MR 50000(2)

MEDICAL REIUMBURSEMENT FOR STATE GOVERNMENT EMPLOYEES

PERSONAL DETAILS DOCUMENTS TO BE ENCLOSED

Name of the Employee 1 G.VENKATESWARLU Please select the documents that are enclosed with Bill

Designation 36 1

Place of Working ZPHS KAVUR 1

Name of the Mandal CHILAKALURIPET 1

Name of the District 7 1

Present Scale of Pay 17 1

Present Basic Pay 29 1

Residential Address

H.No. 16-1-178/A/9 1

Hari Puri Colony 1

Hyderabad

PIN CODE 500072

PATIENT DETAILSName of the Patient 1 Y. Sarala CLICK ON THE FOLLOWING LINKSRelationship with Employee 8

Age of the Patient 15 Years

Name of the Hospital LALITHA SUPERSPECIALITY, GUNTUR

Category of the Hospital 2

Name of the Treatment Fever

Amount of Hospital Bill in figures (Rs.) 20000

Date of Joing in the Hospital DD-MM-YYYY 01-07-2009 Note: To unprotect the sheets from 1 to 6 password: TEACHER

Date of Discharge DD-MM-YYYY 10-07-2009

Date of submission of Proposals to DDO DD-MM-YYYY 22-08-2009

D.D.O. DETAILSName of the D.D.O 1 S. Gurunadha Rao

Designation 7

D.D.O. Place of Working Govt. High School, Begum Bazar

D.D.O. Mandal Khairthabad

D.D.O. District 7

Letter to the D.D.O.Letter to the Higher AuthoritiesNon-Drawl CertificateCheck List for sending Proposals.Appendix - IIDependent Certificate.

Developed By:K. Sreenivas Reddy working on deputation at O/o the District Educational Officer, Hyderabad District.

Please verify with experts before submission.

For your valuable suggestion please contact Ph.No. 9848363735 (or) [email protected]

Essentiality Certificate

Emergency Certificate

Discharge Summary

Investigation Report.

Dependent Certificate

Medicine Bills

Check List.

Non-Drawl Certificate

Date: 22-08-2009

To

Sir,

Sub:

Ref: 1. G.O. Ms.No. 74, M&H Dept., dated: 15-03-2005.

2. G.O. Ms.No. 105, M&H Dept., dated: 09-04-2007.

3. Medical Bills issued by the Doctor concerned.

4.G.O.Ms.No. 68 HM & FW dated:28/03/2011

-o0o-

Thanking You Sir.

Yours faithfully,

Enclosures: ( G.VENKATESWARLU)Essentiality Certificate School Assistant,Emergency Certificate ZPHS KAVUR,Discharge Summary CHILAKALURIPET Mandal,Investigation Report Hyderabad District.Dependent CertificateMedical BillsCheck List

The Head Master, Govt. High School, Begum Bazar, Khairthabad Mandal, Hyderabad District.

Request to sanction the Medical Reimbursement in respect of SRI. G.VENKATESWARLU, School Assistant, ZPHS KAVUR, CHILAKALURIPET Mandal, Hyderabad District - Proposals submitted - Reg.

With reference to the subject cited, I submit here with the Medical Bills with all

the enclosures for Medical Reimbursement for an amount of Rs. 20000=00 (Rupees

(Rupees Twenty Thousand and Zero Only) only) as my Daughter named BABY. Y.

SARALA who is wholly dependent on me has undergone Treatment for the desease FEVER

in the Recognised Hospital by the Andhra Pradesh State Government i.e., at LALITHA

SUPERSPECIALITY, GUNTUR during the period from 01-07-2009 to 10-07-2009 and onward

transmit to the higher authorities for further necessary action in the matter at an early

date.

Non-Drawl Certificate

From To

Respected Madam,

Sub:

Ref: 1. G.O. Ms.No. 74, M&H Dept., dated: 15-03-2005.2. G.O.Ms.No. 105, M&H Dept., dated: 09-04-2007.3. Medical Bills issued by the Doctor concerned.4. Proposals received from the incumbent dated: 22-08-2009

5.G.O.Ms.No. 68 HM & FW dated:28/03/2011

-o0o-

Date of treatment From To

From To

From To

From To

Thanking You Madam.

