ECHS REFERRAL PROCEDURE 1. Reference ... - Indian Army

ECHS REFERRAL PROCEDURE
1. Reference Government of India, Ministry of Defence letter No 24(8)/03/US(WE) / D
(Res) dated 19 Dec 03.
2. A number of requests and representations have been received from ex-servicemen
organisation and environment to review the referral system in ECHS in view of the following : -
(a) Inconvenience and hardships to the patients who have to shuttle between Polyclinic
and service hospital for consultation/referral for speciality / super speciality. The
problem gets compounded because of old age and medical condition of the ECHS
beneficiaries.
(b) The issue of hardships faced by veterans on account of present referral system was
brought out by the Army Commanders during the Army Commanders Conference in Apr
09.
(c) DGAFMS/DGMS (Army) has highlighted that medicare of serving soldiers and their
dependents was suffering because of excessive load of ECHS beneficiaries on
Army/Base/Zonal hospitals.
(d) Deliberations during ECHS Seminar at Chandimandir on 16 Jul 09 substantiated
above problems.
(e) A large number of policy letters on referral system / procedure have been issued
since inception of the scheme by this Organisation. A requirement has been felt to
amalgamate all the letters into one comprehensive letter for convenience of all ECHS
functionaries and Veterans.
3. Review of ECHS referral system has accordingly been included as one of the priority
issues in the ‘Time Bound Action Plan’ to give momentum to ECHS as directed by COAS.
4. Revised ‘Referral Policy’ for NCR as been issued vide our letter No
B/49774/AG/ECHS/Referral dated 10 Aug 09 (Copy encl as Encl 1). Guidelines for referrals to
service / empanelled facilities by ECHS Polyclinics (less NCR) are laid down in succeeding
Paras.
Categorisation of Polyclinics for Referrals
5. The Polyclinics are categorised as Military / Non – Military primarily based on support
they get from service hospitals. The initial listing however has included certain Polyclinics
located in military stations without service hospital as Military Polyclinics. A case has been
taken up with the Government (Ministry of Defence) for conversion of these Polyclinics to Non-

Military Polyclinics. For the purpose of referrals for treatment these Polyclinics will follow the
procedure applicable to Non-Military Polyclinics.
Treatment at Polyclinics
6. Referral from Polyclinics will only be made once all available facilities of the Polyclinics
are fully utilized. Those patients needing additional diagnostic tests/consultation/hospitalisation
should be referred beyond the ECHS Polyclinics.
Authority for Referral to Empanelled Facility
7. Referrals to empanelled facilities will be generated from ECHS Polyclinics. The choice of
empanelled facility will be with the ECHS member. Authority to initiate referrals will be
as follows :-
(a) Referral for General Service Specialities. For General Service Specialities, list
at Appendix ‘A’ attached, Polyclinic Medical Officers, Specialists and Dental Officers (for
dental treatment) are authorised to initiate referrals.
(b) Referral for Specialised Services. Referral for specialized services, list at
Appendix ‘B’ attached, can only be made by a specialist at the Polyclinic or on advice
of concerned specialist of service hospital, subject to load, or concerned specialist of
local Government Hospital or concerned specialist of empanelled hospital (in the absence
of service hospital).
(c) Emergency Referrals. In case of emergency / life threatening conditions a
patient is permitted to take treatment in any hospital. However, if such an emergency
occurs while at Polyclinic, a Medical Officer of Polyclinic may directly refer a patient for
specialized treatment / tests so that emergent medical attention is not delayed. In such
cases, a certificate to this effect will be endorsed by the referring Medical Officer.
(d) Authentication and Endorsement. All referrals from ECHS, Polyclinic will be
authenticated by OIC Polyclinic under his stamp. He will also endorse non-availability of
spare capacity in service hospitals. The endorsement should state as under (a rubber
stamp may be used for the purpose) :-
(i) Military Stations with Service Hospitals. "Verified that beds / speciality
/ facility is Not Available in the local service hospital at present".
(ii) Non – Military Stations/ Military Stations without Service
Hospitals. "There is no service hospital located in the station".
Procedure for Referrals
8. Referral from Military Polyclinics (with Service Hospitals).

(a) The stipulation of referral to service hospital before referring a patient to
empanelled hospital is primarily to economize on the meager resources of the state.
Intention of initial referrals to service hospitals to the ‘extent possible’ is to utilize the
spare capacity, without causing harassment to the veterans or overloading the service
hospital.
(b) In order to avoid undue inconvenience to the patients, following guidelines will be
adhered to :-
(i) Patients must be referred directly to civil empanelled facilities by Medical
Officer / Medical Specialist (as applicable) at ECHS Polyclinics in case of
‘overloading’ or non-existence of medical facilities at the service hospital.
(ii) Patient will be referred to service hospitals only for those diseases for which
facilities exist in the service hospital. All OIC ECHS Polyclinics must possess a list
of such facilities.
(iii) At times the facilities for a disease may exist in a service hospital but it may
be overloaded / bed space may not be available. Such information must be
provided by SEMO to the OIC ECHS Polyclinics under their SEMO cover on a
regular basis.
(iv) A list of specialities with a check box against each is attached as Appendix
‘C’. The same is to be completed by SEMOs and forwarded to the ECHS Polyclinics
under their SEMO cover. OIC ECHS Polyclinic should be in touch with the
concerned Senior Registrar of Command / Zonal Hospital and CO of smaller
hospitals to regularly update the information. In this connection, also refer to
DGMS (Army) letter Nos B/75068/DGMS-5B/ECHS dt 27 Dec 2006 and
B/75086/DGMS-5B/ESM dt 31 Mar 08 (copies encl as Encl 2 and Encl 3).
(c) To the extent possible, a service hospital of the station should NOT refer the
patient to service hospital of a different station, unless in the opinion of the concerned
specialist, such a step is in the interest of the patient. Hence, once a patient is referred
to a service hospital, the patient will either be treated in the service hospital or
outsourced locally to a civil empanelled facility of patient’s choice in that station through
the ECHS Polyclinic.
9. Referral from Non - Military Polyclinics (Including Military Polyclinics without
Service Hospitals).
(a) For the purpose of referrals Military Polyclinics without service hospitals, list
attached at Appendix ‘D’, will follow the procedure applicable to Non Military
Polyclinics.
(b) ECHS patients will be referred to civil empanelled facility having valid MOA with
the Station Headquarters as per instructions contained in Para 7 above.

