Skip to content
+91 98999 90006
Mahamrityunjaya Charitable Trust emblemBlessed to Serve, Committed to Care

ॐ त्र्यम्बकं यजामहे सुगन्धिं पुष्टिवर्धनम् ।उर्वारुकमिव बन्धनान् मृत्योर्मुक्षीय माऽमृतात् ॥

If you know someone who needs help

You do not need to be a doctor or a relative. If you know a cancer patient whose family cannot afford treatment, tell us and we will take it from there.

Refer a cancer patient

Where referrals reach us from

These are the people who usually call. You do not have to be any of them.

  • Government hospitals
  • Cancer hospitals
  • Doctors and oncologists
  • Medical social workers
  • NGOs and community organisations

What we need to assess a case

The form needs at least one of these attached. If you have nothing yet, call us and we will help you get it.

  • Aadhaar card
  • Diagnosis or histopathology report
  • Doctor's prescription
  • Treatment estimate or hospital bills
  • Income proof, a ration card or an Ayushman Bharat card, if available
  • A contact number for the family

How do we decide on your patient referral application?

Six steps, and roughly how long each one takes. If something is missing we call you and the case goes back to step 1 — it is not turned down.

Who: You

Same day

You send the form

You fill in the form on this page and attach the documents.

Who: Operations team

2–3 working days

We check the papers

We read the documents, call the family, and check the income against the proof.

If a document is missing, or we cannot read it — back to step 1

Who: Medical Advisor

2–3 working days

We check with the doctor and the hospital

We confirm the diagnosis, the stage and the cost with the doctor and the hospital treating the patient.

If the doctor or the hospital does not confirm what the form says — back to step 1

Who: Sanctioning authority

Up to 7 days

The amount is sanctioned

The Trust's sanctioning authority approves the amount, and you are told either way.

Who: Operations team

3–5 working days

We pay the hospital

We pay the hospital directly, against its own bill.

Who: Operations team, with the Medical Advisor

Ongoing

We follow up on the patient

We stay in touch with the family to see how the patient is doing after treatment.

Form to payment

About two to three weeks, when nothing has to go back.

We never pay a patient or a relative

We pay the hospital directly, against its own bill. That way the money can only be spent on treatment.

Refer a patient online

Tell us what you know and attach at least one document. The rest can follow.

The patient

A number we can reach the patient or their family on.

Six digits.

Their treatment

What has been diagnosed, and the stage if you know it.

In rupees. An approximate figure is fine.

In rupees. What you are asking the Trust for, as best you can judge it.

In rupees, for the family together. Add up what the patient's father, mother, husband or wife, brothers and sisters each earn in a year — salary, business, farming, rent, interest and pension — before any deductions.

Documents you can provide

Tick what you have and attach it below. At least one document has to come with the form.

Attach the documentsRequired

At least one document is needed. PDF, JPEG or PNG, up to 8 files, 1 MB each. A photo of a report is fine.

Nothing attached yet. The form needs at least one document.

About you

Doctor, medical social worker, neighbour, son, friend — whatever you are to them.

So we can call you back about this case.

We send the reference here, and this is how we reach you in writing.

Do you work with a social or NGO organisation? Optional

Read the consent noticeConsent notice version 1.0, effective 2026-09-19

The patient signs their own consent on page 2 of the printed form. Attach it above if you have it. If you do not, we will take their consent when we call.

This form is emailed to the Trust and, if you give an address, to you. It is not stored on this website, and it is never shared with anyone but the hospital treating the patient.

Download the printable form (PDF) ↓

The same questions on one printable page, for a hospital that would rather send one back signed and stamped.

Or download it in हिन्दी ↓