Enclosures:Essentiality CertificateEmergency Certificate Yours faithfully,Discharge SummaryInvestigation ReportDependent Certificate

GOVERNMENT OF ANDHRA PRADESHDEPARTMENT OF SCHOOL EDUCATION

The Head Master, Govt. High School, Begum Bazar, Khairthabad Mandal, Hyderabad District.

The District Educational Officer, Hyderabad

Lr. No. __________, Dt: __________ .

Request to sanction the Medical Reimbursement in respect of SRI. G.VENKATESWARLU, School Assistant, ZPHS KAVUR, CHILAKALURIPET Mandal, Hyderabad District - Proposals submitted - Reg.

With reference to the subject cited, I submit herewith the Medical Bills with all

the enclosures submitted by SRI. G.VENKATESWARLU, School Assistant, ZPHS KAVUR,

CHILAKALURIPET Mandal, Hyderabad District for your kind sanction of the Medical

Reimbursement for an amount of Rs. 20000=00(Rupees (Rupees Twenty Thousand and

Zero Only) only) as his Daughter BABY. Y. SARALA who is wholly dependent on him has

undergone Treatment for desease FEVER in the Recognised Hospital by the Andhra

Pradesh State Government i.e., at LALITHA SUPERSPECIALITY, GUNTUR during the period

from 01-07-2009 to 10-07-2009 and onward transmit to the higher authorities for further

necessary ction at an early date.

Medical BillsCheck ListNon-Drawl Certificate

NON DRAWL CERTIFICATE

(As per instructions issued in C & DSE, A.P., Hyderabad Procs. Rc.No. 8878/D3-4/2009, dated: 02-09-2009)

This is to certify that, the amount of Rs. 20000=00 (Rupees

(Rupees Twenty Thousand and Zero Only) only) is being claimed now

in this bill by SRI. G.VENKATESWARLU, School Assistant, ZPHS KAVUR,

CHILAKALURIPET Mandal, Hyderabad District has not been paid previusly

towards Medical Reimbursement in respect of his Daughter named BABY.

Y. SARALA age (15) Years who has undergone the Treatment for the

desease FEVER during the period from 01-07-2009 to 10-07-2009 in the

Recongised Hospital by the Andhra Pradesh State Government i.e., at

LALITHA SUPERSPECIALITY, GUNTUR as per the records available

regarding the Medical Reimbursement defined under the Government

Medical Attendance Rules, 1972

It is Certified that this is the ………………. Spell of the treatment for the

disease mentioned.

A note to that effect has also been made in the records of the

school.

Signature of the Government Servant.

Signature of the Drawing & Disbursing Officer.

CHECK LIST

(Vide Rc No.8878/D3-4/2009,Dt.02-09-2009 of C & DSE AP, Hyderabad)

1 Name and Address of the employee Employee code

SRI. G.VENKATESWARLUSchool Assistant

ZPHS KAVUR,

CHILAKALURIPET Mandal,Hyderabad District.

2

3

School Assistant

ZPHS KAVUR,

CHILAKALURIPET Mandal,

Hyderabad District.

cell no.

4 Dates of Treatment

From: 01-07-2009 To: 10-07-2009

From: To:From: To:

From: To:

5 Name and Address of Hospital LALITHA SUPERSPECIALITY, GUNTUR

a)Whether Private Hospital (or) Recognized Hospital RECOGNISED

YES / NO

6 YES / NO

7

Whether the Following are Enclosed1)Appendix-II duly attested by the Head of the office/DDO YES / NO

2)Emergency Certificate YES / NO

YES / NO

5) Non drawl Cerficate YES / NO

YES / NO

Not Applicable

8

9 And whether the availment of No. of Instalments recorded (or) not Not Applicable

10

If Retired a)Date/Year of Retirement b)Designation c) P.P.O.NO

Communication of the Applicant Address For all purposes with cell no.

b)Whether referral Letter Produced (or) Recognized orders to be enclosed along with the proposals

Whether the Medical Reimbursement Proposal sent with in 6 Months from the Date of Discharge

3)DischargeSummary 4)discharge summary

6)Essentially certificate, attested by the authorized doctor, who undertakes treatment

7)If the Patient is dependent on the Govt.Employee-Un Employee crfificate and dependency certificate are to be enclosed with the Medical Reimbursement Proposals

8)In case of the dependents of deceased Govt.Employee/Retired employee whether legal heir certificate in enclosed (or) not.