(c) In absence of local empanelled facilities, direct referrals by Non – Military
Polyclinics to service hospitals in nearby stations are permitted except to Army Hospital
(Research & Referral).
(d) A patient can be referred directly to empanelled facility in nearby city provided the
Station Commander of originating Polyclinic has a valid MOA with the concerned
hospital. Such cross-empanelment is essential to widen the network of referral facilities.
The Station Commanders must proactively liaise with empanelled facilities of nearby
stations and sign MOA for commencement of direct referral to such facilities.
Headquarters Commands must intervene and facilitate this process of cross
empanelment.
(e) Till the time instructions on cross-empanelment are implemented all referrals to
outstation empanelled facilities will be routed through the local ECHS Polyclinic of that
town / station. The outstation referral will be stamped and authenticated by the OIC
Polyclinic of the station where the empanelled facility exists before treatment is started.
e.g. if an ECHS member at Bhatinda is required to be referred to a outstation hospital
for Cancer therapy because there is no facility available in his town, the ECHS Polyclinic
at Bhatinda will initiate a referral for treatment at an empanelled facility at
Ludhiana/Amritsar. ECHS Member will register himself/herself with the Polyclinic at
Ludhiana/Amritsar and get his/her referral form duly stamped and countersigned by the
OIC Polyclinic before the patient takes treatment at the empanelled cancer hospital at
Ludhiana/Amritsar. Cross - empanelment of cancer hospital at Ludhiana/Amritsar by
Station Commander, Bhatinda would have clearly saved the bother of the patient going
through high pressure Polyclinics of Ludhiana/Amritsar. Travel expenses in all such cases
will be regulated as per Para 12(a) of Govt of India, Ministry of Defence letter No
24(8)/03/US(WE) D/Res dated 19 Dec 03.
10. Use of Referral Form. The referrals to empanelled facilities will be made by the
authorized Medical Officers/ Specialists in the Polyclinics on ECHS Referral Form only. A
format of the referral form is attached at Appendix ‘E’. The referral form will be duly stamped
with the seal of the Polyclinic and will clearly outline a brief history of the case, the diagnosis,
the hospital/diagnostic centre to which the ECHS beneficiary has been referred, and the
specific treatment procedure/investigation for which the referral has been made. This
procedure is required to be followed diligently so that the empanelled hospitals do not
undertake unauthorized treatment on the ECHS members. The original referral form is to
accompany bills subsequently presented by the empanelled facility except in conditions
mentioned in para 17. Referrals should clearly indicate the requirement as follows :-
(a) If referral is desired for consultation only, then it should read-‘Referred for
Consultation’.
(b) In case, the referral is for consultation and is to include investigations which the
consultant may order, the same should be endorsed in the referral form as - ‘Referred
for Consultation/Investigations’.

(c) In the event a review is required for some treatment/procedure carried out earlier,
the referral may be endorsed as - ‘Referred for Review/Follow-up’ (Includes
consultation and investigations).
11. The details in Para 8 and 10 above are given in a diagrammatic form at Appendix ‘F’
attached.
Emergencies
12. In emergencies and life threatening conditions, when patients may not be able to follow
the normal referral procedure, they may be admitted to the nearest hospital.
13. In case of admission to an empanelled hospital, the member would be required to
produce his/her ECHS card as proof of ECHS membership. In such circumstances the
empanelled hospital is required to inform the nearest Polyclinic of Station HQ having MOA with
the empanelled hospital concerned, within a period of two working days, regarding the
particulars of the ECHS patient and the nature of emergency. The OIC Polyclinic will make
arrangements for verification of facts and issue a formal ‘Emergency Referral’ (Referral form at
Appendix ‘E’ with ‘Emergency’ stamped on it to be used). Payment of bills will be made by
ECHS and the member is not required to pay.
14. In case of admission to a non-empanelled hospital, the ECHS beneficiary or his/her
representative should inform nearest Polyclinic /Parent Polyclinic/ nearest ECHS Regional
Centre/ Central Organisation (e-mail ID mdechs@bol.net.in) within two working days of such
admission. OIC of nearest Polyclinic will make arrangements for verification of facts and issue
Emergency Information Report (EIR) as per format attached as Appendix ‘G’ on receipt of
information from representative of ECHS beneficiary/ OIC Parent Polyclinic/Regional
Centre/Central Organisation. The responsibility for clearing bills in such cases will rest with the
ECHS member. He/she may thereafter submit the bills alongwith summary of the case and
other documents to the parent Polyclinic. The sanction for reimbursement of such bills has
been delegated to Competent Financial Authorities by the Central Organisation ECHS letter No
B/49778/AG/ECHS/Policy dt 19 Aug 2008 as amended vide letter No B/49773/AG/ECHS/Policy
dt 01 Dec 2008 (copies enclosed as Encl 4 and Encl 5). Such bills will be submitted within a
period of one month from the date of discharge from hospital.
15. While being treated in emergency, if another test/procedure is to be carried out on
account of new illness/complication, treatment of which cannot be deferred, the same may be
undertaken in the hospital and fresh referral is not required. Need for additional procedure
undertaken in emergency is to be elaborated in clinical summary submitted with the bills.
16. Policy already exists for permitting Haemodialysis as an emergency in a non empanelled
hospital (Central Org ECHS letter No B/49770/AG/ECHS dated 26 May 2009 : enclosed as Encl
6). The requirement of obtaining Emergency Certificate from the Hospital and subsequent EIR
from the ECHS Polyclinic is therefore dispensed with. Further, if Haemodialysis is undertaken
on an OPD/Day Care basis there will be no requirement of attaching discharge

