MRC Pendency of the year 2015 - CGHS(South Zone) - as on 31-05-2015 (May 2015) Sl Recd No Card Holder Name Ben IB No. Claimed Reasons for delay Date 1 29/9/2014 Chandra Pal 2 05-08-2014 C S Ahuja 3543485 1280056 3 4 5 6 7 8 Hari Krishen Mahajan Naresh Kumar Passi Piare Lal Sandhu Ravinder Kumar Malik Krishna Kumar Smt. Santosh Rani 936359 2770655 876854 1002037 1212167 1250935 9 17/04/2014 Shyam Sunder Dua 10 17/06/2014 Hari Krishen Mahajan 11 23/05/2014 Smt. Santosh Rani 2178381 936359 1250935 12 28/05/2014 Anand Mohan Bhardwaj 1155675 13 23/05/2014 Anand Mohan Bhardwaj 1155675 + Request letter for condonation of delay in submitting MRC 28302 Copy of prescription + Original payment receipt + Original summary 1179 Day care discharge summary 14 28/05/2014 Ved Singh 15 06-06-2014 Kanshi Ram Sharma 16 06-06-2014 Abdul Mateen Siddique 277974 895778 3648509 1980 Original prescription or original permission letter 19880 Original summary bill 40251 MRC 2004 form signed by card holder 17 18 19 20 21 22 18/06/2014 06-06-2014 17/06/2014 18/06/2014 18/06/2014 25/06/2014 Samir Kumar Banerjee Surjit Kaur Gurdeep Singh Bhatia Shakuntla Rama Nand P J Rai 883491 53029 969908 8,21 852351 20998 3816877 19300 1172085 37365 3797309 26250 23 24 25 26 27 25/06/2014 23/07/2014 25/06/2014 25/08/2014 07-09-2014 P N Khanna Shyam Lal Kain Mehta S S Chhibber Som Nath Dhall Sarla Gupta 883166 2614674 857968 1012625 3926052 23/07/2014 05-08-2014 05-09-2014 17/06/2014 19/05/2014 23/05/2014 Amount 5165 Copy of CGHS Card - Card holder 130692 1. Properly filled MRC 2004 form clearly mentioning claim amount 2. Complete hospital bill break up + discharge summary 76912 Original final bill + Original payment receipt for Rs. 75,000/1870 Prescription / case sheet 3841 Complete hospital bill break up 3000 Original permission letter 237954 Original payment receipt for Rs. 5394/- + Bill Break up 49827 Original payment receipt for Rs. 49,827/- + Request letter for condonation of delay in submission with reason 103235 Original permission letter + Break up + retail invoice 30613 Emergency Certificate + Original payment receipt Rs. 30,613/119262 Discharge summary + Original payment receipt for Rs. 1,19,262/- 20226 6000 2101 3400 35576 All investigation reports + Bill break up for Rs. 50,000/OPR for Rs. 5000/Bill break up + Origina payment receipt for Rs. 14,681/Original payment receipt for Rs. 17,000/Discharge summary + Original payment receipt for Rs. 35,094/Original bill & break up of Rs. 26,250/- + Original payment receipt for Rs. 26,250/Original payment receipt for Rs. 226/Advice letter from the treating doctor break up for the amount Rs. 884/non availability certificate for blood Original permission letter More Doc Req. Date 10-10-2014 05-08-2014 25/07/2014 05-08-2014 05-09-2014 19/06/2014 22/05/2014 28/05/2014 19/06/2014 19/06/2014 28/05/2014 29/05/2014 28/05/2014 06-02-2014 06-12-2014 06-11-2014 20/06/2014 06-11-2014 20/06/2014 20/06/2014 19/06/2014 26/06/2014 26/06/2014 23/07/2014 26/06/2014 28/08/2014 16/07/2014 Sl Recd Card Holder Name Ben IB No. Claimed No Date 28 25/08/2014 Pratima Chatterjee 4335420 29 08-11-2014 Lalit Chandra 30 13/08/2014 K M Acharya 31 25/08/2014 Nazir Ahmed Kamili 32 08-11-2014 Vichitra Singh 1006757 668955 1203213 915019 33 13/08/2014 Ambika