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Monitoring Format - 18072023
Monitoring Format - 18072023
Monitoring Format - 18072023
Time of inspection:
1. Details of AAMC:
District Name of AAMC AAMC Code Average daily OPD Rental/ Porta cabin
Doctor
Pharmacist
MCA
MTW
3. Board of AAMC:
Board Condition of Board Visibility of Condition of Flex Sheets Citizen IEC Signage Separate Complaint
Displayed Board from Charter Displayed for Fire Queue for Box
(Y/N) Road Displayed (Y/N) Exit Senior Availability
(Good/Not (Yes/No) Citizens (Y/N)
Visible) (Y/N)
Good Needs Good Needs
replacement replacement
4. Registers maintained at AAMC (Whether available, maintained properly up to date of visit and verified by incharge doctor on daily basis):
OPD Lab Lab Stock Register Daily Indent Expiry Assets Complaint Visitor Register Any other
Register Register Stock Consumption Register Register Register for /Feedback register
Register Register Non- Register
consumables
Consumable Non-
Consumable
5. Verification of OPD:
Number of phone calls made on the day of No. of OPD/patients verified on telephonic call No. of OPD/patients not verified on
visit telephonic call
6. Laboratory Tests:
Total number Number of lab Are blood & other Are logistics required for sample Are Reports delivered Remarks
of OPDs during investigation samples being supplied in sufficient quantity in time next day by
last billing during last billing collected in time by by outsourced lab (Y/N) outsourced lab (Y/N)
cycle cycle outsourced lab (Y/N)
7. Medicines:
Are medicines Is timely indent being Date of last Duration at Discrepancy in Expired drug Arrangement of
available as per taken by AAMC I/C indent which indent Stock Register available (Yes/No) medicines
EDL (Y/N) Yes/No has been taken
8. IT Equipments:
3 Tablets Available Working Online Reasons if not working Printer available Printout of prescription Internet Issues, Technical
(Yes/No) (Yes/No) online (Yes/No) given to patients (Y/N) if any Issues, if any
9. Equipments:
1 AC
2 Refrigerator
3 Inverter
4 Water Dispenser
5 Medicines Rack
6 Examination Table
7 Chairs
8 CCTV Cameras
9
11. MCA:
12. Pharmacist:
13. MTW:
Assisting Yes / No
Dressing Yes / No
14. Cleanliness: