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Self Declaration Form (FORM No. 10) for travelers arriving from COVID-19 afffected areas can be downloaded from this website. Please submite this form in duplicate in the Medical Section.The Medical Reimbursement Forms have been modified w.e.f. 11.03.2020. Modified Forms can be downloaded from this website. As per clause 12.4 of the Institute Medical Rule all OPD medical reimbursement claims must be submitted within three(03) months of the expenditure.All bills/cash memos/money receipts should be submitted in original while submitting medical reimbursement claim.

 

Reimbursement Form for OPD Treatment by Institute Doctor FORM 1 (pdf) (doc)
Reimbursement Form for OPD Treatment referred to Outside Doctor/Consultants of panel hospitals FORM 2 (pdf) (doc)
Reimbursement Form for Indoor (Hospitalised) Treatment  FORM 3 (pdf) (doc)
Medical Leave Form FORM 4 (pdf) (docx)
Medical certificate of Fitness to Return to Duty FORM 5 (pdf) (doc)
Annexure- A FORM 6 (pdf) (doc)
GMIS Form FORM 7 (pdf)  (docx)
Form for reissue of Medical Book (in case of employees) FORM 8 (pdf) (docx)
Form for reissue of Medical Book (in case of students) FORM 9 (pdf) (docx)
Self-Declaration Form for travelers arriving from COVID-19 affected areas (to be submitted in duplicate) FORM 10 (pdf) (docx)


                                                                                                         

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