospital, Guntur BEJAVADA PEDA KOTAIAH 54 M PRAKASAM III BC

21 Government General
IP Hospital, Guntur SHAIK BASHU 60 M GUNTUR V MINORTIES

22 Government General
IP Hospital, Guntur GANDAM ELISAMMA 45 F GUNTUR V SC

23 Government General
IP Hospital, Guntur SHAIK AMEERUNNISA 45 F GUNTUR V MINORTIES

24 Government General
IP Hospital, Guntur SHAK YUSUPH 38 M KRISHNA V MINORTIES

25 Government General
P Hospital, Guntur SHAIK BHASHA 24 M GUNTUR V MINORTIES

26 Government General
P Hospital, Guntur YAKASIRI VEERAMMA 5 F/C GUNTUR V BC

27 Government General
P Hospital, Guntur KAKUNIRI NAGARAJU 10 M/C GUNTUR V BC

28 Government General
IP Hospital, Guntur NALI SRINIVASARAO 32 M GUNTUR V BC

29 Government General
IP Hospital, Guntur NALI SRINIVASARAO 32 M GUNTUR V BC
30 Government General
IP Hospital, Guntur VEEPOORI BABU Q 16 M GUNTUR V SC

31 Government General
IP Hospital, Guntur GAMIDI SAMBAIAH 34 M GUNTUR V BC

32 Government General
IP Hospital, Guntur GAMIDI SAMBAIAH 34 M GUNTUR V BC

33 Government General
IP Hospital, Guntur PUSAPTI SRINU 30 M PRAKASAM III BC
Government General
34 IP
Hospital, Guntur
SUNKARA KRISHANAMOHAN 20 M KRISHNA V BC

Government General
35 IP
Hospital, Guntur
SUNKARA KRISHANAMOHAN 20 M KRISHNA V BC

Government General
36 IP
Hospital, Guntur
YARRAMURI ADI NARAYANA 15 M PRAKASAM III BC

Government General
37 IP
Hospital, Guntur
SHIDAPA SUBBA REDDY 20 M PRAKASAM III OC

Government General
38 IP
Hospital, Guntur
NAKARA BULLEMA 50 F GUNTUR V BC

Government General
39 IP
Hospital, Guntur
VEEPOORI BABU 16 M GUNTUR V SC

Government General
40 IP
Hospital, Guntur
DOSAPATI CHINNAMMA 60 F GUNTUR V BC

Government General
41 IP
Hospital, Guntur
CHILUMURU GURAVAMMA 65 F GUNTUR V BC

Government General
42 IP
Hospital, Guntur
KATIKALA YESTERAMMA 40 F GUNTUR V SC

Government General
43 IP
Hospital, Guntur
SHAKE BUDESAHEB 47 M GUNTUR V MINORTIES

Government General
44 IP
Hospital, Guntur
TEERATI BABY OF MALESWARI 1 M/C GUNTUR v BC

Government General
45 IP NANNEMOODI SUBBARAO 40 M GUNTUR V BC
Hospital, Guntur

Government General
46 IP N SANJAYKUMAR 1 M/C KRISHNA V SC
Hospital, Guntur
Government
47 IP General Hospital,
Guntur
 UPDATION
NAME OF COST OF PRE-OPERATIVE DATE OF
REFERA OF DATE OF
THE TESTS ESTIMATED SPECIALITY CLINICAL NOTES APPROVAL
L CARD COMPLAINTS&POVISIONAL DIAGNOSIS INVESTIGATION ADMISSION SURGERY/THERAPY PROPOSED SENDING
REFFERAL DONE TESTS CODE (UPDATED/NOT OF PRE-
NO NOTES PRE-AUTH
HOSPITAL DONE UPDATED) AUTH
(YES/NO)
DIRECT NIL RAW AREA-LEFT AK AMPUTATION STUMP X-RAY DONE NO (S15.1.3 ) YES UPDATED Soft Tissue Injury( S15.1.3 ) 12/8/2010 12/8/2010

DIRECT NIL CRUSH INJURY LEFT LEG AND KNEE X-RAY DONE NO ( S15.1.2 ) YES UPDATED Amputation Surgery( S15.1.2 ) 17/8/2010 17/8/2010

DIRECT NIL CRUSH INJURY RIGHT FOOT WITH LOW-END X-RAY DONE NO ( S15.1.2) YES UPDATED Amputation Surgery( S15.1.2 ) 16/8/2010 16/8/2010

INTRA CAPSULAR FRACTURE NECK OF FEMURE

DIRECT NIL X-RAY DONE NO (S15.1.1) YES UPDATED Surgical Correction Of Longbone Fracture ( S15.1.1 ) 18/8/2010 18/8/2010
RIGHT

