Medical attendance rules

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Govt. in Memo. No. 69/K1/89-1, HM&FW, dt. 14-3-89, the authorised

Medical  Attendant to hospitals on outside Govt.  Hospitals  have

indiscriminately  referred cases to hospitals outside  the  State

for  treatment/Surgery without referring such case in  the  first

instance   to  the  Govt.  Hospitals,  viz.,   Gandhi   Hospital,

Secunderabad,  Osmania  General Hospital,  Hyderabad  where  such

facilities are already available for such treatment or to Nizam's

Institute  of Medical Sciences, Hyderabad which is  a  "REFERRAL"

Hospital.  On account of this the department concerned have  been

placed  in embrassing situation, which lead to  with  unnecessary

correspondence with Government.


2.  Government have examined the matter carefully and direct that

all the authorised Medical Attendants should refer the cases that

come  to them for treatment/ surgery to Osmania  Genl.  Hospital,

Hyderabad, Gandhi Hospital, Secunderabad or Nizam's Institute  of

Medical  Sciences, Hyderabad, of serious nature in any case  they

should not refer such cases to hospitals outside when  facilities

are  available  for such treatment/surgery  in  these  government

Hospitals  of  this State while issuing the letter of  advice  to

Nizam's  Institute  of Medical Sciences, Hyderabad,  they  should

certify  that  necessary facilities are not  available  in  their

Institutions.  They  should refer a  case  for  Treatment/surgery

outside the State only in consultation with Nizam's Institute  of

Medical Sciences, Hyderabad, and on obtaining a certificate  that

there are no facilities available in Nizam's Institute of Medical



3.   All the Medical Officers of the Hospitals, and  Dispensaries

in the State should adhere to the above orders scrupulously,  any

deviation of these instructions will be viewed seriously.


9.  Facilities of admission and treatment to the  pensioners  and

their   family   members  in  Super  Specialities   Hospitals   -

Reimbursement of medical expenditure incurred thereon


          [G.O.Ms.No. 401, HM & FW (Kl), Dt. 25-6-1991]


Ref. :- 1.   G.O.Ms.No. 35, M&H, Dt. 26-1-1981.


        2.  G.O.Ms.No. 718, M&H, Dt. 26-11-1981.


3.   From the Secretary, The Hyderabad  Pensioner's  Association,

Hyderabad, Ref. No. 28/B/89/HPA, Dt. 28-8-1989.


4.      From     the    Director    of     Medical     Education,

Lr.Rc.No.l6793/MA.C/89, Dt. 4-12-1989.


Order :- In the G.Os. first and second read above, it was ordered

among other that the retired Government Employees are entitled to

free  medical  treatment in all the Government Hospitals  in  the

State  and that they are not eligible to claim  reimbursement  of

medical expenses and for medicines purchased in the open  market,

if any, on the prescription of the Government Medical Officers.


2.   In the reference third read above, Secretary, the  Hyderabad

Pensioners Association, Hyderabad has represented that pensioners

are  likely  to  fall sick frequently due to their  old  age  and

require  medical  attention and that due to meagre  pension  they

cannot afford to spend huge amounts towards medical treatment. He

has  therefore  requested that free medical aid, in  all  General

Hospitals under the control of Government and Super  Specialities

Hospitals  including  Nizam's  Institute  of  Medical   Sciences,

Hyderabad, may be provided and necessary orders will be issued in

this regard.


3.   After  careful examination, the Government have  decided  to

provide medical treatment to all retired Government Employees and

their  dependents  on par with serving Government  Employees.  In

partial modification of the orders issued in the G.Os. first  and

second   read  above,  Government  hereby  direct  that   medical

treatment  provided  at Nizam's Institute  of  Medical  Sciences,

Hyderabad   to  the  retired  Government  Employees   and   their

dependents  on par with serving Government Employees  who  suffer

with  serious ailments of the Heart, Kidney, Brain Cancer or  any

other  disease or Surgery for which facilities are not  available

in   any  of  the  teaching  hospitals  in  the  State  and   for

reimbursement  of the cost of the treatment including  consumable

and  disposable  and  medicines direct to  Nizam's  Institute  of

Medical Sciences, Hyderabad subject however to a maximum limit of

Rs.  40,0007-  (Rupees  Forty  thousand  only)  or  as  fixed  by

Government from time to time as in the case of serving Government

Employees.  The  reimbursement shall not however, be  allowed  if

they have obtained treatment in any other private hospitals.  The

Nizam's  Institute of Medical Sciences, Hyderabad shall  take  up

cases  only on authorisation by Authorised Medical  Attendant  of

any teaching hospitals as in the case of serving Govt. Employees.

