Loads of questions are being posed by frantic CGHS members about the CGHS scheme. This post attempts to clarify the process of obtaining treatment under CGHS scheme. It chiefly covers the process to obtain pre-approved treatment. Obtaining Emergency Treatment & Subsequent Reimbursement Claim is covered here.

  1. Step 1 would be to visit the CGHS clinic and meet the doctor for a checkup. The patient maybe accompanied by 1 or more attendant. Please carry your CGHS identity card and a few photocopies of it.
  2. After examination, the doctor will typically fill-up the prescription. At Kolkata, the doctor’s use CGHS provided prescription stationary while at Hyderabad, patients are expected to maintain a record-book of their choice.
  3. The prescription will list the medicines, diagnostic tests and further consultation that the patient is required to receive.
  4. Now the patient should approach the Registration counter and register his prescription and obtain the stamp on it. From this point, it can get a little complicated.


Obtaining Consultation:

  1. In case further consultation by a specialized doctor is recommended, an External Consultation form is issued to the patient. At Kolkata, the treating doctor scribbles this as a ‘Refer to …’ on the prescription and the patient is required to get this endorsed by the CMO. At Hyderabad, the doctor will fill-up an ‘External Consultation’ form, request you to get it registered and then endorsed by the CMO.
  2. Within 15 days of the issue of the ‘external consultation/referral’, The patient is required to visit a Govt. hospital, obtain an Out-Patient card and submit it along with the CGHS External Consultation Form/Referral Prescription. While at Kolkata, the patient may visit the hospital only one-day (pre-assigned, for ex: All Fridays) in the week (thus giving only 2 window of opportunities in a fortnight), at NIMS Hyderabad, the patient may visit the hospital any of up-to 4 days in a week (thus giving 8 windows of opportunities)
  3. The patient will be re-directed to the concerned department. At the department, the out-patient card is accepted and queued.
  4. At the patient’s turn, generally Post-graduate/Research medicine students examine the patient and fill-up the case sheet. The H.o.D. does the final evaluation and writes out the prescription. This prescription generally contains an over-riding list of medicines and serves as the master prescription for the patient. All other previous prescriptions are rendered invalid upon issue of this prescription.
  5. Please make sure that the new prescription has all the medicines that you required. Medicines omitted from this list even by mistake will not be issued by CGHS and you will have to go-back to the Govt. hospital to get the prescription corrected. Carry your private list to cross-check.
  6. In case of expensive medicines, please request and obtain an ‘Essentiality Certificate’.
  7. Patients maybe recommended further diagnostic tests in this prescription.
  8. Patient must return to CGHS clinic with the prescription and re-visit the doctor. Based on the prescription, doctor’s write out a final list of medicines and diagnostic tests to be issued to the patient.
  9. To obtain medicines, patients must follow the respective procedure detailed below.
  10. While certain diagnostic tests can be conducted at CGHS itself, others may have to be conducted at the Govt. hospital. In rare cases, CGHS may allow the patient to get the diagnostics done at a CGHS approved private hospital/diagnostic center. Expensive tests require sanction from the CMO and Addl. Director of CGHS at Local HQ.

Obtaining Diagnostic Tests:

  1. To get tests done at CGHS, simply approach the dispensary/nursing station. They will guide you through the procedures. Some tests require the patient to re-visit the clinic on empty stomach.
  2. To get tests done at Govt. Hospital, re-visit the hospital with the CGHS sanction and approach the respective diagnostic department (for ex: radiology). They will typically issue an appointment for some tests and choose to do it instantaneously for others.
  3. In case of CGHS Recognised private diagnostic centers, patients are required to produce copy of the CGHS ID card, copy of the Govt. hospital prescription, original & copy of the ‘CGHS External Diagnostic Form’. Local patients can generally avail of cashless diagnostics. For some diagnostic tests (where a cghs rate ceiling applies), the hospital may charge the patient the differential amount.
  4. Patients can always opt to pay for the entire cost of diagnostics and get them done at a reputed hospital/diagnostic center. Reports from reputed institutes are not disputed and accepted readily by doctors at Govt. hospitals and CGHS.
  5. Patients on CGHS Temporary Permit are required to get the tests done at Govt. Hospitals only for cashless treatment. In case of referral to CGHS recognized private hospital/center, the patient has to pay for the tests and later claim medical reimbursement from CGHS HQ at his home town.
  6. Armed with the reports of the diagnostic tests, the patient must approach the CGHS Doctors for consultation. In case of complex treatment, patient will be re-referred to specialists at Govt. Hostpital. Patient must restart with Step 1 of ‘Obtaining Consultation’.