DIRECT NIL FRACTURE SHAFT OF HUMERUS LEFT X-RAY DONE NO (S15.1.1) YES UPDATED Surgical Correction Of Longbone Fracture ( S15.1.1 ) 18/8/2010 18/8/2010

Excision Or Other Operations For Scaphoid

DIRECT NIL PAIN SWELLING AT LEFT ELBOW X-RAY DONE NO YES UPDATED 23/8/2010 23/8/2010
(S5.1.2) Fractures( S5.1.2 )

DIRECT NIL PAIN SWELLING DEFORMIOTY OF RIGHT WRIST X-RAY DONE NO YES UPDATED Surgical Correction Of Longbone Fracture ( S15.1.1 ) 23/8/2010 23/8/2010
(S15.1.1)

DIRECT NIL X-RAY DONE NO YES UPDATED Surgical Correction Of Longbone Fracture ( S15.1.1 ) 23/8/2010 23/8/2010
PAIN SWELLING DEFORMITY OF LEFT THIGH (S15.1.1)
NON-UNION FRACTURE RADIUS D/3rd SEGMENTAL
DIRECT NIL X-RAY DONE NO ( S15.1.1 ) YES UPDATED Surgical Correction Of Longbone Fracture ( S15.1.1 ) 22/7/2010 22/7/2010
MIDDLE FRAGMENT SEQUESTRUM

Spinal Fixation Rods And Plates, Artificial

DIRECT NIL FRACTURE L1 WEDGE COMPRESSION MRI,X-RAY DONE NO (S10.5.4) YES UPDATED 26/7/2010 26/7/2010
Discs( S10.5.4

EXTRACAPSULAR FRACTURE NECK OF FEMUR

DIRECT NIL X-RAY DONE NO (S15.1.1) YES UPDATED Surgical Correction Of Longbone Fracture ( S15.1.1 ) 31/7/2010 31/7/2010
RIGHT

Soft Tissue Reconstruction Procedures For

DIRECT NIL CTEV RIGHT X-RAY DONE NO (S5.4.6) YES UPDATED 3/8/2010 3/8/2010
Joints/Osteotomy( S5.4.6 )

DIRECT NIL FRACTURE RADIUS LEFT FORE ARM X-RAY DONE NO ( S15.1.1 ) YES UPDATED Surgical Correction Of Longbone Fracture ( S15.1.1 ) 10/8/2010 12/8/2010

DIRECT NIL FRACTURE SHAFT OF FEMUR RIGHT X-RAY DONE NO ( S15.1.1) YES UPDATED Surgical Correction Of Longbone Fracture ( S15.1.1 ) 19/8/2010 19/8/2010

Soft Tissue Reconstruction Procedures For

DIRECT NIL X-RAY DONE NO YES UPDATED 23/8/2010 23/8/2010
CEREBRAL PALSY LEFT (S5.4.6) Joints/Osteotomy( S5.4.6 )

DIRECT NIL X-RAY DONE NO YES UPDATED Surgical Correction Of Longbone Fracture ( S15.1.1 ) 23/8/2010 23/8/2010
PAIN SWELLING AND DEFORMITY OF LEFT HI (S15.1.1)
Reduction Of Compound Fractures & External Fixation(
DIRECT NIL FRACTURSOFTOFFEMURM1/3RIGHTLEG X-RAY DONE NO ( S5.1.4 ) YES UPDATED 27/7/2010 27/7/2010
S5.1.4 )

Reduction Of Compound Fractures & External Fixation(

DIRECT NIL FRACTURBOTHBONERIGHT X-RAY DONE NO ( S5.1.4 ) YES UPDATED 27/7/2010 27/7/2010
S5.1.4 )

DIRECT NIL ECFRACTURFEMURWITHRIGHT X-RAY DONE NO ( S15.1.1) YES UPDATED Surgical Correction Of Longbone Fracture ( S15.1.1 ) 14/8/2010 14/8/2010
FRACTURTIBIALEFTLEGPROXIMAL/3rdWITHCOMM
DIRECT NIL UNINALED&INTRAARTICULAREXTENSION X-RAY DONE NO (S15.1.1) YES UPDATED Surgical Correction Of Longbone Fracture ( S15.1.1 ) 18/8/2010 18/8/2010

DIRECT NIL L4/L5 DISCPROTRUSION X-RAY DONE NO (S10.2.8) YES UPDATED Discectomy ( S10.2.8 ) 19/8/2010 19/8/2010

Reduction Of Compound Fractures & External Fixation(

DIRECT NIL FRACTURBOTHBONEINFECTEDLEFTLEG X-RAY DONE NO (S5.1.4) YES UPDATED S5.1.4 ) 18/8/2010 18/8/2010

TENDERNESS,PAIN,SWELLING,DEFORMITYOFTHE
DIRECT NIL RIGHTHAND X-RAY DONE NO (S15.1.1) YES UPDATED Surgical Correction Of Longbone Fracture ( S15.1.1 ) 23/8/2010 23/8/2010