The  Nizam's Institute of Medical Sciences, Hyderabad shall  take

up  treatment  direct to the pensioners upto the limit  fixed  by

Government  subject  to  scrutiny of the  bills  by  Director  of

Medical Education and claim reimbursement from Government.


4.   The  expenditure  on  this account shall  be  met  from  the

concerned Office/ Department from where the Pensioner worked last

and  retired on attaining the age of superannuation and shall  be

debited  to the "Salaries Head" as in the case of  regular  Govt.



5.  These orders shall come into force with effect from the  date

of issue of orders.


10. Nizam's Institute of Medical Sciences - Medical treatment  of

Govt.   Employees  and  their  dependents  -   Reimbursement   of

expenditure - Simplification of procedure - Orders - Issued


           [G.O.Ms.No. 445, HM&FW(E2), Dt. 19-7-1991]


Ref. :-G.O.Ms.No. 609, HM&FW, Dt. 21-11-1988.


Order  :-1. The Government have, for sometime,  been  considering

simplification  of  the  procedure for  treatment  of  Government

Servants at the Nizam's Institute of Medical Sciences.


The procedure has been outlined in the G.O. cited. Presently  the

Ni/am's  Institute  of Medical Sciences is regarded  as  referral

hospital subject to the following conditions :-


(a)    The  Nizam's  Institute  of Medical  Sciences  will  be  a

referral hospital other than for emergencies.


(b)   Referral  of  patients  to  Nizam's  Institute  of  Medical

Sciences  should be from the teaching hospital with the  approval

of the Head of the Departments/Speciality concerned.


(c)    The  referring  hospital  should  ensure  that  facilities

available  in  that  hospital are fully  utilised  in  the  first

instance ; and


(d)   The  referring hospitals should refer the  cases  with  all

details including a referral summary.


2.   Under the present procedure, the teaching hospitals  in  the

State  are  referring  cases  of  Government  Servants  requiring

specialised  treatment  to  the  Nizam's  Institute  of   Medical

Sciences  whenever  facilities are not available  with  them  for

treatment  of various ailments. The sanction of  expenditure  for

treatment  incurred at Nizam's Institute of Medical  Sciences  is

being regulated in terms of the provisions of the Andhra  Pradesh

Integrated  Medical Attendance Rules, 1972. These  rules  require

that the bills of Nizam's Institute of Medical Sciences should be

scrutinised by the Director of Medical Education before  sanction

is accorded for payment by the concerned Heads of Departments.


3.  The above procedure has been found to be cumbersome and there

are  some cases of delay in the referral of even emergency  cases

to  Nizam's  Institute  of  Medical  Sciences  by  the   teaching

hospitals. The procedure of pre-scrutiny of bills by the Director

of Medical Education is also causing delays.


4.  After due consideration, it has been decided that  Government

Employees  or  their dependants can obtain treatment  at  Nizam's

Institute of Medical Sciences directly for the following ailments

("earmarked categories"). In respect of these cases, referral  by

a teaching hospital will not be required.


