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State of Rajasthan - Section

Section 15 in Rajasthan Legislative Assembly Ex-Members and Family Pensioners (Medical Facilities) Rules, 2010

15. [ Savings. [Notification No. F7(1) Sensad/ 2012 dated 14th June 2012 w.e.f 9 November 2010]

- Nothing in these rules shall be deemed to prevent the Government from granting to a ex-member of Rajasthan Legislative Assembly any concession relating to medical treatment and attendance and traveling allowance for any journey preferred by him which is not authorized by these rules. (w.e.f. 9th November, 2010).]Form-1(See rule 5)Rajasthan Legislative Assembly Ex-Members Medical Concession DiaryDiary NumberIndex
S. No. Details Page Number
1. Medical Card 1
2. Valid Period of Medical Diary 2
3. Prescription of Medicines and Cash Memo 3
4. Details of financial limit 4
5. Life Certificate of ex-member 5
Medical Card
RLASR.........................................................................Dated........................    
1. P.P.O./I.D. Number........................   JOINT PHOTO
2. (a) Name of ex-member.................................................  
Date of Birth..........................................................................  
(b) Name of husband/wife............................................................................    
(if dependent on ex-member)  
Date of Birth........................  
(c) Name of dependent handicapped son/daughter,  
Not capable to earn........................  
(if he/she is authorised for medical facility)  
3. Date of starting of pension.............................................................................    
4. Specimen signature 1. Ex-member..........................................  
  2. Wife/husband...............................  
5. Full Address ...................................................................................................    
.....................................................................................................    
.....................................................................................................    
6. Validity of Medical Diary annual  
  whole life  
    Signature of Secretary
    With Seal
Valid Period of Medical Diary
S. No. Whole life/ Annual Amount (Rs.) Receipt Number and Date Signature of Secretary/Chief Account Officer.
1 Whole life      
2 2009-10      
3 2010-11      
4 2011-12      
5 2012-13      
6 2013-14      
7 2014-15      
8 2015-16      
Name of Hospital/Dispensary.......................................................................  
Name of Patient..............................................................................  
Age....................................................................................................  
Detail of disease...................................................................................................  
Number and date of Outdoor/Indoor.................................................  
Details of prescribed medicines by MedicalAttendant  
Name of Medicines Quantity
1 -  
2 -  
3 -  
4 -  
5 -  
6 -  
7 -  
8 -  
  Name of authorised shop..........................BillNumber......................Date...................Amount..............ProgressiveTotal............
Signature of Authorised Medical Attendantwithseal  
  Signature of Salesmanwith seal of Shop
Details of Financial limitYearOriginal Limit Amount Rupees 5000/-The age of 75 years or above Amount Rupees 10000/-Signature of Salesman
S. No. Sanction order Number and date of RajasthanLegislative Assembly Increased Amount of Financial limit Total Financial Limit Signature of Secretary/ Chief/ Senior AccountsOfficer In case the Financial limit is not available,details of medicines provided as a Indoor patient Name of Shop Bill Number and Date Amount
                 
Life Certificate of Ex-memberIt is certified that Shri/Shrimati.....................Ex-member, P.P.O./I.D. Number.....................is alive and today date..................... I saw him.Dated.....................Signature of Authorised Medical Attendant/Gazetted Officer with sealForm-2(See rule 5)Bill of Medicine For Ex-MembersName of Medical Shop/Store ..........................................................................(Authorised Medical Shop)S. No.....................Shri/Smt..........................................P.P.O./I.D. No. ..........................................Medical Diary No ..........................................O.P. Ticket No. & Date.....................Name of Hospital/Dispensary ..........................................
S. No. Name of Medicine Batch No. Qty. Rate Cost
           
           
           
           
Total :  
Signature of Ex-member or his spouse or hisauthorised representativeSignature of ShopkeeperForm-3(See rule 5)Statement of ClaimName of Medical Shop/Store ...........................................(Authorised Medical Shop)No.........................Date.........................for the month ending.........................20.........................
S. No. Bill No. Amount
     
     
     
Total :  
Signature of Shopkeeperwith seal.Form-4(See rule 8)Form of Application for grant of fixed Medical Allowance to the Ex-member/his spouse drawing pension in other State
ToThe Secretary,Rajasthan Legislative Assembly,Jaipur,Sub:Application for grant of fixed medical allowance of Rs.[300/- per month] [Substituted by Notification No. F(7)(2) Sansad/2009 dated Feb 1, 2012 w.e.f. 1st October, 2011.]to ex-member/his spouse of the Stateof Rajasthan drawing pension in other State.   Photograph duly attestedBy theC . A . O . , R L A( JointPhotograph of theex-member& spouse, if the spouse is alive)