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2014-2015

Dr. Sunil Thakur, MS, LLB, DMCH Chief Medical Officer W.U.S. Health Centre

Chhatra Marg University of Delhi

Delhi-110007

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INDEX Contents Page No. Introduction 3 Organizational Set up 4 List of Medical Officers 5 (W.U.S. Health Centre, North Campus) List of Part-Time Specialists 6 Health Services 7 W.U.S. Health Centre, South Campus 8-9 W.U.S. Health Centre, East & West Campus 10 Eligibility & Membership 11-13 Entitlements of Eligible Members 14 Rates of Health Centre Contribution 15 Guidelines for claim of Reimbursement 16 Medical Fitness Certificates & Medical Boards 17 Annexure I Application Form for All Employees 18-19 Annexure II Application Form for Students (Resident/Non Resident) 20 Annexure III Application for Medical Examination for Fresh/Re-Employment 21-22 Annexure IV Format for No-Dues Certificate 23 Annexure V Approved Hospitals & Diagnostic Centres 24

Annexure VI Form for payment of Investigation Charges Bill 25 Annexure VII Form for payment of Local Purchase Bills through 26 Cheque/Cash

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INTRODUCTION

W.U.S. Health Centre was started in March 1955 by World University Service (W.U.S.), a Geneva based international Non-Governmental Organization (NGO). It has been a satisfying experience to serve its beneficiaries for the past 59 years and our mission has been to provide personalized services to the members of health centre & staff. Subsequently, three more Health Centres in East, West, & South Campus were commissioned with assistance from University Grant Commission (UGC). W.U.S. Health Centres have on its roll 20 doctors (including 5 part time medical officers), 6 staff nurses (including 3 contract nurses), 41 permanent and 15 paramedical employees (on contract) which ensures efficiency in work and willingness to help the clientele when they need us. W.U.S. Health Centres (North campus and South campus) have fully equipped physiotherapy unit to cater to the beneficiaries. WUS Health Centre is a Contributory Health Service Scheme and with its four operational units in North, South, East and West, it caters to health related needs of the Delhi University employees, their family members and students. The North or the Main Campus unit of the Health Centre is the nodal point and has a team of 14 Doctors (including 3 medical consultants on contract and three part-time medical officers), 12 visiting part-time specialists, 30 permanent, 12 employees on contract paramedical staff and all major investigative facilities are available here. The unit in the South Campus has 04 doctors (including 02 part-time medical officers), 03 visiting part-time specialists and limited investigative facilities are available here. East and West Health Centres are managed by single doctor. This Information Booklet contains collated information about various aspects of the Health Centre viz its organization, administration, operational facilities, rules and regulations in a summarized form. This booklet will serve as a guide book for all Health Centre beneficiaries, doctors and the administrative staff in the University and constituent colleges. The membership of health centres for employees / teachers is obtained by submitting duly filled membership pro forma for which assistance is sought from the concerned institutions to remit the required subscription of the members every month regularly along with the requisite information i.e. (i) Name, Token Card No. (ii) Present basic pay, (iii) Amount deducted from salary. Regarding the subscription of students, it has to be collected on Annual basis (for 12 months) at the time of admission and it must be remitted by 31 March of the year. The remittance cheque is to be prepared in favour of the Registrar, University of Delhi for delivery of the same in the Health Centre. For members of the WUS Health Centre, South Campus, the remittance cheque is to be prepared in favour of the Director, University of Delhi South Campus.

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ORGANISATIONAL SET-UP Interim Governing Council (IGC) The WUS Health Centres in University of Delhi has an Interim Governing Council (IGC) appointed by the Executive Council. The Committee formed on 04.07.2012 is as follows:

Prof. V.K. Chaudhary - (Chairperson, Professor and Head of the Department of Bio-Chemistry nominated by Vice-Chancellor,)

1. Prof. Anil Tyagi - Professor, Department of Bio-Chemistry (Member)

2. Prof. S.C. Bhatla - Professor and Head, Department of Botany. (Member)

3. Dr. Jolly Rohtagi - Professor of Ophthalmology, UCMS (Member)

4. Prof. T.R. Sheshdri - Professor, Department of Physics (Member)

5. Prof. Rani Gupta - Professor, Department of Micro-Biology (Member)

6. Dr. Sunil Thakur - Chief Medical officer, W.U.S. Health Centre (Member Secretary)

The Interim Governing Council (IGC) formulates various rules and regulations for the Health Centres on behalf of the Executive Council. It provides basic functional guidelines and develops long-term policies for operationalisation of the Health Centres.