Pratap Singh 34 13/08/2014 Daljit Singh 35 08-11-2014 Vasdev Vaswani 1013050 896999 1087616 36 08-11-2014 Santosh Vishnoi 936377 37 08-11-2014 Prakash Chand 38 13/8/2014 Lachhman Das Miglani 897108 1170887 39 13/8/2014 Anuradha Ahuja 958632 40 41 09-01-2014 Sudershan Kapoor 09-03-2014 Jagdish Prasad Sharma 16343 387323 42 43 04-10-2013 Smt. Mohuya Banerjee 04-10-2013 Ram Kaur Jain 1016472 1026848 44 04-10-2013 Dr. Meera Dass 45 04-10-2013 Ramji Lal 46 17/04/2013 Hoshiar Singh Arya 47 23/04/2013 Vidya Sharma 3674362 2612699 994901 3328238 48 23/04/2013 M L Kohli 963463 49 23/04/2013 Ram Kishan 874997 Reasons for delay Amount 379904 Proper affidavit by the claimant +NOC other legal heirs + valid CGHS card 57076 Original payment receipt for Rs. 50,000/960 Prescription of the treating doctor on days consulted 54457 Discharge summary / Death summary 99391 Original payment receipt for Rs. 45,000/- + Day care discharge summary + Summary bill for treatment 28793 Original payment receipt for Rs. 3000/41464 Detailed break up for Rs. 20,700/15000 Original permission lette or request letter for condonation of procedural lapse + Original bills and bill break up 3760 Original permission letter + Original prescription of the treating doctor 4189 Bill breakup for Rs. 2497/104067 Original permission letter / emergency certificate + Final detailed bill (break up ) + Original payment receipt for Rs. 96,567/-, Rs. 5000/- and Rs. 2500/81171 Prescription or Medical record + Emergency certificate / permission letter + Original payment receipt for Rs. 15,000/216 MRC 2004 form signed by card holder 33265 Certificate from the treating specialist for the use of single dialyser for each dialysis 35528 Complete Hospital Bill Break Up details 8425 LTI of the claimant on M 2004 form to be verfiy by the competent authority, complete break up bill 17857 Original Payment receipt of Rs. 8000/19934 Original Payment receipt of Rs. 13200/9270 original Hospital bill , Original Payment receipt of Rs. 9270/34447 Original bill/cash memo for surgical itemsamounting Rs. 22030/-, More Doc Req. Date 28/08/2014 26/08/2014 29/08/2014 09-02-2014 20/08/2014 29/08/2014 29/08/2014 20/08/2014 20/08/2014 14/08/2014 15/09/2014 18/09/2014 09-02-2014 18/09/2014 24/07/2013 04-09-2013 16/04/2013 04-10-2013 18/04/2013 13/08/2013 Original payment receipts for Rs. 11945/2500 M 2004 form to be filled, original final Hospital bill, Comlete 23/04/2013 hospital Bill break up, permission letter of cghs competent authority 46132 Original Hospital final bill, complete hospital break up bill details, 23/04/2013 original payment receipts for Rs. 25000/- Sl Recd Card Holder Name No Date 50 29/04/2013 Krishan Gopal Goel 51 30/04/2013 Manohar Lal Gulati Ben IB No. Claimed 973389 944423 52 05-01-2013 C L Dhingra 53 15/05/2013 Satinder Singh Gujral 873604 975822 54 13/05/2013 Sneh Lata Bakshi 971654 55 16/05/2013 Shri Lal 886272 Amount 4000 Permission letter 4451 Affidavit for submission of MRC, NOC form legal hiers on stem paper 444522 NOC for three siblings not attached. 