9)Whether the Medical reimbursement proposal is prepared and submitted with reference to G.O.Ms.No.74 H.M. & FW(K1) Dept. Dt. 15-03-2005 and G.O.Ms.No.60 HM &(K1) Dept.Dt 09-04-2007 and also G.O. Ms No 180 dt.11-05-2006.

Whether the medical Reimbursement claim is processed throught the drawing officer and received with in the stipulated time.

Whether an entry is Made in the Service Register (or) not for previous claim

Signature of theGovernment Servant

Signature of theHead of the Office

APPENDIX – II

1SRI. G.VENKATESWARLU

SCHOOL ASSISTANT

2 Office in which Employed

ZPHS KAVUR,

CHILAKALURIPET Mandal,

Hyderabad District.

3 14860-39540 / 14860

4 Place of Duty

ZPHS KAVUR,

CHILAKALURIPET Mandal,

Hyderabad District.

5

H.No. 16-1-178/A/9,

Hari Puri Colony,

Hyderabad.

PIN - 500072

6Baby. Y. Sarala, (Daughter)

Aged 15 Years

7 Place at which the patient fell ill LALITHA SUPERSPECIALITY, GUNTUR

8 Nature of illness and its duration

FEVER

From: 01-07-2009 To: 10-07-2009From: To:

From: To:

9

List of Medicines in detailed

and

Essentiality Certificates are enclosed

10 Total amount claimed

Rs. 20000=00

(Rupees Twenty Thousand and Zero Only)

11 List of Enclosures

Essentiality Certificate

Emergency Certificate

Discharge Summary

Investigation Report

Dependent Certificate

Medical Bills

Check List

Non-Drawl Certificate

APPLICATION FOR CLAIMING REFUND OF MEDICAL EXPENSES INCURRED IN CONNECTION WITH MEDICAL ATTENDANCE AND TREATMENT OF GOVERNMENT SERVANT AND THEIR FAMILIES

Name, Designation & Section of Government Servant (in block letters)

Pay of the Government Servant as defined in F.Rs. and other employments which should be shown separately

Full Residential Address with door number, name of the Mohalla and District

Name of the Patient, his/her relationship to the Government Servant, in case of children state age also

Details of amount claimed, cost of Medicines purchased from the market/ list of Medicines purchased with cash memos, and the Essentiality Certificate should be attached each in duplicate signed

I here by declare that, the statements in this application are true to the best of my knowledge and belief and that the person for whom Medical Expenses were incurred is a member of my family as defined under the Govt. Servant Medical Attendance Rules and wholly dependent upon me.

Signature of the Government Servant

Signature of theHead of the Office

DEPENDENT CERTIFICATE GIVEN BY THE GOVERNMENT SERVANT

(As per instructions issued in C & DSE, A.P., Hyderabad Procs. Rc.No. 8878/D3-4/2009, dated: 02-09-2009)

I, SRI. G.VENKATESWARLU, School Assistant, ZPHS KAVUR,

CHILAKALURIPET Mandal, Hyderabad District, do hereby declare that, BABY.

Y. SARALA, age (15) Years is my Daughter and has no property of income of

her own and that, she is wholly dependent on me only, she is also not a

Employee or Pensioner

Signature of the Government Servant.

Signature of theDrawing & Disbursing Officer.

DES 0 DISTRICT 0 GENDER 0 01 Assistant Director 1 Adilabad Di 1 Male 12 Assistant Engineer 2 Ananthapur 2 Female 23 Asst. Commissioner for Govt. E 3 APSR Nellor 0 0 04 Asst. Section Officer 4 Chittoor DisTYPE OF 0 HRA PER5 Asst. Statistical Officer 5 East Godava 1 Govt. Quar 16 Auditor 6 Guntur Dist 2 Own Hous 27 Cashier 7 Hyderabad D 3 Rented Ho 38 Deputy Director 8 Kareemnaga 0 0 49 Deputy Educational Officer 9 Khammam Di 0 0 0

