(1) When, (a) a Minister or the Leader of Opposition or the Chief Whip or any of the members of his family receives medical treatment from a hospital or medical attendance by a medical practitioner or other person within India if a medical officer not below the rank of a District Medical Officer, or
(b) a Minister or the Leader of Opposition or the Chief Whip or his or her spouse received medical treatment from a hospital or medical attendance by any medical practitioner or other person abroad, if the Director relating to the system of medicine in which treatment was undergone by him or by her, certifies that a substantial amount is required for such treatment or such medical attendance the Government may sanction such amount as they think fit towards advance payment relating to the cost of such treatment or such medical attendance.
(2) When, -
(a) the Speaker or the Deputy Speaker or a Member any of the members of his family receives medical treatment from a hospital or medical attendance by a medical practitioner or other person within India if a Medical Officer not below the rank of a District Medical Officer; or
(b) the Speaker or the Deputy Speaker or a Member or his or her spouse receives medical treatment from a hospital or medical attendance by a medical practitioner or other person abroad, if the Director relating to the system of medicine in which treatment was undergone by him or by her; certifies that a substantial amount is required for such treatment or such medical attendance the Speaker may sanction such amount as he thinks fit towards advance payment relating to the cost of such treatment or; such medical attendance.
(3) The amount, if any, sanctioned under sub rule (1) or sub rule (2) shall be adjusted subsequently from the amount due under these rules to the Member concerned.
FORM OF APPLICATION FOR CLAIMING REIMBURSEMENT OF COST OF TREATMENT OR MEDICAL ATTENDANCE BY MEMBERS {See Rule 9 (1) and (2)}
1. Name and office held (in block letters) :
2. Residential address :
3. Name of patient and relationship with the Member :
4. Place at which the Member/Spouse/ family member fell ill :
5. Whether hospitalised or not :
6. If hospitalised within the State, whether in Government hospital or Private hospital with the name of hospital :
7. If hospitalised outside the State or abroad, name of Institution with address :
8. In the case of treatment outside the State or abroad, whether certificate of the authority mentioned in Rule 7 or rule 8 is attached :
9. Whether consent of the Speaker obtained for treatment abroad :
10. Cost of treatment (List of medicines, cash memos and essentiality certificate should be attached ) :
(i) Charges for consultation, nursing etc. :
(ii) Charges for medicine :
(iii) Charges for surgery :
(iv) Charges for laboratory services etc. :
(v) Charges for accommodation :
(vi) Charges for diet :
(vii) Charges for purchase of human organs :
(viii) Charges for purchase of artificial teeth, eye ball etc. :
(ix) Charges for blood, oxygen etc. :
(x) Other charges :
11. Total amount claimed (in figures and words) :
12. List of enclosures :
(i) Essentiality Certificates :
(ii) List of cash bills. :
DECLARATION TO BE SIGNED BY MEMBER I .................................................................................................................................... do hereby declare that the statement given above is true to the best of my knowledge and belief and that the medical expenditure is incurred for me/my spouse/member of my family.
Place : Signature of Member preferring claim.
Date :
ESSENTIALITY CERTIFICATE Part A I, 1Dr .......................................................................................................................... do hereby certify that 2Shri/Smt ..................................................................................................
...................................M.L.A./Spouse of/member of the family of 3 Shri/Smt........................
............................................M.L.A. has been receiving medical treatment from this hospital/medical attendance in my hospital/at his/her residence for the period from ..........
............................. to ................................. and that the under mentioned medicines prescribed by me in this connection were essential for the recovery/prevention of serious deterioration in the condition of the patient.
Name of medicine Price he patient was suffering from4 ...................................................................................
A sum of Rs....................was charged for consultation, nursing etc.
A sum of Rs...................was charged for administering medicines /injections in my hospital.
A sum of Rs....................was charged for laboratory services.
A sum of Rs.....................was charged for surgical operation.
A sum of Rs................... was charged for blood transfusion, oxygen etc.
A sum of Rs..................was charged for purchase of human organs.
A sum of Rs..................was charged for other charges.
I referred the patient to 5Dr.........................................in the interest of his/her safety/securing the best and advanced special treatment for speedy recovery.
Signature Place : Name of Medical Officer Date : Name of Institution ESSENTIALITY CERTIFICATE Part B (For use when a patient is referred to another doctor) I 5Dr ..............................................................................................................do hereby certify that the patient was admitted to this hospital on the advice of
1Dr.............................................................................and that the patient had been under my treatment for the period from .......................... to ................................... and also that the under mentioned medicines prescribed by me in this connection were essential for the recovery /prevention of serious deterioration in the condition of the patient.
Name of medicine Price A sum of Rs................................. was charged for consultation, nursing etc.
A sum of Rs.................................. was charged for administering medicines/injections in my hospital A sum of Rs............................. was charged for laboratory services.
A sum of Rs............................. was charged for surgical operation.
A sum of Rs............................. was charged for blood transfusion, oxygen etc.
A sum of Rs................................ was charged for purchase of human organs.
A sum of Rs..................was charged for other charges.
Signature Place : Name of Medical Officer Date : Name of Institution COUNTERSIGNED I certify that the patient has been under treatment at the ......................................
hospital and that the facilities provided, the medicines administered or other medical treatment given were the minimum which were essential for the medical treatment of the patient.
Signature Name .............................
(of R.M.O./Authorised Medical Officer/D.M.O./Director) Place :
Date Address:
1. Here enter name of doctor
2. Here enter name of Member, name of spouse or name of family member
3. Here enter name of Member
4. Here enter name of disease
5. Here enter name of the doctor whom the patient was referred to by the old doctor
6. Here enter name of hospital Strike out what is not necessary.
********************