summary/certificate signed by the Medical Supdt/Hospital Signatory with the claim for
reimbursement.
Follow-up Treatment/Reviews
17. In cases where regular follow-up/reviews are required, such follow-up treatment,
(OPD/Indoors) will be provided for periods of one month at a time. Referral form in such cases
should mention the same e.g., ‘Referred for follow-up treatment for a period of one
month.’ Fresh referral has to be initiated on termination of the 1 month period.
18. The same provisions will apply for cases where treatment procedures are to be repeated
at regular intervals as an ongoing process, e.g., cases requiring dialysis or regular long term
physiotherapy. The referral should read as ‘Referred for Haemodialysis, 3 sessions per
week for a period of one month.’
19. In case of mil-Polyclinics referrals for follow up treatment for the same ailment should
not be routed through the service hospitals.
20. The original referral form will be attached alongwith the first lot of bills in all such cases.
A photocopy of the referral form will be attached with subsequent bills for the same referral,
with an endorsement by the hospital linking the case to the original referrals.
Oncology Referrals
21. In order to rationalize Oncology referrals, the following procedures will be implemented :-
(a) All patients reporting initially to ECHS Polyclinic and suspected / confirmed to be
suffering from cancer should first be referred to a Oncology Centre of a service hospital
(if available locally) or in the absence of service hospital with Oncology Dept, to an
empanelled hospital recognized for oncology where registration, work-up and treatment
planning can be carried out.
(b) Patients requiring surgery as part of their multi-modality treatment will be treated
in the service hospital (subject to availability of spare capacity) or the empanelled
hospital (recognized for onco surgery). If facility is not available locally, patient will be
referred to the nearest service hospital/empanelled facility where such a facility is
available.
(c) Patient requiring Chemotherapy/Radiotherapy (RT) will be issued a referral to local
service hospital with Onco Dept (subject to load) or ECHS empanelled Onco centres
once only for the entire duration of treatment.
(d) The stipulation of one month validity for referral forms will not apply for Oncology
cases prescribed Chemotherapy/Radiotherapy.
End Stage Disease

22. In certain cases where the medical finality has been reached and active treatment is
over, the patient would require rehabilitative care/terminal care. Such patients should be
transferred to an appropriate empanelled institution like a Rehabilitation Centres or a Hospice.
Hospitalisation in non-empanelled hospices/terminal care centres has been permitted vide our
letter No B/49771/AG/ECHS/Policy dated 07 Aug 09, with a view to reduce expenditure on
prolonged hospitalisation of such patients. Treatment in such an Institute is permitted for a
maximum period of six months.
Period of Hospitalisation
23. Where a patient is admitted for specific treatment, he will be hospitalized for such period
only as is necessary for completion of the treatment. For treatments, specialized procedures or
diagnostic tests for which Package rates are specified, the periods of hospitalisation should not
exceed the following limits, under ordinary circumstances :-
(a) Specialised procedures - 12 days.
(b) Other procedures - 08 days.
(c) Laparoscopic surgery - 03 days.
(d) Day care/minor procedures - 01 day.
24. In case the beneficiary has to stay in the hospital for his/her recovery for more than the
period covered under package rates, the additional payment will be limited to room rent as per
entitlement, cost of the prescribed medicines and investigations, doctors visits (not more than
2 times a day).
25. Referral for ECHS Members in Remote/Hilly Area.
(a) Representations have been received from the environment that ECHS beneficiaries
residing in remote/hill areas face great inconvenience for getting referrals even for minor
ailments from their nearest Polyclinics due to difficult terrain/distance involved.
(b) ECHS beneficiaries are permitted to avail the facilities/services of nearest Govt
Health Care Centres/Primary Health Centre/Government Hospitals (deemed
empanelled)without prior referral from the Polyclinic as elucidated in this HQ letter No
B/49774-P/AG/ECHS/Referral dt 05 Apr 07 and letter No B/49774-P/AG/ECHS/Referral dt
25 Apr 07 (copy enclosed as Encl 7 and Encl 8).
(c) Regional Centre, ECHS and HQ Comds may as and when required review areas to
be declared remote for the above purpose and forward their recommendations for
addition/delition to Central Organisation for approval.
26. Referral to Reputed Hospitals for planned Treatment.

(a) Presently, ECHS beneficiaries are referred from ECHS Polyclinic to various
empanelled hospitals / diagnostic centres / dental centres, to avail cashless medical
treatment. In emergency, they can avail medical facilities at any hospital. In case of
non-empanelled hospital, the individual has to make payment and claim re-imbursement
at ECHS rates.
(b) Certain private reputed hospitals, viz, Sir Ganga Ram Hospital, Rajiv Gandhi
Cancer Institute, Indraprastha Apollo Hospital and VIMHANS, had signed MOA with
ECHS but later terminated the MOA. Patients had to pay to get treatment from such
hospitals (deemed non-empanelled). Re-imbursement was not permitted to individual
and piecemeal sanctions were issued to tide over such contingencies.
(c) ECHS members may be referred to such hospitals for planned procedures on
merits of the case. Approval for such referrals would be granted on case to case basis by
Central Organisation, ECHS based on
recommendations by Medical Officer/Specialist at the Polyclinic, OIC Polyclinic and
concerned Regional Centre.
(d) Ex-Post-Facto sanction is not permitted. There is no provision for waiver to such a
sanction.
(e) The cost of treatment would be borne by ECHS member. Reimbursement would be
limited to ECHS approved rates.
(f) TA/DA will NOT be entitled in such cases.
27. Treatment at Medical Institute of National Repute. Admission/ treatment in the
Institutes of National repute listed below is permitted. In case ESM or their dependents are
referred by ECHS Medical Officer/Specialist to any of the Institutes mentioned below, an
advance in the form of a crossed cheque payable to the concerned hospital will be drawn by
the patient from the concerned Station Headquarter after submitting the referral form by an
ECHS Polyclinic and estimate from the concerned hospital. The hospitals where such an
arrangement is permitted are as follows :-
(a) All India Institute of Medical Sciences, New Delhi.
(b) Post Graduate Institute, Chandigarh.
(c) Sanjay Gandhi Post Graduate Institute, Lucknow.
(d) National Institute of Mental Health and Neurosciences, Bangalore.
(e) Tata Memorial Hospital, Mumbai (for Oncology)
(f) JIPMER, Pondicherry.

(g) Christain Medical College, Vellore.
(h) Shankar Nethralaya, Chennai.
(j) Medical Colleges and Hospitals under the Central or State Governments.
28. Our following letters are hereby superseded :-
(a) Central Organisation ECHS letter No B/49774/AG/ECHS/Referral dated 01 Sep 04.
(b) Central Organisation ECHS letter No B/49774/AG/ECHS dated 03 Mar 05.
(c) Central Organisation ECHS letter No B/49774/AG/ECHS dated 27 May 05.
(d) Central Organisation ECHS letter No B/49764/AG/ECHS dated 05 Nov 05.
(e) Central Organisation ECHS letter No B/49774/AG/ECHS dated 23 Aug 06.
(f) Central Organisation ECHS letter No B/49774-P/AG/ECHS/Referral dated 04 Apr 07.
(g) Central Organisation ECHS letter No B/49770-P/AG/ECHS/Referral dated 05 Apr 07.
(h) Central Organisation ECHS letter No B/49774/AG/ECHS/Referral dated 27 Jun 07.
(j) Central Organisation ECHS letter No B/49774/AG/ECHS/Referral dated 13 Jul 07.
(k) Central Organisation ECHS letter No B/49774/AG/ECHS/Referral dated 17 Jul 07.
(l) Central Organisation ECHS letter No B/49774/AG/ECHS/Referral dated 22 Oct 07.
(m) Central Organisation ECHS letter No B/49774/AG/ECHS/Referral dated 21 Aug 08.
(n) Central Organisation ECHS letter No B/49774/AG/ECHS dated 23 Apr 09.
Appendices :- ‘A’ - List of General Service Facilities.
‘B’ - List of Specialised Services.
‘C’ - List of Specialities with Check Box.
‘D’ - List of Polyclinics without Service Hospitals.
‘E’ - Format of the Referral Form.
‘F’ - Diagrammatic Form of ECHS Referral Flow Chart.
‘G’ - Format of the Emergency Information Report.
(A Srivastava)
Maj Gen
MD ECHS