Purchase Committee All purchases for the Health Centres are made through duly constituted purchase committees proposed by the Chairperson of the IGC or the Chief Medical Officer/Medical Administrator and approved by the Pro-Vice Chancellor on yearly basis. Being head of the administration, the Chief Medical Officer is responsible for the smooth functioning of all the Health Centres. However, Health Centres in the South, West and East are locally administered by respective Senior Medical Officer-in- Charges.

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WUS HEALTH CENTRE, NORTH - MAIN CAMPUS

Chattra Marg, Delhi-110007 Telephone: 27666257

Timings: MONDAY to SATURDAY* Morning 8 AM to 2 PM Evening 2 PM To 8 PM Night 8 PM to 8 AM * Saturday: 2 Doctors work in Morning Shift & 1 Doctor in Evening Shift. Sunday: 8.30 AM to 10.30 AM Only Except National Holidays, Night Service: All Days

LIST OF MEDICAL OFFICERS

S.No. Name Qualification Designation

1. Dr. Sunil Thakur MB;BS, MS, L.L.B, DMCH Chief Medical Officer 2. Dr. R.K. Gupta M.B;B.S, DCH Sr. Medical Officer 3. Dr. (Mrs.) Sheela Jaiswal M.B;B.S, MD (Gynae.) Sr. Medical Officer 4. Dr. Dr. S. Karmakar M.B;B.S. Sr. Medical Officer 5. Dr. (Mrs.) Neelu Madan M.B;B.S., MD (Gynae.), DNB Sr. Medical Officer 6. Dr. S.S. Dugtal M.B;B.S., MD (Med) Sr. Medical Officer 7. Dr. (Mrs.) Ritu Tanwar M.B;B.S. Medical Officer 8. Dr. Y.P. Singh M.B;B.S, DTCD Medical Officer (Contract)

LIST OF MEDICAL CONSULTANTS (ON CONTRACT)

1. Dr. J.L. Jain M.B;B.S, MBA (HCA), WHO Fellow Sports Medicine (USA) 2. Dr. Archana Gupta M.B;B.S, MD (Gynae.) 3. Dr. K.K. Kohli M.B;B.S, DTCD

LIST OF PART-TIME MEDICAL OFFICERS (ON CONTRACT)

1. Dr. Sudha Goel M.B;B.S, MD (Gynae.) 2. Dr. Neena Paul M.B;B.S 3. Dr. M.K. Grover M.B;B.S, DCH

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LIST OF PART-TIME /FULL TIME SPECIALISTS Room No.

CARDIOLOGY 1. Dr. Dinesh Kumar Gupta

MD, DM (Cardio) Tuesday 9:00 A.M. – 11:00 A.M.

(HEART) Wednesday 9:00 A.M. – 11:00 A.M. Thursday 9:00 A.M. – 11:00 A.M. DENTISTRY 1. Dr. Preeti Mahajan BDS Wednesday 10:00 A.M. – 01:00 P.M. 8 Saturday 10:00 A.M. – 01:00 P.M. Friday 10:00 A.M. – 01:00 P.M. 2. Dr. Shalu Pruthi BDS Monday 10:00 A.M. – 01:00 P.M. Thursday 10:00 A.M. – 01:00 P.M. 3. Dr. Gaurav Kumar Vats BDS Tuesday 10:00 A.M. – 01:00 P.M. E.N.T. 1. Dr. Sunil Thakur MS, L.L.B, DMCH Monday-

Friday 8:30 A.M. – 10:30 A.M. 27

(Full time Specialist) NEUROLOGY 1. Dr. K.S. Anand MD, DM (Neuro) Saturday 3:00 P.M. – 5:00 P.M. 5 (BRAIN) OPTHALMOLOGY 1. Dr. P.K. Vaish MS (Ophthalm),

DOMS Monday 9:00 A.M. – 11:00 A.M. 28

(EYE) Wednesday 9:00 A.M. – 11:00 A.M. Friday 9:00 A.M. – 11:00 A.M. ORTHOPAEDICS 1. Dr. R.K. Gupta MS (Ortho) Monday 4:00 P.M. – 6:00 P.M. 7 (BONE & JOINTS) Wednesday 4:00 P.M. – 6:00 P.M. Friday 4:00 P.M. – 6:00 P.M. PAEDIATRICS 1. Dr. Anjali Gera MD (Ped) Monday 9:30 A.M. – 11:30 A.M.

