how can i get esic medical claim on basis of emergency certificate

i am working on under govt dept in Delhi. Few months ago i admitted in hospital due to an heart attack although this hospital does not consider as esic panel. Hospital has charged almost 2 lakh rs. when i discharged after three days of admitted there. Now i want to claim my medical claim as i am member of esic where my esic contribution is up to date. I had contacted my local esic dispencery and they said to me that i can claim because i have emergency certificate. Now the main proplem i have facing that i am unable to find esic claim form or form B. kindly give a copy of esic medical claim form which is applicable in Delhi. thanks

Sir, I think, you or your family member can contact ESIC dispensary to which you are attached and obtain blank REIMBURSEMENT FORUM. Further, I think, you can also contact ESIC Branch Office Manager and get necessary guidance on the issue. These offices can also be contacted on telephones and their numbers may also be available on the website of ESI Regional/Sub Regional Offices to which your unit is attached.