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    File No. HFW-36012/49/2019-MR SEC-Dept. of H&FW (Computer No.

    183896 ) 1

    Note No. #1

    Government of West Bengal


    Health & Family Welfare Department
    HS & MR Branch
    File No. HF/N/HS&MR/R-42A/18

    P.U.D. No. nil, Dated nil,a Claim from Sri Yogendra Prasad Pramanick,Ex-UDA of Health &
    Family Welfare Department, Govt. of W.B. put up for kind perusal.

    This is a case of medical reimbursement in respect of medical treatment as follows.

    ITEMS Claim-1 Claim-2


    Name of the claimant with SRI YOGENDRA PRASAD PRAMANICK, Ex-UDA
    Designaton
    Employee Health Card Identicaton No.111427424 /1/1
    Details (at CP-13)
    Name of the patent with Sri Yogendra Prasad Pramanick, Self
    Relatonship
    Name of the H.C.O. with AMRI Hospitals, Salt Lake[0411037]
    Code No.
    Nature of treatment OPD
    Name of the disease Heart Disease
    Period of treatment 08.09.18 to 16.11.18 30.11.18 to 22.01.19
    Amt. claimed in Form IV/I Rs.4,122/- Rs.2,096/-
    Prior permission if any NA NA
    Advance taken if any NA NA
    Prescripton/Discharge CP-11-12 CP-31
    Certicate/Estmate
    Applicaton in Form III CP-16-17 CP-19-20
    Essentality Certicate in Form CP-2-3 CP-23-24
    IV1
    Checklist in Form in Form V CP-14-15 CP-21-22
    Any other informaton He is a Heart patent & contnuing his OPD treatment at AMRI
    required Hospitals.Admissibility of the claim and/or notes as follows :
    Relevant G.O. [Cl 7/V of Memo CP-33
    No. 7287-F Dt 19.09.18

    Claim-1
    Items & Code Amount (Rs.) CP
    Consultaton-OPD [01001002] 250/- 4
    Medicines-OPD 2081.06/- 7-10
    Total 2,331.06/-=2331/-(R. Off

    Claim-2
    File No. HFW-36012/49/2019-MR SEC-Dept. of H&FW (Computer No. 183896 ) 2

    Items & Code Amount (Rs.) CP


    Medicines-OPD 2095.76/- 25-30
    Total 2,095.76/-=2096/-(R. Off

    Net reimbursable amount [Claim1+Claim2]= Rs.4,427/-


    [Rupees four thousand four hundred twenty seven only]

    Now, if
    approved the ile may be placed before Special Secretary of this Dept. for his kind approval
    on Rs.4,427/-[Rupees four thousand four hundred twenty seven] only in favour of Sri
    Yogendra Prasad Pramanick, Ex-UDA of this Dept. for OPD treatment of his own at the
    AMRI Hospitals, Salt Lake[0411037].
    Submited.

    26/04/2019 3:55 PM
    DALIA MAZUMDAR
    (UDA(MR)(H&FW))

    Note No. #2

    Notes above may kindly be seen.


    Shri Yogendra Prasad Pramanick , Ex-U.D.A. of this Department has preferred two M.R. claims for
    his own the O.P.D. treatment (Heart Disease). As per Form IV1 (C.P.-2 & C.P.-23) the claim amount
    for Claim-1 is Rs.4,122/- and the claim amount for Claim-2 is Rs.2,096/-. But after careful scrutiny the
    admissible reimbursable amount has been assessed for Claim-1 is Rs.2,331/-(round off) and for Claim-
    2 is Rs.2,096/-(round off). So the total admissible amount for two claim is Rs.4,427/-(Rs.2,331/- +
    Rs.2,096/-). As per Prescription(C.P.- 12 & 31) the patient is suffering from Heart Disease. The claim
    has been settled as per Clause-7(v) of F.D. Notification No.7287-F. Dated-19.09.2008(C.P.-33).
    Now the file may be placed before the Higher Authority for kind perusal and necessary approval of
    Rs.4, 427/- in favour of Shri Yogendra Prasad Pramanick, Ex-U.D.A. of this Deptt for medical
    reimbursement for his own O,P,D. treatment at AMRI Hospital, Kolkata.

    29/04/2019 1:29 PM
    JOYANTA KALI MUKHERJEE
    (SO(MR)(H&FW))

    Note No. #3

    Pl check admissibility of claim 1.

    29/04/2019 3:35 PM
    MANIKA BHATTACHARYYA
    (JS(MR)(H&FW))

    Note No. #4
    File No. HFW-36012/49/2019-MR SEC-Dept. of H&FW (Computer No. 183896 ) 3

    30/04/2019 4:11 PM
    JOYANTA KALI MUKHERJEE
    (SO(MR)(H&FW))

    Note No. #5

    Checked and resubmitted.

    10/07/2019 1:54 PM
    DALIA MAZUMDAR
    (UDA(MR)(H&FW))

    Note No. #6

    10/07/2019 2:16 PM
    JOYANTA KALI MUKHERJEE
    (SO(MR)(H&FW))

    Note No. #7

    Notes above & prepage may kindly be seen.


    Rs.4, 427/- ( cl1 Rs2331& cl11 Rs.2,096/-) may kindly be approved in favour of Shri Yogendra Prasad
    Pramanick, Ex-U.D.A. of this Deptt for medical reimbursement for his own O,P,D. treatment at AMRI
    Hospital, Kolkata from 08.09.18 to 16.11.18 & 30.11.18 to 22.01.19 respectvely as detailed at note1.

    10/07/2019 3:34 PM
    MANIKA BHATTACHARYYA
    (JS(MR)(H&FW))

    Note No. #8

    11/07/2019 12:38 PM
    ARFAN ALI BISWAS
    (SS(MR)(H&FW))

    Note No. #9

    11/07/2019 1:36 PM
    MANIKA BHATTACHARYYA
    (JS(MR)(H&FW))
    File No. HFW-36012/49/2019-MR SEC-Dept. of H&FW (Computer No. 183896 ) 4

    Note No. #10

    11/07/2019 1:44 PM
    JOYANTA KALI MUKHERJEE
    (SO(MR)(H&FW))

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