NE-Il Telecom Circle, a anat dare fra farts ew rt Mn BSNL ( a a) ‘Telephone Exchange Building, Connecting indie BHARAT SANCHAR NIGAM LIMITED DIMAPUR-797 112, NAGALAND fa {A Govt. of India Enterprise) No. CGMT/NE-II/Admn/Genl/Med/17-18/4 Dt. 29.06.2017 To, All SSA Heads and Unit Heads Circle Office Sub: Submission of medical applications for indoor medical treatment — reg. Sees Henne It is to intimate that applications for approval of indoor medical treatment are being received without all the necessary documents and also applications are being sent even after expiry of 6 months. The applications for approval should reach this office complete in all aspects within 6 months. On expiry of 6 months period no application should be sent to this office. To avoid delay in processing of applications, a checklist is being issued by this office. It may henceforth be ensured that all medical applications for indoor medical treatment are submitted along with all relevant documents as per the checklist. Applications submitted without the relevant documents as per the checklist will be summarily rejected. SSA heads are requested to give wide publicity. Enclo: Checklist s KAO Asst. General Manager (HR & A) 0/o CGMT, NE-II Circle Dimapur, NagalandChecklist to be submitted for Administrative Approval of indoor medical treatment in Empanelled Hospital S.No Description 1 | intimation letter from the claimant 2 | Copy of MRS Card 3 | Doctor Certificate for hospitalization by registered Medical Doctor 4 | Authorization letter issued by competent authority for | treatment at empanelled hospital Checklist to be submitted for Adm: 1rative Approval of indoor medical treatment in Non-Empanelled Hospital Description Intimation letter from the claimant Copy of MRS Card Doctor Certificate for hospitalization by registered Medical Doctor 4 | a). Emergency certificate for treatment at non- empanelled hospital (or) b). Prior approval taken for treatment at non- empanelled hospital win la|Z Checklist to be submitted for Administrative Approval of indoor medical treatment outside the state medical treatment outside the state Description Intimation letter from the claimant Copy of MRS Card wln|Rle Doctor Certificate for hospitalization by registered Medical Doctor 4 |a). Reference letter from empanelled hospital/state medical board for treatment outside the state (or) b). Prior approval of competent authority for | treatment outside the state