Medical attendance rules

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reimbursed  from  the State funds under  the  Medical  Attendance



(4)   The advances shall be treated like advances  of  travelling

allowance  and  pa on transfer and recovery must be  effected  by

adjustment  of  claim  for  reimbursement  c  medical   expenses.


                        (G.O.Ms.No. 1274, M&H, Dt. 29-2-197)


(5)   The Head of the Office competent to draw pay bills  of  his

office,  ma sanction, draw and disburse the advances to  all  the

Non-Gazetted  employees  workin under him; where the Head  of  an

Office drawing pay bills happens to be Non-Gazette Employee,  the

advance  has to be sanctioned to him by the  Officer  immediately

superii to him but he may himself draw the advance.


(6)   The  amount of the advance shall be limited to  the  amount

required to me actual reimbursable medical expenses certified  by

the  Authorised Medical attendant of tl employee or  the  nearest

Civil Assistant Surgeon subject to a maximum of Rs. 50/- at time.

If  the  sanctioning  authority is satisfied  that  the  case  is

emergent, he may sanction an advance upto a maximum limit of  Rs.

507- without insisting upon completion of necessary formalities.


                        (G.O.Ms.No. 317, M&H, Dt. 14-4-197)


(7)  When an advance is sanctioned to a non-permanent  Government

Employee  has to be drawn and disbursed to him only after a  bond

in  Form  II  of the Andhra Prade Financial  Code,  Volume  I  is

executed by him together with the surety of a permane  Government

Servant drawing a pay not less than the borrower.


(8)  (a)  The advance should be adjusted in full within a  period

of  three  mont  from  the  date of  drawal  of  the  advance  by

presenting  the  claim  in the form prescrib  under  the  Medical

Attendance Rules irrespective of the fact that the treatment last

for  me than three months. The claim should be furnished  to  the

Director  of  Medical and Hea Services or  the  Special  Officer,

Indian Medicine, as the case may be, through t Authorised Medical

Attendant and the Medical Officer who gave the treatment. After t

claim  is received back from the Director of Medical  and  Health

Services/Special Offu Indian Medicine, it should be presented  to

the Treasury or the Accountant-General, Andl Pradesh, as the case

may  be  by the Heads of Offices for adjustment  against  advance



(b) A second advance of this kind should not be granted until the

first  c  has been fully adjusted. The Bill for the  2nd  advance

should  be  accompanied by the certificate from  the  sanctioning

authority that the previous advance has been adjusted full.


If  the  advance is not adjusted or returned within a  period  of

three months it shoi summarily be recovered from his salary.


(9)   When any portion of the claim for reimbursement of  medical

expense is any reason disallowed, such amount should be recovered

from the salary of the individ in four instalments starting  with

the pay drawn immediately after the claim has been disallowed.


(10)  In  every  office the drawal of these  advances  should  be

recovered in register of temporary advances and their recovery by

adjustment   or  refund  should  watched.  When  a  borrower   is

transferred  to a new office the details of the advance  shoi  be

closed.  In  the  new  office  which  the  borrower  joins,   the

particulars  of the advance shoi be entered in the  Register  and

the recovery watched.


(11)  Ordinarily  not more than one advance shall be  granted  in

respect  of the sa illness or injury, but when the amount of  the

first  advance  has already been spent, a second advance  can  be

sanctioned  when the sanctioning authority is satisfied that  the

previous  advance has already been spent and the Medical  Officer

concerned has certified the necessity of further expenditure. The

total amount of both the advances shall not exceed Rs. 30 or four

month's  pay  which ever is less. There is no  objection  to  the

borrower if a claim for the adjustment of the first advance  even

before  the  treatment is over and later on presenting  a  second

claim  regarding the further expenses to be adjusted  the  second



(12) The term "Pay" for this purpose shall mean the pay  actually

drawn, including personnel pay, as on the date of application but

shall exclude special pay.


