HOSPITAL INFORMATION

Gereral Information
Type of Hospital: Single Specialty Multi Specialty
Type of Care: Primary Care Secondary Care Tertiary Care
PPN Status PPN Non-PPN
Name of Hospital:
Address:
Place:
City:
State:
Pin Code:
Phone No.:
Mobile No.:
E-Mail Address:
Medical Superintendent:
Marketing/TPA Head:
Registration Number of Hospital:
Registering Authority:
Rohini Code:
PAN Number of Hospital:
PAN Card Holder Name:
Basic Information
Number of Inpatient Beds:
Number of Day Care Beds
Number of ICU Beds
Number of RMO:
Whether RMO is available round the clock: Yes No
Number of qualified Nursing Staff:
Whether Nursing Staff is available round the clock: Yes No
Pharmacy-In House or Out Source:
Oxygen Supply Centralized or Cylinder:
Pathological Lab In House or Out Source:
Whether Hospital is Fully Air-Conditioned:
Whether ambulance facility is available:
Whether In-House Investigation facilities available for:
ECG Yes No
Ultrasound Yes No
X-Ray Yes No
T.M.T. Yes No
Medical Staff Details
Specialty Visiting Consultants Full Time Consultants House Staff (Recipients and Registrars)
Anesthesia
General Surgery
Thoracic Surgery
Primary/Family Practice
Internal Medicine
Cardiology
Obstertrics/Gynaecology
Pediatrics
Psychiatry
Orthopedics
Neurology
Urology
Oncology
Pulmonoligy
G.E.(Medicine)
E.N.T
Nero Surgery
Plastic Surgery + Burns
Ophthalmology
Others (Specify)
TOTAL
Nursing Staff Profile
Total Number of nurses on Staff:
Number of University trained nurses on staff:
Number Staff (N) to patient (P) ratio during three different shifts:
B.Sc. Nurses:
Operation Theatre
No of Operation Theatres:
Anesthesia Machine: Yes No If yes, then specify the No:
High Pressure Autoclave: Yes No If yes, then specify the No:
Suction Apparatus: Yes No If yes, then specify the No:
Diathermy: Yes No If yes, then specify the No:
Monitors: Yes No If yes, then specify the No:
Operating Microscope: Yes No If yes, then specify the No:
Labour Room
Neonatal Resuscitation Kit: Yes No
Fontal Monitor: Yes No
Radiant Warmer: Yes No
Suction Apparatus: Yes No
Oxygen: Yes No
Emergency Services
Average No. of Emergency Room visits per month:
Emergency Services available 24 hours a day. 7days a week: Yes No
Licensed Physician on site 24 hours a day. 7 days a week: Yes No
Specialists on call 24 hours a day. 7 days a week: Yes No
Full time nursing staff with emergency service training: Yes No
Ambulance service available: Yes No
If yes, owned by hospital: Yes No
Intensive Care/Critical Care Services
Licenced Physician on site 24 hours a day. 7 days a week: Yes No
Specialists on call 24 hours a day. 7 days a week: Yes No
Full time nursing staff with critical care training: Yes No
Intensive Care/Critical Care Services
Blood Transfusion Service available: Yes No
Blood product services available: Yes No
Willingness for Installing our Software Modules: Yes No
Medical Records(World Health Organization Coding)
ICD_10 Coding: Yes No
Computers used in
Billing: Yes No
Wizards: Yes No
Appointments: Yes No
Doctors: Yes No
Clinical Areas: Yes No
OT/ICU Facilities Available
Cardiac Monitor Yes No
Ventilator Yes No
Defibrillator Yes No
C-ARM Yes No
Pulse Oxymeter Yes No
Auto Analyzer Yes No
Suction Machine Yes No
Boyle's Apparatus Yes No
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