Guidelines for referrals to CGHS empanelled hospitals

No.RA/Cons/Hyd/09-10/CGHS IV

Government of India

Ministry of Health & Family Welfare

Department of Health & Family Welfare

                          Nirman Bhawan, Maulana Azad Road                           

                                                                        New Delhi 110108  dated  the 11th June, 2010

    To
    Additional Directors / Joint Directors
    of all CGHS cities

Subject: Guidelines for referrals to CGHS empanelled hospitals in CGHS cities outside Delhi, where there are no Central Government hospitals.
             I am directed to state that it has come to notice that CGHS beneficiaries residing in cities covered by CGHS (outside of Delhi) are facing difficulties in getting services of specialists from State Government hospitals and they cannot avail services directly from private empanelled hospitals. After careful consideration of the ground realities, it has been decided to issue the following guidelines for strict compliance:
(1) CGHS beneficiaries must compulsorily be referred to polyclinics wherever set up by the CGHS;
(2) It posts of specialists are lying vacant in polyclinics, GDMOs, who are post graduates may be posted in polyclinics for consultation, and on the basis of the advice / opinion to be tendered by them, CMO i/c, AD / JDs may refer patients to private empanelled hospitals and diagnostic centres, according to the choice of the beneficiary;
(3) In those cities which do not have polyclinics and if GDMOs who are post graduates are available, their services as specialist may be utilised and patients may be referred to the dispensary in which such PG GDMOs are posted or if space is available in a centrally located dispensary, the PG GDMOs may be posted there;
(4) In the event of neither a specialist nor a PG GDMO is available in a city, CMO i/c shall make a provisional diagnosis and refer the patients to private empanelled hospital for specialists’ consultation;
(5) A referral from CGHS dispensary is required every the patient is advised any procedure for investigation;
(6) If any specific treatment / procedure is advised (except in emergency) by private empanelled hospital, it must be counter-signed by CMO i/c before the services are availed, to check possible misuse;
(7) No permission is required in case of emergency, where a beneficiary can avail treatment in a private empanelled hospital, as per existing instructions;
(8) The beneficiary will have to go back to the dispensary where his / her card registered for collection of medicines prescribed by the specialist of the private empanelled hospital. No indent of such medicines will be made, for which similar drugs with same generic formulation available in the dispensary will be supplied, as per standing instructions;
(9) Beneficiaries can purchase prescribed medicines for 3 (three) days only from open market, which shall be reimbursed by the CGHS / Ministry / Department, as the case may be . For requirement of medicines beyond three days, medicines will have to be procured from the dispensaries; and
(10) Once a diagnosis and treatment has been advised by the specialist, doctors in dispensaries may follow up the case instead of referring back after the specific period of the prescription gets exhausted. They have to use their own clinical judgement for follow-up and adjust the dose schedules, if required.
2.This issues with the approval of Director General of Health Services.

                                                                                                                                                                                Yours faithfully

R. Ravi)

Deputy Secretary to the Government of India