II. The advance granted under these rules should be accounted for

under new subhead, "Advance for Medical Attendance and Treatment"

to  be opened under the head "T.III. Deposits Advances  I.  Civil



Certificate to be furnished by the Medical Officer under Rule 6


Certified  that Sri/Smt.................. a member of the  family

of Sri/Smt............working the  office  suffering  from.............and

that  a  sum of Rs.............(Rupees................)  only  is

necessary as advance to cover the medical expenses  reimbursement

by Government in this case.


Date :                                    Signature :


Station :                                 Designation :


          Certificate by Medical Officer under Rule 11


Certified  that  Sri/Smt.............a member of  the  family  of

Sri/Smt.................working   the

Office of the.................. at...............(Place) is still

suffering  from...........................and that a further  sum

of Rs...........(Rupees.........) only is necessary as advance to

cover the reimbursable medical expenses in this case as from this



Date :                                 Signature :


Station :                              Designation :


Note  :-Strike off the unnecessary portion when  the  certificate

relates to the Government Employee himself.


                             PART II


Rules  relating  to  Medical  Attendance  of  Central  Government

Employees  and their Families, Military Personnel, Merchant  Navy

and Special Police Establishments.


Note :-Not Printed.


                     EXECUTIVE INSTRUCTIONS


Facilities of admission and treatment to pensioners at Government

hospitals Consolidated orders - Modifications


         [G.O.Ms.No. 718, M. & H. (Kl), Dt. 26-11-1981]


Note  :-For  the text of the G.O. see Instruction No. 2  of  next


2.  Medical Advance - Treating like T.A. Advance


[U.O.  Note  No. 5463A/167/A & L/82-1, Fin. &  Pig.  (Fin.  Wing.

Accts. & Loans), Dt. 30-3-1982]


Ref  :_  i.    From  the Acctt.-Genel.,  A.P.,  I,  Hyd.,  Lr.No.

TM/I/II/12-53/76-79/4, Dt. 27-4-1979.


        2.  G.O.Ms.No. 426, M. & H. (KI), Dt. 28-7-1981.


Order  :-In  the reference first cited,  the  Accountant-General,

Andhra  Pradesh,  I  Hyderabad has suggested  amendments  to  the

Andhra Pradesh Integrated Medical Attendance Rules, 1972 and  has

requested  the Government to issue specific instructions  to  all

the drawing and disbursing officers/all the Treasury Officers and

the  Pay  and  Accounts Officers to treat  Medical  Advance  like

advance of T.A. and Pay on transfer.


2.  The  matter  has been considered carefully,  keeping  in  the

changed  conditions the Drawing and Disbursing Officers, and  the

Treasury  Officers and the Pay and Accounts Officers  are  hereby

directed to treat the advance for Medical treatment as an advance

of  T.A. and Pay on transfer and efforts shall be made that  such

an  advance  for Medical treatment is adjusted  within  the  time

stipulated, avoid probable objections at a later date.


3.  Advances for Medical Treatment


[Memo.  No. 39027/724/BG/82, F.& P. (Fin. Wing-B.G.),  Dt.  21-9-



Ref. :-G.O.Ms.No. 1274, M. & H., Dt, 29-12-1978.


Order  :-Under  the revised accounting classification  which  has

come  into  force with effect from 1-4-1974, the  expenditure  on

Medical  advances  was  being classified  under  "766.  Loans  to

Government  Servants-MH. 25 Other Advances, SH (03) Advances  for

Medical  attendance and treatment. But in consultation  with  the

Accountant-General, Andhra Pradesh, Hyderabad certain  amendments

were  issued  to the A.P. Integrated  Medical  Attendance  Rules,

1972, through the reference cited. Among other things it was also

ordered  therein that the Medical advances shall be treated  like

advances  of  Travelling Allowance and pay on  transfer  and  the

recovery  must  be  affected by adjustment  from  the  claim  for

reimbursement  of medical expenses. Even though orders have  been

issued to the above effect, it has been brought to the notice  of

the  Government  that  the  Medical  advances  are  still   being

accounted for under "Loans and Advances".


