STATEMENT SHOWING DETAILS OF SUPER SPECIALTY TREATMENT CHARGES SANCTIONED TO EMPANELLED PROCEEDINGS No.S2- 7309(1)/2017/DIMS dt 12/04/2017 Name of ESI Sl. / Name of empanelled hospital Order No. and date Amount TDS Balance No. SST Sl.No. re No. re Dispensary Annexu 1 Chalakkudy Amala Institute of Medical Sciences Thrissur M/667/16/ESID/CLDY dt 21/11/16 36490 3649 32841 11 718 2 Chalakkudy Medical Centre Thrissur M/99/17/ESID/CLDY dt 30/01/17 41119 4112 37007 12 720 3 Lourdes Hospital Ernakulam G2-1658/16/ESIH/EKM dt 10/11/16 611776 61178 550598 1 698 4 Ernakulam KIMS Hospital, Ernakulam G2-1026/16/ESIH/EKM dt 10/11/16 28019 2802 25217 2 700 5 Ernakulam Hospital Ernakulam G2-431/16/ESIH/EKM dt 22/11/16 672411 67241 605170 3 704 6 Ernakulam Lourdes Hospital Ernakulam G2-3009/16/ESIH/EKM dt 22/11/16 384986 38499 346487 4 706 7 Ernakulam Sunrise Hospital Kakkanad G2-601/2016/ESIH/EKM dt 30/01/17 137340 13734 123606 33 752 8 Ernakulam Lourdes Hospital Ernakulam G2-6825/2016/ESIH/EKM dt 30/01/17 156332 15633 140699 34 753 9 Ernakulam Sunrise Hospital Kakkanad G2-1129/2016/ESIH/EKM dt 04/02/17 44626 4463 40163 35 755 10 Ernakulam Malankara Orthodox Syian Church Hospital G2-3118/16/ESIH/EKM dt 4/2/17 50382 5038 45344 36 756 11 Feroke Baby Memorial Hospital Calicut G2-8017/15/EHF dt 28/12/16 297731 29773 267958 15 725 12 Feroke Baby Memorial Hospital Calicut G2-8019/15/EHF dt 24/12/16 301412 30141 271271 16 726 13 Feroke Baby Memorial Hospital Calicut G2-8025/15/EHF dt 26/12/16 233423 23342 210081 17 727 14 Feroke Baby Memorial Hospital Calicut G2-8052/15/EHF dt 26/12/16 284342 28434 255908 18 728 15 Koratty Aster Medcity Hospital Ernakulam 283/16/ESID/Koratty dt 25/11/16 363 36 327 5 710 16 Koratty Little Flower Hospital 281/16/ESID/Koratty dt 25/11/16 2268 227 2041 6 712 17 Koratty Little Flower Hospital Angamaly 280/16/ESID/Koratty dt 25/11/16 44376 4438 39938 7 713 18 Koratty Little Flower Hospital Angamaly 279/16/ESID/Koratty dt 25/11/16 11166 1117 10049 8 714 19 Koratty Little Flower Hospital Angamaly 277/16/ESID/Koratty dt 25/11/16 16878 1688 15190 9 716 20 Nilambur KIMS AlShifa Perinthalmanna 15/17/ESID/NBR dt 10/01/17 19975 1998 17977 19 730 21 Nilambur KIMS AlShifa Perinthalmanna 16/17/ESID/NBR dt 10/01/17 18424 1842 16582 20 731 22 Nilambur KIMS AlShifa Perinthalmanna 18/17/ESID/NBR dt 10/01/17 24405 2441 21964 21 733 23 Nilambur KIMS AlShifa Perinthalmanna 19/17/ESID/NBR dt 10/01/17 17312 1731 15581 22 734 24 Nilambur MIMS Hospital, Calicut 20/17/ESID/NBR dt 10/01/17 480 48 432 23 735 25 Nilambur MIMS Hospital, Calicut 21/17/ESID/NBR dt 10/01/17 23607 2361 21246 24 736 26 Nilambur KMCT Medical College Hospital Mukkam 23/17/ESID/NBR dt 10/01/17 135 14 121 25 738 27 Nilambur KIMS AlShifa Perinthalmanna 24/17/ESID/NBR dt 10/01/17 34870 3487 31383 26 739 28 Nilambur MIMS Hospital, Calicut 26/17/ESID/NBR dt 10/01/17 135 14 121 27 741 29 Nilambur MIMS Hospital, Calicut 27/17/ESID/NBR dt 10/01/17 825 83 742 28 742 30 Nilambur MIMS Hospital, Calicut 29/17/ESID/NBR dt 10/01/17 2836 284 2552 29 743 31 Nilambur EMS Hospital Perinthalmanna 30/17/ESID/NBR dt 10/01/17 41501 4150 37351 30 744 32 Nilambur EMS Hospital Perinthalmanna 34/17/ESID/NBR dt 10/01/17 27432 2743 24689 31 749 33 Nilambur EMS Hospital Perinthalmanna 39/17/ESID/NBR dt 10/01/17 1167 117 1050 32 751 34 Vadavathoor Bharath Hospital Kottayam G1-7642/16/ESIH dt 15/12/16 12600 1260 11340 10 717 35 Velloor Lourdes Hospital Ernakulam 169/16 dt 22/12/16 37413 3741 33672 13 722 36 Velloor Bharath Hospital Kottayam 168/16 dt 22/12/16 1335 134 1201 14 723 37 Velloor Lourdes Hospital Ernakulam 3/2017/ESID/Vellor dt 13/1/17 32168 3217 28951 37 757 38 Velloor Aster Medcity Hospital Ernakulam 13/2017/ESID/Vellor dt 30/1/17 245054 24505 220549 38 758

TOTAL 3897114 389715 3507399

DIRECTOR OF INSURANCE MEDICAL SERVICES