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