FAIR PRICE DIAGNOSTICS CENTER
&
DIALYSIS SERVICES
User Session Timed Out!!!
Capturing of Swasthya Sathi/Other Insurance Scheme in Government Hospital PPP Cases
-- Select Patient Type --
Government Hospital Patient
Private Case
Have you Swasthya Sathi URN?
Yes
No
Fetch Previous Treatment Data
Swasthya Sathi URN
*
Patient Name not found in SS Database, Cilck here to add
Patient Name
-- Select Patient --
*
Patient Name
*
Patient State
-- Select State Type --
West Bengal
Outside West Bengal
*
-- Select Country Type --
Within India
Outside India
*
-- Select State --
-- Select Country --
Whether Covered with Other Insurance Scheme
Yes
No
*
-- Select Mediclaim Type --
CBHS
WBHS
ESI
Corporate Mediclaim
Insurance of Govt. Sponsored Scheme
Personal Mediclaim
*
Patient District
-- Select District --
*
Block/Municipality
-- Select Block/Municipality --
Block
Municipality
*
Block
-- Select Block Name --
*
Gram Panchayat
-- Select Gram Panchayat --
*
Village
-- Select Village --
*
Municipality
-- Select Municipality Name --
*
Ward
-- Select Ward --
*
Patient Address
*
Patient's HOF Name (Father/Spouse)
*
Patient Relation with HOF
-- Select Relation --
*
Patient Gender
-- Select Gender --
Male
Female
Others
*
Patient Date of Birth (DD/MM/YYYY)
Patient Age
*
Patient Aadhaar No.
*
No Aadhaar No.
Patient Mobile No.
*
Treatment Type (IPD/OPD)
-- Select --
IPD
OPD
Emergency
Private
*
Treatment ID (IPD/OPD ID)
Ward Type (General Ward,ICU,etc.)
-- Select Ward Type --
General Ward
ICU
CCU
ICCU
CICU
FPDC
*
Treatment Procedure/Department Name
-- Select Procedure --
Type of Services
-- Select Type of Services --
Type of PPP Model
Date of Service (DD/MM/YYYY)
Treatment Package Name
Treatment Package Amount (Rs.)
Unique No. of the Patient