Application for Medical Advance

Topics: Patient, Hospital, Illness Pages: 2 (250 words) Published: July 3, 2011
APPLICATION FOR THE ADVANCE OF MEDICAL TREATMENT

|1) Name & Designation |: | | |2) Office in Which working |: | | |3)a) Basic Pay |: | | |b)Dearness Pay | | | |Total | | | |4) Whether Permanent or Temporary? |: | | |5) Name of the Patient and relationship |: | | |with the Government Servant. | | | |6) Nature of Illness |: | | |7) Whether treatment is received as in-patient or outpatient? |: | | |8) Name of the Hospital in which patient is treated and whether |: | | |it is recognised one? | | | |9) Whether Necessary certificate from the Medical Officer/ |: | | |Specialist of the recognised...
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