(a)  Acute Mycardial Infraction (Cardiology Department)


(b)  Acute renal failure (Nephrology Department)


(c)    Severe  cases  of head and  spinal  injury  (Neuro-Surgery



(d)  Cases of Coma (Neurology Department)


5.  With regard to the above earmarked categories, the  following

procedure shall be followed :-


(a)    The Nizam's Institute of Medical Sciences need not  insist

on  advance payment by the Government Servants and  may  commence

treatment immediately taking into account the seriousness of  the



(b)   The Nizam's Institute of Medical Sciences should prepare an

estimate  of  the approximate expenditure for the  treatment  and

hand  it over to the concerned Government Employee who,  in  turn

may  apply for advance to the concerned Head of  Department.  The

estimate of expenditure shall be calculated only with respect  to

items  reimbursable under the Andhra Pradesh  Integrated  Medical

Attendance Rules. This has to be ensured by Nizam's Institute  of

Medical  Sciences. After the advance is sanctioned the amount  of

advance shall be made over by the Head of Department directly  to

Nizam's  Institute  of Medical Sciences. Normally,  the  Head  of

Department  should ensure that the amount sanctioned  as  advance

reaches Nizam's Institute of Medical Sciences within a period  of

15  days.  The  amount of advances drawn  shall  be  adjusted  by

preferring   claims  by  the  respective  departments  with   the

necessary certificates and vouchers.


(c)    Orders  delegating  powers to  Heads  of  Departments  for

drawing of advances are being issued separately.


(d)   It will no longer be necessary to get the bills  scrutinsed

by  the Director of Medical Education. The Nizam's  Institute  of

Medical  Sciences  shall take necessary steps to  scrutinise  the

bills  in accordance with the Andhra Pradesh  Integrated  Medical

Attendance Rules and forward them for payment to the Head of  the

Department concerned. The bills so sent must relate only to items

of  expenditure  admissible under the Andhra  Pradesh  Integrated

Medical Attendance Rules.


(e)   The Nizam's Institute of Medical Sciences must make its own

arrangements  with the Government Employee concerned for  payment

with  regard  to  items  of expenditure in  the  bill  which  are

inadmissible   under  the  Andhra  Pradesh   Integrated   Medical

Attendance  Rules.  Likewise, the Nizam's  Institute  of  Medical

Sciences  must  make  its own arrangements  with  the  Government

Employee concerned for payment of bills in excess of Rs. 40,000/-

which is the limit for reimbursement of medical expenses  incured

by a Government Servant.


6.  With regard to any matter not covered by the above procedure,

the  provisions  of the G.O. cited shall continue  to  apply.  In

respect of the other cases, viz., cases not falling under any  of

the above earmarked categories, the existing instructions  issued

in the G.O. cited will continue to be in force.


11.  NIMS  -  Medical  treatment of  Govt.  employees  and  their

dependents  -Reimbursement  of expenditure  -  Simplification  of

procedure - Regarding


     (Letter No. 2706/K1/92-1, HM & FW Dept, Dt. 30-1-1992)


Ref. :- G.O.Ms.No. 445, HM & FW, Dt.  19-7-91.


