Aarogyasri Health Care Trust, Warangal

From To
……………………… Hospital The CMCO Medical Officer
NWH Aarogyamithra AHCT Warangal. Hyderabad.

Respected Sir /Madam,

Sub: AHCT Warangal: Patient Documents Verified - Request to issue CMCO

Beneficiary copy –Reg.

*****
As per above subjected citied Patient by Name ………………………………
Bering Aadhar Card Number …………………………………. He / She has consulted this
hospital.
Here with I have verified patient following documents and confirming that there is
no option to register through the documents he / she had.
Verified Documents:
1. BPL Card available (Yes /No):
2. RAP / TAP Card available (Yes /No):
3. FSC newly issued (Yes /No):
a. FSC reflecting old Ration Card (Yes /No):
4. Previously any BPL card issued (Yes /No):
5. Identity of Tealangana residence verified (Yes /No):
a. Verification document :……………………(Any identity & address proof)
6. Treating doctor letter mentioning surgery /therapy code (Yes /No):
Hence I request to you Sir / Madam please issue CMCO beneficiary copy to
provide treatment under Aarogyasri.

Thanking you Sir / Madam,

Yours faithfully

Patient / Attendant Name: NWH Mithra Name & EMP ID:

Sign: Sign:
Contact No: CUG / Contact No:
Note: BPL card, RAP /TAP, FSC Card reflecting old Ration card Number patients will not be
referred to CMCO office Hyderabad.

Aarogyasri Health Care Trust –Warangal Urban