& ැම ද අශ ෙට ණඩ (SMS) ෙෝ ැැල (අශ ාය ක න) ඉලමෙග ජා ැඳමත අංය
^Pdhd msgm; gm; wuqKka Kkak&
Tnf.a ysâlu âlu wod, jkafka bosrfhka fs hka ^ ^√& oukak' k ' rcfha frday,l y ,l fm!oa.,s . ,sl frday,l y ,l ore Wm;la weialka l kaKdõ K dõ yDo ie;alula l ula
1' b,a,q ,us quslre ms
ms
සමපර ku() ^isxyf,ka& mQcH$uhd$ush$fukjs h$fukjs h( h( ''''''''''''''''''''''''''' ''''''''''''''''''''''''''' '''''''''''''''''''''''''' '''''''''''''''''''''''''' ''''''''''''''''''''''''''' ''''''''''''''''''''''''''' '''''''''''''''''''''''''' '''''''''''''''''''''' '''''''''
fjk;a frda.
'''''''''''''''''''''''''' '''''''''''''''''''''''''' ''''''''''''''''''''''''''' ''''''''''''''''''''''''''' ''''''''''''''''''''''''''' ''''''''''''''''''''''''''' '''''''''''''''''''''''''' '''''''''''''''''''''''''' '''''''''''''''''''''''''' '''''''''''''''''''''''''' ''''''''''''''''''''''''''' '''''''''''''''''''''''''''' ''''''''''''''''''''''''''' ''''''''''''''''''''''''' '''''''''''''''''''' uq,l= ,l=re iu. ku ^bx.%Sis ifhka fs hka&()--------------------------------------------------------------1'2
mqoa oa.,sl ,smkh(^is skh(^isxyf,ka&()'''''''''''''' )''''''''''''''''''''''''''' ''''''''''''''''''''''''''' ''''''''''''''''''''''''''' '''''''''''''''''''''''''' ''''''''''''''''''''''''''' '''''''''''''''''''''''''' ''''''''''''''''''''''''''' '''''''''''''''''''''''''''' '''''''''''''''''''''''''' ''''''''''''''''''''''''' ''''''''''''''''''''' '''''''''
1'2
mqoa.,s .,sl ,smskh ^bx.%Sis ifhka fs hka&() &() ''''''''''''''''''''''''''' ''''''''''''''''''''''''''' '''''''''''''''''''''''''''' ''''''''''''''''''''''''''' '''''''''''''''''''''''''' '''''''''''''''''''''''''' '''''''''''''''''''''''''' ''''''''''''''''''''''''''' '''''''''''''''''''''''''''' ''''''''''''''''''''''''' '''''''''''''''''
1'3
Wmka os oskh() kh() '''''''''''''''''''''''''' '''''''''''''''''''''''''' ''''''''''''''''''''''' ''''''''''
1'4
rl:k wxlh () rdcldrs''''''''''''''' '''''''''''''''''''''''''''' ''''''''''''''''''''''''''' ''''''''''''''''''''''''''' ''''''''''''''''''''''' '''''''''' 'mq oa., ., sl'''''''''' l'''''''''''''''''''''''' '''''''''''''''''''''''''''' ''''''''''''''''''''''''''' '''''''''''''''''''''''''''' ''''''''''''''''''''''''' ''''''''''
2' Tn /lshdj hdj lrk wdh;kfha ku ku iy ,sm sskh ()'''''''''''''''''''''' ''''''''''''''''''''''''''' ''''''''''''''''''''''''''' '''''''''''''''''''''''''' '''''''''''''''''''''''''' ''''''''''''''''''''''''''' ''''''''''''''''''''''''''' '''''''''''''''''''''''''' '''''''''''''''''''''' ''''''''' ''''''''''''''''''''''''''' '''''''''''''''''''''''''' '''''''''''''''''''''''''' ''''''''''''''''''''''''''' '''''''''''''''''''''''''''' ''''''''''''''''''''''''''' '''''''''''''''''''''''''' '''''''''''''''''''''''''' '''''''''''''''''''''''''' '''''''''''''''''''''''''' '''''''''''''''''''''''''' '''''''''''''''''''''''''''' '''''''''''''''''''''''''''' '''''''''''''''''''''''''' ''''''''''''''''''''''''' ''''''''''''''''' ''''' 3 l,;%hdf.a f;dr;= f;dr;=re 3'1 3'2 3'3
cd;sl ැඳමත wxlh() ku()''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' fiajd jd ia:dkfha :dkfha ku iy ,smskh()'''''''''' kh()''''''''''''''''''''''' ''''''''''''''''''''''''''' '''''''''''''''''''''''''' '''''''''''''''''''''''''' ''''''''''''''''''''''''''' '''''''''''''''''''''''''' ''''''''''''''''''''''''''' ''''''''''''''''''''''''''' '''''''''''''''''''''''''' '''''''''''''''''''' ''''''' '''''''''''''''''''''''''' '''''''''''''''''''''''''' ''''''''''''''''''''''''''' ''''''''''''''''''''''''''' ''''''''''''''''''''''''''' ''''''''''''''''''''''''''' '''''''''''''''''''''''''' '''''''''''''''''''''''''' '''''''''''''''''''''''''' '''''''''''''''''''''''''' ''''''''''''''''''''''''''' ''''''''''''''''''''''''''' ''''''''''''''''''''''''''' ''''''''''''''''''''''''''' '''''''''''''''''''' '''''''
