Hospital Details All (*) fields are required.

Hospital Photographs

Accounts Details

Contact Information

Bed Strength Details

Medical Services

Clinical Support Services Within Premises

Human Resources

Ambulance

General Amenities

Hospital Tariff (Schedule of Charges)

Insurance/TPA Details whom Hospital working with

Hospital Certification / Accreditation

Declaration

Special Note - 1 :  IT to ensure that IP address or other relevant details (Contact details of person who is submittng this form) to be captured to check & capture the genuity of the provider.

2 :  Excel need to be extracted from backend for following entries.