Simplilication of Referral System Under CGHS – 2018

Simplilication of Referral System Under CGHS – 2018

File No .z 15025 / 117 /20 17 DIR/CGHS/

File No .z 15025 / 117 /20 17 DIR/CGHS/ EHS
Goyernment of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
EIIS Section
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Nirman Bhawan, Nerv Delhi
Dated the 15’h January,2018

OFFICE VIEMORANDUM

Sub: Simplilication of referral system under CGHS

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With reference to the above mentionecl subject the undersigned is directed to state that this Ministry has been receiving representations for simplification of procedure for CGHS beneficiaries to Lrndertake treatment at private hospitals empanellecl under CGHS. The guidelines issued earlier on referral/ permission under office Memoranda No S I 11011/6/96-CGHS (p) dt. 11/6/97 and 02/09/99, s-120/20/97 -CGHS (P) dt. 07/04/99, s. 11011/1/200-CGHs (p) dt. 10/04/2001 and RA/cons/H yd/09-10/CGHS-Iv, dated 11/o6/2010 and z’15025/105/2017 /DIR/CGHS dt. 09/11/2017  has been revierved and it has now been decided to revise the guidelines fbr consultation and treatment at CGHS empanelled private hospitals as per the details given under:

i) All CGHS beneficiaries (in all CGHS Cities) shall be permitted for seeking opD consultation from Specialists at Private hospitals empanellid under CGHS afte;being ref’erred by any Medical officer/cMo or bcus wellness Centre. The referral may be mentione.d on the computer -generated Prescription slip. After consultation at empanelled hospitals beneficiary shall report back to concerned wellness centre, rvhere Mo/CMo would endorse listed investigation and issue medicines”u. p.. guidelines mentioned below. For unlisted inveltigation/treatment proceclure CMo Incharge shall submit the prescription to competent iLrthority for consideration in case of pensioner beneflciaries. Serving emplol,ees shall seek permission for unlisted inYestigation/treatment procedure lrom their’department as per prevailing guidelines.

ii) The medicines prescribed by specialists shall be supplied by CGHS as per the available -generic name at the cGHS weilness centre.

In case the medicine prescribed by the Specialist is available by an alternative brand name having the same composition. it shall be supplied by the brand name available at CGHS Wellness Centre.

If, the medicine prescribecl by the Specialist is not available at CGHS Wellness Centre either by generic name or alternate brand name, it shall be indented by the same brand name through Authorized Local Chemist.

iii) With reference to OM 2.15025110512017/DIR/CCHS dated 09llll20l7, it is clarified that the validity of the advice of Central Government /State Government Specialist / CGHS Medical otficer fbr listed treatment procedures shall be treated as valid fbr three months unless mentioned otherwise and no other referral (permission) letter is required to under-{o. the treatment procedure at any of the empanelled Hospitals. It is also clarified that once a specific treatment procedure (listed) has been advised by a Specialist of Central Government /State Government or a CGHS
Medical officer, it is the option of CCHS beneficiary to undergo at any of the CGHS empanelled hospitals of his/her choice and it is not compulsory that Specialist /CGHS Medical officer shall ref-er the beneficiary for treatment to any CGHS recognizecl hospitals.

iv) In case of Haemo-Dialysis, the advice for treatment can be macle upto six months and in such cases thg advice shall be valid for upto six months.

v) In case of Radio-therapy lChemotherapy advised by a Government Specialist the advice shall be valid for all the cycles of Radio+herapy/Chemotherapy. The specialist has to specify the specific Radio-therapl’procedure. Self-attested (by beneficiary) photo-copies of the permission letter is required to be submitted.

vi) In case of post-operative fbllor,v up treatment in six conditions as specified in OM dated 10.04.2001, permission fbr follou.up treatment shall be required from competent authoritl,.

vii) In case of non-listed investigations / treatment procedures permission from competent authority is required to be obtained.

2. This issues with the approval of competent  authority in supersession of earlier  guidelines.

[Dharminder Singh]
Under Secretary to Government of India
Tel- 011-23062666

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