*The LOG form needs to be filled in by the member/patient and the attending doctor.
Part 1 – Insured Member
Part 2 – Attending Doctor (only if the admission is to a private hospital)
Along with the duly filled LOG form, please share ;
- Financial Counsellor/cost estimation form issued by the hospital
- A referral Letter/memo issued by the attending doctor recommending the procedure and the confirmation of the current medical condition
Participating Hospital List:
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