Karnataka Police Arogya Bhagya Yojane Annexure - B
AUTHORISATION LETTER
KARNATAKA POLICE
AROGYA BHAGYA YOJANE
From: To:
------The Managing Director,
------
------
Reference: ABY/2002/UNIT* ______/0000#______dated _____/ ____ /20___.
Subject: Medical treatment under Arogya Bhagya Yojane for Sri./Smt./Kumari ______an employee of this unit (Arogya Bhagya Yojane Card No. ______or *(Sri/Smt /Kumari ______a dependent of Sri/Smt/Kumari ______an employee of this unit (Arogya Bhagya Yojane Card No. ______)*.
Sir,
Sri/Smt/Kumari______(mention the designation) a beneficiary of Arogya Bhagya Yojane (ABY) with card number ______, suffering from ______(mention the ailment/medical conditions) is being referred to your hospital for medical treatment*/ has been admitted to your hospital on ______under emergency*. He/She may be provided necessary medical treatment under the terms of the scheme.
The bills for the admissible amount (in triplicate), duly countersigned by the treating doctor, may be raised in the name of Arogya Bhagya Yojane, as per specially approved tariff by Arogya Bhagya Yojane Trust, as the case may be. These may be sent to M/s Basket option Pvt Ltd., Arogya Bhagya Yojane C/o. DGP’s office, Nrupathunga Road, Bangalore, Karnataka along with the copies of investigation report and discharge summary for processing and payment.
It may be noted that the present letter of authorization is for the treatment of the ailment/ medical condition mentioned in this letter, other than mentioned in this letter, but covered under the scheme, would require a fresh authorization letter.
Date of Birth / : / Basic Pay / :Eligibility of ward / : / KGID Number / :
Thanking You,
Yours faithfully,
(______[Mention Name in Full])
Copy to:
1. M/s. Basket option Pvt Ltd, Arogya Bhagya Yojane, DGP’s office, 4th Floor, Nrupathunga Road, Bangalore.
Note:
*Mention name of the unit * Delete which ever is not applicable
#Mention serial number of beneficiary for the current year
$ The authorizing officer must ensure that the ailment/medical condition for which the treatment is recommended must find place in the approved list of Arogya Bhagya Yojane. For list of such ailments/medical conditions, the authorizing officer may refer to the Circular Memorandum ______issued by this office)
The treating hospital may verify the Arogya Bhagya Yojane card and permissibility of treatment for ailment/medical condition under the scheme. ^The Unit officer (in emergencies authorized alternate officer) whose signatures have been made available to the accredited hospitals may only sign the letter.