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    (CRPE-HOSP)

    OfFICE OF THE IGMED/MED SUPDT, COMPOBTE HOSPATA,


    CRPE, CHANDRAYANGUTTA, HYDERABAD-500005
    gchhyd@erpf.gov.in
    Telephone No.040-97801717 (O), o40-444091(Energency) E Mal:
    Emergency/oPD N e o
    Cachlese/ Payment Basts () .sta

    Subject REEEÉRAL oPATIENR


    Age....sex.....F/0,M/O,S/O,D/O,
    Naune of Patient.8.:SRILAIA 9. y.. i s being
    H/0,
    reerredwjO),
    to yourIRLA/ BoroeforNOaANUALÀ3
    hospital
    .NamG
    .acnitK
    PRIMARY DIAGNOSIS: -
    SRIER BISTORY, POSITIVE FINDINGS AND

    DNVESTIGATIONS:

    PR....g

    TREATMENT GIVEN: -

    Changn..
    PROVDED TO RATIENT; -
    PURPOSE OF REFERRAL (WHAT AL, SERVICES TO BE

    Bafe..Neualesg camullke ytuantoan


    CERTIFICATE
    It is certifed that above mentioned investigations/lacility is not available at
    (Name of CH/ Hospitay
    IG{DEED)/DI) /CMOI/C HOSP. TRRAY
    Name
    NaTne.s.s.oss Rankua<itlcaa
    Rank/Quaifon.nyn
    Starap/Registration No... Stanp /R Sp
    M.O.(Rladiology)/Dy.
    lD rDeepikat
    .
    of Health & Family Wellare 0.M. NY S.iy
    Commandan1

    Patient is authorized to g6t CGHS Beneits vide Mu.stry CoHS bezniciars.


    04/02/2018 The Charges should be retricted to races fixoct lor
    CH,
    CRPF,
    Hyrabad.

    IGP(Medical)/Medical Superinte:ident

    Composite Hospltal, CRPE, HYD-5

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