20000 Original payment recpt Rs. 20000 with signature and stamp of dealer over revenue stamp, three year warranty period card of HA. 5596 Refferal slip/permission letter for consultant/investigations/medicines at Gajiv Gandhi Cancer Institute 11892 Daycare summary and bill break up details for I V fluids charge of Rs. 590 3780 Complete bill break up of Rs. 3780/1886 complete hospital bill Break Up details for Rs. 1886/1600 Original Permission letter for compression stockings. 1873 Original permission letter 1325 Permission letter for consultation & Investigations 56 57 58 59 60 17/05/2013 16/05/2013 17/05/2013 20/05/2013 27/05/2013 Gunwanti Bhambhani R K Kaushik Shashi Ahluwalia Som Nath Suraj Sugnehal Gopalani 3469574 1210586 488076 3589277 912063 61 62 63 64 28/05/2013 27/05/2013 27/05/2013 20/06/2013 Kedar Nath Sharma Ram Dass Kashmir Chand Vahi Sada Ram Yadav 3176770 20000 1158524 8811 877860 12950 3916343 1489258 65 06-04-2013 S V Chari 925113 Reasons for delay Request letter for condonation of delayed MRC Submission Bill break up of Rs. 3897/- duly verified by hospital Original Permission letter for MHD Valid CGHS card, Original payment receipt, certificate of Insurance company , all the invoices certify in ink and stamp by the insurance company 876 Original bill/receipt of Rs. 300/- for holter, Adviced slip for Holter More Doc Req. Date 30/04/2013 05-01-2013 23/04/2013 16/05/2013 13/05/2013 17/05/2013 07-04-2013 09-09-2013 20/05/2013 20/05/2013 28//05/2013 28/05/2013 18/06/2013 28/05/2013 30/10/2013 06-06-2013 66 31/05/2013 Ashok Kumar Aneja 1050276 20990 Permission Letter for Oncology consultation at Medanta Hospital 06-05-2013 67 31/05/2013 Smt. Birbati 68 06-05-2013 R J Abichandani 1229338 951741 7000 Three years warranty period card of HA 31/05/2013 31496 clarification by the hospital regarding the surgery undertaken in 07-08-2013 this care 11852 Complete hospital bill break up, Doctor's advice for investigation 24/06/2013 69 13/06/2013 Chhami Lal 70 14/06/2013 Smt. Bhagwati 71 07-04-2013 Narottam Singh 72 14/06/2013 A L Ahuja 73 13/06/2013 A K Karsija 74 07-03-2013 S K Koul 877056 935592 886689 901956 896205 1136408 550 26149 3558 20336 52325 Permission letter for LS belt Emergency ecrtificate, complete break up bill Bill break up details for Rs. 3500 Second set of MRC Original payment receipt for Rs. 52325 24/06/2013 07-04-2013 17/12/2013 24/06/2013 07-03-2013 Sl Recd Card Holder Name No Date 75 16/07/2013 Ashok Mehta 76 25/06/2013 Mrs. G L Bhatia Ben IB No. Claimed 3964166 941242 77 26/06/2013 Raj Kumari Bhatia 78 07-09-2013 Babu Lal 577752 860845 79 07-03-2013 Sushil Chandra Saha 847456 80 81 82 83 84 85 07-04-2013 07-05-2013 07-08-2013 07-08-2013 07-08-2013 07-09-2013 Shashi Prabha Raj Bal Sarv Parkash Mehra Sanyogita Devi Chopra Ramesh Chandra Gaur Shayam Parkash 1141510 997686 856678 986856 1169170 1023636 86 07-08-2013 Subhash Chandra Basu 1002102 87 88 89 07-10-2013 Rajender Chander Joshi 07-08-2013 Ramesh Chandra Gaur 07-12-2013 Gulshan Rai Mendiratta 908690 1169170 3918615 90 16/07/2013 Kumud Kapur 91 07-11-2013 Madan Mohan 3888084 674653 92 24/10/2013 Harish Chandra 93 09-10-2013 B R Mehta 905492 857220 94 864719 08-07-2013 Sushila Pathak 95 24/07/2013 C L Jasra 96 29/07/2013 Baldev Prasad 97 08-05-2013 Brahm Dutt 98 08-07-2013 Raghbir Singh Nanda 99 08-07-2013 Nihal Singh 100 08-06-2013 Maya Devi 932598 952173 866976 980446 1000926 3624 Reasons for delay Amount 67000 Original payment receipt and three years waranty card 4565 MRC card not filled, proper bill break up, MRC to be submitted period wise separately 85000 complete bill break up of Rs. 85000/42505 Proper/complete Discharge Summary, Original Payemnt of Rs. 1001 7812 Claimant to clarify - whether an under taking for the cost different of inpatient has been given or not. 10510 Original payment receipt Rs. 10510/1595 Bill break up details of Rs. 1095/30000 complete bill break up details for Rs. 30000 65323 Original payment receipts for Rs. 12750 and Rs. 47250 223 Bill break up for Rs. 223/13265 Original payment receipts Rs. 13265, Complete discharge summary 169615 Original payment receipts Rs. 169615/-, original final hospital bill, Proper bill break up of Rs 30210/- for investigations and of Rs. 56209 for pharmacy charges. 2760 Seprate MRC for seprate period of admission 411 Bill break up for Rs. 411/68747 The original papers of examiniation done before surgery supporting the diagnosis 136910 complete break up bill details of Rs. 134760 947 complete break up bill details of Rs. 500 for emergency and Rs. 377 for consumables 40551 Original bills 3112 Request letter for condonation of delayed MRC Submission, Discharge Summary, Affdavit & NOC for legal hairs. 1369 Bill breakup details of Pharmacy and consumable charges Rs. 730. 30000 Original payment receipt of Rs. 30000, Complete Hospital bill break up for Rs. 30000 10020 Original payment receipt Rs 10020. 8177 Original payment receipt Rs. 7837/64002 Original payment receipts for Rs. 32001/5095 Break up bill Rs 4770 for misc (other) charges 48000 Claimant to submit the document relating to the date of retirement from the service More Doc Req. Date 17/07/2013 25/06/2013 26/06/2013 22/08/2013 18/02/2014 07-05-2013 07-05-2013 07-08-2013 07-09-2013 07-08-2013 07-10-2013 07-08-2013 07-10-2013 07-08-2013 29/07/2013 17/07/2013 07-11-2013 21/04/2013 19/07/2013 13/08/2013 24/07/2013 29/07/2013 08-05-2013 20/08/2013 08-07-2013 08-06-2013 Sl Recd Card Holder Name No 101 102 103 104 Date 19/08/2013 Pawan Kr. Kedia 13/08/2013 D B Jain 13/08/2013 Gulab Singh Verma 14/08/2013 Prem Lata Pahwa 401999 940325 1021800 2689019 105 08-12-2013 Madhu 106 19/08/2013 Prehlad Rai Sondhi 3964058 1242852 107 23/08/2013 D D Kumar 108 09-09-2013 Brij Lal Bhardwaj 109 09-02-2013 Shivraj Singh 897065 846943 1009017 110 08-02-2013 Ashwani Kumar Bhola 111 26/08/2013 Bajnti Devi 877585 1199068 112 23/09/2013 Dr. Krishan Lal 113 24/10/2013 Prem Prakash 881257 3473992 51240 Complete hospital bill break up 24/09/2013 39852 Original final bill (consolidated) + Refund receipt for Rs. 10,148/- 28/10/2013 114 115 10-09-2013 Surinder Kumar Monga 10-07-2013 Shiv Dutt Goswami 1006090 1080312 116 10-09-2013 Shiv Dutt Goswami 1080312 117 10-09-2013 Kiran Arora 2586905 118 10-04-2013 Jasbir Singh Bhatia 2038684 627 Doctor's prescription slip 9065 Proper/complete Discharge Summary + Permission letter + Complete bill break up 18278 Original permission letter of CGHS completent authority for treatment 51274 Complete hospital bill break up of pharmacy issue of Rs. 10,352/CGHS card 10015 Original permission letter of CGHS competnet authority for the treatment 5252 Complete bill break up for Rs. 4,370/52687 Original payment receipt of Rs. 49,888/- + Complete bill break up + CGHS card 4114 Original payment receipts