10 Deputy Inspector of Schools 10 Krishna DisMONTHS 0 C.C.A11 District B.C. Welfare Officer 11 Kurnool Dis 1 Not Applica 112 District Educational Officer 12 Mahboobnag 2 40247 213 District Tribal Welfare Officer 13 Medak Distr 3 40278 314 Divisional Engineer 14 Nalgonda Di 4 40308 415 Executive Engineer 15 Nizamabad 5 40339 516 Gazetted H.M. Gr-I 16 Prakasham 6 40369 017 Gazetted H.M. Gr-II 17 Ranga Redd 7 40400 018 Joint Director 18 Sreekakulam 8 40431 SURRENDE19 Junior Assistant 19 Vishakapat 9 40461 020 Junior Lecturer 20 Vizianagara 10 40492 121 L.F.L. Head Master 21 Warangal Di 11 40522 222 L.F.L. Head Mistress 22 West Godava 12 40553 323 Language Pandit 23 YSR Kadapa 13 40584 024 Language Pandit (Hindi) 0 0 0 0 025 Language Pandit (Sanskrit) 0 0 0 0 CPS26 Language Pandit (Tamil) SCALE OF PAY 0 0 0 127 Language Pandit (Telugu) 1 6700-2011 0 0 228 Language Pandit (Urdu) 2 6900-2068 0 0 029 Mandal Educational Officer 3 7100-2125 0 0 030 Office Subordinate 4 7520-2243 0 0 031 Physical Education Teacher 5 7740-2304 0 0 032 Principal 6 7960-2356 0 0 033 Project Officer 7 8440-2495 0 0 034 R.J.D.S.E. 8 9200-2700 0 0 035 Record Assistant 9 9460-2770 0 0 036 School Assistant 10 10020-292 0 0 037 School Assistant (Bio. Sc.) 11 10900-315 0 0 038 School Assistant (English) 12 11530-332 0 0 039 School Assistant (Hindi) 13 11860-340 0 0 040 School Assistant (Maths) 14 12550-358 0 0 041 School Assistant (Phy. Edn.) 15 12910-367 0 0 042 School Assistant (Phy. Science) 16 13660-385 0 0 043 School Assistant (Soc. Stu.) 17 14860-395 0 0 044 School Assistant (Telugu) 18 15280-405 0 0 045 School Assistant (Urdu) 19 16150-425 0 0 046 Secondary Grade Teacher 20 18030-436 0 0 047 Senior Assistant 21 19050-458 0 0 048 Senior Lecturer 22 20680-469 0 0 049 Superintendent 23 21820-481 0 0 0

0 0 24 23650-493 0 0 00 0 25 25600-505 0 0 00 0 26 27000-517 0 0 00 0 27 29200-530 0 0 00 0 28 31550-530 0 0 01 Father 29 34050-543 0 0 02 Mother 30 37600-543 0 0 0

3 self 31 41550-556 0 0 04 Legal Hier 32 44740-556 0 0 05 Husband 0 0 0 0 06 Wife 1 Sri. 0 0 07 Son 2 Smt. 0 0 08 Daughter 3 Kum. 0 0 09 Widower 0 0 0 0 0

10 Nephew 1 Baby. 0 0 011 Niece 2 Kum. 0 0 0

0 0 3 Master. 0 0 0DDO 0 4 Miss. 0 0 0

1 Assistant Director 5 Mrs. 0 0 02 Deputy Director 6 Smt. 0 0 03 Deputy Educational Officer 7 Sri. 0 0 04 Deputy Inspector of Schools 0 0 0 0 05 Gazetted H.M. Gr-I 0 0 0 0 06 Gazetted H.M. Gr-II 1 Governmen 0 0 07 Head Master 2 Private 0 0 08 Head Mistress 0 0 0 0 09 Mandal Educational Officer 0 0 0 0 0

10 Principal 0 0 0 0 011 Project Officer 0 0 0 0 012 R.J.D.S.E. 0 0 0 0 0

0 0 0 0 0 0 00 0 0 0 1 Father he0 0 0 0 2 Mother she0 0 0 0 3 self he0 0 0 0 4 Legal Hier she0 Assistant Director 2 0 5 Husband he0 Deputy Director 2 0 6 Wife she0 Deputy Educational Officer 1 0 7 Son he0 Deputy Inspector of Schools 1 0 8 Daughter she0 Gazetted H.M. Gr-I 2 0 9 Widower she0 Gazetted H.M. Gr-II 2 0 10 Nephew he0 Head Master 2 0 11 Niece she0 Head Mistress 2 0 0 0 00 Mandal Educational Officer 1 0 0 0 00 Principal 2 0 0 0 00 Project Officer 1 0 0 0 00 R.J.D.S.E. 1 0 1 Father his0 0 0 0 2 Mother her0 0 0 0 3 self his0 0 0 0 4 Legal Hier her1 Adilabad District Adilabad 0 5 Husband his2 Ananthapur District Ananthapur 0 6 Wife her3 APSR Nellore District Nellore 0 7 Son his4 Chittoor District Chittoor 0 8 Daughter her5 East Godavari District Kakinada 0 9 Widower her6 Guntur District Guntur 0 10 Nephew his7 Hyderabad District Hyderabad 0 11 Niece her8 Kareemnagar District Kareem Nagar 0 0 0 09 Khammam District Khammam 0 0 0 0