4' rCIK m% %;,dN , s dN ඉලම lrkafka fka ()Tng fyda l,;%hdg fkd ෙ kම wod, fldgfia ^√& fhdod සමපර lrkaak' k' 4'1
orejkag(
ujg(
mshdg( hdg(
4'2'1
Tyqf.a f.a$wehf.a $wehf.a ku()''''''''''''''''''''''' ''''''''''''''''''''''''''' '''''''''''''''''''''''''' '''''''''''''''''''''''''' ''''''''''''''''''''''''''' '''''''''''''''''''''''''' '''''''''''''''''''''''''' ''''''''''''''''''''''''''' '''''''''''''''''''''''''''' ''''''''''''''''''''''''''' '''''''''''''''''''''''''' '''''''''''''''''''''''''' '''''''''''''''''
4'2'2
Tyqf.a f.a$wehf.a $wehf.a Wmka oskh () '''''''''''''''''''''''''' '''''''''''''''''''''' ''''''''' jhi '''''''''''''''''''''''' '''''''''' /ls hdj'''''''''''''''''''''' ''''''''''''''''''''''''''' '''''''''''''''''''''''''' '''''''''''''''''''''''''' ''''''''''''''''''' ''''''
5' nexl= .sKqම ms,s ,sn වia a;rh () 5'1
ෙ i|yka Tnf.a ku(- ''''''''''''''''''''''''' nexl= .s .sKq Kqෙ ''''''''''''''''''''''''''' ''''''''''''''''''''''''''' '''''''''''''''''''''''''' '''''''''''''''''''''''''' '''''''''''''''''''''''''''' ''''''''''''''''''''''''''' '''''''''''''''''''''''''' ''''''''''''''''''''''''' '''''''''''
5'2
.sKqම wxlh
5'3
nexl=fï ku(- '''''''''''''''''''''''''' '''''''''''''''''''''''''' '''''''''''''''''''''''''' ''''''''''''''''''''''''''' ''''''''''''''''''''''''''' ''''''''''''''''''''''' '''''''''' nexl= YdLdj(- ''''''''''''''''''''''''''' ''''''''''''''''''''''''''' ''''''''''''''''''''''' ''''''''''
ා ා" fld
wxl ( 0114)873901)5
wka;රcd,h ( www.nitf.lk oq oqrl:k Bෙම,a ( (
[email protected]
*elaia i a a () 0114 ) 702667
6' fuu wh¥qම m;g wod, වhoම ckdධm;s wruqof,ka fyda fjk;a wdh;khlska b,a,qමlr fyda f.ම lr ;sfæ kම tu වia;r"
6'1
wdh;kfha ku iy ,smskh(- ''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' '''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''
6'2
f.jQ uqo,(- '''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''
6'3
හම wxlh $fhduq wxlh(- ''''''''''''''''''''''''''''''''''''''''''''''
7' wh¥qමlref.a m%ldYh by; ioyka f;dr;=re i;H yd ksjeros nj;a" uu fyda uf.a l,;%hd fuu හමmEu by; 06 fcaohg hg;aj fjk;a wdh;khlska " fjk;a l%uhla u.ska fyda ta ioyd b,a,Sula bosrsm;a lr fyda fkdue;s nj uu fuhs ka iy;sl fj' oskh()
''''''''''''''''''''''''''''''''''' '''''''''''''''''''''''''''''''''''''''''''''''''' wh¥qමlref.a w;aik
8' wdh;k m%Odkshdf.a iy;slh() uf.a wxlh() ''''''''''''''''''''''''''''''''''''''''''''''' by; වia;r ioyka '''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''uy;d$ uy;a hf.a rCIK yslu wjYH lghq;= ioyd ksරfoaYlr ෙම iu. bosrm s ;a lr' by; ioyka f;dr;=re i;H yd ksjeros nj;a" Tyqf.a$wehf.a fm!oa.,sl ,smsf.dkqj wkqj iy;sl lr' rlaIs;hd m%;sldr ,enQ frdayf,ka neyerjQ udihg fmr udih jQ '''''''''''''''''''''''''''''''''''''''''udifha odhl uqo, whlr ''''''''''''''''''''''''''''''''''''''''''''''''''''''''nexl= ෙව '''''''''''''''''''''''''''''''''''''''''''''''''''''''''''YdLd ෙව wxl '''''''''''''''''''''''''''''''''''''''''''''''''' orK fpla m;lska cd;sl rlaIK Ndr wruqof,a uyck nexl=fjs /csk YdLdfjs 033-2-001-2-2467951 orK .s Kqug nerl< remsh,a '''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''l uq o,g we;=,;a lr we;' w;aik() ''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' ku() '''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' oskh() ''''''''''''''''''''''''''''''''''''''''
;k;= r() ''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' ^ks, uqo%d%dj ;eබu w;HjYHhs&s&
9' frda.shdf.a fYaIaI{ ffjoHjrhd $Y,H ffjoHjrhd is ska සමපර l< hq;qh'^fm!oa.,sl frday,l fkajdis slj m%;l s dr ,nd we;akqම muKla fuu fldgi සමපර l< hq;h q '& Should be filled by the specialist / Surgeon of the Patient.