TENDERNESS,PAIN,SWELLING,DEFORMITYOFTHE Open Reduction & Internal Fixation Of Fingers &

DIRECT NIL RIGHTELBOW X-RAY DONE NO (S5.1.3) YES UPDATED Toes( S5.1.3 ) 25/8/2010 25/8/2010

Reduction Of Compound Fractures & External Fixation(

DIRECT NIL TENDERNESS,PAIN,DEFORMITYOFRIGHTWRIST X-RAY DONE NO (S5.1.4 ) YES UPDATED S5.1.4 ) 21/8/2010 23/8/2010

PAININRIGHTIP SINC8mn
DIRECT NIL PAINTENDERNESSTORIGHTHIP X-RAY DONE NO ( S5.1.1 ) YES UPDATED Bone Grafting As Exclusive Procedure( S5.1.1 ) 21/8/2010 21/8/2010

PAININRIGHT IPSINCE 8mn Avascular Necrosis Of Femoral Head (Core

DIRECT NIL PAINTENDERNESSTORIGHTHIP X-RAY DONE NO ( S5.4.5 ) YES UPDATED Decompression)( S5.4.5 ) 21/8/2010 21/8/2010
 TENDERNESS,PAIN,SWELLING,DEFORMITYOFTHE Reduction Of Compound Fractures & External Fixation(
DIRECT NIL RIGHTFOREARMBOTHJOINTS X-RAY DONE NO ( S5.1.4 ) YES UPDATED S5.1.4 ) 21/8/2010 21/8/2010

TENDERNESS,PAIN,SWELLING,DEFORMITYOFTHEL
DIRECT NIL EFTLEG X-RAY DONE NO ( S15.1.1 ) YES UPDATED Surgical Correction Of Longbone Fracture ( S15.1.1 ) 25/8/2010 25/8/2010

TENDERNESS,PAIN,SWELLING,DEFORMITYOFTHEL
DIRECT NIL EFTLEG X-RAY DONE NO ( S15.1.1 ) YES UPDATED Surgical Correction Of Longbone Fracture ( S15.1.1 ) 25/8/2010 25/8/2010

PAIN SWELLING DEFORMITY AND TERDENESS Reduction Of Compound Fractures & External Fixation(
DIRECT NIL PRESENT RIGHT LEG X-RAY DONE NO ( S5.1.4 ) YES UPDATED S5.1.4 ) 25/8/2010 25/8/2010
PAIN SWELLING DEFORMITY AND CREPTUS Open Reduction & Internal Fixation Of Fingers &
DIRECT NIL X-RAY DONE NO YES UPDATED 27/8/2010 27/8/2010
PRESENT LEFT FOOT ( S5.1.3 ) Toes( S5.1.3 )

DIRECT NIL PAIN SWELLING AND DEFORMITY OF LEFT LEG X-RAY DONE NO YES UPDATED Surgical Correction Of Longbone Fracture ( S15.1.1 ) 27/8/2010 27/8/2010
( S15.1.1 )

DIRECT NIL PAIN SWELLING DEFORMITY OF LEFT X-RAY DONE NO YES UPDATED Surgical Correction Of Longbone Fracture ( S15.1.1 ) 28/8/2010 28/8/2010
( S15.1.1 )

DIRECT NIL INJURY TO RIGHT LEG X-RAY DONE NO ( S15.6.2 ) YES UPDATED Grade-Iii( S15.6.2 ) 28/8/2010 28/8/2010

PAIN SWELLING ABNORMAL MOVEMENTS AT LEFT

DIRECT NIL X-RAY DONE NO YES UPDATED Surgical Correction Of Longbone Fracture ( S15.1.1 ) 28/8/2010 28/8/2010
THIGH ( S15.1.1 )
TENDERNESS,PAIN,SWELLING,DEFORMITYOFTHE
DIRECT NIL X-RAY DONE NO YES UPDATED Surgical Correction Of Longbone Fracture ( S15.1.1 ) 28/8/2010 28/8/2010
RIGHTLEG ( S15.1.1 )

DIRECT NIL PAIN SWELLING AND DEFORMITY OF LEFT THIGH X-RAY DONE NO ( S15.1.1 ) YES UPDATED Surgical Correction Of Longbone Fracture ( S15.1.1 ) 31/8/2010 31/8/2010

