Issuance of Restricted Medicines
Restricted medicines include chemotherapy medicines for cancer and other medicines as enumerated in the “restricted drugs” list of CGHS. This list is available in under “circulars”. When restricted medicines like those for cancer and other such conditions are prescribed the following procedure is to be followed :-
1. An authority slip for MSD / AD of the city will be issued from the wellness
center for the restricted drugs on the specialist prescription.
2. This authority slip along with following documents (all duly verified by CMO I/C) are to be submitted at MSD / AD?s office.
- Application to AD forwarded by CMO I/C
- Copy of specialist prescription/discharge summery (Emergency cases)
indicating restricted drugs - Copies of investigation reports
- Permission letter for treatment in CGHS recognized hospital
Photocopy of CGHS card - Utilization certificate (This is required when the same medicines have been issued earlier also. The certificate in case of orally administered medicines can be given by the beneficiary himself and for those administered parentally certificate from CMO I/C or treating specialist is required.)
- Person (If not beneficiary himself) who is to collect these medicines must carry authorization letter, the original CGHS card and his photo I/D.
Source: CGHS
I have to apply for requisition of injections through my dispensary D-77 from MSD Gol Market.. There is some form in which the application has to be made through my dispensary. I just want a copy of that blank form which I may fillup and submit to CMO, CGHS Dispensary, D-77