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OPTION FORM

By Carolyn Wells,2014-11-26 17:07
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OPTION FORM

    OPTION FORM

Read G.O(P) No. 69/10/H&FWD Dated 17-02-2010 before filling the option form. Copy of

    G.O available at DHS and All DMO’s(H) and also at www.arogyakeralam.gov.in)

     I , Dr. ……………………………………………………… Addl. DHS / Dy. DHS / CS / AS hereby elect the Branch A- Administrative Cadre / Branch-B-General Cadre /

    Branch C- Specialty Cadre / Branch D(a) -Public Health Lab Cadre / Branch D (b) -

    Blood Bank / Transfusion cadre as per the provisions of G.O(P) No. 69/10/H&FWD,

    Dated. 17-02-2010 Special Rules.

    Branch A Branch B Branch C Branch D(a) Branch D(b) 1. Name of Cadre

    (Please ; the respective column)

     2 Name of Specialty Opted :

    ( in block Letters)

    3 Name :

    (in block Letters)

4 Date of Birth :

5 Gender (Male / Female) :

6 Date of Entry in Health Services :

    Department

7 Date of commencement of :

    continuous service in the Health

    Services Department (service of

    other Dept will not be entertained)

8 Present Post / Cadre with :

    seniority No.

9 Date of last promotion in the :

    case of Civil Surgeon / Dy. DHS/

    Addl. DHS etc with Rank no. in

    the select list)

10 Present Official Address with :

    district

11 Date from which working in the :

    present institution

12 Total service in the present :

    institution

13. Details of LWA availed during the period of service with reference to the service certificate

    issued by the Accountant General. ( A copy of service certificate should be attached)

    Period From (Date) To (Date) No. of Years / Months

14. Details of Qualifying examinations Passed:

    Sl. Course Date of Month and Completed Less LWA Net Points as No. Joining in Year of qualifying Period service per

    HSD acquiring service in Appendix

    Degree years E(iii)

    Special

    Rules 1 MBBS / BDS

    (2 points per year)

    2 P.G Diploma

    (1 point per year)

    3 P.G Degree / DNB

    in opted specialty

    (2 points per year)

     4 Super Specialty

    Degree DM / M.Ch

    / DNB ( 3 points per

    year)

15 Whether PG acquired in service :

    quota ( if yes copy of G.O should

    be attached)

    16 Address for communication :

     Mobile Land Phone

    (with STD Code) 17 Telephone Number

    18 Choice of Institution with (1) (2) (3)

    District

    Declaration

    1. I hereby declare that I have read the provisions governing in the Special Rules for

    Medical Officers as per G.O(P) No. 69/10/H&FWD Dated 17-2-2010 and agree to

    abide by them.

    2. I also declare that all the statements made in this option are true, complete and correct

    to the best of my knowledge and belief and that in the event of any information

    furnished herein is fraudulent or incorrect or ineligibility being detected before or after

    the implementation , action can be taken against me by the Government / Department.

     Signature of the

     Medical Officer with Date.

     Name of the Medical Officer.

     Signature of the Authorized

     Superior Officer.

    Instructions

    1. The Medical Officers should be read the Special Rules 2010 before filling the option.

    Copy of the G.O(P) No. 69/10/H&FWD Dated. 17-02-2010 Special Rules are

    available with DHS / DMO’s(H) and also at www.arogyakeralam.gov.in

    2. The Medical Officers who are in service as on 31-12-2006 and acquired PG upto

    31-8-2009 will be exercised option within the time specified in any of the Branch as per

    Special Rules 2010.

    3. Attested copy of service certificate issued by the Accountant General (A&E) , Kerala

    will be enclosed with the option if necessary.

    4. Attested copies of PG Diploma / Degree , Certificate and TC Medical Council / Dental

    Council Registration.

    5. The Medical Officers who are doing fresh PG / completed PG after 31-8-2009 shall be

    exercised option in General Cadre / Administrative Cadre through the DMO’s(H)

    concerned. Duration of PG Course should be mentioned.

    6. The Medical Officers those who are unauthorized absent / not now in service / facing

    disciplinary action will be exercised option with permission of the DHS / Government

    7. The Present cadre / post, Promotion details, cadre seniority number in the present

    post etc should be clearly mentioned in the option form with relevant government

    orders.

    For Office use only

    Name of Specialty / Cadre Remarks

     Service points

     ( upto 31-12-2008)

     PG Diploma points

    (upto 31-8-09)

     PG Degree points

    (upto 31-8-09)

    Super specialty points

LWA period

Total points

Signature of the Authorized

    officer

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