MUMBAI PORT TRUST
MEDICAL DEPARTMENT
Sub : Treatment to Non-port Trust patient in MbPT hospital
Non port Trust patients are provided Medical treatment in Mumbai Port Trust hospital on payment basis.
Procedure:
(1.) Non port trust patients should approach Account cell on week days during office hours or enquiry counter after office hours or on Sundays/holiday for obtaining application form/consent form for availing treatment in P.T. Hospital. After obtaining Chief Medical Officer/Asst. Chief Medical Officer's approval on application they are required to pay initial deposit in cash in Account cell or at Enquiry counter whenever Account Cell is closed of P.T. hospital as follows:
1. For OPD treatment Rs.1300/-
2. For Indoor treatment Rs.6500/-
3. For HBO treatment Rs.4500/-
(2.) Necessary case paper will be issued to the patient on payment of deposit in cash
(3) While availing the treatment , if the deposit amount is found insufficient for the treatment, the patient will be asked to pay the additional amount as suggested by the Account cell.
(4) On completion of treatment, account cell ,P.T. Hospital will process the case for calculation of charges towards the medical treatment availed by the NPT patient.
(5) If the charges for the treatment are less than the amount of deposit, the balance amount is refunded in cash to the depositor by Account cell, P.T. Hospital after audit in due course.
DA. Set of documents for NPT patient.
Assistant Superintendent
Account cell
MUMBAI PORT TRUST
MEDICAL DEPARTMENT
Application form for Non Port Trust Patients
1. Patient's Name in full:
2. Patient's Address:
Telephone Number:
3. Referred by Doctor:
(Name and Address)
4. Employee's Name:
5. Employee Address:
Telephone Number:
6. Designation/ Section/
Department:
7. P.I. Card Number:
8. Relation with patient:
9. Diagnosis (Suffering From):
10.Investigation and treatment:
required from P.T. Hospital
I also undertake to pay the hospital bill, if the patient fails to pay the same.
______
Signature of Employee Signature of patient
______
MBPT Doctor's SignatureCHIEF MEDICAL OFFICER
Consent For Hyperberic Oxygen Therapy
I hereby give my consent for undergoing Hyperberic Oxygen Therapy.
The procedure has been explained to me in my language.
I am aware of the risks involved in undergoing such a therapy.
I am also aware that this procedure can cause unexplained deaths.
I am giving my consent only after understanding all of the above.
The doctors or the ancillary staff of Mumbai Port Trust will in no way be responsible for any untoward consequences resulting out of this Hyperberic Oxygen Therapy.
______
Signature of Patient or GuardianSignature of Witness
Relationship of the Guardian with the patient______
Signature of the doctorDate:
Please note: Non Port Trust patients should be accompanied by a nurse and a doctor.