DIRECT NIL PAIN SWELLING AND DEFORMITY OF LEFT ELBOW X-RAY DONE NO ( S15.1.1 ) YES UPDATED Surgical Correction Of Longbone Fracture ( S15.1.1 ) 31/8/2010 31/8/2010

TENDERNESS,PAIN,SWELLING,DEFORMITYOFTHE
DIRECT NIL X-RAY DONE NO ( S15.1.1 ) YES UPDATED Surgical Correction Of Longbone Fracture ( S15.1.1 ) 1/9/2010 1/9/2010
RIGHTHAND

TENDERNESS,PAIN,SWELLING,DEFORMITYOFTHEL
DIRECT NIL X-RAY DONE NO YES UPDATED Surgical Correction Of Longbone Fracture ( S15.1.1 ) 1/9/2010 1/9/2010
EFTLEG ( S15.1.1 )
Soft Tissue Reconstruction Procedures For
DIRECT NIL DEFORMITY OF RIGHT LEG X-RAY DONE NO YES UPDATED 3/9/2010 3/9/2010
( S5.4.6 ) Joints/Osteotomy( S5.4.6 )

Open Reduction & Internal Fixation Of Fingers &

DIRECT NIL X-RAY DONE NO YES UPDATED 3/9/2010 3/9/2010
( S5.1.3 ) Toes( S5.1.3 )

Soft Tissue Reconstruction Procedures For

DIRECT NIL DEFORMITY OF RIGHT LEG X-RAY DONE NO YES UPDATED 3/9/2010 PENDING
( S5.4.6 ) Joints/Osteotomy( S5.4.6 )
 PRE-AUTH
PENDING POST OPERATIVE SATISFACTORY
DATE OF DISCHARGE TRANSPORTATI
APPROVED/PENDI ENHANCE UPDATION SURGERY CLINICAL NOTES LETTER
CLAIM NUMBER PRE-AUTH CONVERSIONS DATE & ON (PAID/NOT
NG/REJECTED MENTS DATE (UPDATED/NOT (TAKEN/NOT
REJECTION SUMMARY PAID)
(UPDATED/NO UPDATED) TAKEN)
T UPDATED)
ARGI/PKM/2010/P3R2/08124452 APPROVED NIL NIL NIL NIL 13/8/2010 NOT UPDATED NIL NOT TAKEN NOT PAID