(Creche) 25

(CHILDREN) Friday 9:30 A.M. – 11:30 A.M. 2. Dr. Manjoo Gupta MD (Ped) Wednesday 9:30 A.M. – 11:30 A.M.

(Creche) 23

Tuesday 9:00 A.M. – 11:00 A.M. PSYCHIATRY 1. Dr. Anandi Lal MD (Psychiatry) Monday 9:00 A.M. – 11:00 A.M. 23 DERMATOLOGY 1. Dr. Monika Garg DVD Wednesday 10:00 A.M. – 12:00 NOON 25 (SKIN) Friday 10:00 A.M. – 12:00 NOON 2. Dr. Divya Aggarwal MD (Dermat) Tuesday 8:30 A.M. – 10:30 A.M. 25 Thursday 8:30 A.M. – 10:30 A.M.

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SERVICES

FACILITIES AT W.U.S. HEALTH CENTRE (NORTH CAMPUS):- PHYSIOTHERAPY SERVICES:- 1. Sh. R.S.K. Nair Physiotherapist 09.00 AM to 04.00 PM (Monday to Friday) 2. Mrs. Meenakshi Nair Physiotherapist 09.00 AM to 04.00 PM (Monday to Friday) 3. Ms. Kiran Sharma (on contract) Physiotherapist 10.30 AM to 05.30 PM (Monday to Friday) 09:00 AM to 04:00 PM

(Saturday) CLINICAL PATHOLOGY LABORATORY (Monday to Friday 9.00 A.M. to 5.30 P.M.) 1. Ms. Shilpa Singh Technical Assistant 2. Sh. Gopal Dutt Tiwari Technical Assistant (on contract) (Sample collection is done between 09.30 AM to 12.30 only) (Sugar, KFT, Lipid Profile & LFT are performed only on Mon, Wed & Fri) Laboratory Services are not available on Saturday & Sunday Thyroid Profile (T3, T4, TSH) is performed on 2nd & 4th Tuesday of the month only X-Ray

Monday to Friday from 09:00 AM to 05:00 PM 1. Sh. Baljit Singh Sr. Technical Assistant DENTAL SERVICES AT NORTH CAMPUS Monday to Saturday from 10:00 AM to 01:00 PM Dr. Preeti Mahajan Dr. Shalu Pruthi Dr. Gaurav Vats Root Canal Treatment is available daily ADDITIONAL SERVICES AVAILABLE

1. Ayurvedic Dispensary Dr. (Mrs.) Shuchi Gauba (Run by Municipal Corporation of Delhi) Summer: Mon to Sat-08.00 AM to 02.00 PM Winter : Mon to Sat. 09:00 AM to 03:00 PM

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WUS HEALTH CENTRE, SOUTH CAMPUS BENITO JUAREZ ROAD, NEW DELHI-110021.

Telephone: 24110505 FACILITIES AVAILABLE AT W.U.S. HEALTH CENTRE (SOUTH CAMPUS):- W.U.S HEALTH CENTRE (SOUTH CAMPUS) PROVIDES HEALTH SERVICES FROM MONDAY TO SATURDAY WITH LIMITED INVESTIGATIVE SERVICES.

