Documents

Dispensary OPD slip (Referral slip from dispensary to hospital) – Printed
ESI Hospital _________ OPD slip
Referral slip from ESI Hospital ____________ to Higher Institute (Pvt emp., PGI, GMCH etc.)
Prescription / OPD slip of Higher Institute
Medical Board form + patient photo (attested by SMO)
ESI card, Eligibility form, Aadhaar card
History Sheet
Medicine demand with RC no. (by specialist / Dispensary)
Self declaration form
Application by IP
Consumption Certificate

kindly take two photos of Patient and two of IP.