LIST OF FOLLOW-UP DRUGS, STRENGTH AND DOSAGE X. Xx. System Formulation Name of the Drug Dose 1 HEART Tab Warfarin Sodium* 5 mg 2 Tab Acitrom* 1mg/ 2mg /3mg /4mg 3 Tab Aspirin 150 mg 4 Tab Clopidregel 75 mg 5 Tab Atenolol 50 mg 6 Tab Amoloride+Hydrochlorothiazide* 20mg+12.5mg 7 Tab Digoxin* 0.25mg 8 Tab Nifedepin 10mg 9 Tab Amolodepin 5mg/ 10 Tab Enalapril maleate 2.5 mg/5mg 11 Syrup Kcl Syrup* 100 ml 13 Tab Sorbitrate 10mg 14 Tab Metoprolol 25mg 15 Tab Amadioron(Cardron) 100mg 16 Tab Losartan Potassium 25mg 17 Tab Atorvastatin 10mg,20mg 18 Injection Benzathine Pencillin* 12 lakh units 19 Neuro-Surgery including Trauma Tab. Eptoin 100mg 20 Tab Sodium Valprodate 400mg 21 Tab. Carbamazepine 200mg 22 Kidney Tab. Allopurinol(Xyloric ) 100mg 23 Ortho-Trauma Tab. Diclofenac Sodium 50 mg 24 Tab Aceclofenac* 100 mg 25 Tab Serroptiopeptidase 10 mg 26 Antibiotics Cap. Ampicillin 250mg 27 Cap. Ampicillin 500 mg 28 Cap. Cephalexin 250mg 29 Cap. Cephalexin 500mg 30 Tab Ciprofloxacin 500mg 31 Syrup Ampicillin 125mg/ 5ml(60 ml) 32 Others Tab Ranitidin 150mg 33 Tab Pantaprozole 20mg 34 Tab Pantaprozole 40mg 35 Tab Prednisolone 10mg,20mg,30mg.
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Samples: Agreement, app.ysraarogyasri.ap.gov.in, app.ysraarogyasri.ap.gov.in
LIST OF FOLLOW-UP DRUGS, STRENGTH AND DOSAGE X. Xx. System Formulation Name of the Drug Dose 1 HEART Tab Warfarin Sodium* 5 mg 2 Tab Acitrom* 1mg/ 2mg /3mg /4mg 3 Tab Aspirin 150 mg 4 Tab Clopidregel 75 mg 5 Tab Atenolol 50 mg 6 Tab Amoloride+Hydrochlorothiazide* 20mg+12.5mg 7 Tab Digoxin* 0.25mg 8 Tab Nifedepin 10mg 9 Tab Amolodepin 5mg/ 10 Tab Enalapril maleate 2.5 mg/5mg 11 Syrup Kcl Syrup* 100 ml 13 Tab Sorbitrate 10mg 14 Tab Metoprolol 25mg 15 Tab Amadioron(Cardron) 100mg 16 Tab Losartan Potassium 25mg 17 Tab Atorvastatin 10mg,20mg 18 Injection Benzathine Pencillin* 12 lakh units 19 Neuro-Surgery including Trauma Tab. Eptoin 100mg 20 Tab Sodium Valprodate 400mg 21 Tab. Carbamazepine 200mg 22 Kidney Tab. Allopurinol(Xyloric ) 100mg 23 Ortho-Trauma Tab. Diclofenac Sodium 50 mg 24 Tab Aceclofenac* 100 mg 25 Tab Serroptiopeptidase 10 mg 26 Antibiotics Cap. Ampicillin 250mg 27 Cap. Ampicillin 500 mg 28 Cap. Cephalexin 250mg 29 Cap. Cephalexin 500mg 30 Tab Ciprofloxacin 500mg 31 Syrup Ampicillin 125mg/ 5ml(60 ml) 32 Others Tab Ranitidin 150mg 33 Tab Pantaprozole 20mg 34 Tab Pantaprozole 40mg 35 Tab Prednisolone 10mg,20mg,30mg.. 36 Liq. Oral Glycerol Annexure - V Rajiv Aarogyasri Community Health Insurance Scheme Undertaking By Hospital for establishing Rajiv Aarogyasri Kisok with all Infrastructure We (Hospital name) hereby Undertake to provide space for kisok and hardware such as Computer system, scanner, printer, webcam, digital cam, Bar Code reader,xxxx,speakers and provide 1 mbps broadband connection to the kiosk and other stationery items. We understand that the Insurance company i.e M/x.Xxxx Health and Allied Insurance Co. Ltd (The Insurer for Aarogyasri I ) Will facilitate the provision of the above mentioned items to the hospital. We hereby agree to the Insurance company to deduct the entire amount for providing the above-mentioned items from the payment of our first xxxx to the Insurance Company. We also agree for deducting the charges of broadband connectivity for one year. Hospital Stamp Signature of Hospital CEO / CMD Date: Place: Annexure - VI Rajiv Aarogyasri Community Health Insurance Scheme Undertaking for Providing Stop Gap arrangement for Infrastructure We (hospital name) understand that M/s. Star Health and Allied Insurance Co. Ltd the Insurer For “Aarogyasri – I” will provide us the complete infrastructure such as Computer, printer, scanner, digital camera, web camera, bar code reader, xxxx, speakers etc… on chargeable basis, and will be deducted from our first xxxx submitted to their office for claim settlement. However we hereby agree and undertake till such time of receiving the Infrastructure to provide the above mentioned infrastucture from our end to ensure the smooth operation. Hospital Stamp Signature of Hospital CEO / CMD Date: Place Annexure - VII Rajiv Aarogyasri Community Health Insurance Scheme Core Banking Number - IFSC code We (hospital) hereby declare that we have the core banking facility with the Bank (mention the name of the Bank having Branch at . The IFSC No. (Mention your core banking Number) Authorized Signatory In case of non availability of IFSC Code I agree to provide the IFSC number within Five working days on receipt of this information Hospital Stamp Signature of Hospital CEO
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Samples: app.ysraarogyasri.ap.gov.in