TIMINGS: 09.00 AM to 05.30 PM, MONDAY to FRIDAY SATURDAYS: Emergency services are available from 09:00 AM to 03: 00 P.M. Sunday closed. LIST OF MEDICAL OFFICERS S.No. Name Qualification Designation Time 1. Dr. V.P. Garg M.B;B.S, MD (Ped) Sr. Medical Officer 09:00 AM to 03:00 P.M 2. Dr. Rinku Mathur M.B;B.S, DMCH Medical Officer 11:30 AM to 05:30 P.M PART TIME MEDICAL OFFICERS 1. Dr. Aneet Wadhwa M.B;B.S Part-time Medical Officer 02:30 PM to 05:30 P.M. 2. Dr. Renu Verma M.B;B.S, MS Part-time Medical Officer 09:00 AM to 12:00 P.M. Clinical Pathology Laboratory 1. Ms. Nirmala Kumari Technical Assistant A. Sample collection time 09.30 AM to 11.30 AM B. Routine Blood, Urine, Stool Tests is done on: Monday to Friday C. Blood Sugar Test is done on: - Tuesday & Thursday D. LFT, KFT, Lipid Profile, RA Factor is done on: Thursday

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DENTAL SERVICES:- Dr. N.K. Pahwa, BDS Tuesday, Wednesday & Thursday 02:15 PM to 04:15 PM Root Canal Treatment is available on Tuesday, Wednesday & Thursday GYNAECOLOGICAL SERVICES: Dr. Neelu Gandhi, M.B;B.S, MD (Gynae) Monday, Wednesday & Friday

09:00 AM to 11:00 AM

EYE SERVICES:- Dr. Tarun Kapoor, M.B; B.S, MS (Ophthalm) Monday & Thursday

03:00 PM to 05:00 PM PHYSIOTHERAPY SERVICES:- Ms. Vertika Goel Physiotherapist 09.30 AM to 03.30 PM (Monday to Saturday

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WUS HEALTH CENTRE, EAST B.R.AMBEDKAR COLLEGE CAMPUS, STAFF QUARTERS-2&3

YAMUNA VIHAR, DELHI-110094 Telephone: 22813870

TIMINGS: 09.00 AM to 03.00 PM, MONDAY to FRIDAY SATURDAYS & SUNDAYS CLOSED

Dr. J.K. Siddhartha, M.B;B.S, DHHM, MBA Sr. Medical Officer 09:00 AM to 03:00 PM

Pathological Testing are available on Tuesday & Thursday from 09:00 AM to 03:00 PM

WUS HEALTH CENTRE, WEST SHIVAJI COLLEGE CAMPUS, RING ROAD,

DELHI-110027 Telephone: 25105659

TIMINGS: 09.00 AM to 03.00 PM-MONDAY to FRIDAY

SATURDAYS & SUNDAYS CLOSED

Dr. T.K. Chumbak, M.B;B.S Medical Officer 09.00 AM to 03.00 PM Pathological Testing are available on Monday, Wednesday & Friday from 09:00 AM to

03:00 PM

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ELIGIBILTY & MEMBERSHIP

1. All permanent employees of Delhi University and its Constituent Colleges and Members of their family (as recorded in the service book) are entitled for all approved facilities of Health Centres.

2. All ad-hoc employees and temporary employees are issued Treatment Card

for the specified period of employment and entitled only to existing in-house facilities of the Health Centres. They are not entitled for any form of reimbursement.

3. Full time students of the University are entitled to become temporary members on

year to year basis.

i. Each eligible member is issued a Health Book or Card bearing a recent passport size photograph. It should be pasted on the inner side of the Health Book or in the front portion of the Treatment Card.

ii. In case a member does not bring the Treatment Card/ Health Book while

approaching the Doctor, medicines will not be given for more than 3 days.

iii. Members holding Treatment Card with ‘D’ (day students) membership are eligible only for the facilities available in the Health Centre. No reimbursement of any kind will be allowed.

iv. Members holding Treatment Card with ‘R’ (resident student) and ‘T’

(temporary members) membership are also not eligible for reimbursement of treatment at other Hospitals either in their OPD or IPD.

v. Investigative laboratory tests, Radiological tests and Medicines readily

available in the Health Centre will not be allowed to be done or purchased from the open market. Such bills will not be entertained for reimbursement.

vi. For seasonal/routine ailments, medicines will be issued initially for 3 to 5

days before making a long tern treatment plan.

vii. For chronic ailments and long term on-going treatments, medicines can be issued for one full month.