Encls :-
1. Central Org ECHS letter No B/49774/AG/ECHS/Referral dt 10 Aug 09.
2. DGMS (Army) letter No B/75068/DGMS-5B/ECHS dated 27 Dec 06.
3. DGMS (Army) letter No B/75086/DGMS-5B/ESM dated 31 Mar 08.
4. Central Organisation ECHS letter No B/49778/AG/ECHS/Policy dt 19 Aug 2008.
5. Central Organisation ECHS letter No B/49773/AG/ECHS/Policy dt 01 Dec 08.
6. Central Organisation ECHS letter No B/49774-P/AG/ECHS/Referral dt 05 Apr 07.
7. Central Organisation ECHS letter No B/49774-P/AG/ECHS/Referral dt 25 Apr 07.
8. Central Organisation ECHS letter No B/49770/AG/ECHS dt 26 May 2009.
Copy to :-
DGAFMS/DG 3(A)
DGMS (Army)/DGMS 5(B)
DGMS (Navy)/Dir ECHS
DGMS (Air)/DMS(MB) (Med-7)
All Regional Centres, ECHS
Internal
Ops & Coord
P&FC

LIST OF GENERAL SERVICE SPECIALITIES
Appendix ‘A’
(Refer to Para 7(a) of letter No
B/49774/AG/ECHS/Referral
dt ____ Dec 2009)
Type of Speciality Type of Speciality Type of Speciality
General Medicine General Surgery Obstetrics and
Gynaecology
ENT Ophthalmology Paediatrics
Emergency Services Psychiatry Dermatology
Dental Anaesthesia Pathology
Microbiology Blood Bank (Blood
Transfusion)
LIST OF SPECIALIZED SERVICES
Radio diagnosis
Appendix ‘B’
(Refer to Para 7(b) of letter No
B/49774/AG/ECHS/Referral
dt ____ Dec 2009)
Specialised Services Specialised Services Specialised Services
Surgery Medicine Obstetrics and
Gynaecology
Neuro Surgery Neuro Medicine Gynaecological
Oncology
Plastic and
Reconstructive Surgery
Cardiology Infertility and assisted
reproduction
Cardio Thoracic Surgery Respiratory Diseases Gynaecological

Endocrinology
Vascular Surgery Gastro enterology Materno foetal Medicine
Genito Urinary Surgery Endocrinology
Paediatric Surgery Nephrology Paediatrics
Oncology (Surgery) Rheumatology Neonatology
Gastro Intestinal
Surgery
Clinical Haematology Cardiology
Traumatology Clinical Immunology Neurology
Joint Replacement
Surgery
Oncology (Medical) Haematology
Spinal Surgery Critical care medicine Nephrology
Prosthetic Surgery Interventional
Cardiology
Laparascopic Surgery Medical Genetics
Endovascular Surgery Geriatric Medicine
Oncology
Geriatric Surgery Radiotherapy Pathology
Radio Diagnosis &
Imaging
Onco Pathology
Molecular Pathology
CT Scan Transplant Pathology
MRI AIDS & Virology
Interventional and
Vascular Radiology
Molecular Immuno
Pathology
Genetic Pathology
Transfusion Medicine

FACILITY AVAILABLITY IN SERVICE HOSPITALS
NAME OF POLYCLINIC : _________________________________
NAME OF HOSPITAL : ___________________________________
A. GENERAL SERVICES
Appendix ‘C’
(Refer to Para 8(b) (iv) of letter
No B/49774/AG/ECHS/Referral
dt ____ Dec 2009)
Type of Speciality Type of Speciality Type of Speciality
General Medicine General Surgery Obstetrics and
Gynaecology
Opthalmology Paediatrics
Dermatology
Dental Pathology
Orthopaedics Blood Bank(Blood
transfusion)
B. SPECIALIZED SERVICES
Radio diagnosis
Specialised Services Specialised Services Specialised
Services
Surgery Medicine Obstetrics &
Gynaecology
Neuro Surgery Neuro Medicine Gynaecology Oncology
Plastic and
Reconstructive Surgery
Cardiology(consultation
and diagnostics)
Cardio Thoracic Surgery Interventional
Cardiology
Vascular Surgery Gastro enterology
Infertility and assisted
reproduction
Genito Urinary Surgery Endocrinology Paediatrics
Paediatric Surgery Nephrology Neonatology
Oncology ( Surgery) Rhematology

Gastro Intestinal Surgery Clinical Haematology
Traumatology Clinical Immunology
Joint Replacement
Surgery
Oncology (Medical)
Prosthetic Surgery Respiratory Diseases
Laparascopic Surgery Radiotherapy
Geriatric Surgery Nuclear Medicine Pathology
Onco Pathology
Transfusion Medicine
Other (Specify)
CT Scan Orthodontia
MRI Prosthodontia
Oral Surgery
Other
Dated: (Signature of CO/Comdt
Hospital/Designated Offr)
Note : PLEASE MARK AGAINST SPECIALITIES FOR WHICH ECHS PATIENTS CAN BE REFERRED.
PLEASE MARK AGAINST SPECIALITIES FOR WHICH SPARE CAPACITY IS NOT AVAILABLE.

