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HOSPITAL EMPANELMENT

HOSPITAL NAME *
CUSTOMER CARE NO. *
EMAIL ID *
WEBSITE
UPLOAD HOSPITAL PHOTO(JPG/PNG)
UPLOAD RATE LIST(PDF)
UPLOAD CANCELLED CHEQUE(JPG/PNG)
ADDRESS *
STATE *
CITY *
AREA *
PIN CODE *
LANDMARK
GST NO.
LIST OF TPA PANEL
INSURANCE COMPANY PANEL

CORPORATE PANEL DETAIL
CORPORATE-1
CORPORATE-2
CORPORATE-3
CORPORATE-4
CORPORATE-5
CORPORATE-6
CORPORATE-7
CORPORATE-8
CORPORATE-9
CORPORATE-10

ADMINISTRATOR DETAIL
ADMINISTRATOR NAME *
MOBILE NO. *
 
ALTERNATE MOBILE NO.
EMAIL *

STAFF DETAIL
NO. OF NURSING STAFF *
NO. OF RMO
OTHERS

CERTIFICATION DETAIL
ISO :
NABH :
IS THE HOSPITAL/NURSING HOME REGISTERED WITH LOCAL AUTHORITY *
NO. OF BED'S *
PVT. ROOMS *
AC *
NON AC *

CORPORATE DISCOUNT- APS CARD MEMBER
IPD(%)
OPD(%)
DIAGNOSTIC(%)
INHOUSE MEDICINE(%)
CREDIT LIMIT(INR)
OTHERS

EMPANELED DETAIL
TPA :
CGHS :
DGHS :
ECHS :
GOVERNMENT PANEL :
AYUSHMAN YOJNA PM :
OTHERS

INFRASTRUCTURE & FACILITY
DIGITAL FILMS BY RADIOLOGY :
IN HOUSE LAB :
24 HOUR PHARMACY :
LABOUR ROOM :
FULL TIME CONSULTANT :
BLOOD BANK :
OPERATION THEATER :
CT SCAN :
24 HR. IN HOUSE X-RAY :
MRI :
PHYSIOTHERAPY :
TMT :
AMBULANCE 24HR. :
EEG :
ULTRA SOUND (USG) :
EPS :
DENTAL TREATMENT :
ECG :
COMPUTERRIZED BILLING :
NO. OF OPD DOCTOR :
ICCU :
NO. OF BED'S
ICU :
NO. OF BED'S
NICU :
NO. OF BED'S
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