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Sick Commutation

The document outlines procedures for medical examination and treatment of employees injured in accidents covered by the Workmen’s Compensation Act within the South East Central Railway. It includes a referral form for railway patients to SECL hospitals and a request template for converting sick leave into commuted leave. The document emphasizes the need for proper authorization and billing arrangements for medical services provided to railway employees.

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4 views4 pages

Sick Commutation

The document outlines procedures for medical examination and treatment of employees injured in accidents covered by the Workmen’s Compensation Act within the South East Central Railway. It includes a referral form for railway patients to SECL hospitals and a request template for converting sick leave into commuted leave. The document emphasizes the need for proper authorization and billing arrangements for medical services provided to railway employees.

Uploaded by

ssepwaybrh
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOC, PDF, TXT or read online on Scribd

Annexure-I

SOUTH EAST CENTRAL RAILWAY

MEDICAL DEPARTMENT
WORKMEN’S COMPENSATION ACT

FROM OF MEDICAL MAMO FOR EMPLOYEES ALLGED TO BE INJURED IN ACCIDENT COVERD


BY THE ACT.

Memo No/ IOD/


The ADMO/DMO/[Link]/ACMS/KJZ Station .

1. The bearer Sri Ravi Shankar Kaiwart is reported to have been injured in an accident
arising out of and in the course of the employment at / in the KJZ Yard
on 28.10.2013 and is sent for medical examination and treatment.
2. Cause of injury During Push Trolly Work.
3. Please issue the necessary certificate giving the nature and extent of the injury probable period of
disablement.

Signature…………

Designation

Date 28.10.2013

Place BRH.
SOUTH EAST CENTRA RAILWAY

PROFORMA FOR REFERRING RAILWAY PATIENT TO SECL HOSPITALS

Letter No: Date:

1. Reference :- Vide arrangement as per letter no. SECL/BSP/MED/CMS/05/180 Dated 15.04.2005

2. Name of Hospital referred :

3. Name of the Patient :

4. Age/ Sex :

5. Relationship with Employee :

6. Name of the Employee :

7. Designation and posting :

8. Pay Scale :

9. Diagnosis :

10. Reason for referral :

11. Identification mark of patient :

i.

ii.

Seal and date Authorized Signatory


ACMS/KJZ

Note:- 1. Referred hospital shall provide indoor Treatment to patient only on bill payment system basis with SECR
inclusive of transportation charges as the case would be.
2. Referral letter in duplicate shall be issued by SECR.
3. A copy of referral letter shall be returned to Authorized signatory along with bills in duplicate for arranging
payment .
4. ACMS/MDGR of ACMS/KJZ will be referred for any additional information.

SOUTH EAST CENTRA RAILWAY


To, Date :
The C.M.O.( Incharge ) Time :
S.E.C.L. Hospital From Station Manager

Sub: Treatment of the Railway Patient.

Kindly arrange to provide medical treatment in your hospital to under


mentioned Railway patient .

1. Name of the Patient :

2. Age/ Sex :

3. Relationship with Employee :

4. Name of the Employee :

5. Designation and posting :

6. Chief complaint of Patient :

7. Identification mark of patient

a.

b.

Note :- 1. Authorized Medical officer SECR interned and permission


2. Forma referral letter fro authorized Railway authority will
3. As per agreement between medical authorities of SECR and SECL.

To,
The ………………
SEC Rly/ Bilaspur

Through : Proper Channel


------------x------------

Sub- Conversion of Sick Period into commuted leave


from……………………to…………………(RMC/PMC)

** **
Sir,

Most humble and respectfully I beg to state that I was under sick (RMC/PMC)

From …………………..to …………………Memo No…………………..due to illness.

I, therefore, request you to kindly convert my sick period into commuted

LHAP/ LAP Leave .

Thanking you,

Yours faithfully,

Dt……………………… Signature:

Name:

Designation:

Office:

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