*LONG TERM MEDICINES: CLAIM / REIMBURSEMENT / NA FROM ECHS PC PANAJI*
One time sanction is accorded to reimburse above expenditure
under individual reimbursement of medical claims.
NA medicines may be purchased by beneficiary and seek
reimbursement instead of visiting the Polyclinic again & again due to
rising covid cases.
Reimbursement claims of medicines from 23 Mar 20 may be submitted.
Doc needed:
1) Previous prescription of ECHS Dr / MH / CH / SeHAT (ECHS online OPD) /
Empanelled
hospital: original and one xerox.
2) Bill in the name of ESM from Pharmacy: original and one
xerox.
3) 2 copies of ECHS Card of patient.
4) Bank details where reimbursed amt to be credited--Cancelled
cheque/ pass book: original and one xerox.
5} Aadhar card: 2 copies.
6} Contingent bill: we will fill details. You need to sign lower right of the page: affix Revenue stamp and then
sign if over Rs 5,000, attached here, can email if requested.
7} Can send by Registered
Post with Ack Due Card: ECHS Poly Clinic General
Bernardo Guedes Rd, Near Geeta Bakery, S. V. Rd Panaji 403001 Goa
8]
Simple application. addressed to OIC Poly clinic Panaji.
Phone: Hav Pawan Dessai: 0830 – 1530 hrs:
0832 2420829
9552584587
Email : echspolyclinic.panajigoa@gmail.com
