ESIC medical claim - private hospital for dengue due to emergency?

In September I took treatment from private hospital for dengue due to emergency, though I have esic card so now am I eligible to claim my expenses of medical through esic, if yes can any one suggest me which form is require for that and what are necessary attachment??

Dear ABL.LOND,
You can take the issue to your HR team who can issue a letter to the ESIC Doctor of your dispensary stating the reason for treatment outside the ESIC along with your supporting documents like IP record, case sheet,medical bills,discharge summary etc.
The local ESIC doctor has to initial the letter and recommend to the Branch Manager of ESIC for necessary claim.

Thnq Venkata Vamsi Krishna sir