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SR. HO PARTICUIARS Detailt To lie FillH

1 Do you practice multiple tariff (Vt)
2 Reason for practice multiple tariff
rVO
3
4
Total Na of Resident Medical Officer
Total No of Consultants r
sj
s Total No of Nursing Staff
I '2.
6 Total No of Technician Staff
7
2
Total No of Suri1eon s :.I_
8 Total Bed Strength of the Hospital
9 Total number of ICU beds in the hospital
L.. t:>
10 Total No of Number of Doctors
11
:3
Total Number of full time doctors with qualification approved by MCI in the rolls of the hospital
12
l
Number of doctors (with Qualification of MBBS/MD)
13
l
Number of doctors (with Qualification of MBBS/MD) exclusively available for ICU ::J.
14 Total number of qualified nurses in the hospital
15
I 7...
Number of qualified nurses available taking all the shifts together
16 Number of qualified nurses available exclusively in the ICU taking all the shifts together
17 NURSE-BED RATIO
=j
18 NURSE-BED RATIO IN ICU
I: ID
I 1 1
19 DOCTOR-BED RATIO
, , ro
20
21
DOCTOR-BED RATIO IN ICU
AVERAGE ADMISSION TIME (HH/MM)
u f

22
11:00~/'1
AVERAGE DISCHARGE TIME (HH/MM)
23
'7... 1 00 P fV \
AVERAGE LENGHTH OF STAY (ALOS) FOR MEDICAL CASES
_1--1 DII-Y<:;
24 AVERAGE LENGHTH OF STAY (ALOS) FOR SURGICAL CASES
25
' '> [J_fj_f<-,
CESAREAN SECTION RATIO
l t?'f_,
26 Hospital Web Address

Accrediation received by the Hospital (Pre-entry level certificate or higher level of certificate) issued by
27 National Accrediation Board for Hospital and Healthcare providers (NASH) or State level certificate (or higher
level of certificate) under National Quality Assurance Standards {NQAS), issued by National Health Systems
Resources Centre (NHSRC) (Details of Accredlatlon shall provided)

28 Certification Level
Entry Level/Pre Entry/Accrediated/Non
29 Certification No.
30 From Date
31 Up to Date