File No.Z15025/117/2017/DIR/CGHS
Z 15025/117/2017/DIR/CGHS/EHS
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
EHS Section
Nirman Bhawan,New Delhi
Dated the 15th January, 2018
OFFICE MEMORANDUM
Sub: Simplification of referral system under CGHS
With reference to the above mentioned subject the
undersigned is directed to state that this Ministry has been receiving
representations for simplification of procedure for CGHS beneficiaries to
undertake treatment at private hospitals empanelled under CGHS. The guidelines
issued earlier on referral/ permission under Office Memorandum No S 11011/6/96
—CGHS (P) dt. 11/6/97 and 02/09/99, S-12020/4/97 —CGHS (P) dt. 07/04/1999,
S.11011/1/200-CGHS (P) dt. 10/04/2001 and RA/Cons/Hyd/09-10/CGHS-IV, dated
11/06/2010 and Z.15025/105/2017/DIR/CGHS dt. 09/11/2017 has been reviewed and
it has now been decided to revise the guidelines for 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 empanelled under CGHS after being referred by any Medical Officer/CM0
of CGHS Wellness Centre. The referral may be mentioned on the computer
generated Prescription slip. After consultation at empanelled hospitals
beneficiary shall report back to concerned wellness centre, where MO/CMO would
endorse listed investigation and issue medicines as per guidelines mentioned
below. For unlisted investigation/treatment procedure CMO Incharge shall submit
the prescription to competent authority for consideration in case of pensioner
beneficiaries. Serving employees shall seek permission for unlisted
investigation/treatment procedure from 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 Wellness
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 prescribed 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
Z.15025/105/2017/DIR/CGHS dated 09-11-2017, it is clarified that the validity
of the advice of Central Government /State Government Specialist/CGHS Medical
Officer for listed treatment procedures shall be treated as valid for three
months unless mentioned otherwise and no other referral (permission) letter is
required to undergo, 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 CGHS 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 refer the beneficiary for
treatment to any CGHS recognized hospitals.
iv) In case of Haemo-Dialysis, the advice for
treatment can be made upto six months and in such cases the advice shall be
valid for upto six months.
v) In case of Radio-therapy/Chemotherapy advised
by a Government Specialist the advice shall be valid for all the cycles of
Radio-therapy/Chemotherapy. The specialist has to specify the specific
Radio-therapy procedure. Self-attested (by beneficiary) photo-copies of the
permission letter is required to be submitted.
vi) In case of post-operative follow up treatment
in six conditions as specified in OM dated 10.04.2001, permission for follow-up
treatment shall be required from competent authority.
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