ARGI/GNT/2010/P5R2/25140083/02 APPROVED NIL NIL NIL NIL 17/8/2010 UPDATED NIL NOT TAKEN NOT PAID

ARGI/GNT/2010/P5R2/25140083 APPROVED NIL NIL NIL NIL 16/8/2010 UPDATED NIL NOT TAKEN NOT PAID

ARGI/GNT/2010/P5R2/25140240 APPROVED NIL NIL NIL NIL NIL NOT UPDATED NIL NOT TAKEN NOT PAID

ARGI/GNT/2010/P5R2/25140239 APPROVED NIL NIL NIL NIL 27/8/2010 UPDATED NIL NOT TAKEN NOT PAID

APPROVED NIL NIL NIL NIL NIL NOT UPDATED NIL NOT TAKEN NOT PAID
ARGI/PKM/2010/P3R2/08117465

ARGI/PKM/2010/P3R2/08117465/01 APPROVED NIL NIL NIL NIL NIL NOT UPDATED NIL NOT TAKEN NOT PAID

ARGI/WGI/2010/P2R2/05133651 APPROVED NIL NIL NIL NIL 24/8/2010 UPDATED NIL NOT TAKEN NOT PAID

ARGI/PKM/2010/P3R2/08112888/02 APPROVED NIL NIL NIL NIL NIL NOT UPDATED NIL NOT TAKEN NOT PAID

ARGI/WGI/2010/P2R2/05132438 APPROVED NIL NIL NIL NIL NIL NOT UPDATED NIL NOT TAKEN NOT PAID

ARGI/GNT/2010/P5R2/25139144 APPROVED NIL NIL NIL NIL NIL NOT UPDATED NIL NOT TAKEN NOT PAID

ARGII/GNT/2010/P5R2/25239296 APPROVED NIL NIL NIL NIL NIL NOT UPDATED NIL NOT TAKEN NOT PAID

ARGI/GNT/2010/P5R2/25139697 APPROVED NIL NIL NIL NIL NIL NOT UPDATED NIL NOT TAKEN NOT PAID

ARGI/GNT/2010/P5R2/25140313 APPROVED NIL NIL NIL NIL NIL NOT UPDATED NIL NOT TAKEN NOT PAID

ARGII/GNT/2010/P5R2/25231624/01 APPROVED NIL NIL NIL NIL NIL NOT UPDATED NIL NOT TAKEN NOT PAID

ARGI/GNT/2010/P5R2/25140484 APPROVED NIL NIL NIL NIL NIL NOT UPDATED NIL NOT TAKEN NOT PAID

ARGI/PKM/2010/P3R2/08123867/01 APPROVED NIL NIL NIL NIL 29/7/2010 UPDATED NIL NOT TAKEN NOT PAID

ARGI/PKM/2010/P3R2/08123867 APPROVED NIL NIL NIL NIL 29/7/2010 UPDATED NIL NOT TAKEN NOT PAID

ARGI/GNT/2010/P5R2/25140011 APPROVED NIL NIL NIL NIL NIL NOT UPDATED NIL NOT TAKEN NOT PAID

ARGI/GNT/2010/P5R2/25140219 APPROVED NIL NIL NIL NIL NIL NOT UPDATED NIL NOT TAKEN NOT PAID

ARGI/GNT/2010/P5R2/25140217 APPROVED NIL NIL NIL NIL NIL NOT UPDATED NIL NOT TAKEN NOT PAID

ARGI/KRS/2010/P5R2/06136442/03 APPROVED NIL NIL NIL NIL NIL NOT UPDATED NIL NOT TAKEN NOT PAID

ARGI/GNT/2010/P5R2/25140418/01 APPROVED NIL NIL NIL NIL 24/8/2010 NOT UPDATED NIL NOT TAKEN NOT PAID

ARGI/GNT/2010/P5R2/25140596 APPROVED NIL NIL NIL NIL 26/8/2010 UPDATED NIL NOT TAKEN NOT PAID

ARGI/GNT/2010/P5R2/25140420 APPROVED NIL NIL NIL NIL 23/8/2010 UPDATED NIL NOT TAKEN NOT PAID

ARGI/GNT/2010/P5R2/25140421 APPROVED NIL NIL NIL NIL NIL NOT UPDATED NIL NOT TAKEN NOT PAID

ARGII/GNT/2010/P5R2/25240421/01 APPROVED NIL NIL NIL NIL NIL NOT UPDATED NIL NOT TAKEN NOT PAID
ARGI/GNT/2010/P5R2/25140422/01 APPROVED NIL NIL NIL NIL 23/8/2010 UPDATED NIL NOT TAKEN NOT PAID

ARGI/GNT/2010/P5R2/25140595/01 APPROVED NIL NIL NIL NIL 26/8/2010 UPDATED NIL NOT TAKEN NOT PAID

ARGI/GNT/2010/P5R2/25140595/02 APPROVED NIL NIL NIL NIL 26/8/2010 UPDATED NIL NOT TAKEN NOT PAID

ARGI/PKM/2010/P3R2/08124864 APPROVED NIL NIL NIL NIL NIL NOT UPDATED NIL NOT TAKEN NOT PAID

ARGI/KRS/2010/P5R2/06137883 APPROVED NIL NIL NIL NIL NIL NOT UPDATED NIL NOT TAKEN NOT PAID

ARGI/KRS/2010/P5R2/06137883/01 APPROVED NIL NIL NIL NIL NIL NOT UPDATED NIL NOT TAKEN NOT PAID

ARGI/PKM/2010/P3R2/08124580/01 APPROVED NIL NIL NIL NIL NIL NOT UPDATED NIL NOT TAKEN NOT PAID

ARGI/PKM/2010/P3R2/08122650/02 APPROVED NIL NIL NIL NIL 28/8/2010 UPDATED NIL NOT TAKEN NOT PAID

ARGI/GNT/2010/P5R2/25140776 APPROVED NIL NIL NIL NIL 28/8/2010 UPDATED NIL NOT TAKEN NOT PAID

ARGI/GNT/2010/P5R2/25140422/02 APPROVED NIL NIL NIL NIL 27/8/2010 UPDATED NIL NOT TAKEN NOT PAID

ARGI/GNT/2010/P5R2/25140938 APPROVED NIL NIL NIL NIL NIL NOT UPDATED NIL NOT TAKEN NOT PAID

ARGI/GNT/2010/P5R2/25140936 APPROVED NIL NIL NIL NIL NIL NOT UPDATED NIL NOT TAKEN NOT PAID

ARGI/GNT/2010/P5R2/25140980 APPROVED NIL NIL NIL NIL NIL NOT UPDATED NIL NOT TAKEN NOT PAID

ARGI/GNT/2010/P5R2/25140708/01 APPROVED NIL NIL NIL NIL NIL NOT UPDATED NIL NOT TAKEN NOT PAID

ARGII/GNT/2010/P5R2/25239296/01 APPROVED NIL NIL NIL NIL NIL NOT UPDATED NIL NOT TAKEN NOT PAID

ARGI/PKM/2010/P3R2/08125128 APPROVED NIL NIL NIL NIL NIL NOT UPDATED NIL NOT TAKEN NOT PAID

ARGII/KRS/2010/P5R2/06238214 APPROVED NIL NIL NIL NIL NIL NOT UPDATED NIL NOT TAKEN NOT PAID
CANCELL
DEATH
ATION OF
CASES
PRE-AUTH