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HOW TO BECOME A MEMBER OF THE WUS HEALTH CENTRE

Health centre facility is available to only eligible members who have enrolled themselves (teachers, non-teaching, students & retired staff of Delhi University and its affiliated Colleges) in the health centre. To obtain membership, a prescribed pro forma has to be filled up by University employees/students along with payment of the prescribed subscription fee. A specimen of application form is enclosed (Annexure I-II). 1. University Employee (a). In service employees Academic and Non-academic employees are required to submit properly verified Application Form, from their respective department/college alongwith following documents:-

Copy of Appointment Letter Date of Birth Certificate of wife and children(s) Two copies of recent passport size photograph of each book-holder Certificate from the work place of spouse in case s/he is working, mentioning that

s/ she will not avail any medical facility from their organization. The subscription for membership for one month has to be deposited in cash in the Health Centre between 10:00 a.m. to 12:30 p.m. along with the application form. The subscription for subsequent months will be forwarded by their respective college/department. (b) Retired employees A retired employee is required to submit a properly verified Application Form along with following documents:-

No Dues Certificate Two copies of recent passport size photograph of each book-holder

The Pay Band and Grade Pay at the time of retirement must be mentioned clearly on the Application Form. 10 years subscription is taken as Life Membership only for the Retired Employees, which is also payable year wise without any break or lump-sum payment at the time of final retirement. The amount has to be paid in Cash or by Cheque/Demand Draft in favour of Registrar, University of Delhi and has to be deposited in the Office of the Health Centre.

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2. Students registered in full time Courses They are required to submit the following additional information along with the regular Application Form:

Photocopy of the college / department fee receipt. Photocopy of the College / Departmental Identity Card. Two latest passport size photographs.

3. Students registered in diploma/ part time /correspondence Courses Students pursuing diploma / part-time /correspondence courses are not eligible for Health Centre Membership.

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ENTITLEMENTS OF ELIGIBLE MEMBERS

1. All Non-Resident Students will be provided only Emergency Treatment at the Health Centre as and when required. OPD treatment will be given only to those Non-resident Students who have paid membership fee of the Health Centre on per session basis. No Reimbursement of any kind will be allowed.

2. All Resident Students (in Halls/Hostels of the University and its affiliated colleges)

will be provided OPD treatment with facility for local purchase of reimbursable medicines if these are not readily available in the Health Centre. No other form of reimbursements will be allowed.

3. All permanent Employees of the Institute of Economic Growth, C.P.D.H.E.

and Agro Economic Centre will be allowed to continue their Membership of the WUS Health Centre and avail investigation and treatment facilities available at the Health Centre. However, all hospitalization related expenses and any other investigation charges will be paid to these employees directly by the respective employers or the funding agencies only.

4. Regular full time employees of Delhi University Co-operative Society, WUS-

DU Committee and Delhi University Women’s Association will be given membership of the WUS Health Centre on payment of Rs. 120/- for each session (August 1 to July 31). The membership will include all eligible members of family as per University norms. They will be provided only OPD facilities available at the Health Centre. No reimbursement facility will be allowed.

5. All workers employed on Ad-hoc and contract basis and personnel appointed

in time bound Research Projects will be allowed only OPD consultation and treatment on production of valid identity cards clearly showing the period for which s/he is engaged in work with the University. No reimbursement facility will be allowed. The facility will be given to individuals only and shall not include any other members of the family. Rate chargeable for the members will be in accordance with the rate slabs applicable for drawing other benefits.

6. Visiting Faculty will enjoy full OPD facility including local purchase of medicines

not available at the Health Centre. All other investigation and in-door treatment bills will be paid by the Sponsor or Donor institution as the case may be.

7. All regular University and affiliated college employees will enjoy the

consultation and treatment at the Health Centre with reimbursement of medicine and tests required for diagnoses by the attending Medical Officer. However, Emergency and hospitalization will be reimbursed by the College/University as the case may be.

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SUBSCRIPTION FOR HEALTH CENTRE MEMBERSHIP

(w.e.f. 23.06.2009) (B) Non Resident Students (Day Students)

120/- p.m. payable on annual basis from the academic year beginning 2005. . (C) Resident Student (Hostel)

240/- p.m. payable on annual basis from the academic year 2005. (D) Ph.D./M.Phil student

240/- per academic session. (E) Junior Research Fellows, Senior Research Fellows, Research Associates: As per salary slabs applicable to regular employees Note: 10 years subscription is taken as Life Membership only for the Retired Employees,

which is also payable year wise without any break or lump-sum payment at the time of final retirement. The amount has to be paid in cash or by Cheque/Demand Draft in favour of Registrar, University of Delhi and deposited in the Office of the Health Centre.

