Scribd Logo
Upload

Welcome to Scribd!

  • 7 views

    Contributory: Ex-Servicemen Health Scheme

    Uploaded by

    Ashvani Singh
    This 3 sentence summary provides the key details from the ECHS referral form: The form refers Kirtiverma, a 14 year old female dependent of LNK Munna Kumar, for consultation with a rheumatologist and orthopedist at an ECHS empaneled facility in Patna for further management and review of her RA condition. Basic medical information is included on the form such as no issues found with her cardiovascular, respiratory, abdominal, or central nervous systems. The form indicates no reimbursement is required for attendant or travel costs.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content

    You might also like

    Contributory: Ex-Servicemen Health Scheme

    Uploaded by

    Ashvani Singh
    7 views1 page
    This 3 sentence summary provides the key details from the ECHS referral form: The form refers Kirtiverma, a 14 year old female dependent of LNK Munna Kumar, for consultation with a rheumatologist and orthopedist at an ECHS empaneled facility in Patna for further management and review of her RA condition. Basic medical information is included on the form such as no issues found with her cardiovascular, respiratory, abdominal, or central nervous systems. The form indicates no reimbursement is required for attendant or travel costs.

    Original Description:

    ref

    Original Title

    Ref

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    This 3 sentence summary provides the key details from the ECHS referral form: The form refers Kirtiverma, a 14 year old female dependent of LNK Munna Kumar, for consultation with a rheumatologist and orthopedist at an ECHS empaneled facility in Patna for further management and review of her RA condition. Basic medical information is included on the form such as no issues found with her cardiovascular, respiratory, abdominal, or central nervous systems. The form indicates no reimbursement is required for attendant or travel costs.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    7 views1 page

    Contributory: Ex-Servicemen Health Scheme

    Uploaded by

    Ashvani Singh
    This 3 sentence summary provides the key details from the ECHS referral form: The form refers Kirtiverma, a 14 year old female dependent of LNK Munna Kumar, for consultation with a rheumatologist and orthopedist at an ECHS empaneled facility in Patna for further management and review of her RA condition. Basic medical information is included on the form such as no issues found with her cardiovascular, respiratory, abdominal, or central nervous systems. The form indicates no reimbursement is required for attendant or travel costs.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    of 1

    Ex-servicemen contributory Health scheme

    Referral Form inic : Vaishali


    ,:rlr r..;l : r, :I t' :,,:.i,.;,,.'linlt,,,,,,l] i r...,,irr,. :i:::,,1. ;r .t i.t!'r. I ti. ,." i-.:,
    i ;:.illlr.i:ti;i i".l',iii i:i-'1
    orc COL ARUN KI.JMAR SINGH
    9596546161
    Jt Dir (HS) CoI Y S YADAV
    950761968
    **********NO-f
    E roR 64KB S M ART CA RD HO LDERS, PLE ASE u)t CARD NU MB E RS ONLY PREFIX NOT REQUIR E D**********

    Referrai lnformati nr)


    Referral No 03680000200794
    Clairn lt) Claim lD will be ECHS empanelled facility
    Validity Upto

    Date Of lssue 28-01-2022


    No O{ Session Allowed
    3
    Patient lype
    OPD

    &iSMt nformalion
    Narne Of Patient
    KiRTIVERMA
    14.4
    Gender Female ESM Daughter
    tJlDAl (Aadhar Number)
    Advised
    MQ
    Rank
    LNK Catego ry: General
    Service No No4276093W Card No 000192606B
    EStv4 Name
    Munna Kumar Force
    Army
    ESlvl Contact Nunrber 94713A4652 tmaillt) kirtitheyesh@gmail,com

    in

    Blood Pressure (Bp)


    no
    Prllse
    NO

    Cardio Vascular Systen: (CVti)


    no
    Respiratory System (RS)
    no
    Abdomen

    Central Nervous System (Cl',rS) no

    Provisional Di nosis
    Clinical Notes
    RA
    Admission
    IF REQUIRET)
    lnvestigation
    IF REQUIREI)
    Consultation l-or
    YES NV R HFUMATOLOGIST & ORTHOP EDICS n EPTT FOR F U RTt"{t R MGT & REVIEW

    Referrerj lb a/'
    Referred'lo rL HS Emparrelled Med ical Facility Located within the
    AO R of RC Patna
    Altendant Reirnbursement
    No Travel Reimbursement : No
    Pr:ivclinic Renrarks
    RA

    This Referral Form is


    No lnk Siqnature rs required Offlcer ln Charge Vaishali (Hajipur)

    You might also like