Utilization Certificate Form: Required for Issuance of Restricted Medicine from CGHS | Central Govt Employees News -
Utilization Certificate Form: Required for Issuance of Restricted Medicine from CGHS
Utilization Certificate
This is to certify that … … … … … … … … … … … … … … (Name of Medicines, quantity, dose, frequency) … … … … … … … … … … … … … issued to … … … … … … … … … … … … … … (Name & Token No of Patient /Name of Dispensary) issued on… … … … … … … … … (Date of issue) has been utilized /will be utilized by(Date) … … … … … … … If required empty strips/vials will be submitted.
| Signature of Patient Token No: Address & Telephone No | Signature of the Specialist/ CMO Date:- Stamp |
Counter Signature of CMO I/C WC with Stamp
View: CGHS: Instructions for Issuance of Restricted Medicines
[https://cghs.gov.in/showfile.php?lid=6216]
RelatedUtilization Certificate Form: Required for Issuance of Restricted Medicine from CGHS
Utilization Certificate
This is to certify that … … … … … … … … … … … … … … (Name of Medicines, quantity, dose, frequency) … … … … … … … … … … … … … issued to … … … … … … … … … … … … … … (Name & Token No of Patient /Name of Dispensary) issued on… … … … … … … … … (Date of issue) has been utilized /will be utilized by(Date) … … … … … … … If required empty strips/vials will be submitted.
| Signature of Patient Token No: Address & Telephone No | Signature of the Specialist/ CMO Date:- Stamp |
Counter Signature of CMO I/C WC with Stamp
View: CGHS: Instructions for Issuance of Restricted Medicines
[https://cghs.gov.in/showfile.php?lid=6216]
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