10 Krishna District Machilipatnam 0 0 0 011 Kurnool District Kurnool 0 0 0 012 Mahboobnagar District Mahboobnagar 0 0 0 013 Medak District Sanga Reddy 0 0 0 014 Nalgonda District Nalgonda 0 0 0 0

15 Nizamabad District Nizamabad 0 0 0 016 Prakasham District Ongole 0 0 0 017 Ranga Reddy District Hyderabad 0 0 0 018 Sreekakulam District Sreekakulam 0 0 0 019 Vishakapatnam District Vishakapatnam 0 0 0 020 Vizianagaram District Vizianagaram 0 0 0 021 Warangal District Warangal 0 0 0 022 West Godavari District Elure 0 0 0 023 YSR Kadapa District Kadapa 0 0 0 0

0 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 0

0 0 0 0 0 0 0

0 BASIC PA 0 0 LIST OF 0 0 0 0Yes 1 6700 0 1 A.P. Super 0 Emp Res 0No 2 6900 0 2 Aditya Hosp 0 Sri. G.VENKA

0 3 7100 0 3 Alpha Hosp 0 0 00 4 7300 0 4 Amaravathi 0 0 0

10 5 7520 0 5 0 0 012.5 6 7740 0 6 American I 0 0 0

20 7 7960 0 7 Andhra Hos 0 Baby. Y. Sarala30 8 8200 0 8 Ankith Mult 0 0 0

0 9 8440 0 9 Apollo DRD 0 0 00 10 8680 0 10 Apollo Hosp 0 0 0

Not Applica 11 8940 0 11 Apollo Hosp 0 0 0GHMC 12 9200 0 12 Apollo Hos 0 Sri. S. GurunaGVMC 13 9460 0 13 Apollo Hosp 0 0 0Vijayawada 14 9740 0 14 Aravind Ki 0 Sir 0Other MC 15 10020 0 15 Aravind Ne 0 0 0

0 16 10300 0 16 ARK Hospit 0 0 00 17 10600 0 17 Arun Kidney 0 0 00 18 10900 0 18 Asha Hospi 0 0 00 19 11200 0 19 Asian Insti 0 0 0

Not Applica 20 11530 0 20 Aswini Dent 0 0 015 21 11860 0 21 0 0 030 22 12190 0 22 Baba Denta 0 0 0

0 23 12550 0 23 Bhimavaram 0 0 00 24 12910 0 24 Bollineni E 0 0 00 25 13270 0 25 Bollineni H 0 0 0

Yes 26 13660 0 26 Bollineni R 0 0 0No 27 14050 0 27 Care Hospit 0 0 0

0 28 14440 0 28 Care Hospit 0 0 00 29 14860 0 29 Care Hospi 0 0 00 30 15280 0 30 Chaitanya 0 0 00 31 15700 0 31 Challa Hos 0 0 00 32 16150 0 32 Charitasri 0 0 00 33 16600 0 33 City Cardia 0 0 00 34 17050 0 34 City Super 0 0 00 35 17540 0 35 Dental Venu 0 0 00 36 18030 0 36 Diacon Dia 0 0 00 37 18520 0 37 Dilsuknagar 0 0 00 38 19050 0 38 Dr. Gowds 0 0 00 39 19580 0 39 Dr. J.S.R. 0 0 00 40 20110 0 40 Dr. Sridhar 0 0 00 41 20680 0 41 E.N.T. Nur 0 0 00 42 21250 0 42 FMS Dental 0 0 00 43 21820 0 43 Frontier Lif 0 0 00 44 22430 0 44 0 0 00 45 23040 0 45 Global Hosp 0 0 00 46 23650 0 46 Global Hosp 0 0 00 47 24300 0 47 Global Meid 0 0 00 48 24950 0 48 Gowri Gopal 0 0 00 49 25600 0 49 GSL Genera 0 0 00 50 26300 0 50 GVR Childr 0 0 00 51 27000 0 51 Harini Gas 0 0 00 52 27700 0 52 Health Hosp 0 0 00 53 28450 0 53 Heart Care 0 0 00 54 29200 0 54 Help Hospi 0 0 00 55 29950 0 55 Heritage H 0 0 00 56 30750 0 56 Hope Child 0 0 0

Ameerpet Superspeciality Dental Hospital & Implant Centre, 102 Classic Avenue, 6-3-790/7, Behind chowdary Mansion, Ameerpet, Hyderabad.