2. The Director of Treasuries and Accounts is therefore requested

to issue suitable instructions to all District Treasury  Officers

to  adopt the revised classification debiting the expenditure  on

Medical advances to the Service head of account instead of  Loans

and Advances head of account.


4.  Reimbursement of Medical expenditure - Instructions


       [U.O. Note No. 3142/K1/85-1, M. & H, Dt. 17-4-1986]


Order  :-According  to Rule 5(3) (ii) of the  Integrated  Medical

Attendance  Rules, all claims for refund of expenses incurred  on

account  of  the  purchase of the  special  medicines  should  be

preferred  in the manner indicated in Appendix-Ill. According  to



2  (ii) of the said Appendix, the reimbursement bills arising  in

the Hyderabad City will be scrutinised and passed for payment  by

the Superintendents of the concerned Hospitals. According to Para

4  of  the  said Appendix, claims  for  reimbursement  should  be

accompanied  by an Essentiality Certificate from  the  Authorised

Medical  Attendant or from the Medical Officer in-charge  of  the

case in the hospital.


2.  With reference to the provisions referred to in Para 1 above,

employees,  of  various departments of Secretariat  are  claiming

reimbursement  of expenditure incurred by them on  medicines  for

treatment of self and family members on the basis of essentiality

certificate  and  certificate of non-availability  of  the  drugs

given  by  the  Authorised Medical  Attendant  of  the  concerned

Hospital  and sometimes certificate of non-availability of  these

drugs  in  the  Secretariat dispensary,  issued  by  the  Medical

Officer of Secretariat Dispensary. The Departments of Secretariat

are referring such claims for reimbursement of expenditure to the

Medical and Health Department for concurrence.


Reference  of  such  cases to this department  has  been  on  the

increase resulting in avoidable work load in this department  and

delay in reimbursing the claims. The Secretariat departments  are

therefore   informed   that  the  proposals   for   sanction   of

reimbursement  of  expenditure incurred  by  Government  Servants

which are in accordance with the provisions of rules referred  to

in   Para  1  above,  Viz.,  the  calims  for  reimbursement   of

expenditure  for  treatment in Government  Hospitals  within  the

State  which are accompanied by an Essentiality  Certificate  and

certificate of non-availability of medicines from the  Authorised

Medical  Attendant and when they are satisfied that the claim  is

in  accordance  with  the provisions in  Appendix-III  to  Andhra

Pradesh  Integrated Medical Attendance Rules, 1972, need  not  be

referred to Medical and Health Department for remarks/acceptance.

This applies to the cases referred by Heads of Departments to the

Administrative Departments of Secretariat also.


3.    However  as provided in the note under Para 2 (ii)  of  the

Appendix - III to the Integrated Medical Attendance Rules,  1972,

all   cases   requiring   Special  sanction   or   relaxation   ;

clarification  or interpretation of the State Medical  Attendance

Rules should be referred to this department invariably.


5.    Treatment underwent in the Appollo Hospital, Madras,  etc.,

for by-pass surgery, etc., - Certain instructions issued


   (G.O.Ms.No. 69/K1/89-1,, H.M. & F.W. Dept., Dt. 14-3-1989)


Ref. :- 1.  G.O.Ms.No. 317, M&H (Kl), Dt. 7-5-1986.


