Essentiality Certificate (IP) - I
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ESSENTIALITY CERTIFICATE
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CERTIFICATE ' B'
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(To be Completed in the case of Patients who are 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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PART - A
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I, Dr.________________________________________ hereby certify :-
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(a).That the Patient was Adimitted to Hospital on the Advice of ____________________________ (Name of The Medical Officer) / on my advice.
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(b).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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(c).That Injections Administrated repay in Formatting or Prophylactic purposes.
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(d).That patient is/was Suffering from ________________________________ and is/was under my Treatment from _________ to _________.
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(e).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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(f).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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PART - B
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I Certify that the Patient has been under Treatment at the ______________________________ Hospital and that the service of the Special Nurses , for which an Expenditure of Rs. _____________ was incurred vide bill and Receipts attached, were essencial for the recovery / prevention of serious deteration in the conition of the Patient.
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I certify that patient has been Under treatment at the _________________________________ Hopital and the facilities provided were minimum which essential for the patient's treatment.
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Counter SignedSignature and Designation of the Medical Officer In Charge of the Hospital
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ESSENTIAL (IP) - 1