Aswini Hospital, Near RTC Bus Stand Mangalagiri Road, Guntur 

Geeta Mutli Speciality  Hospital, Seceunderabad.

0 57 31550 0 57 Hyderabad 0 0 00 58 32350 0 58 Image Hosp 0 0 00 59 33200 0 59 Indo- Ameri 0 0 00 60 34050 0 60 Jaya Hospi 0 0 00 61 34900 0 61 Kalyani De 0 0 00 62 35800 0 62 Kamineni H 0 0 00 63 36700 0 63 Karumuri H 0 0 00 64 37600 0 64 Kinnera Su 0 0 00 65 38570 0 65 KNM Smile 0 0 00 66 39540 0 66 Konaseema 0 0 00 67 40510 0 67 Krishna Chi 0 0 00 68 41550 0 68 Krishna Ins 0 0 00 75 49360 0 69 Kurnool He 0 0 00 76 50560 0 70 L.K. Hospit 0 0 00 77 51760 0 71 Lalitha Sup 0 0 00 78 53060 0 72 Lazarus Ho 0 0 00 79 54360 0 73 Life Hospit 0 0 00 80 55660 0 74 Life Kare 0 0 00 0 0 0 75 Life Line 0 0 00 0 0 0 76 Lions Dist 0 0 00 0 0 0 77 Lotus Child 0 0 00 0 0 0 78 M.S. Multi 0 0 00 0 0 0 79 Madhava Nu 0 0 00 0 0 0 80 Mamatha Ge 0 0 0

she 0 0 0 81 Maxivision 0 0 00 0 0 0 82 Mediciti Ho 0 0 00 0 0 0 83 Medwin Gen 0 0 00 0 0 0 84 Medwin Hos 0 0 00 0 0 0 85 Meena Hosp 0 0 00 0 0 0 86 MNR Medica 0 0 00 0 0 0 87 Modern Eye 0 0 00 0 0 0 88 MVS Accide 0 0 00 0 0 0 89 Mythri Mult 0 0 00 0 0 0 90 N. N. Speci 0 0 00 0 0 0 91 Nagarjuna 0 0 00 0 0 0 92 Narayana M 0 0 00 0 0 0 93 0 0 00 0 0 0 94 Naveen Dent 0 0 00 0 0 0 95 Navya Nethr 0 0 0

her 0 0 0 96 New Life H 0 0 00 0 0 0 97 Nightingal 0 0 00 0 0 0 98 NRI General 0 0 00 0 0 0 99 Padma Chan 0 0 00 0 0 0 100 0 0 00 0 0 0 101 Partha Dent 0 0 00 0 0 0 102 Pinamaneni 0 0 00 0 0 0 103 Poulomi Ho 0 0 00 0 0 0 104 Pragna Chi 0 0 00 0 0 0 105 Premier Ho 0 0 00 0 0 0 106 0 0 00 0 0 0 107 R.K. Super 0 0 00 0 0 0 108 Rainbow Ch 0 0 00 0 0 0 109 Raju Neuro 0 0 00 0 0 0 110 Ram Hospit 0 0 00 0 0 0 111 Ravi Instit 0 0 00 0 0 0 112 Remedy Hea 0 0 00 0 0 0 113 Remedy Hos 0 0 0

Navata Multi Speciality Dental Care Center, 5-6-224, Saraswathi Nagar, Opp. RDO Office, Nizamabad. 

