Need Help Finding a Medicine Bill Reimbursement Form for ESIC – Can Anyone Assist?

I require a Medicine Bill Reimbursement Form under ESIC. If anyone has a form like this, please help me.

With regards,
Manmohan Singh

Dear Shri Manmohan Singh,

Please find a Medicine Bill Reimbursement Form under ESIC, Rajasthan. You may obtain this form from your nearest ESIC dispensary during the dispensary's working hours.

Regards.

In general, we ask for the ‘Medicine Bill Reimbursement Form’ under ESIC. There is no number defined for the said form.

Instructions for ESIC-Covered Employees

With reference to your ESIC-covered employees, please do the following:

1. Ask the Insured Person to obtain a sick certificate/fitness certificate from the concerned doctor at the ESIC dispensary and submit a copy to you for marking ESI leave in their attendance record. Also, advise the Insured Person to confirm with the BRANCH OFFICE-ESIC that they are also receiving a copy of the sick certificate/fitness certificate from the ESIC dispensary.

2. Salary for the sick period (as per rules) may be obtained from the Branch Office-ESIC.

3. After obtaining fitness, all certified medicine bills along with the doctor's prescription documents should be processed for claiming through the reimbursement form. The completely filled in and attested form may be submitted to the ESIC dispensary for verification and reimbursement of the expenses.

Regards