HOSPITAL INFORMATION

Gereral Information Continue...
Type of Hospital: Single Specialty Multi Specialty
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
Intensive Care Unit
Available: Yes No If yes, then specify the No:
Surgical ICU: Yes No If yes, then specify the No:
Medical ICU: Yes No If yes, then specify the No:
Cardiac ICI: Yes No If yes, then specify the No:
Neurology ICU: Yes No If yes, then specify the No:
Pediatric ICU: Yes No If yes, then specify the No:
Blood Routinely Screened For
Blood Type: Hepatitis A Hepatitis B Hepatitis C Hepatitis B core Antigen HIV Syphilis Others
Medical Staff Profile
             
Note: Consultants are specialists with Post Graduation, Super-specialization and minimum 5 years after Post Graduation OR Specialists above 45 years of age with Post Graduation in their respective fields.

Please fill in number of physicians for each category. (Note: Some Physicians may be counted in more than one column.)
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:
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 -09 Coding: Yes No
ICD_10 Coding: Yes No
Computers used in:
Billing: Yes No
Wizards: Yes No
Appointments: Yes No
Doctors: Yes No
Clinical Areas: Yes No
Areas of Interest:
Telemedicine:
Waste Management:
Health Insurance:
Hopital Particular Sheet:
Name of Hospital:
Address:
Phone No.:
Mobile No.:
E Mail Address:
MedicalSuperintendent:
Marketing/TPAHead:
Registration Number of Hospital:
Registering Authority:
PAN Number of Hospital:
Number of IN-Patient Beds:
Number of RMO:
Whether RMO is available round the clock:
Number of qualified Nursing Staff:
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:
Number of fully equipped:
O.T.
ICU
ICCU
Whether In-House Investigation facilities available for:
ECG Yes No
Ultrasound Yes No
X-Ray Yes No
T.M.T. 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