for Rs. 3,637/26905 Operative notes & findings 6600 Original bill cum receipt for Rs. 900/- + Original hospital bill + Original receipt for Rs. 5500/- 119 29/10/2013 Sanyogita Rani 120 31/10/2013 Ranajit Ghose 121 30/10/2013 J M Banerjee 122 17/10/2013 D A Sachdev 123 12-12-2013 T C Jain Ben IB No. Claimed 611198 877522 3916862 871062 906133 Amount 42865 7650 10500 43220 Reasons for delay More Doc Req. Date Original final Inpatient bill 24/08/2013 original permission letter for Investigation 14/08/2013 Original Permission letter 14/08/2013 1. Original final bill (summary) 2.Complete hospital bill break up. 20/08/2013 3. Patient share bill break up for Rs. 20,306/3644 Govt. doctor referral letter for treatment at Artemis hospital 436588 1. Original payment receipt for Rs. 3,72,000/- 2. MRC form signed by card holder 3. All investigation reports 21503 Original payment receipt for Rs. 2450/13556 Hospital bill break up for Rs. 11,750/3000 Original permission letter of CGHS competent authority to purchase the ankle brace 11219 Original payment receipt for Rs. 11,219/889 Bill break up for OPD Rs. 153/- and Medicine charges of Rs. 595/- 22/08/2013 24/08/2013 23/08/2013 29/10/2013 09-02-2013 08-02-2013 27/08/2013 10-09-2013 10-07-2013 10-09-2013 11-05-2013 10-04-2013 29/10/2013 31/10/2013 30/10/2013 18/02/2014 12-12-2013 Sl Recd Card Holder Name No Date 124 12-05-2013 Paresh Chandra Biswas Ben IB No. Claimed 4011881 Amount 167653 881865 950251 509 40000 125 126 12-02-2013 Shyam sunder 12-05-2013 Mrs. Ram Murti Phool 127 11-07-2013 Asha Sharma 1050400 574362 128 12-06-2013 Ved Vyas jetley 1028528 6300 129 12-12-2013 Balbir Chandra Sakocna 914554 60626 130 12-12-2013 Balbir Chandra Sakocna 914554 203856 131 16/12/2013 Arun Kumar 132 16/12/2013 L N Tiwari 133 12-10-2013 Bhupendra Deva Sahay 134 29/01/2014 Smt. Leela Menon 3519152 880090 2619211 1240594 3198 3903 102356 1404 135 24/01/2014 Leela Menon 1240594 136 24/01/2014 Leela Menon 1240594 137 20/12/2013 Santosh 996470 138 28/01/2014 Anand parkash Sharma 925128 139 02-05-2014 D S Patwal 1269704 140 29/01/2014 Kailash Chandra 931249 141 930485 02-04-2014 Chadan Singh Reasons for delay More Doc Req. Date 1. Outer pouch of the stent packet along with the sticker on it 2. 12-05-2013 Copy of relevant Invoice of the stent with batch number 3. Complete hospital bill break up (details) Day care summary 12-03-2013 1. 3 years warranty details of the Hearing Aid, 2. Original 12-05-2013 payment receipt for Rs. 40,000/1. Original payment receipt for Rs. 3,01,962/- 2. Original 11-07-2013 Inpatient bill 3. Complete bill break up 1. MRC 2004 to be duly filled and signed by card holder 2. 12-12-2013 Permission letter of CGHS competent authority for follow up treatment 1. Complete hospital bill break up 2. Ambulance Certificate 3. 12-12-2013 discharge summary Hospital bill break up (details) date wise/ metioned of date on 12-12-2013 the bill break up Permission letter for OPD consultation & investigation 16/12/2013 Prescription / case sheet of the treating doctor 16/12/2013 Complete discharge summary + Original payment receipt 12-11-2013 Original payment receipt for Rs. 1404/- + Bill break up (details) 29/01/2014 20602 Original payment receipt for Rs. 20,602/- + Complete hospital bill break up 41029 1. Original payment receipt for Rs. 38,673/- 2.Copy of CGHS BID card 12000 Original sticker of the lens with signature & stamp of the trating eye specialist on it. 7000 1.Proper bill for the external loop recorder. 