NIL NIL

NIL NIL --Select--

Discharge
NIL NIL
On Bed

NIL NIL

NIL NIL

NIL NIL

NIL NIL

NIL NIL

NIL NIL

NIL NIL

NIL NIL

NIL NIL

NIL NIL

NIL NIL

NIL NIL

NIL NIL

NIL NIL

NIL NIL

NIL NIL

NIL NIL

NIL NIL

NIL NIL

NIL NIL

NIL NIL

NIL NIL

NIL NIL

NIL NIL
NIL NIL

NIL NIL

NIL NIL

NIL NIL

NIL NIL

NIL NIL

NIL NIL

NIL NIL

NIL NIL

NIL NIL

NIL NIL

NIL NIL

NIL NIL

NIL NIL

NIL NIL

NIL NIL

NIL NIL
S.NO NAME OF THE HOSPITAL SPECIALITIES TOTAL BEDS AAROGYASRIBEDS
OP IP ON BED PRE OP POST OP STEP DOWN MALE/FEMALE/CHILD DISCHARGE STATUS
 TO BE CONSOLIDATED BY TL's, RC's, AAM
FOLLOWUP & DRUGS VACANT BEDS PRE-AUTH REQUEST PRE-AUTH PENDING PRE-AUTH PENDING UPDATED
TL's, RC's, AAM's, AM's
INSURANCE PENDING INSURANCE PENDING UPDATED TRUST PENDING TRUST PENDING UPDATED
CLINICAL NOTES UPDATED SURGERY UPDATES UPDATED BY MITHRA'S NAMES ON JOB/LEAVE
CUG NO FIELD T.L/NO AAM / NO AM / NO
S.NO NAME OF THE EMPLOYEE DESIGNATION
NAME OF THE HOSPITAL LOCATION TOTAL BEDS AG BEDS OP
IP ONBED PRE-OP POST-OP STEP DOWN
TOTAL NO:OF SURGERIES NO:OF MITHRAS INFERENCE
 IP/OP CONVERSIONS TELEPHONIC INTIMATIONS
NAME OF THE HOSPITAL DISTRICT
S.NO
NO OF
UPDATED IN
NO OF TELEPHONIC
CONVERTED PENDING TELEPHONIC
REGISTRATIONS INTIMATIO INTIMATION ID's
NS TAKEN
 PRE AUTHORISATIONS
HONIC INTIMATIONS ON BED STATUS NOFOLLOW
OF UP MEDICINES
No. Of PATIENT
No of cancellati S
Preauths surgeries Pending ons
Approved COVERE
DIRECT ON BED ACTUAL ON NEED TO BE PATIENTS
PENDING D UNDER
REGISTRATIONS STATUS BED UPDATED FOLLOW AVAILED
UP
PACKAG
ES
W UP MEDICINES

STILL
PENDIN
G
 Cards
search
option
used for Records G.G.H GUNTU
SL.NO NAME OF THE NWH TOTAL OP cards accepted not found
G.G.H GUNTUR
 Hospital Infrastructure Report
SNO ITEMS Avaialable Present No.

1 Welcome Banner

2 Arrow Mark Sticker

3 Kiosk - At Entrance / Reception

4 Appron

5 NWH

6 OP / IP Registers

7 On Bed Register

8 Referal Card/IP CARDS

9 Brochure

10 RAMCO

11 AMCCO

12 Computer

13 Scanner

14 Printer

15 Web Cam

16 Digital Camera

17 Internet Bandwidth
cture Report
Requirement No.
 AarogyaMithra Patient Registration

SNO MODULE INCHARGE PROCESS FLOW NUMBERS

1 REGISTRATION

1.1 Referral Systems

1.1.1 108

1.1.2 104

1.1.3 CMCO

1.1.4 PHC

1.1.5 Medical Camp

1.1.6 Call Center

1.1.7 Direct

1.1.8 Emergency Case

2 Online Registration Form

Notes: Once the details of the patient is capture in the system, An Aarogyamithra registration form has to be generated from
the patient has to be guided to the RAMCO and the concern Specia
t Registration

REMARKS VERIFICATION REMARKS (ONLINE STATUS)

has to be generated from the System and hand over the form to the patient. After that
O and the concern Specialist.
 RAMCO Check List / Responsibilities