Ser No Polyclinic
1. Janglot
2. Moga
3. Sangrur
4. Sirsa
5. Jaisalmer
6. Ajmer
Appendix ‘D’
(Refer to Para 9(a) of letter No
B/49774/AG/ECHS/Referral
dt ____ Dec 2009)
LIST OF MILITARY POLYCLINICS WITHOUT SERVICE HOSPITAL
7. Saharanpur (Sarsawa)
8. Bharatpur
9. Balasore
10. Nagpur
11. Yelahanka
12. Dimapur
13. Shajahanpur
14. Kotdwara
15. Haldwani
16. Mumbai (Upnagar) Powai

EX-SERVICEMEN CONTRIBUTORY HEALTH SCHEME
ECHS POLYCLINIC …………………(Station)
REFERRAL FORM
Part I
OPD Regn No ……………………………… date ……………………
ECHS Card No ……………………………..
Name of patient ………………………… Age ……. Relationship with ESM ………….
Service No ………………….. Rank ………….. Name of ESM ………………………….
Tele No …………………………………..
Brief Clinical Notes
Provisional Diagnosis
Appendix ‘E’
(Refer to Para 10 of letter No
B/49774/AG/ECHS/Referral
dt ____ Dec 2009)
Vide Referral Serial No ………………………………….. the above named is referred for
(a) Admission ………………………………………………. (Specify)
(b) Investigation ………………………………………………. (Specify)
(c) Consultation for ………………………………………………. (Specify)
Referred to ……………………………………………………………………………………
(Specify Hospital, Nursing Home, Diagnostic Centre)

Place : Signature of Med Officer
(with stamp)
Dated :
OIC POLYCLINIC
* Travel reimbursement allowed (Yes/No).
* Attendant reimbursement allowed (Yes/No).
Place :
Dated :
Part II
SUMMARY OF THE CASE
(To be completed by the empanelled hospital, nursing home, diagnostic centre and
consultant)
Clinical Summary/Investigation Reports (for Diagnostic centres)

Final Diagnosis …………………………………….. ICD Code No …………………….
Treatment Summary
Place : (Signature and Stamp)
Date :
Part III
Final Disposal
(a) Admission to …………………………………………………………………………
(Specify Hospital, Nursing Home, Diagnostic Centre)
(b) To follow treatment as specified.
Place : Signature of Med Officer ECHS
with stamp
Dated :

Specialists Medical Dental
E
On Advice of Concerned M
- Specialists Polyclinics E
ECHS REFERRAL FLOW CHART
Medical Officer Officer
Gynaec
- Specialists Service Hospitals R
- Specialists Govt Hospital G
- Specialist Empanelled Facility E
N
C
General Service Specialised Service Y
VERIFICATION
OF ECHS
MEMBER
Further Diagnostic Tests / Treatment / Hospitalisation Required
Appendix ‘F’
(Refer to Para 11 of letter No
B/49774/AG/ECHS/Referral
dt ____ Dec 2009)

Is facility
available
in Service
Hospital On Advice of :-
MO Polyclinics / Specialist
Polyclinic
Yes No
Choice of Patient
Spare
capacity
to
treat Empanelled Facility
ECHS
patient
Yes No
Service Hospital
in Station

Appendix ‘G’
(Refer to Para 14 of letter No
B/49774/AG/ECHS/Referral
dt ____ Dec 2009)
ECHS POLYCLINIC,_______________________________
Particulars of ECHS member
EMERGENCY INFORMATION REPORT (EIR)
(To be issued by OIC Polyclinic)
ECHS No ______________________ Date of membership ________________
Service No ______________ Rank ____________ Name __________________
Patient Particulars
Name _______________________ Relationship _____________ Age _________
Diagnosis _________________________________________________________
Emergency Detail
1. Provisional Diagnosis :
2. Name of Hospital :
3. Date and Time of Admission :
4. Date and Time Information Received at Polyclinic :
5. Remarks.
Regd No
Date : Signature of OIC Polyclinic
(Affix Polyclinic Stamp)

Encl ‘1’
(Refer to Para 4 of letter No B/49774/AG/ECHS/Referral dt ____ Dec 2009)
Tele: 25684945 Central Organisation, ECHS
ASCON: 6833 Adjutant General's Branch
Army Headquarters
Maude Lines
Delhi Cantt-110010
B/49774/AG/ECHS/Referral 10 Aug 09
Air HQ (VB), DPS
HQ Western Command (A ECHS/Med)
REFERRAL TO EMPANELLED HOSPITALS IN DELHI/NCR
1. A number of requests and representations had been recd from ex-servicemen orgs and
environment to review the referral system in ECHS in view of the following :-
(a) Inconvenience and hardships to the patients from ECHS Polyclinics (non-mil) who have to
shuttle between Polyclinic and MHs for consultation/referral for speciality/super speciality. The
problem gets compounded because of old age and medical condition of the ECHS beneficiaries.
(b) The issue of hardships faced by our veterans on acct of present referral system was brought out
by the Army Cdrs during the Army Cdrs Conf in Apr 09.
(c) DGAFMS/DGMS (Army) had highlighted that service to serving soldiers and their dependents
was suffering because of excessive load of ECHS beneficiaries on Army/Base/Zonal hospital OPDs.
(d) Deliberations during ECHS Seminar at Chandimandir on 16 Jul 09 substantiated above
problems.
2. Review of ECHS referral system had accordingly been included as one of the priority issues in the
‘Time Bound Action Plan’ to give momentum to ECHS as directed by COAS.
3. Earlier ECHS policy governing referrals had been formulated with the aim of controlling excessive
referrals to empanelled hospitals through evaluation of patient by a Service Specialist as also to ensure
that spare capacity of service hospitals is fully utilized. This was necessary for a mega-medical scheme
during its stabilization phase. While the scheme is yet to see its final state, it has now become inescapable
to review and refine the referral system. The review primarily covers ECHS Polyclinics (non-mil) or those
without service hospitals. Revised policy is contained in succeeding paras.
4. The revised referral policy in respect of Polyclinics in Delhi/NCR will as follows :-
Ser No NAME OF POLYCLINIC POLICY OF REFERRAL
(a) Delhi Cantt and Lodhi
Road
All referrals to empanelled hospitals in
NCR having MOA with Stn Cdr will be
subject to non availability of spare
capacity with Base Hospital/Army Hosp
(R&R).

