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ESIC MODEL HOSPITAL CUM ODC M.I.D.C. ANDHERI (E), MUMBAI 400 093. Telefax : 022 28203266 EPBX 2836720307. Email : msandheri@esic.nic.in No. : EMHAMum / Godrej Appliance / AG / VollII //2014Dated :

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How to fill out esic model hospital cum

01

Obtain the ESIC Model Hospital Cum dispensary form from the ESIC branch office.

02

Fill in the required personal details such as name, address, contact information, etc.

03

Provide details about your medical history and current health conditions.

04

Include any details about your insurance coverage or ESIC membership.

05

Make sure to sign and date the form before submitting it to the ESIC office.

Who needs esic model hospital cum?

01

Employees who are covered under the Employees’ State Insurance scheme (ESIC) may need to fill out the ESIC Model Hospital Cum form. This form is used to provide information about the employee's medical history, current health conditions, and insurance coverage in order to access healthcare services through the ESIC model hospital cum dispensary.

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What is esic model hospital cum?

The ESIC Model Hospital cum is a healthcare facility established under the Employees' State Insurance Corporation (ESIC) aimed at providing comprehensive medical care to insured employees and their dependents.

Who is required to file esic model hospital cum?

Employers covered under the ESIC Act who operate in industries or establishments with relevant workforce must file the ESIC Model Hospital cum.

How to fill out esic model hospital cum?

To fill out the ESIC Model Hospital cum, employers need to gather necessary employee details, medical services provided, and ensure all relevant information as per ESIC guidelines is included before submission.

What is the purpose of esic model hospital cum?

The purpose of the ESIC Model Hospital cum is to facilitate structured information reporting regarding healthcare services provided to insured workers, ensuring compliance with ESIC regulations.

What information must be reported on esic model hospital cum?

The information that must be reported includes employee personal details, types of medical services provided, treatment records, and any other prescribed details by the ESIC.

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