Esi File

Kindly prepair our file in this order as soon as possible. 

Documents in Sr. order

1. Letter form ESI (to be made by ESI Disp.)
2. Request Leter form IP to ESI
3. e-Pehchan Card
4. Entitled to benefit sheet.
5. History sheet of the patient (ESI signature)*
6. OPD slip of ESI Hospital
7. History sheet of patient (from specialty hospital)
8. Letter head of specialty hospital 
9. OPD slip of speciality hospital
10. ESI R.C. (2 pages)
11. Aadhar card issued person
12. Aadhaar card of patient
13. 2 Passport size photo of IP + (2 Photos of patient)
14. ESI board form

May be required 

1. Consumption certificate
2. Copy of Privious OPD slip of Specialty Hospital (on which privious medicine was recived) - Part of ESI Board Form.
3. Any other if required

Formats  (Kindly edit formats on PC / Laptop) mobile may not support.

NOTE - DIFFERENT DISPENSARY / HOSPITAL HAVE DEFEND VIEWS AND REQUIREMENT - THESE ALL FORMATS HAVE BEEN CONTRIBUTED BY OUR BLOOD BROTHERS - KINDLY DOWNLOAD WHICH IS REQUIRED TO YOU.

Letter 1 and Letter 2 

Letter 3 - PDF

ESI RC - PDF  ( ਆਰ. ਸੀ )

Consumption certificate - PDF

ESI Board Form  - PDF  ( ESI ਬੋਰਡ ਫਾਰਮ )

Self Diclaration Form  - PDF ( ਸਵੈ-ਘੋਸ਼ਣਾ ਫਾਰਮ )

Advance Medicine Checklist - PDF

HCT Document Checklist

*

👉 Kindly update RC Referance on - History sheet of the patient (ESI signature) 

Updated lines - (Emicizumab - Hemlibra)

Require medicine available to ESIC RC No./item No./ Item No.:-2209/2210 RC.NO.-U-25/12/RC/159TO163/2022-Med. V(E-117064)/159,160 dated-08.04.2025, with ADDENDUM dated 02/07/2025. It is to certify that this medicine is available on the Rate Contract of ESIC RC No.159 & 160. Further, this medicine is not in the stock of ESI Dispensary/Hospital.

Updated lines - (FOR FACTOR VIII)

Require medicine available to ESIC RC No. 166 / item No. 2643/2645 ref to DG-ESIC CENTRAL RATE CONTRACT NO. -166 FOR SUPPLY OF DRUGS & DRESSINGS (VALID FROM 11th DECEMBER, 2025 to 10th DECEMBER,2027), It is to certify that this medicine is available on the Rate Contract of ESIC RC No.166 . Further. this medicine is not in the stock of ESIC Dispensary/Hospital

Updated lines - (FOR FACTOR IX)

Require medicine available to ESIC RC No. 166 / item No. 1451 ref to DG-ESIC CENTRAL RATE CONTRACT NO. -166 FOR SUPPLY OF DRUGS & DRESSINGS (VALID FROM 11th DECEMBER, 2025 to 10th DECEMBER,2027), It is to certify that this medicine is available on the Rate Contract of ESIC RC  No.166 . Further. this medicine is not in the stock of ESIC Dispensary/Hospital