Revised Guidelines for Referral Process In CGHS
File No.: Z15025/19/2024/DIR/CGHS/EHS(Comp No. 8281286)
1/3687286/2024
Government of India
Ministry of Health A Family Wolfare
(EHS Section)
Nirman Bhawan. New Delhi
Dated the 28-06-2024
OFFICE MEMORANDUM
Subject: Revised guidelines for Referral Process In CGHS-reg.
In partial modification of MoHFW OM No. Z. 15025/117/DIR/CGHS/EHSS dated 15 01.2018 and 10.12.2018. the undersigned is directed to convey approval of the Competent Authority for issue of revised guidelines for referral procedures for Consultation. Investigations and Treatment in Government and Private hospitals (empanelled with CGHS). as per details given below:
A. In continuation of OM No Z. 15025/18/2020 dated the 09.10.2020 the term “Government hospital”, shall also include all AIIMSs, Institutions of National Importance (INIs), North East Institutions, Tata Memorial Hospital and all other medical institutions under central government. No referral permission/endorsement shall be required for undergoing consultation investigation/ treatment procedure including unlisted investigations/procedures.
B Treatment at Private empanelled hospital(s):
i. Single referral for Specialist Consultation: A referral issued by any Medical Officer of a CGHS Wellness Centre will be valid for three months. During this period, the beneficiary may consult two more specialists i.e. up to total of three specialists, if recommended by the primary specialist. A maximum 6 consultations shall be allowed during this validity period of 3 months.
ii. Investigation and treatment Procedures advised by specialist of empanelled private hospital after referral by CGHS: No further endorsement from CGHS shall be required for undergoing routine listed investigations and minor procedures, not requiring admission in the hospital, as advised by the specialist, within the validity period of 3 months from the date of issue of the initial referral. However. Referral/endorsement from CGHS shall be required for special investigations like CT Scan. MRI Scan, PET Scan and any other investigation costing over Rs. 3.000/- and the referral will be valid for 3 months.
iii. Correspondingly, referral, endorsement would be required from Medical Officer of CGHS for any procedure requiring admission in the hospital, which would be valid for 3 month.
iv. Unlisted Investigation(s) and treatment procedures advised by the Specialist of CGHS empaneled hospital: Permission for undergoing such investigations and treatment procedures shall be considered as per the delegated powers vide OM Z. 15025/14/2023/ DIR/CGHS dated 27.12.2023 in case of pensioners and OM No. S 12020/4/97-CGHS(P) dated 07.04.1999 in case of serving employees, i.e.
a. CGHS (Additional Director/ Director) in case of Pensioner beneficiaries.
b. Head of the Department/ Office (HOD/HOO) in case of serving employee(s)
v. In partial modification of O.M. No.Z15025/35/2019/DIR/CGHS/CGHS(P) dated 29.05.2019, the special provision for CGHS beneficiaries to avail Consultation/ investigations/treatment procedures shall hereinafter apply to CGHS beneficiaries aged 70 years and above, as against 75 years prescribed in OM as mentioned above dated 29.05.2019. The other conditions shall remain unchanged. The beneficiaries can also avail of the services through tele-consultation facility available through e-Sanjeevani 2.0 (https://esanjeevani.mohfw.gov.in/).
vi. In case of treatment under emergency and post-operative follow-up treatment, the instructions shall remain as per extant rules. Reference Instructions:
a. O.M. No. S.I1011/29/2019-EHS dated 13.09.2019.
b. O.M. No. Z15025/35/2019/DIR/CGHS/CGHS(P) dated 29.05.2019 (regarding post-operative follow-up treatment).
Signed by
Hemlata Singh
Under Secretary to the Government of India
Source: CGHS