Order  :-In the G.O. cited, orders have been  issued  identifying

the earmarked ailments one each in the Departments of Cardiology,

Nephrology,  Neuro-surgery and Neurology of Nizam's Institute  of

Medical  Sciences  in which the Government  employees  and  their

dependents have been permitted to approach the Nizam's  Institute

of Medical Sciences directly for the treatment without  reference

from teaching hospitals in the State. It is however noticed  that

the  cases  received  from other Departments  for  various  other

ailments,  the  Government  employees and  their  dependents  are

directly  approaching the Nizam's Institute of  Medical  Sciences

for  treatment  i.e., other than those  identified  as  mentioned

above  and others obtaining the estimates for the  treatment  and

approaching  the  government for sanction of  advance  to  obtain

treatment   or  for  reimbursement  for  the  treatment   already

obtained.  In  the Estimation Certificates/Bills  issued  by  the

Nizam's  Institute of Medical Sciences authorities, there  is  no

indication as to whether or not, the ailments for which treatment

is sought for or obtained are those identified for the  treatment

in Nizam's Institute of Medical Sciences as provided in para 4 of

G.O.Ms.No.  445,  H.M. & F.W., Dt. 19-7-1991. In the  absence  of

such   information,  it  has  become  necessary  to  enter   into

correspondence  with  the Departments and  Nizam's  Institute  of

Medical Sciences tO  Obtain  the exact position  in terms of  the

aforesaid   orders  thereby resulting in delay in  settlement  of

medical  claims  of  the  employees  consequently  a  subject  of



2. With a view to avoid correspondence and consequential delay in

settlement    of    medical    claims    of    the     Government

employees/pensioners,  I  am directed to request  you  kindly  to

incorporate  in the estimation certificate to be sent or  on  the

medical  bills  to  be  given by  Nizam's  Institute  of  Medical

Sciences  to  the  Government  employees  or  retired  Government

employees,  as the case may be, a certificate whether or not  the

case  is covered by the orders issued in G.O.Ms.No. 445.  H.M.  &

F.W.,   dated  19-7-91  or  whether  it  meets  the   requirement

prescribed in G.O.Ms.No. 609, H.M. & F.W. dated 21-11.1988 (i.e.,

reference  to  Nizam's  Institute  of  Medical  Sciences  from  a

Teaching Hospital).


12.  Sanction of Medical Advance for Medical treatment  of  Govt.

Employees and their dependants in NIMS, Hyd. for certain  serious

diseases  -  Delegation  of powers to Heads  of  Departments  for

sanction of Advance - Orders Issued.


               [G.O.Ms.No. 86, F&P, Dt. 1-6-1992]


Ref. :- 1.  G.O.Ms.No. 609, HM&FW (E2), Dt. 21-11-1988.


        2.  G.O.Ms.No. 445, HM&FW (E2), Dt. 19-7-1991.


        3.  G.O.Ms.No. 184, HM&FW (Kl), Dt. 2-4-1992.


Order :-In the G.O. 1st read above, Government have issued orders

declaring  Nizam's  Institute  of Medical  Sciences  as  referral

Hospital subject to the following conditions :-


1.  The Nizam's Institute of Medical Sciences will be a  referral

Hospital other than for emergencies.


2.   Reference  of  patients  to  Nizam's  Institute  of  Medical

Sciences should be from the Teaching Hospitals with the  approval

of the Head of the Department/Speciality concerned.


3.   The  referring  hospitals  should  ensure  that   facilities

available  in  that  hospitals are fully utilised  in  the  first



4.   The  referring  hospitals should refer the  cases  with  all

details including a referral summary.


5.  The patients should be clearly informed that taking up of the

case by the Nizam's Institute of Medical Sciences is dependent on

the  availability  of accommodation and other facilities  in  the

Nizam's Institute of Medical Sciences.


2.  In consideration of the difficulties being experienced by the

beneficiaries and also the delay involved in setting the  medical

claims,  it  has  been decided to delegated  the  powers  to  the

concerned  Heads of Departments for sanction of Medical  advances

to  the employees working under their administrative  control  in

respect of the following diseases without referral by  Authorised

Medical Attendant vide orders issued in G.O. 2nd read above.


(a)   Acute Myocardial In Infraction (Cardiology Department)


(b)  Acute renal failure (Nephrology Department)


(c)    Severe  cases  of head and  spinal  injury  (Neuro-Surgery



(d)  Cases of Coma (Neurology Department)


3.   The medical claims of State Government Employees covered  by

A.P.I.M.A. Rules, 1972 can be broadly categorised into :


(i)    Claims    preferred    against    treatment    in    Govt.

Hospitals/Referral Hospitals/ Recognised Hospitals.


(ii)  Claims preferred against treatment in unrecognised  Private



(iii)  Calims  preferred  against treatments  in  NIMS  who  were

admitted  direct without reference by the A.M.A. under  emergency

circumstances  to undergo treatment for the diseases noted  under

Para 2 above.


4.   At present in respect of the claims noted against Items  (i)

and  (iii)  under  Para 3 above, Government is  vested  with  the

powers  of sanction of medical advances to  Government  Employees

and  their dependents towards medical expenditure incurred  while

undergoing treatment for certain diseases.


