Esic - mother is admitted in private hospital - can I apply for reimbursement?

I come under ESIC, my mother is admitted in private hospital due to some emergency. pls let me know can I apply for reimbursement from ESIC.
29th March 2018 From India, Mumbai

Below is url for ESIC reimbursement
Reimbursement
29th March 2018 From India, Chennai

Attached Files (Download Requires Membership)

medical reimbursement.pdf (919.0 KB, 650 views)

Could someone please forward section 17(2) IT act form please? Unable to get it on internet.. Thanks
11th August 2019 From India, Bengaluru

application format from ip reimbursement of medical bills along with reason for not attending esic ghospital for emergency certificate
4th August 2020 From India, Gurgaon