SNO MODULE INCHARGE PROCESS FLOW

2 OP/IP Status

2.1 Diagostic Test Requisition Slip

2.1 Inhouse Diagostic/Tie-Up Centers

2.2 Updation in the website

2.3 If OP - OP Registration Form

2.4 If IP - IP Card

Onbed patient status - Actual onbed vs

2 Online report

3 Surgeries performed

4 Discharges

5 Deaths

6 Follow up patient details

7 Claims
ponsibilities

NUMBERS REMARKS
 Case Sheet Check List

SNO MODULE INCHARGE

1 Case Sheet RAMCO

1.1 Copy of white Ration Card/Health Card/CMCO Referral Card RAMCO

1.2 Aarogyamithra Registration form RAMCO

1.3 Diagnostic Test Requistion form RAMCO

1.4 Inpatient Card RAMCO

1.5 Pre authorisation Request form RAMCO

1.6 Approval for Cashless facility RAMCO

1.7 Patient concent letter of Tratment/Surgery RAMCO

1.8 Referral Card if any RAMCO

1.9 Test Requisition slip and all other documents generated from the system RAMCO

1.10 Discharge summary RAMCO

ck List

PROCESS FLOW NUMBERS REMARKS

PROCESS FLOW
 GGH PATIENT'S ATTENDENCE REPORT A
PREAUTH PREAUTH
S.NO PATIENT NAME WAP NO. IP DATE SENT APPROVED

1 ALEAT CHINNAYEASULU WAP080600400053/01 11/8/2010 12/8/2010 12/8/2010

2 SANDANAM ARULAMANI WAP082402700043/02 16/8/2010 16/8/2010 16/8/2010

3 MOHAMMAD SHAJAHAN WAP062800500178/01 16/8/2010 16/8/2010 16/8/2010

4 SHAIK KARIEM WAP0781092A0082/01 17/8/2010 17/8/2010 17/8/2010

5 SHAIK KARIEM WAP0781092A0082/01 16/8/2010 16/8/2010 16/8/2010

6 BANDARI PEDAVENKAYAMMA YAP0791015A0168/06 27/7/2010 18/8/2010 18/8/2010

7 GOVATHOTI KOTAIAH WAP074802900369/01 18/8/2010 18/8/2010 18/8/2010

8 I JAYAMMA WAP081601800241/02 20/8/2010 23/8/2010 23/8/2010

9 I JAYAMMA WAP081601800241/02 20/8/2010 23/8/2010 23/8/2010

10 KOSURI LAKSHMI NARAYANA WAP052500100118/01 23/8/2010 23/8/2010 23/8/2010

11 PUNUGU NAGARAJU WAP081700300292/04 19/7/2010 22/7/2010 22/7/2010

12 TOKALA DAYAKAR WAP070900200175/04 19/7/2010 22/7/2010 26/7/2010

13 DUKKIPATI PEDDIRAJU WAP052401600057/02 23/7/2010 26/7/2010 26/7/2010

14 KANTETI TIRUPATAMMA WAP071301500097/01 30/7/2010 31/7/2010 31/7/2010

15 TEERATI BABY OF MALESWARI WAP071205700528/05 2/8/2010 3/8/2010 3/8/2010

16 SRIPATI LAKSHVAMMA WAP072702100324/01 6/8/2010 6/8/2010 6/8/2010

17 VALLAGI BAJIBABU WAP075706000321/02 9/8/2010 10/8/2010 12/8/2010

18 SHAIK SUBHANI WAP078503000085/02 13/8/2010 13/8/2010 13/8/2010

19 KADAVEETI JOWTHI WAP072502700236/04 16/8/2010 19/8/2010 19/8/2010

20 MEKALA VENKATESWARLU WAP071301100487/02 19/8/2010 19/8/2010 19/8/2010

21 POTHURI SIVAKRISHNA WAP074200500279/04 21/8/2010 23/8/2010 23/8/2010

22 BURAGADDA SUSEELA WAP072622200200/02 21/8/2010 23/8/2010 23/8/2010

23 MAGULURI MANIBHUSANARAO WAP081702900184/01 23/7/2010 24/7/2010 24/7/2010

24 BEJAVADA PEDA KOTAIAH YAP084002600302/01 26/7/2010 27/7/2010 27/7/2010

25 BEJAVADA PEDA KOTAIAH YAP084002600302/01 26/7/2010 27/7/2010 27/7/2010

26 WAP078110300474/01
SHAIK BASHU 13/8/2010 14/8/2010 14/8/2010

27 WAP078115900097/02
GANDAM ELISAMMA 14/8/2010 18/8/2010 18/8/2010

