Essentiality Certificate - OP
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ESSENTIALITY CERTIFICATE
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CERTIFICATE ' A'
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(To be Completed in the case of Patients who are not admitted to Hospital for Treatment)
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Certificate granted to Mr. /Mrs. /Miss._______________________________________ Mother/Father/ Wife/Son/Daughter of Mr. /Mrs. /Miss.________________________________________________employed in the Office___________________________________________________________________________________________.
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I, Dr.________________________________________ hereby certify :-
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(a). I charged and Received Rs.______________ for _________________________________ Consultations on _________ (Dates to be Given ) at My Consulting Room / at the Residence of the Patient.
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(b).That I Charged and Received Rs.___________ for Administering Intramuscular/ Intravenous/ Subcutaneous Injections on ______________ (Dose to be given) at My Consulting Room / at the Residence of the Patient.
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(c).That Injections Administrated repay in Formatting or Prophylactic purposes.
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(d).That the patient has been under treatment at ___________________________ Hospital / My Consulting room 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. The medicines are not stocked in the_______________________.hospital and do not include proprietary preparations for which cheaper substances of equal therapeutic values are available not preparations which are primarily foods, tonics, toilets or disinfectants.
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S.No.Name of the MedicineCost
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Total
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(e).That patient is/was Suffering from ______________________ and is/was under my Treatment from _________ to _________.
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(f).That the patient was/not given pre-natal or post natal post treatment.
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(g).That the X ray, laboratory tests etc, for which an expenditure of Rs.__________ was incurred was necessry and were under taken on my adivce at________________________________ (Name of the Hospital or Lab)
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(h).That I referred the patient to Dr.___________________________ for Specialist Consultation and that the Necessary Approval of Director, Medical Service as required under the rules was obtained.
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(i).That the patient did not require/required hospital etc.
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Counter SignedSignature and Designation of the Medical Officer In Charge of the Hospital
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ESSENTIAL (OP)