In service employee intending to become member of Health Centre shall have to

pay one month subscription in cash in the Health Centre Office and subsequent payments will be deducted from their salary in their respective institutions.

Re-employed employees shall make one time payment in cash for the specified

period of re-employment. The amount is to be calculated on the basis of the rate of subscription payable at the time of reemployment.

Grade Pay In Service Retired Per Month

Contribution Life Time

Contribution Upto 1,650/- per month

50/- 6,000/-

1,800/-; 1,900/-; 2,000/- 2,400/- ; and 2,800/- per month

125/- 15,000/-

4,200/- per month

225/- 27,000/-

4,600/-; 4,800/-; 5,400/-; and 6,600/- per month

325/- 39,000/-

7,600/- and above per month

500/- 60,000/-

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GUIDELINES FOR CLAIM OF REIMBURSEMENT

1) There is no need to obtain reference from the WUS Health Centre for availing treatment at the hospital.

2) The treatment must be availed only from the Hospitals empanelled by the

University. However, in emergency cases, the treatment can be availed from the nearest hospital even if that Hospital is not on the University approved panel. The nature of Emergency will have to be justified and approved by the Medical Administrator for availing reimbursement of expenses.

3) Reimbursement bill ought to be submitted by the beneficiaries directly to their

concerned College/Department / University in which the beneficiaries are working. Form (A) for OPD treatments and /Form (B) for Hospitalization expenses. The College/University will make the reimbursement as the case may be. All claims must be made within three months of the treatment.

4) The Retired employee must submit their Hospital /OPD claims directly to

the College/Department / University from where they retired. The reimbursement will be made by College /University as the case may be.

5) The reimbursement will be as per CGHS approved rates. All extra charges other

than the CGHS approved rate list will be the responsibility of the incumbent.

Reimbursement of Diagnostics/ X-ray charges Such reimbursement will be allowed only if such test facilities are not available or operational in the particular WUS Health Centre. Availability and functionality of these tests/equipments must be ascertained from the Pathological, Analytical labs and X-ray before getting the investigations done in other laboratories.

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MEDICAL FITNESS CERTIFICATE & MEDICAL BOARDS

1. Medical fitness certificate in case of fresh or re-employment is provided by the W.U.S. Health Centre as per guidelines illustrated in Annexure-III. In case of new appointments to the University, Medical Examination shall be done daily from Monday to Friday from 09:00 AM to 05:30 PM.

Candidates are required to submit 2 passport size photographs duly attested alongwith the letter of appointment.

2. Any student requiring writer or extension of time during examination should apply

to the Principal of the respective college one month in advance. The application is routed through the Examination Branches at the North or South Campus to the Chief Medical Officer WUS Health Centre (MAIN CAMPUS), Chhatra Marg, University of Delhi, Delhi-110007.

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Annexure-I WUS HEALTH CENTRE UNIVERSITY OF DELHI

DELHI-110007 Application Form for Membership in the WUS Health Centre (Permanent/Temp./Retd.Employees )

Addition of the name of dependants/ Duplicate The Chief Medical Officer WUS Health Centre, Token Card No…………….. University of Delhi,

Dated……………………… Dear Sir, I, (______________________) wish to avail the medical facilities provided at the Health Centre. I agree to abide by the rules and regulations of the WUS Health Centre as framed by the Executive Council and also agree to have the necessary contribution deducted from my salary every month. I undertake that: 1. I am not a member of any other Health Centre of University of Delhi. 2. Enclose the age proof Birth Certificate/School Certificate for the dependant beneficiaries. 3. Enclose copy of University Employee I-Card Two Photograph of each member. 4. Certificate from the respective deptt. of spouse that he/she is not availing any medical facilities form his/her 5. Office (If he/she is working). (Signature)

(To be filled by the Applicant)

Name (in Block Letters)…………………………………………………..…………Age………..……. Sex………..........

Designation…………………………………..……………Department/College…...…………………….…………….. …

Date of Appointment/Date of Retirement…………………………………………….

Residential Address…………………………………………………..……………………………………………………..