5.  In respect of claims preferred by the individuals either  for

sanction  of advance or for reimbursement of medical  expenditure

incurred   for  treatment  undergone  in   unrecognised   Private

Hospitals   the  Government  would  not  entertain  such   claims



6.  After due consideration, it has been decided to delegate  the

powers to Heads of Departments concerned for sanction of  medical

advance   to  Government  Employees  and  their  dependents   and

settlement  of  final bills for undergoing treatment in  NIMS  in

respect  of  cases referred to under G.O.Ms.No. 445,  HM&FW  (E2)

Dept., Dt. 19-7-91 subject to the following conditions :-


(a)   the maximum amount should not exceed Rs.  50,000/- and  the

expenditure incurred over and above Rs. 50,000/- should be  borne

by the individual.


(b)   The  Head of the Department should ensure that  the  amount

sanctioned  as  advance  shall  be  paid  to  NIMS  by  means  of

Cheque/Draft  within  15  days  from  the  date  of  receipt   of

estimation of the expenditure from the NIMS.


(c)   The advance drawn and paid to the NIMS shall be adjusted by

preferring claims by the concerned Head of the Department  within

3  months  from  the date of drawal  of  advance  with  necessary

certificates and vouchers prescribed in A.P.I.M.A. Rules, 1972.


(d)  The claim sent by the NIMS must relate only to the items  of

expenditure admissible under the A.P.I.M.A. Rules, 1972.


(e)    The bills need not be sent to the D.M.E. for scrutiny  and

the  claim  be admitted based on  the  admissibility  certificate

issued by NIMS.


7.   If a Government Servant seeks admission in NIMS vide  orders

issued  in  G.O.Ms.No. 609, H&M, Dt. 21-11-1988 the Head  of  the

Department  is competent to sanction advances and also the  final

bill  following  the  conditions mentioned in Para  6  above.  In

addition  he shall ensure that the patient is preferred to  NIMS,

Hyderabad by the Authorised Medical Attendant. The A.M.A. of  the

Teaching  Hospitals  with  the  approval  of  the  Heads  of  the

Departments/Specialists  of the Hospital alone have to refer  the

cases   to   NIMS.   Other   Heads   of   Departments   of    any

mofusall/Headquarters or City Hospitals who are not the Heads  of

Departments/Specialists  of the Teaching Hospitals would  not  be

reckoned as Authorised Medical Attendants, competent to refer the

cases  to NIMS covered vide order issued in G.O.Ms.No. 609,  M&H,

dated 21-11-1988.


8.  Where the authority referring the cases to NIMS is not deemed

as Authorised Medical Attendant, such cases are to be referred to

Government  for  relaxation  of A.P.I.M.A. Rules, in  HM  &  F.W.

Dept.,  and Finance and Planning (FW) Department for  concurrence

and  for  relaxation  of  A.P.I.M.A.  Rules.  The  Head  of   the

Department is not empowered to sanction advance if relaxation  of

A.P.I.M.A. Rules is involved.


9.   The  Government extend the facility  available  for  Central

Government Servant wherein a member of the family can also  apply

and  draw the advance when the Government Servant  is  critically

ill and hospitalised so as the avoid inconvenience. In such cases

the wife or a legal heir of the Government Employee shall  submit

an  application  for  sanction  of advance to  the  Head  of  the

Department  under  whom  the  employee is  working  in  case  the

employee is critically ill and cannot sign the application.  This

facility is available to all Government Servants who avail of the

facilities  in the NIMS, Hyderabad under G.O.Ms.No. 445,  H.M.  &

F.W.  (E2) Dept, dated 19-7-1991 and G.O.Ms.No.609, H.M.  &  F.W.

(E2) Department, dated 21-11-1988.


10.  The advance sanctioned shall be debited to the Service  Head

of Account to which the' pay and other allowances of the employee

are being debited.


13.  Provision of Corrective Glasses and Hearing Aids -  Fixation

of limit of expenditure for reimbursement - Orders - Issued


          [G.O.Ms.No. 276, HM & FW (Kl), Dt. 11-5-1993]


Ref. :- 1.  G.O.Ms.No.175, HM & FW, Dt. 7-3-1990.


        2.  Govt. Memo. No. 2118/K1/90-1, Dt. 28-4-1990.


3.  From the Director of Medical Education, Lr.No. 14845/MA B/90,

Dt. 23-8-1990.


Order :-In the Government Order 1st cited above orders have  been

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