2. Ortiginal paymentrecipt for the external loop recorder. 22587 Copy of CGHS BID card of D S Patwal + Discharge summary + Emergency certificate + MRC 2004 form signed by card holder 1955 Doctor's advice slip for the test + permission letter for CGHS competent authority for the test 15536 Separate claims for two different hospital in different periods + Original Invoice cum receipt 24/01/2014 24/01/2014 24/12/2013 30/04/2014 07/2012014 29/01/2014 02-08-2014 Sl Recd Card Holder Name No Date 142 29/01/2014 Satya Kukreja 143 02-01-2014 Pushpa Verma Ben IB No. Claimed 1271306 995407 144 28/01/2014 Jaswant Bahadur 1045836 145 3882825 02-01-2014 Daya Chand 146 31/01/2014 Tanmey Das 147 02-04-2014 Indira M 148 01-08-2014 M.L.NARULA 709902 1058488 932821 149 1049315 02-05-2014 Raj Rani Barman 150 02-04-2014 Manotama Tiwari 151 31/01/2014 Sheela Motwani 152 02-04-2014 Jaitun Nisha 2655318 3536798 4164081 153 02-05-2014 Chander Parkash Taneja 154 02-05-2014 Ajay Kumar Misra 1268017 155 02-10-2014 Dr. K K Pandey 1141479 156 04-03-2014 Ram Krishna Dixit 157 158 159 160 21/03/2014 17/04/2014 13/05/2014 24/04/2014 O F Richard Bimal Chandra Dutta Khitesh Chakravarty Dr. Shalini Agrawal 880225 915138 951767 3253481 873543 1263060 Reasons for delay Amount 6941 Complete Medicines record of Max Healthcare & Sup Speciality hospital for treatment taken on 08/12/2013. 50000 1.Medical Necessity form. 2. Original payment receipt. 3. ABG report. 4. Sleep study report.5. Affidavit for return to CGHS(MSD) nthe item after ater he has not utilized. 17433 Permission letter for CT Urography done at Mahajan Imaging done on 30/08/2013. 161876 Prescription / case sheet from the treating doctor + Discharge summary 3000 Doctor's advice slip for the test 12893 Permission letter + Prescription / case sheet 7650 Original bill (summary) + Original payment receipt for Rs. 7650/543 Claimant to correct the claimed amount of Rs. 543/ ro Rs. 265/as bill attached is for Rs. 265/1265 Permission letter + Prescription / case sheet 9308 Permission letter 38095 Discharge summary + prescription / case sheet, MDR- Original payment receipt with stamp & signature of authorised signatory on revenue stamp for Retails Invoice 4000 Permission letter from competent authority for purchase of L.S.Carset belt 65217 Request letter for condonation of delayed + Emergency certificate 23776 Original payment receipt for Rs. 23,776/- + Break up details of patient share amount 36391 Original consolidated bill + Original payment receipt for Rs. 35,691/- + Self explanatory letter with justification of claim 13866 Original complete hospital bill break up details 17788 Affidavit, original payment receipt Rs 16088 217555 Correctly filled MRC 2004 form 10123 Original payment receipt for Rs. 8,923 + Original final bill summary More Doc Req. Date 03-10-2014 22/05/2014 28/01/2014 02-01-2014 31/01/2014 02-08-2014 23/01/2014 02-01-2014 02-08-2014 31/01/2014 03-04-2014 02-10-2014 02-10-2014 02-12-2014 04-03-2014 27/03/2014 17/04/2014 13/05/2014 24/04/2014
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