………………………………………………………………………….Phone No……………………………

S.No. Name of the family Date of Birth Marital Status Relation Income of the Member

Members

(To be filled in by the Office of the Applicant)

Present Last Pay Scale …………………………………………Grade Pay………………………………………………..

Pay Band…………………………………………………… Date of increment…………………………………………..

(i) I certify that the particulars filled in by the Applicant and the Office are correct to the best of my knowledge and belief.

He/She may be admitted to the Health Centre. The Health Centre Contribution will be deducted from the salary of the applicant every month according to the rules.

(ii) Certified that the H.C. Contribution in respect of Sh./Ms. ……………………………………..….is being/has been deducted ……………….p.m. w.e.f. ………………………….. and being (regularly)/ has been remitted to the University/Centre vide Ch.No…………….. dated…………………

Chief Medical Officer Seal of the Institution

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Page 1 of 2

WUS HEALTH CENTRE UNIVERSITY OF DELHI

DELHI – 110 007 TOKEN CARD NO. :_______________

DATED: _________________________

Issue of Health Book – Regular Employees/Retired Employees along with dependants

I hereby affix my family photographs for Health Books. Name of Applicant Name _________ Name__________ Name__________

Relation________ Relation_________ Relation________

Name__________ Name__________ Name__________ Name__________

Relation________ Relation________ Relation________ Relation________

Signature of Applicant

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Page 2 of 2 Annexure II

Specimen Copy

WUS HEALTH CENTRE UNIVERSITY OF DELHI

DELHI-110007

FOR NON RESIDENT/RESIDENT STUDENT T.C. No. D……………

R Application for Membership

(To be filled in by the applicant)

Name (in block letters)…………………………………..………….…………….…..Age………….Sex…………...

College/Department…………………………………..…….Class…………….……..Roll No………………..….....

Home/Hostel Address…………………………………………………………………………....................................

……………………………………………………………………………….......Phone No…………………............

I…………………………………….……………………………..wish to register my name with the W.U.S. Health

Centre to avail a sum of Rs. ____________ as membership fees for the session.

(Attach a photocopy of the fee receipt and Photo Copy of Identity Card and Two Passport size photographs.)

I have already paid ………………….…at WUS Health Centre Contribution Vide R.No.(__________________) Dt (______________________________________) in the Hostel. (Attach a copy of the Receipt)

Signature

Certified that the particulars given above by the applicant are correct to the best of my knowledge. I recommended him/her for registration in the WUS Health Centre.

Rates of Health Centre Contribution For Resident student 240/- per academic session. For Non-Resident student 120/- per academic session. For Ph.D./M.Phil student 240/- per academic session. For Non-Resident Student

Received ______________ for WUS Health Centre fee

Vide R.No.________________ dated__________________

Signature of Cashier/S.O. with stamp Signature and Seal with the Of the Department/Institution Head of the Institution/Hostel

(FOR HEALTH CENTRE USE) Received a sum of _______________________ vide Receipt No.__________________ Dated_____________ Chief Medical Officer Section Officer

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Annexure III Specimen Copy

WUS HEALTH CENTRE UNIVERSITY OF DELHI

DELHI-110007

APPLICATION FOR MEDICAL EXAMINATION FOR FRESH/RE-EMPLOYEMENT

The following document/test reports are being submitted for medical examination: 1. Chest X-Ray 2. Recent E.C.G. 3. Vision Report RE/LE 4. Fundoscopy Report 5. Urine/R/ME 6. Blood Sugar-Fasting/P.P./HB 7. Gynecology Examination Report for female

candidate 8. Audiometric/ENT Report

9. Copy of offer letter for employment/re-employment Note: Tests to be performed only in the Govt./University approved Hospitals and Diagnostic Centre.

(To be filled by the Candidate) 1. Name (in block letter).............................................................................................Sex: Male/Female

2. Date of Birth………………………….. College/Institution………………………………………...

3. Designation……………………………………… Department……………………………………..

4. Marital Status: Married/Single

5. Vegetarian/Non-Vegetarian

6. Do you smoke: Yes/No 7. Do you take alcoholic drink: Yes/No

8. Any games played or exercise taken regularly

9. Immunity Status- When last immunized against:

Typhoid…………………. Hepatitis-B……………………………………………………….

Any other……………………………………………………………………………………….

11. History of serious illness, operation, hospitalization.

…………………………………………………………………………………………………........

