(1) The following levels of health services will be upgraded as follows:- Sr.No. Current level to be upgraded Service in the relevant level Last two financial years Service level in remote areas Period to be done Period to be done in performance appraisal Marks to be obtained 1 4th 5th 5 years At least preferably at least one year in extreme remote areas or two years in remote areas 2. Fifth
(a) Initial appointment or 6th 5th year at least best 5th level at least one year after promotion to 5th level. Completed minimum educational qualification for level in extremely remote areas or two years in remote areas (b) Entering the fifth levelPromotion by competitive examination 6th 8th year At least best At least one year higher than for that level Two remote or remote Year in remote areas without minimum educational qualification. 3. Sixth
(a) Completing the process of Public Service Commission at the 6th level, 7th level are automatically appointed. (b) Upgradation to Sixth Level Seventh Five Years At Least Best Of At Least One Year Senior Fifth Level   Very remote or two years in remote areas with level matching (c) Those who have been promoted to the sixth level, the seventh, the five years, the minimum, the best, the minimum one year, the initial appointment in the fifth level, or two years in the remote areas. The seventh
(a) Medical Officer, Dental Officer, Ayurveda Practitioner, Integrative Medicine 8th Automatic – Officer or other similar medical officer (b) Except for Clause (a), an officer initially appointed in the sixth level and having been promoted to the post of the seventh level for at least one year and in the seventh level, the eighth  Three years minimum best remote or two years other authorized employees initially appointed in remote areas 5 ninth 10th two years minimum best -
(2) If the employee mentioned in sub-section (1) does not work in the area mentioned in that sub-section for the period mentioned in that sub-section, such employee will be upgraded only after he has been present and worked in that area for the said period. However, if an employee cannot be assigned to such an area due to lack of position or rank, there will be no obstacle to upgrading such employees to a higher level, subject to the other sub-sections of this section.
(3) The upgraded employees will be grouped in the respective groups on the basis of merit. If the employee who has been classified as such is not in good health due to any reason, the post he/she is holding will automatically be cancelled.
(4) An employee who has been upgraded to a higher level, in accordance with sub-section (3) of section 17 of the Act or section 9B. He will have to work at the same level from which he was promoted until he is appointed as per the above.
(5) Other arrangements related to upgrading shall be as prescribed.