Request For Hospital Empanelment

Gereral Information
Basic Information
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
Operation Theatre
No of Operation Theatres
Anesthesia Machine If yes, then specify the No
High Pressure Autoclave If yes, then specify the No
Suction Apparatus If yes, then specify the No
Diathermy If yes, then specify the No
Monitors If yes, then specify the No
Operating Microscope If yes, then specify the No
Labour Room
Emergency Services
Intensive Care/Critical Care Services
Blood Services
Medical Records(World Health Organization Coding)
Computers used in
OT/ICU Facilities Available
Upload Document