12. Allergy, if any……………………………………………………………………………………….

13. Any other information about your health…………………………………………………………...

14. Residential Address and Telephone No……………………………………………………………..

SIGNATURE

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Page 1 of 2

MEDICAL REPORT

Name………………………………………………………… Date of Exam………………………….

GENERAL EXAMINATION:

1. Apparent………………………. Age……………………………...

2. Build: Thin/Medium/Heavy…………………… 3. Nutrition…………………………

4. Height…………………………. 5. Weight…………………………..

6. Chest Normal………………….. 7. Expanded………………………..

8. Abdominal girth………………. 9. Eye (External)……………………

10. Vision RE/LE 11. Ear/Nose/Throat/Teeth

12. Pulse Rate/Volume/Rhythm/…………………………………

13. Heart……………………….. 14. Blood Pressure……………………

15. Lungs………………………. 16. Liver/Spleen………………………

17. Glands………………………

18. Bones/Joints/Muscles…………………………………………………………..

19. Skin/Hair/Nails…………………………………………………………………

20. Hernia/Hydrocele/Varicose veins………………………………………………

21. Gynae/Obstetric History……………………………………………………….

22. E.C.G. …………………………………………………………........................

23. Laboratory Investigation:

24. Urine/R/MF……………………………………………………………………

25. Blood HB…………………………………………………………...Gms/1000

26. Any Special Investigation:

27. Remarks of Examining Medical Officer

CHIEF MEDICAL OFFICER MEDICAL OFFICER

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Annexure IV Specimen Copy

W.U.S. HEALTH CENTRE UNIVERSITY OF DELHI

NO DUES CERTIFICATE

(To be submitted on Retirement/Death/Withdrawal of Membership/Deputation)

1. Name ………………………………………....……. Designation ……………………………. 2. College/Institute …………………………………...Department ………………………….. 3. Are you member of Health Centre ? ………………………………. ………….. 4. Token Card No. …………………………… ……….. 5. Basic Pay + Grade Pay as on to date ………………………………………….. 6. Health Centre Contribution (old rate) deducted ………….. P.M. from ……………to………………

7. Health Centre Contribution (new rate) deducted @ ……………. P.M.from .……….to …………… 8. Date of Retirement/Death……………….. ……………………………………………

9. Health Centre Contribution arrears deducted ………………………

The particulars are correct as per office record

Principal/Head/Section Officer (With Seal)

Note: The concerned employee should be directed to surrender the Token Card and all the Treatment Books. ----------------------------------------------------------------------------------------------------------------------------------

W.U.S. HEALTH CENTRE UNIVERSITY OF DELHI

(Clearance Certificate)

Certified that nothing is to be recovered from Mr./ Ms. ………………………Designation…………….…... Working in…….………………………………….……………..Token Card no….………………………… Having Books also surrendered by him/her. Amount deposited ……………………………………….. for the month of ……………………………

SECTION OFFICER

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Annexure -V Please visit University website to see for updated list of approved hospitals and diagnostic centres.

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Annexure VI

Specimen Copy

The Chief Medical Officer, University of Delhi, Delhi-110007.

Subject: Payment of investigation Charges Bills Sir, I am enclosing herewith bill / bills of investigation charges as detailed below:- S.No. Name of Hospital Nature of Investigation Amount 1. 2. 3. 4. Total

Yours Faithfully, Signature……………………………………

Name of Employee…………………………

Token No. ………………………………….

Designation…………………………………

College/Deptt……………………………….

Telephone No……………………………….

Address……………………………………..

.……………………………………………..

S.B.I. Delhi University Main Branch

Saving Bank A/c No.

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Annexure VII

Specimen Copy

The Chief Medical Officer University of Delhi Delhi-110007.

Subject: Payment of Local Purchase bills through Cheque/Cash Sir, I am enclosing herewith bill / bills L.P. Medicines charges as detailed below:- S.No. Cash Memo No./ Date Amount 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Total Yours Faithfully, Signature……………………………………

Name of Employee…………………………

Token No. ………………………………….

Designation…………………………………

College/Deptt……………………………….

Telephone No……………………………….

Address……………………………………..

.……………………………………………..

S.B.I. Delhi University Main Branch

Saving Bank A/c No