2.  G.O.Ms.No. 72, I&CAD (Irrigation Ser. II) Dept., Dt. 4-2-1988.


Order :-Certain instructions were issued in the Government  Order

1st cited in respect of availment of medical treatment for Kidney

transplantation and Coronory Bypass Surgery in private  hospitals

in the State by the Government employees. Government servants and

others entitled for treatment under the Medical Attendance Rules,

1972  were permitted to undergo Kidney transplantation  operation

in the Mahavir Hospital, Hyderabad and Coronory Bypass Surgery in

the  Durga Bai Desmukh Hospital, Andhra Mahila Sabha,  Hyderabad,

on the letter of advice given by the Authorised Medical Attendant

in  the  Osmania General Hospital/Nizams's Institute  of  Medical

Sciences,  Hyderabad respectively where the above operations  are

done. A condition was also stipulated in the G.O. first cited  to

the effect that those who obtain prior permission of the Director

of Medical Education, Kidney Transplantation and Coronory  Bypass

Surgery  will  be eligible for reimbursement  of  all  admissible

expenditure  including charges for accommodation and also for  an

advance  as  per  the estimate given by  the  concerned  hospital

undertaking the operation.


2.   Though the above facilities were extended to the  Government

employees  for  treatment, some of the Heads of  Departments  are

sending proposals to Government recommending for sanction of  the

claims  of  the  Government employees for  reimbursement  of  the

expenditure  incurred  by them for their treatment  for  Coronory

Bypass  Surgery  and  Kidney transplantation,  etc.,  in  private

hospitals, like Appollo, etc., outside the State in deviation  of

the  instructions  issued in the Government Order 1st  cited  and

though relevant instructions were issued from time to time.


3.   The Government after careful consideration have decided  not

to  reimburse the claims of the Government employees who  undergo

treatment  in Appollo Hospital, Madras or any other  institutions

outside  the  State or in Hyderabad hereafter, which are  not  in

accordance  with the instructions issued in the Government  Order

1st  cited unless specific prior permission is obtained from  the


6.  Medical treatment to Government Employees - Reimbursement  of

Medical expenditure incurred - Fixing the maximum ceiling to *Rs.



         [G.O.Ms.No. 281, H.M. & F.W. (K), Dt. 1-5-1989]


Note :-These orders as amended subsequently are applicable to the

non-teaching  staff  of all Universities in the  State  -Vide  of

G.O.Ms.No. 542, Edn., Dt. 20-11-1998.


Ref. :- \.  G.O.Ms.No. 170, M&H(K1), Dt. 14-3-1985.


Order  :-In the G.O. first read above, orders were issued  fixing

the  maximum  limit of */**Rs. 40,0007- to  Government  Employees

towards  reimbursement  of expenses incurred by them  on  medical

treatment, subject to the condition specified therein.


However,  several  instances  have  come to  the  notice  of  the

Government  to the effect that Government Employees are  claiming

huge  amounts  towards medical treatment beyond  the  permissible

ceiling limit of Rs. 40,0007- fixed by the Government.


Since  the  Government  is providing free  treatment  to  persons

belonging  to Weaker Sections of the society who are  green-card-

holders,  the Government after careful examination  have  decided

and  direct  that the maximum ceiling limit of  */**Rs.  40,0007-

(Rupees  forty thousand only) be fixed for the  State  Goveniment

employees  towards  their  medical  reimbursement,  whether  they

obtain  treatment in the State Government Hospitals, or in  other

States  in  India,  or outside India,  includes  Air  Passage  of

patient  and expenditure incurred towards Personal Attendant.  If

the  treatment  is  required abroad, or outside  the  State,  the

Authorised  Medical Attendant should certify to the  effect  that

there  is need for obtaining the treatment of the patient,  i.e.,

outside  the  State, or outside India and prior approval  of  the

Director  of Medical Education/Government in Health  Medical  and

Family  Welfare Department should also be obtained by the  person

who wants to obtain treatment outside the State, and outside  the

Country.  A certificate from the Director, Medical  Education  is

also  to be obtained by the Department concerned who process  the

claim putforth by the individual for sanction of the  expenditure

by  producing the bills/ vouchers to be reimbursed. These  orders

shall come into force with effect from 1-5-1989.