Partha Dental Hospital & Research Centre,  Rama Talkies Circle , Viskhapatanam 

Purna Heart Institute Kovelamudivari Street, Suryaraopet,Vijayawada  

0 0 0 0 114 0 0 00 0 0 0 115 Rohini Med 0 0 00 0 0 0 116 Royal Hospi 0 0 00 0 0 0 117 Rukku's sav 0 0 00 0 0 0 118 Sai Bhavan 0 0 00 0 0 0 119 Sai Care H 0 0 00 0 0 0 120 Sai Krishn 0 0 00 0 0 0 121 Sai Vani Ho 0 0 00 0 0 0 122 Sai Venkat 0 0 00 0 0 0 123 Sanjana Pa 0 0 00 0 0 0 124 Sankar Fou 0 0 00 0 0 0 125 Satya Kidn 0 0 00 0 0 0 126 0 0 00 0 0 0 127 Sharat Las 0 0 00 0 0 0 128 Shravana H 0 0 00 0 0 0 129 Sibar Chari 0 0 00 0 0 0 130 Sigma Hospi 0 0 00 0 0 0 131 Siri Dental 0 0 00 0 0 0 132 Smiline De 0 0 00 0 0 0 133 Smt. Bhagw 0 0 00 0 0 0 134 0 0 00 0 0 0 135 Sri Devi E 0 0 00 0 0 0 136 Sri Sai Hos 0 0 00 0 0 0 137 Sri Sai Kid 0 0 00 0 0 0 138 Sri Vijaya 0 0 00 0 0 0 139 Sridhar Sup 0 0 00 0 0 0 140 St. Ann's H 0 0 00 0 0 0 141 0 0 00 0 0 0 142 SVS Dental 0 0 00 0 0 0 143 Swatantra H 0 0 00 0 0 0 144 Udai Clini 0 0 00 0 0 0 145 Usha Cardi 0 0 00 0 0 0 146 Usha Mullap 0 0 00 0 0 0 147 Vamshi Mult 0 0 00 0 0 0 148 Vasavi ENT 0 0 00 0 0 0 149 Vasvi Eye 0 0 00 0 0 0 150 0 0 00 0 0 0 151 Vijaya Hea 0 0 00 0 0 0 152 Vijaya Sup 0 0 00 0 0 0 153 Vijetha Hos 0 0 00 0 0 0 154 0 0 00 0 0 0 155 Wockhardt 0 0 00 0 0 0 156 Woodlands 0 0 00 0 0 0 157 Yashoda Ho 0 0 00 0 0 0 158 Yashoda Su 0 0 00 0 0 0 159 Yashoda Su 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0

Remedy Hospitals, Road No.4, KPHB Colony Kukatpally, Hyderabad - 500 072 

Seven Hills Hospital, Rockdale Layout, Visakhapatanam 

Soumya Multi Speciality Hospital, Karkhana, Secunderabad 

SVR Neuro Hospital ( Aunit of SVR Neuro & Trauma Super Speciality Hospital  Pvt. Ltd., M.G. Road, Vijayawada

Vijaya Eye Hospital, 5-8-104, Lakshimpuram, Guntur 

Viswa Bharati Super Speciality Hospital, Gayatri Estates, Kurnool 

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0Name of thDesignatio Place of woMandal District Scale of P Basic Pay Add1 Add2Sri. G.V School AssZPHS KAVCHILAKALUHyderabad D14860-395 14860 H.No. 16-1 Hari Puri C

0 0 0 0 Hyderabad14860-3954 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0

Name of thRelationsh Age of PatiName of thName of thAmount in Amount in Date of Joi Date of DiBaby. Y. S Daughter 15 Years LALITHA Fever 20000 (Rupees T 39995 40004

0 0 15 Category of 0 0 0 0 00 0 0 Private 0 0 0 0 00 0 0 0 0 0 0 0 0

Name of t Designatio Place of woMandal District 0 0 he 0Sri. S. Gu Head Mast Govt. High Khairthaba Hyderabad D 0 0 his him

0 2 0 1 0 0 0 00 The Head MastThe Head MastThe District EThe Commissio 0 0 0 00 0 0 0 0 0 20000=00(R 0 0

ENCLOSU 0 0 0 0 0 0 0 0Essentiality 2 Essentiality 0 0 0 0 0Emergency 2 Emergency 0 0 0 0Discharge 2 Discharge 0 0 0 0 0Investigati 2 Investigati 0 0 0 0 0Dependent C 2 Dependent C 0 0 0 0 0Medical Bil 2 Medical Bil 0 0 0 0 0Checklist 2 Check List 0 0 0 0 0Non-Drawl C 2 Non-Drawl C 0 0 0 0 0SUM 16 0 0 0 0 0 0 0

0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 DEPENDEN 0 00 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0

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Date of su 040047 0

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