(b) Noida, Gurgaon &
Faridabad
(i) Direct referral to empanelled hospitals
in NCR having MOA with Stn Cdr.
(ii) Cases for Jt Replacement will be
referred to Army Hospital (R&R) for
evaluation.
(c) Hindan (i) All referrals to empanelled hospitals in
NRC having MOA with Stn Cdr, will be
subject non-availability of spare capacity
with 11 AFH.
(ii) Cases for Jt Replacement will be
referred to Army Hospital (R&R) for
evaluation.
5. Referral will only be made once all available facilities of the Polyclinic are fully utilized. Choice of
empanelled hospital/ diagnostic centre will with the ECHS member.
6. ECHS Cells have been established at Army Hosp (R&R) and Base Hosp Delhi Cantt. Prior written
intimation by the ECHS Cells about non-availability of Specialist/facilities / bed space for a particular
duration will become an authority for OsIC Polyclinics Delhi Cantt, Lodhi Road and Hindan to refer patients
directly to empanelled hospitals.
7. On remarks by the service specialists of Army Hosp (R&R)/BHDC indicating treatment from
empanelled hospital, ECHS Cell at these hospitals will directly refer patients to the empanelled hospital of
patient’s choice. Photocopy / fax of such referral form will be forwarded to the originating ECHS Polyclinic.
8. In case veteran desires to be treated at Service Hospital, referral will be made to Army Hospital
(R&R) / Base Hospital Delhi Cantt / 11 AFH as per his choice.
9. The above policy will be implemented with effect from 01 Sep 09. Following letters are hereby
superseded :-
(a) B/49774/AG/ECHS dated 23 Aug 2006.
(b) B/49774/AG/ECHS/Referral dated 18 May 2009.
(c) B/49774/AG/ECHS/Referral dated 01 Jul 2009.
10. The policy shall be reviewed after six months.
Sd/- x x x x x x x
(A Srivastava)
Maj Gen
MD ECHS

Copy to :-
Integrated HQ MoD (Navy)
HQ WAC, Subroto Park (PMO)
HQ Delhi Area, Delhi Cantt -10
Army Hosp (R&R), Delhi Cantt -10
Base Hospital Delhi Cantt – 10
Regional Centre ECHS, Delhi Cantt -10
Encl ‘2’
(Refer to Para 8(b)(iv) of letter No
B/49774/AG/ECHS/Referral
dt ____ Dec 2009)
Tele : 23094763 Dte General of Med Services (Army)
Adjutant General’s Branch
Army Headquarters
‘L’ Block, New Delhi – 110 001
B/75068/DGMS-5B/ECHS 27 Dec 2006
HQ Southern Command (Med)
HQ Eastern Command (Med)
HQ Western Command (Med)
HQ Central Command (Med)
HQ Northern Command (Med)
HQ South Western Command (Med)
BED AVAILABILITY AT SERVICE HOSPITAL FOR ECHS MEMBERS
1. Further to this HQ letter No B/75068/DGMS-5V dt 02 May 2006.
2. It has been observed that ECHS member on being referred to service hospital by the ECHS
Polyclinics could not be treated at times in these hospitals due to non availability of concerned

specialist facility/beds/specialist. This leads to an avaidable inconvenience to the ECHS
members. In order to overcome this communication gap, all Senior Registrars/COs of the
hospitals mentioned at appendix ‘A’ will keep themselves updated daily on the availability of all
specialist officers/beds in their respective hospitals. The same will also be communicated to
the OIC Polyclinic daily to avoid referral to the specialist who is not available and also to avoid
admitting a patient when a bed is not available.
3. The OIC Polyclinic in turn will also confirm the availability of the concerned specialist
facility/bed from the Senior Registrar/CO of the hospitals before the ECHS members are
referred to the service hospitals. In hospitals where only one specialist is available leave roster
of the concerned specialists will be fwd to the OIC Polyclinic.
4. In case the concerned specialist facility/bed is not available in the Service hospital, the
ECHS member will be referred to the empanelled facility by the OIC Polyclinic directly.
Copy to :-
Cent Org ECHS
Maude Line
Near Old Base Hosp
Delhi Cantt
Sd/-x-x-x-x-x-x-x-x
(Suresh Hiwale)
Lt Col
JDMS (ESM Cell)
For DGMS (Army)

Encl ‘3’
Appendix ‘A’
BED AVAILABILITY AT SERVICE HOSPITAL FOR ECHS MEMBER
Srl No NAME OF HOSPITAL COMMAND
1. CH (SC)
2. MH TRIVANDRUM SOUTHERN COMMAND
3. MH CHENNAI
4. MH SECUNDERABAD
5. CH(EC) EASTERN COMMAND
6. 151 BH
7. CH WC
8. AH (R&R)
9. BH DELHI CANTT WESTERN COMMAND
10. MH JALANDHAR
11. MH AMRITSAR
12. 166 MH
13. MH AMBALA
14. CH(CC) CENTRAL COMMAND
(Refer to Para 8(b)(iv) of letter No
B/49774/AG/ECHS/Referral
dt ____ Dec 2009)
Tele : 23094763 Integrated HQ of MoD (Army)
Adjutant General Branch

Dte General of Med Services (Army)
‘L’ Block, New Delhi – 110 001
B/75086/DGMS-5B/ESM 31 Mar 2008
Headquarters
Southern Command (Med)
Eastern Command (Med)
Western Command (Med)
Central Command (Med)
Northern Command (Med)
South Western Command (Med)
ECHS REFERRAL POLICY STATIONS
1. Refer this Dte Gen letter No B/75068/DGMS-5B/ECHS dated 27 Dec 2006 (Copy enclosed).
2. It has been observed that despite clear cut instructions on the subject, representations are
still being received at this Dte Gen that patients have to make several unnecessary trips to
service hospitals for specialist opinion/referral to empanelled hospitals.
3. You are requested to disseminate the contents of the letter so as to ensure that ECHS
Members do not have to make unnecessary trips to service hospitals.
Sd/-x-x-x-x-x
(PK Singh)
Col
Dir MS (Health)
for DGMS (Army)

Copy to :-
Cent Org ECHS - for info wrt your note No B/49774/AG/ECHS/Referral
Adjutant General’s Branch dated 26 Feb 2008.
Maude Line
Delhi Cantt
Encl ‘4’
(Refer to Para 14 of letter No
B/49774/AG/ECHS/Referral
dt ____ Dec 2009)
24
Tele : 011- 25684945 Central Organization, ECHS
Mil : 36833 Adjutant General’s Branch
Integrated HQ of MOD (Army)
Maude Line
Delhi Cantt – 110 010
B/49778/AG/ECHS/Policy 19 Aug 2008
IHQ of MoD (Navy)/DGMS/(N) for OIC ECHS
Air HQs (VB)/AOA/DPS
HQs SC,EC,WC,CC,NC,SWC(A/Med)
HQs WNC,SNC & ENC
HQs WAC, CAC, EAC, TC, SWAC, & MC IAF