28 WAP078108900252/01
SHAIK AMEERUNNISA 14/8/2010 19/8/2010 19/8/2010

29 WAP068420800044/01
SHAK YUSUPH 14/8/2010 18/8/2010 18/8/2010

30 WAP078110700041/03
SHAIK BHASHA 23/08/2010 23/8/2010 23/8/2010

31
YAKASIRI VEERAMMA YAP071101200036/03 24/08/2010 25/8/2010 25/8/2010

32
KAKUNIRI NAGARAJU YAP072001700315/03 20/8/2010 21/8/2010 23/8/2010

33
NALI SRINIVASARAO WAP071401300035/01 21/8/2010 21/8/2010 21/8/2010

34
NALI SRINIVASARAO WAP071401300035/01 20/8/2010 21/8/2010 21/8/2010

35
VEEPOORI BABU Q WAP070902100217/04 20/8.2010 21/8/2010 21/8/2010

36
GAMIDI SAMBAIAH WAP0790011A0255/02 24/8/2010 25/8/2010 25/8/2010

37
GAMIDI SAMBAIAH WAP0790011A0255/02 24/8/2010 25/8/2010 25/8/2010

38
PUSAPTI SRINU WAP082902800231/01 25/8/2010 25/8/2010 25/8/2010

39 SUNKARA KRISHANAMOHAN YAP060701000443/02

27/8/2010 27/8/2010 27/8/2010

40 SUNKARA KRISHANAMOHAN YAP060701000443/02

27/8/2010 27/8/2010 27/8/2010

41 SHIDAPA SUBBA REDDY WAP083301400554/03

28/8/2010 28/8/2010 28/8/2010

42
NAKARA BULLEMA WAP071702700259/02 28/8/2010 28/8/2010 28/8/2010
43
VEEPOORI BABU WAP070902100217/04 28/8/2010 28/8/2010 28/8/2010
44
YARRAMURI ADI NARAYANA YAP083605000257/05 28/8/2020 28/8/2010 28/8/2010
NCE REPORT AS ON 31/8/2010
Claim SURGERY PATIENT PHONE Patient Feed Back
WARD Patient Signature
Amount DATE NUMBERS (Remarks about service)

5000 13/8/2010 2323221 PARAPEGIA

44000 NIL 7702545714 NEW BLOCK

30000 NIL 9248772213 ORTHO

2500 17/8/2010 9177986833 I.C.U

5000 16/8/2010 9177986833 I.C.U

22000 NIL 9701139299 PARAPEGIA

22000 27/8/2010 9533854260 PARAPEGIA

15000 NIL 949015127 PARAPEGIA

22000 NIL 949015127 PARAPEGIA

22000 24/8/2010 9963251039 I.C.U

22000 23/8/2010 2323221 ORTHO

30000 18/8/2010 2323221 PARAPEGIA

85000 NIL 1234 PARAPEGIA

22000 NIL 12345 NEW BLOCK

NEW BLOCK
30000 NIL 9440262634
(ORTHO)

22000 19/8/2010 12345 NEW BLOCK

22000 21/8/2010 8142813951 104

5000 26/8/2010 2323221 PARAPEGIA

44000 21/8/2010 12345 I.C.U

22000 NIL 2224059 PARAPEGIA

30000 26/8/2010 9618539647 NEW BLOCK

22000 NIL 2224059 NEW BLOCK

15000 29/7/2010 2323221 ORTHO

15000 29/7/2010 9676910226 PARAPEGIA

15000 29/7/2010 9676910226 PARAPEGIA

22000 9248772213 ORTHO

NIL

22000 9708611812 NEW BLOCK

NIL

25000 822864281 NEW BLOCK

NIL

15000 9951548634 TRAMA

20/8/2010

22000 9550189518 TRAMA

24/8/2010

15000 26/8/2010 9550139513 I.C.U

15000 23/8/2010 9550189518 ORTHO

15000
NIL 9912579358 PARAPEGIA

10000 NIL 9912579358 PARAPEGIA

22000 23/8/2010 9885413901 I.C.U

22000 26/8/2010 90012085321 TRAMA

22000 26/8/2010 90012085321 TRAMA

15000 NIL 222425 ORTHO

15000 NIL 222425 ORTHO

22000 NIL 222425 POLYTRAMA

10000 NIL 9440011725 POLY TRAUMA

22000 NIL 9603642681 POLY TRAUMA

22000 NIL 9885413901 POLY TRAUMA

22000 NIL 9949842953 POLY TRAUMA

 Greviance Report

S No Patient Name Type of Greviance

Note : Documentary evidence of the above cases has to be submitted

 Greviance Report

Discussion with Conclusion

ubmitted