Obtaining Medicines:

  1. To obtain medicines, a registered prescription should be produced at the Pharmacy. To obtain a registered prescription, simply visit the CGHS doctor with the prescription & diagnostic reports that were recommended at ‘Obtaining Consultation’. The CGHS doctors typically copy the prescription from the Govt. Hospital form to their internal form/patient notebook. This form/notebook must be produced at CGHS Registration Counter for endorsement.
  2. In case the patient was referred for ‘External Consultation’, photocopy of the following documents has to be submitted at the pharmacy: (a) CGHS External Consultation Referral Form (b) Govt. Hospital Prescription (c) CGHS Registered Prescription obtained after Govt. Hospital Prescription (d) Photocopy of CGHS ID Card (e) Temporary Permit (if applicable)
  3. Expensive medicines such as dialysis fluids, Erythropoietin injections require an ‘Essentiality Certificate’ before they can be issued.
  4. To obtain medicines, at Kolkata, you simply drop the prescription attached to required photocopies into a cardboard box kept outside the pharmacy and come back 3 working days later to pick up your medicines. This approach is risky as hell since there really is no acknowledgment that your request was received. Your prescription could go missing and you would be back to square one.
  5. At Hyderabad, approach the pharmacy with the patient notebook. The pharmacist will note down all the medicine requests and indent them as necessary. Sometimes, generic medicines maybe issued on-the-spot and and will be crossed off the list. Other medicines have to be indented by the pharmacy and will be distributed 3-4 working days later.
  6. Medicines are generally issued for 1 month at a time. Expensive medicines are issued on a weekly/fortnightly requirement basis.
  7. If the Govt. Hospital prescription has recommended the treatment to continue for 3 months; and CGHS is issuing medicines for 1 month only, you need not visit the Govt. Hospital every month. Photocopies of the documents will be accepted towards issuing the medicines for 3 months. After 3 months, you are required to follow all the steps from the start of this document.
  8. Expensive medicines are generally issued from the CGHS Central Store and not the dispensary. To obtain such medicines, you are required to write a letter to the ‘Addl. Director, CGHS’ and request for the medicines since they are unavailable in your dispensary. This letter must be accompanied by photocopy of (a) CGHS External Consultation Referral Form (b) Govt. Hospital Prescription (c) CGHS Registered Prescription obtained after Govt. Hospital Prescription (d) photocopy of CGHS ID Card (e) Temporary Permit (if applicable) (* all documents attested by the CMO of the dispensary). Make Four copies of this set and approach the CGHS Central Store to file a request for the medicines.
  9. Upon acceptance of the request, original+1 copy of the document set will be retained by CGHS store and 1 copy acknowledged and returned to you. You will be notifed of the tentative date when your medicines are likely to arrive.
  10. On the date of medicine collection from the CGHS Store (please call and confirm that your medicines have arrived), approach the pharmacy at the store with the acknowledgment copy and additional copy. The Pharmacist will retain the additional copy and issue the medicines. He will also make notes on the acknowledgment copy. You are required to carry this copy on your next visit.

Download: Letter To CGHS Store Requesting Issue of Expensive Medicines

This particular post is still work-in-progress and will be modified from time-to-time. Also, it only reflects my experience with the system at two places in India. Other cities may have a widely different mechanism.

Comments are appreciated.