File No.: U-16/30/649/2023-SST 23-06-2026
CIRCULAR
Subject: Standard Operating Procedure (SOP) For P1 Referral Process across all ESI Institutions.
Enclosed herewith is a copy of Standard Operating Procedure (SOP) for P1 Referral Process for adoption and compliance by all ESIC/ESIS Hospitals, Medical Colleges, Regional Offices and other concerned field units.
The SOP has been formulated to streamline P1 Referral Process and to ensure uniformity, transparency and timely decision-making across all locations.
This is issued for kind information.
Encl.: SOP for P1 Referral Process.
(Dr. Bijoy Chandra Deka)
Deputy Medical Commissioner (SST)
Copy to:
- PPS to DG/FC/CVO for information.
- Zonal Insurance Commissioners / Zonal Medical Commissioners for kind information.
- All ESIC/ESIS institutions.
- Website Content Manager to upload on website.
- Rajbhasha Shakha - for Hindi translation
U-16/30/649/2023-SST
I/4041138/2026
STANDARD OPERATING PROCEDURE (SOP) FOR P1 REFERRAL PROCESS
1. Real-Time Photograph
A real-time/live photograph of the patient shall be captured and saved in the P1 form and should be legible.
2. Referring Doctor
The P1 referral form shall be generated through the system (Dhanwantri). P1 should be generated by the Referring Doctor only.
Strict segregation of duties is to be ensured as follows:
- Initiator: Treating Doctor/Medical Officer
- Verifier: Head of the Department (HOD)
- Approver: Competent Authority of the respective unit
3. User Credentials
Sharing of User ID and Password is a security risk and is strictly prohibited.
4. Signature of Competent Authority
The Dean/Medical Superintendent (Competent Authority), as the case may be, should sign as the authorized signatory in the P1 form, as these are financial sanctions and the MS/Dean should have first-hand information regarding overall functioning, since referrals reflect the overall deficiencies in hospitals on a daily basis.
5. Diagnosis/Provisional Diagnosis
All P1 forms should contain the Diagnosis/Provisional Diagnosis.
The Referring Doctor should draft the P1 form in consultation with the Head of the Department (HOD).
6. Patient Details Verification
The Referring Doctor shall check for possible impersonation, i.e., identity verification.
The active eligibility and entitlement status of the Insured Person (IP) or dependent family members shall be confirmed before initiating any referral action.
7. Patient/Attendant Signature
The patient or their attendant must provide their signature or thumb impression on the P1 form.
8. Selection of Referral Type
The Referring Doctor shall select:
- Nature of Referral: Emergency/Routine
- Type of Referral: Secondary/Tertiary
- Referral Institution: Government/Tie-up Hospital
Selection shall be made as applicable and with due diligence to avoid conversion of a genuinely Secondary Care referral into a Tertiary Care referral.
9. Open Billing Package/Extended Stay
Proper justification shall be provided if an "Open Billing Package" or an extended stay is clinically necessary.
(The proforma for extension of stay already circulated shall be used.)
10. P1 Generation
P1 generation should not be outsourced.
11. Mandatory Signatures on P1
The P1 form shall bear:
- Signatures of Referral Committee Members
- Signature of the Competent Authority with official stamp
Full signatures shall be used instead of initials.
12. Reasons for Referral
"Reasons for Referral" is a mandatory field and is available through radio button options.
All doctors shall select the most appropriate and genuine reason for referral, considering that the respective doctor has precise knowledge of the department/facility where the case can be treated.
Example:
If there is no in-house ICU facility, the reason should be selected as "Lack of ICU" and not "Lack of Specialist."
13. Final Submission
After verifying all details, the Referring Doctor shall save and submit the P1 referral form in the system, ensuring completeness and correctness of the information entered.
14. Mandatory Signatures
All signatures fields as mentioned in the P1 form are mandatory.
The signature of the Competent Authority (Dean/MS) shall be present in the P1 form as specified.
15. Referrals from Eligible Dispensaries and DCBOs (SST)
In case of routine referrals from eligible Dispensaries and DCBOs:
- Signature of the Referral Committee shall be obtained from the nearest/Hub ESIC/ESIS Hospital.
- The Hub Hospital shall be decided by the ZMC in such areas.
- Signatures shall be obtained in digital mode.
- A copy shall be retained by DIMS/AMO/MS/Dispensary In-Charge, as applicable.
This provision shall apply to all routine referrals.
16. Same-Day Referral Processing
All referrals may be issued on the same day.
To reduce patient waiting time, the Competent Authority’s final signature may be planned through referral slots as follows:
Referral Signature Slots
a) First Slot – 11:00 AM
b) Second Slot – 1:00 PM
c) Last Slot – 4:00 PM
Saturday: Only the first two slots shall be followed, considering the half-day schedule.
17. Claim ID Generation
The person assigned for generating Claim IDs shall be placed on duty:
- Monday to Friday: 10:00 AM to 5:00 PM
- Saturday: 10:00 AM to 2:00 PM
- Lunch Break: 2:00 PM to 2:30 PM (30 minutes)
After obtaining the signature of the Competent Authority, Claim IDs shall be generated promptly to reduce waiting time and referral-related grievances.
18. Surprise Inspection
Surprise inspections may be conducted at any location by officials of ESIC, as assigned, to:
- Review referral trends
- Examine suspicious referral patterns
- Identify abnormal referral practices
19. Priority for Routine Referrals
All ESIS Hospitals and Dispensaries shall prioritize routine referrals to ESIC Hospitals and Medical Colleges as the first preference.
20. Attachment of Supporting Documents
All treatment details, investigation reports, entitlement certificates, and other relevant supporting documents shall be attached with the P1 form.
U-16/30/649/2023-SST
I/4041138/2026