All  the  Departments  of  Secretariat  and  all  the  Heads   of

Departments  are  informed  that  any  claim  of  the  Government

Employees  for reimbursement of their medical expenditure  beyond

the  maximum limit of *Rs. 40,0007- as specified in Para 3  above

shall  not be entertained and they should issue  instructions  to

all their subordinates to follow these orders strictly.


7.    Medical  Treatment - Cardiac Surgery - Free  of  charge  to

members  of  public belonging to weaker  sections  in  Government

hospitals - Orders - Issued


     (G.O.Ms.No. 580, H.M. & F.W. (SCK) Dept, Dt. 30-9-1989)


Order :-Of late several requests are being made by the members of

public  directly  or though their representatives  for  financial

help  towards  payment of expenses on medical  treatment  and  on

cardiac surgery undertaken by certain hospitals under the control

of  the  Government where such facilities  are  available.  Govt.

depending  on  the eligibility of the person and  need  for  such

medical  treatment have been authorising the concerned  hospitals

for giving free treatment or for free cardiac surgery as the case

may  be  with a request to send necessary bills  to  the  Revenue

Department for effecting payment towards the cost of  consumable,

disposables from out of Chief Ministers Relief Fund.


As  requests for financial aid towards cardiac surgery  are  ever

increasing  and in order to rationalise the entire procedure  the

following guidelines are issued:


1.   All  requests  made by the members of  public  belonging  to

weaker  sections  of  society,  recommended  by  any  Department,

M.L.As., MPs, Ministers, etc., shall be forwarded for examination

by   the  Government  in  Health,  Medical  and  Family   Welfare

Department.   No  representations  made  by  any  individual   or

representatives of the patients shall be received by any hospital

either  for  examination  or for treatment free  of  cost  unless

specific orders are issued by the Government.


2.   The  applicant  requesting  free  medical  treatment/cardiac

surgery shall be a member of weaker sections of society and shall

possess a green ration card.


3.  The bonafides of the applicant requesting free treatment  for

his dependent shall be verified to ascertain that the dependent's

name figures in the green ration card possessed by him and is the

same person for whom medical treatment is sought.


4.  The beneficiary shall execute a bond on a five rupee  stamped

paper  (non-Judicial) to the effect that he/she is member of  the

family of the green ration card holder.


5.   The  applicant  shall  affix  a  passport  size  of   latest

photograph  of  the beneficiary/ dependent on the  righthand  top

corner of the applicant for and also enclose a xerox copy of  the

green ration card before sending to the Government.


6.   Government in Health, Medical and Family Welfare  Department

after  verifying  the application form and if it found  that  the

applicant  or  his  dependent fulfills all  conditions  for  free

medical  treatment/free Cardiac Surgery necessary orders will  be

issued  to  the hospitals under the control of  Government  where

such  facilities  are available for free  medical  treatment/free

cardiac  surgery  and only after issue of such orders  the  cases

shall  be admitted and given free treatment/surgery.  Expenditure

on  consumables/disposables,  if any shall be met  by  Government

from out of Chief Minister's Relief Fund.


7. The concerned hospitals where cardiac surgery is done free  of

Cost to any person on the orders of Government in Health, Medical

& Family Welfare Department, shall at the end of every month send

a  statement, quoting relevant references from the Government  in

Health,  Medical  and  Family Welfare  Department  of  Health  of

patients,  treatment  given,  surgery  conducted  and  the  costs

involved with regard to consumables or disposables to the Revenue

Department  for purposes of effecting necessary payment from  out

of  Chief  Minister's  Relief Fund under  intimation  to  Health,

Medical & Family Welfare Department.


8.   Medical Attendance - Issuing of letter of advice to  undergo

treatment  /  Open  Heart Surgery outside  the  State  -  Certain

Instructions Issued


    (Memo.No. 2113/K1/89-1, H.M. & F.W. Dept., Dt. 4-10-1989)


Order  :-It is observed that despite the instructions  issued  by

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