F.

06 NWH INSPECTION FORM (NON TECHNICAL)

NWH INFORMATION
Hospital Type :CORPORATE Address : D.No. 6-3-248/2 ,Banjara Hills, hyderabad District:HYDERABAD Total ASRI Bed Strength:67 Date of Empanelment: 05/03/2011 NWH Contact No.: 8374445358 Hospital Name :Care Banjara

Tota

GENERAL INFRASTRUCTURE DETAILS

1 Separate Out Patient Department Yes No 7 Basic Diagnostic facility Advanced diagnostic facility availability Generator Visitors Register is maintained Lift Yes No 1 3 Pharmacy

OP Registers Maintained

Yes No Yes No Yes No Yes No Yes No

Yes No

1 4 1 5 1 6 1 7

Food/pantry

IP Registers Maintained On Bed Register Maintained Operation Theatre ASRI Ward (Male & Female)

9 1 0 1 1

Yes No

Blood Bank Ambulance (Ordinary) Ambulance (Life Supporting)

Yes No

5 6

Yes No Yes No

12 Ramp

MANDATORY APPROVAL DETAILS

Name of approval Issuing Authority Original Document Validity /Availabilit y (Y/N) # Name of approval

APMCE Registration

DM & HO

Yes No

Pharmacy license

D C a (D

PCPNDT Act Registration

DM & HO Director Drug Control administration (DCA) Fire Services Authority

Yes No

Pollution control board certificate Registration certificate of Ambulance

P B

Blood bank license

Yes No

R T A

Fire department clearance certificate

Yes No

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F.06
HOSPITAL SERVICES
# 1 2 3 4 5 6 7 8 9 10 11 12 13 Cashless Treatment Hospital rendering cashless treatment? Hospital evaluating the beneficiaries by conducting free diagnostics tests Counseling the patient who are not covered under the scheme Hospital is not collecting any original document from the aarogyasri patient Hospital is not collecting any amount towards followup medicine & Consultation Food is given to patients NWH is given 48 hrs time to get the card in emergency Beds and bed sheets are clean Drinking water is provided Separate toilets exist and are working NWH is not refusing the aarogyasri beneficiary NWH is not collecting money for blood where i) ii) Blood is treatment Replacement donor is available As per requirement? Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Remarks

Mithras are wearing Aprons Health Camp

1 2

NWH conducting Mega Health camps as per Schedule NWH conducting proper IEC Activity Discharge, Treatment and Medicine

Yes No Yes No

NWH is providing transportation as per APSRTC

Yes No

HOSPITAL INFRASTRUCTURE FOR AAROGYASRI

# 1 2 3 4 5 6 7 8 9 10 Equipment New model kiosk as per standard given by AHCT Computer with windows operating system and other required application software 2 MBPS Dedicated internet connectivity Printer Scanner Web Camera / Digital camera Barcode reader Biometric device provided by AHCT Biometric device provided by NWH to ramco system for discharges Laptop with biometric device provided by NWH for emergence cases

As per requiremen

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

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F.06
FACILITIES
Empanelled Category CARDIAC AND CT On-bed patients 55 0 0 0 0 0 YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES Total on bed patients at the time of inspection : Facilities exist to treat NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO

CARDIOLOGY NEPHROLOGY GENITO URINARY NEURO SURGERY ORTHOPEDIC

Note: 1. This form is applicable for non technical inspectors. 2. For filling up the columns under patient care, refer the following: 1.(i) OP-Consultation free?; 1-(ii) Investigations free?; 2-IP (i) admission free?; 2-(ii)Investigation free?; 2-(iii)Drugs free ?, 2-(iv ) consultation free?; 2-(iv)Blood &Blood products free?; 2-(v)Food free?; 2-(vi) Transport free?,2-(vii) Discharge Medicines Free?, 2-(viii) Follow up medicine free? 3. Please Tick () at Yes (or) No Box

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4.

F.06 NWH INSPECTION FORM (NON TECHNICAL)

NWH INFORMATION
Hospital Type :CORPORATE Address : ROAD NO.10, BANJARA HILLS, HYDERBAD. District:HYDERABAD Total ASRI Bed Strength: 30 Date of Empanelment: 02/02/2010 NWH Contact No.: 8374445399 Hospital Name :Star

Tota

GENERAL INFRASTRUCTURE DETAILS

Separate Out Patient Departme nt OP Registers Maintaine d IP Registers Maintaine d On Bed Register Maintaine d Operation Theatre ASRI Ward (Male & Female) Yes No Basic Diagnostic facility Advanced diagnostic facility availability 1 3

Yes No

Pharmacy

Yes No

Yes No

1 4

Food/pantry

Yes No

Generator

Yes No

1 5

Blood Bank

Yes No Yes No Yes No

1 0 1 1

Visitors Register is maintained Lift

Yes No

1 6 1 7

Ambulance (Ordinary) Ambulance (Life Supporting)

Yes No

12 Ramp

Yes No

MANDATORY APPROVAL DETAILS

Name of approval Issuing Authority Original Document Validity /Availabilit y (Y/N) # Name of approval

APMCE Registration

DM & HO

Yes No

Pharmacy license

D C a (D

PCPNDT Act Registration

DM & HO Director Drug Control administration (DCA) Fire Services Authority

Yes No

Pollution control board certificate Registration certificate of Ambulance

P B

Blood bank license

Yes No

R T A

Fire department clearance certificate

Yes No

Page-1/5

HOSPITAL SERVICES
# 1 2 3 4 5 6 7 8 9 10 11 12 13 Cashless Treatment Hospital rendering cashless treatment? Hospital evaluating the beneficiaries by conducting free diagnostics tests Counseling the patient who are not covered under the scheme Hospital is not collecting any original document from the aarogyasri patient Hospital is not collecting any amount towards follow-up medicine & Consultation Food is given to patients NWH is given 48 hrs time to get the card in emergency Beds and bed sheets are clean Drinking water is provided Separate toilets exist and are working NWH is not refusing the aarogyasri beneficiary NWH is not collecting money for blood where i) ii) Blood is treatment Replacement donor is available As per requiremen t? Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No NIL NIL Yes No Yes No NIL NIL NIL Yes No NIL Remarks NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL

Mithras are wearing Aprons Health Camp

1 2

NWH conducting Mega Health camps as per Schedule NWH conducting proper IEC Activity Discharge, Treatment and Medicine

NWH is providing transportation as per APSRTC charges

F.06
HOSPITAL INFRASTRUCTURE FOR AAROGYASRI
# 1 2 3 4 5 6 7 8 9 10 Equipment New model kiosk as per standard given by AHCT Computer with windows operating system and other required application software 2 MBPS Dedicated internet connectivity Printer Scanner Web Camera / Digital camera Barcode reader Biometric device provided by AHCT Biometric device provided by NWH to ramco system for discharges Laptop with biometric device provided by NWH for emergence cases

As per requiremen

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

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F.06

FACILITIES
Empanelled Category On-bed patients Facilities exist to treat YES YES YES YES YES YES YES YES YES YES YES YES YES YES Total on bed patients at the time of inspection : NO NO NO NO NO NO NO NO NO NO NO NO NO NO

Cardiac and CT surgery

Neurosurgery Dialysis

12
3 18

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