The Union health ministry has simplified the referral system under CGHS, permitting all beneficiaries to seek OPD consultations from specialists at empanelled private hospitals after due referral.
 

The referral will be mentioned on computer-generated prescription slips. As part of the new guidelines mentioned in the office memorandum dated January 15, after consultation at the empanelled hospital, a beneficiary shall report back to the wellness centre concerned, where the medical officer or chief medical officer would endorse listed investigation and issue medicines.

"For unlisted investigation/treatment procedure, CMO in-charge shall submit the prescription to competent authority for consideration in case of pensioner beneficiaries. Serving employees shall seek permission for unlisted investigation/treatment procedure from their department as per prevailing guidelines," it said. The medicines prescribed by specialists will be supplied by CGHS according to available generic names at the CGHS wellness centres.

According to the order, in case only an alternative brand name of a prescribed medicine having the same composition is available, it shall be supplied by the available brand name. If the medicine prescribed is not available at the CGHS wellness centre either by generic name or alternative brand name, it shall be indented by the same brand name through authorised local chemist, said the order.

According to the order, the validity of the advice of the central/state government specialist/CGHS medical officer for listed treatment procedure shall be treated as valid for three months unless mentioned otherwise. No other referral letter is required to undergo the treatment procedure at any of the empanelled hospitals. In case of Haemo Dialysis, the advice for treatment can be made up to six months. However, in case of radio-therapy, chemotherapy, advised by a government specialist, the advice shall be valid for all cycles of radiotherapy/chemotherapy.

The specialist has to specify the procedure and self attested (by beneficiary) photocopies of the permission letter are required to be submitted, the order stated. "In case of non-listed investigations/treatment procedures permission from competent authority is required to be obtained," the order stated.