| Employee name | Amount | Type | Diagnosis | Remarks |
|---|
- - - -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
| Employee name | Amount | Type | Diagnosis | Remarks |
|---|
| SL No | Revised Disease Category | SUM of approved amount | Number of claims |
|---|---|---|---|
| Grand Total | - | - | |
| SL No | Employee name | SUM of approved amount |
|---|