9.1 Name of the Patient:- …………………………………………………………………………………… 9.2 Diagnosis of Disease:- …………………………………………………………………………………… ………………………………………………………………………………………………………………… 9.3 Date of Admission:-……………………………………………… Date of Discharge:- ……………………………………………………… I hereby certify that I am specialist / Surgeon of the above named patient and approve submission with regard to this claim. …………………………………. Date:……………………….. Signature of Specialist / Surgeon
AI
1' 2' 3' 4' 5'
frday,ska msgú osk 90 we;=,; ysïlï whoqïm; cd;sl rCIK Ndr wruqo, fj; fhduq l, hq;=h' Tn wmfj; fhduq lrk iEu ,sms f,aLkhlu cd;sl ye ඳkqñm;a wxlh meyeos,sj" ksjerosj ,sùu w;HjYHfú' ,smsf,aLKj, Pdhd msgm;a bos rsm;a lrk iEu úgu wdh;k m%Odkshd úiska tajd iy;sl l, hq;=fú' iajdñmqreIhd " NdrAhdj" fofokdu rlaIs;hka kñ w' ysñlñ m; frda.shdjq rlaIs;hdu bosrsm;a l, hq ;=hs' wd' idudcslhdf.a orejka fjkqfjka ysñlñ b,a,qñ l, hq;= jkafka tla wfhl= muKs' hefmkakka i|yd ysñlñ wh]ñm;a bosrsm;a lsrfS ñoS my; f,aLk j, iy;sl l, cdhd msgm;a túh hq;=hs' w' l,;%hd i|yd - újdy iy;slfha Pdhd ms gm;la wd' orejka i|yd - Wmamekak iy;slj, cdhd ms gm;a ^orejd - jhi wjqreÿ 21 g wvq wújdyl /lshdjla fkdlrkafkl= úh hq;=hs& rCIs;hdf.a uj$mshd i|yd - ^uj$mshd - jhi wjq reÿ 70 g wvq úh hq;=hs& • • • •
rCIs;hdf.a Wmamekak iy;slfha cdhd ms gm;a ujf.a $mshdf.a Wmamekak iy;slfha fyda cd;sl ye\kqïmf;a cdhd msgm;la wújdyl nj oekaùug wdh;k m%Odkshdf.a ,smshla ujg$mshdg ;ukaf.ka hefmk njg yd Tjqkag lsis\ wdodhï udrA.hla fkdue;s njg .%du fiajd iy;slhla m%dfoaYSh f,alïf.a wkq w;aik iys;j
6'
ysñlñ b,a,qñ lrk ldrKh i|yd fjk;a wdh;khlska rlaIK m%;s,dN ,nd we;s úg " fuu wdh;kfhkao m%;s,dN ,nd .ekSug wfmalaId lrkafka kñ tu wdh;kfha f.úï l, uqo, i|yka ,smshla iu. iy;sl lrk ,o ish,qu bkafjdhsisj,$ì,am;aj,$l=ú;dkaij s , Pdhd msgm;a bosrsm;a l, hq;=fú'
7'
ksis mrsos iñmQrAK l, whÿñm; iu. my; i|yka ,sms f,aLK bosrsm;a l, hq;=fõ' w' frday,a.;ùuloS fyda ie;aluloS$yDo ie;alulos$ms
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•
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wd' ore m%iQ;shloS ^wjia:d folloS muKla f.jkq ,efì& by; ,shlshú,s j,g wu;rj orejdf.a Wmamekak iy;slfha iy;sl l, Pdhd msgm;la fyda Wm;a úia;r m;%sldfú iy;sl l, msgm;la rcfha frday,l frda. úksYaph ldûm; ,ndfkdfokafka kñ " .rANkS igyka jd¾;dfú iy;sl l< msgm;la ^frday,g we;=,;a l, oskh yd msgjq oskh i|yka jsh hq;=hs& •
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we' weia lKaKdû i|yd ^uq,a msgm;a ,nd osh hq;=hs'& - m%Yak wxl 3"4"7"11 msrúu wjYH fkdfú' fm!oa.,sl ffjoHjrfhl= weia mrSCId lf,a kï ffjoHjrhd pek,a l< rsisám; yd jáfgdarej ^ffjoHjrhdf.a w;aik yd ks, uq`j ;sìh hq;=hs'& rcfha frday,l weia mrSCId lf,a kñ jáfgdarej ^ffjoHjrhdf.a w;aik yd ks, uq`j ;sìh hq;=hs'& lKaKdû i|yd uqo,a f.jq ,ÿmf;a “f.újd” f,i igyka lr wdh;kfha ks, uq`j ;sìh hq;=hs' ^wjqreoq 03lg jrla rCIs;hdg muKla f.jkq ,efì& •
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