Here are all required WB Health Scheme Form for West Bengal Govt Employees, Pensioners, DDO/HOO and empaneled Hospitals.
সূচিপত্র
Click here to view the new revised form (Updated on 22/10/2019)
WB Health Scheme Form for Employees:
| Description | Form No | Download Link |
|---|---|---|
| Application for enrolment | Form-A | 
|
| Application Form for settlement of claim for reimbursement | Form-C |
|
| Checklist For Reimbursement of Medical Claims | Form-E |
|
| Essentiality Certificate for Indoor/Day Care treatment & related OPD treatment | Form-D2 |
|
| Essentiality Certificate for treatment in Health Scheme non-recognised H.C.O.s | Form-D3 |
|
WB Health Scheme Form for Pensioners:
| Description | Form No | Download Link |
|---|---|---|
| Application for enrolment | Form-I |
|
| Application Form for settlement of claim for reimbursement | Form-III |
|
| Certificate of enrolment (Government pensioner/ family pensioner) | Form-II |
|
| Checklist For Reimbursement of Medical Claims | Form-V |
|
| Essentiality Certificate for Indoor/Day Care treatment & related OPD treatment | Form-IV2 |
|
| Essentiality Certificate for OPD treatment | Form-IV1 |
|
| Essentiality Certificate for treatment in Health Scheme non-recognised H.C.O.s | Form-IV3 |
|
| Prayer for Changing Sanctioning Authority in Connection with WBHS 2008 | Form-VII |
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