PROCEDURE FOR PAYMENT AND REIMBURSEMENT OF
MEDICAL EXPENSES UNDER ECHS
1. Reference GOI, MoD letter No 24(8)/03/US(WE)/D(Res) dt 19 Dec 2003 and this HQ letter
No B/49778/AG/ECHS/Policy dt 16 May 2007.
2. Presently, all individual medical bills are being processed through this HQ. It has been
decided that the time taken for processing of these bills needs to be reduced without
compromising on the efficiency of scrutiny.
3. Over five years of experience, the following problems have been noticed in the above
procedure :-
(a) The procedure is time consuming.
(b) Virtually no value addition after SEMO/Stn HQ level.
(c) Avoidable paper work and addl effort.
(d) Results in dissatisfaction amongst the veterans.
4. In order to overcome the above difficulties and based on the directions of Secy (ESW), the
authority is delegated to lower HQ since there is no loss to the State. Therefore, the individual
medical claims will also be processed and sanctioned like claims for reimbursement to
empanelled hospitals, by the appropriate CFA.
5. Diagrammatic representation of the revised system is att as per Appx `A’. For bills below Rs
2 Lakh, Regional Centres have been kept out of this loop to save time.
6. This procedure will be implemented with immediate effect. Bills already despatched to
Regional Center/Central Org, ECHS will be processed as done hithertofore.
7. Sanction by the CFA on behalf of Central Org, ECHS will be granted. A sample of the
sanction is attached as Appx `B’
8. Necessary amendments to Govt letter will be carried out after the overall review of ECHS.
Sd/-x-x-x-x-x-x
(KJS Makker)
Wg Cdr
Offg Dir(Med)
For Managing Director

Encls : (As above)
_________________ - Please ensure dissemination of above contents to all
(All Regional Centres) concerned under AOR.
Kendirya Sainik Board - For info.
Internal
Web JCO
Payment
Appx ‘A’
(Refer para 5 of letter
Central Org ECHS
letter No.
B/49778/AG/ECHS/Pol
icy dt 19 Aug 08)
REVISED CHANNEL OF PROCESSING OF INDIVIDUAL REIMBURSEMENT BILLS
1. Claims above 2 lakhs will be sent to Regional Centre (except RC, Chandimandir
and Regional Centre Delhi) as hithertofore.
2. Claims above 4 lakhs will be fwd to Central Org ECHS for further processing.

SANCTION OF CFA FOR
Appx ‘B’
(Ref Para 7 of Central Org ECHS letter
No B/49778/AG/ECHS/Policy dt
19 Aug 08)
EMERGENCY TREATMENT IN NON-EMPANELLED HOSPITAL
DEBITABLE TO MAJOR HEAD – 2076, MINOR HEAD – 107
SUB HEAD – F, CODE HEAD – 365/00
1. Under the provisions of Government of India, Ministry of Defence letter No
24(8)/03/US/(WE)/D(Res) dated 19 December 2003, on ‘Procedure for Payment and
Reimbursement of Medical Expenses" under ECHS, read in conjuction with Serial 1 of Appendix
to Govt of India, Ministry of Defence letter No 24(3)/03/US(WE)/D(Res)(i) dated 08 September
2003 and Central Org ECHS letter No B/49778/AG/ECHS/Policy dt 19 Aug 2008, sanction of
CFA is hereby accorded for payment to ________________
___________________________________ (Retd) as per the following details :-
(a) ECHS Card No/Regn No : _________________________
(b) Name of patient : _________________________
(c) Name of the Hospital : _________________________
_________________________
_________________________
(d) Period of Hospitalisation : _________________________
(e) Diagnosis : _________________________
_________________________
(f) Amount Sanctioned : Rs ______________________
(Rupees ______________________________________________ only)

File Ref : (Sanction of CFA)
Date
Encl ‘5’
(Refer to Para 14 of letter No
B/49774/AG/ECHS/Referral
dt ____ Dec 2009)
Tele : 011-25684945 Central Organization, ECHS
Mil : 6833 Adjutant General’s Branch
IHQ of MOD (Army)
Maude Line, Delhi Cantt – 10
B/49773/AG/ECHS/Policy 01 Dec 2008
IHQ of MoD (Navy)/DGMS/(N) for OIC ECHS
Air HQs (VB)/AOA/DPS
HQs SC,EC,WC,CC,NC,SWC(A/Med)
HQs WNC,SNC & ENC
HQs WAC, CAC, EAC, TC, SWAC, & MC IAF
1. Reference:-
PROCEDURE FOR PAYMENT AND REIMBURSEMENT
OF MEDICAL EXPENSES UNDER ECHS
(a) GOI, MOD letter No 24(8)/03/US(WE)/D(Res) dated 19 Dec 2003.

(b) This HQ letter No B/49778/AG/ECHS/Policy dated 16 May 2007.
(c) This HQ letter No B/49778/AG/ECHS/Policy dated 19 Aug 2008.
2. Following paragraph may be added to this HQ letter at para 1 (c) for allowing review and
reconsideration of the claims being rejected :-
Copy to :-
" In case any claim preferred by an ECHS member is not recommended, it will not
be rejected from any intermediate functionary due to any reason, whatsoever.
Claim will be fwd to Central Organisation, ECHS for review alongwith detailed
reasons for rejection"
Sd/-x-x-x-x-x-x-x
(AK Naik)
Lt Col
Jt Dir (Med)
For Managing Director
__________________________ - Please ensure dissemination of above contents to all
All Regional Centres ECHS concerned under AOR
Kendirya Sainik Board - For info please.
Internal :-
Web JCO
P & FC Sec
Encl ‘6’
(Refer to Para 16 of letter No
B/49774/AG/ECHS/Referral
dt ____ Dec 2009)
Tele: 011-25684945 Central Organisation ECHS
Mil: 233 36833 Adjutant General’s Branch
Integrated HQ of MoD
Maude Lines
Delhi Cantt –10

