January 06, 2015
Guidelines on referral system in CGHS – Referral Mechanism by CGHS
Treatment under medical emergency: No referral is required and beneficiary can directly go to any private empanelled hospital for availing treatment.
II. Elective treatment at Empanelled hospitals in Delhi/NCR :
(i) CGHS/Government Specialist advises specific treatment procedure required. Permission letter has to be obtained from CGHS Wellness centre / Addl. Director of CGHS in case of pensioners, ex- MPs , etc., and from the department in case of serving employees for undergoing the treatment at any of the CGHS empanelled hospitals of his / her choice.
(ii) In satellite towns of NCR, viz., Faridabad, Ghaziabad, Gurgaon and Noida, CMO i/c of CGHS Wellness centres can refer the CGHS beneficiaries directly to private empanelled hospitals for treatment and management. In such cases permission for specific treatment procedure is to be obtained from competent authority i.e., from CGHS in case of pensioners, etc., and from the department in case of serving employees.
III. Treatment at Empanelled hospitals in other CGHS covered cities outside Delhi/NCR :
(i) CGHS beneficiaries must compulsorily be referred to Polyclinics wherever set up by the CGHS. On the advice/opinion of the Specialists/ Post graduate GDMOs, CMO In-charge, AD/ JDs may refer CGHS beneficiary to private empanelled hospitals of the choice of the beneficiary.
(ii) In those cities which do not have polyclinics and if GDMOs who are post Graduate are available, their services as specialist may be utilized and patients may be referred to the dispensary in which such PG. GDMOs are posted or if space is available in a centrally located dispensary, the PG GDMOs may be posted there.
(iii) In the event of neither a specialist nor PG GDMO is available in a city CMO In-charge shall make a provisional diagnosis and refer the patients to private empanelled hospital for specialist consultation. If any specific treatment/ procedure is advised (except in emergency) by private empanelled hospital, It must be counter-signed by CMO I/c before the services are availed to check possible misuse.
The process of referral through Government/ CGHS specialists provide a check and balance in the system, so far as correct diagnosis and treatment is concerned.