B/49770/AG/ECHS 26 May 2009
_________________
(All Regional Centres)
RE-IMBURSEMENT OF DIALYSIS CHARGES
1. In a Stn which does not have an empanelled facility for Haemodialysis, the treatment can permitted in
the non-empanelled hospital as a life saving treatment.
2. Haemodialysis can also be permitted in a non-empanelled hospital when the facility in an empanelled
hosp is not available to an ECHS member due to its limited capacity.
3. The following are the guidelines :-
(a) EIR should be raised by OIC Polyclinic with an endorsement stating that Haemodialysis is not
available in a Service/Empanelled hospital in the stn. Non availability of Haemodialysis in
empanelled hosp be examined with ref to provn of Para 2 above.
(b) Bills are to be processed for a period of one month at a time.
(c) The maximum amount admissible will be as per CGHS package applicable in the area or the
amount claimed, whichever is less.
4. This supersedes Central Organisation ECHS letter No B/49770/AG/ECHS dt 31 Oct 2007.
Copy to :-
All Comd HQs
Sd/-x-x-x-x-x-x
(KJS Makker)
Wg Cdr
Offg Dir (Med)
for Offg MD

Encl ‘7’
(Refer to Para 25 (b) of letter No
B/49774/AG/ECHS/Referral
dt ____ Dec 2009)
Tele: 011-25684945 Central Organisation ECHS
Mil: 233 36833 Adjutant General’s Branch
Integrated HQ of MoD
B/49774-P/AG/ECHS/Referral 05 Apr 07
IHQ of MoD (Navy)/DGMS (N) for OIC ECHS
Air HQ (VB)/AOA/DPS
HQs SC, EC, WC, CC, NC, SWC (A/Med)
HQs WNC, SNC & ENC
HQs WAC, CAC, EAC, TC, SWAC & MC IAF
MEDICAL CARE FOR ECHS BENEFICIARIES IN REMOTE/HILLY AREAS
Maude Lines
Delhi Cantt –10
1. Representations have been received from the environment that ECHS beneficiaries residing in
remote/hilly areas face great inconvenience for getting referrals even for minor ailments from their nearest
Polyclinics due to distance/terrain.
2. It has been decided that ECHS beneficiaries will henceforth be permitted to avail the facilities/services
or nearest Govt Health Care Centres/Primary Health Centre/Govt Hospitals (deemed empanelled) without
prior referral from the Polyclinic subject to the following conditions :-
(a) Distance from nearest Polyclinic should be more than 50 Kms.
(b) Applicable for residents of following states only :-
(i) Jammu & Kashmir.
(ii) Himachal Pradesh.
(iii) Uttranchal.

(iv) North Eastern States of Sikkim, Arunachal Pradesn, Mizoram, Manipur, Tripura and
Nagaland.
(v) West Bengal : District – Darjiling only.
(vi) Karnataka : District – Chikmagalur, Kodagu only.
(vii) Tamil Nadu : District – Nilgiris only.
(viii) Chattisgarh : Distt – Bastar and Dantewara only.
(ix) Orissa : District – Koraput only.
(c) Treatment permitted for maximum period of 07 days.
3. Parent Polyclinic will be notified of such treatment undertaken at the earliest (within two working days).
Info can be sent by person/telephone/mail/fax/telegram. Parent Polyclinic will generate a referral
immediately on receipt of information and attach the same with the claim when received. Claims for
reimbursement of expenditure incurred should be submitted to Parent Polyclinic within one month of
completion of treatment. The claim will include the following :-
(a) Application of claim by the member. Summary of case including diagnosis and outcome/further
advise by treating doctor/hospital to be enclosed.
(b) Photocopy of ECHS Smart Card/Regn Slip.
(c) Prescription/Clinical notes of treating doctor.
(d) Bills of medicines/investigations/treatment procedure in original duly authenticated by treating
doctor/hospital, alongwith a photocopy. In cases of treatment in Govt Hospitals, consultation is
normally free. Bills, therefore, would pertain to medicines and treatment/investigation charges only,
as applicable.
4. The bills will be processed by Parent Polyclinic as per procedure laid down vide this HQ letter No
B/49773/AG/ECHS dated 25 May 04 read in conjunction with this HQ letter No B/49773/AG/ECHS/R dt 28
Oct 04 for treatment in Govt Hospital and payment made through cash assignment of local Station
Headquarters. Sanction of Central Organisation, ECHS is not required.
5. In cases of Emergency, patients can get admitted to any hospital. Emergency bills will continue to be
processed as per existing instructions. Similarly in cases where further treatment is advised by local Govt
Hosp, and/or major treatment procedure is required, patient will be referred to suitable
Service/Empanelled Hospital through Parent Polyclinic as per existing procedure.

Sd/-x-x-x-x
(RK Kalra)
Maj Gen
MD ECHS
Copy to :-
DGAFMS/DG-3A
DGMS (Army)/DGMS 5(B) - for info please.
DGMS (Navy)
DGMS (Air Force
All HQ Area/Sub Area - Please disseminate the above contents to all
Encl ‘8’
(Refer to Para 25 (b) of letter No
B/49774/AG/ECHS/Referral
dt ____ Dec 2009)
Tele: 011-25684945 Central Organisation ECHS
Mil: 233 36833 Adjutant General’s Branch
Integrated HQ of MoD
B/49774-P/AG/ECHS/Referral 25 Apr 07
IHQ of MoD (Navy)/DGMS (N) for OIC ECHS
Air HQ (VB)/AOA/DPS
HQs SC, EC, WC, CC, NC, SWC (A/Med)
All Regional Centres Polyclinics under jurisdiction.
Maude Lines
Delhi Cantt –10

HQs WNC, SNC & ENC
HQs WAC, CAC, EAC, TC, SWAC & MC IAF
MEDICAL CARE FOR ECHS BENEFICIARIES IN REMOTE/HILLY AREAS
1. Further to this Organisation letter No B/49774-P/AG/ECHS/Referral dt 05 Apr 2007.
2. Para 2(b) of this Org letter quoted in ref may please be deleted and reconstructed as under :-
‘Applicable for residents of following stats only :-
Copy to :-
(i) Himachal Pradesh.
(ii) Uttranchal.
(iii) North Eastern States of Sikkim, Arunachal Pradesn, Mizoram, Manipur, Tripura, Nagaland and
Meghalaya (less district Shillong).
(iv) West Bengal : District – Darjiling only.
(v) Karnataka : District – Chikmagalur and Kodagu only.
(vi) Tamil Nadu : District – Nilgiris only.
(vii) Chattisgarh : Distt – Bastar and Dantewara only.
(viii) Orissa : District – Koraput and Mayurbhanj only.
DGAFMS/DG-3A
DGMS (Army)/DGMS 5(B) - for info please.
DGMS (Navy)
DGMS (Air Force
All HQ Area/Sub Area - Please disseminate the above contents to all
All Regional Centres Polyclinics under jurisdiction.
Sd/-x-x-x-x
(G Ghose)
Col
Dir (Med)
For MD ECHS