ð` Applicant Details
Application Number Type of Applicant Applicant Sta
MH12305 Individual Pending
Applicant Name DOB ( DD/ MM / YYYY) Mobile Numb
DR SHRADDHA RAHUL GHOLSE 16 - 07 - 1993 7038564716
Email Id Technical Qualification Nationality
shraddhaganorkar16@[Link] MBBS MS OBGY Indian
Residential Address of The Applicant
Indira Nagar TUMSAR TUMSAR, 441912
Signing Authority Details
Name Designation Aadhaar Car
DR SHRADDHA RAHUL GHOLSE Doctor 4968378878
Nursing Home Details
Name of The Nursing Home in Respect of Which The Registration is Being Applied for Type of Institutions for Which Registration is Being Applied Sub Type of I
GHOLSE HOSPITAL Allopathy -
Whether Collection Centre Available ?
No
Firm/ Company Website Address Date of Esta
NULL NULL
Type of Specialty
Single
Details of The Procedure/Services
Procedure / Services Details
OPD IPD OPD IPD
Place where The nursing home situated
Plot No./ House No Colony / Area City
Indira Nagar TUMSAR TUMSAR
District Taluka Pincode
Bhandara Tumsar 441912
Brief Description of the Construction , the Nursing Home or any Premises Used in Connection Therewith Type Plan of the Nursing Home Whether The Applicant is Interested in any Other Nursing Ho
AREA OF THE HOSPITAL 2250 SQ FEET No
Infrastructure Details
Total Beds Proposed
No. of Maternity Beds [Link] ICU Beds( Adults ) [Link] ICU Bed
6 0 0
Other Beds
Details of Equipments
Equipment Make Model
List Attached Separately SANJIVINI 2025
Sanitary Arrangement for Patients
Sanitary Arrangement No. of Arrangements
Functional And Clean Toilets With Running Water And Flush 3
Bed Pan Washing Sinks 3
Continuous Water Supply 2
Detail of Rooms for Employees
Room Type Floor Space / Area ( In Sq. Ft) Number of Rooms
Servant Room 100.00 1
Other Room 100.00 1
Sanitary Arrangement for Employees
Sanitary Arrangement No. of Arrangements
Hand Washing Facility 2
Toilet 2
Arrangements for Immunization of The Employees are Available or Not ?
Yes
Arrangement Made for Medical Check - Up of The Employees Regular immunization & Health Checkups are being held in
Yes WITHEN 6 MONTH
Whether The Nursing Home or any Premises Used in Connection There With are Used or are to be Used for Purposes Other than that of Details for purposes other than that of carrying on a nursing
Carrying On A Nursing Home
No
Arrangements Made for Service of Food
Storage of Food
No Service
Refrigerator
Staff Details
Name, ages & qualification of members/Staff/Employee of the nursing home
Full Name Designation Qualification Medical Council Registration Number with Date of Validity Upto
ANITA BRIJLAL PADWAR ANM ANM XII- 8200
Place Where The Nursing Staff Is Accommodated
Name, ages and qualification of The resident or visiting physiciansor surgeons in The nursing home
Full Name Designation Qualification Council Registration Num
DR RAHUL ASHOK GHOLSE General Physician MBBS MD PHARMOCOLOGY 2015/ 05 / 2846
DR AKASH ASHOK GHOLSE RMO MBBS MS 2015/ 06 / 3470
DR SHRADDHA RAHUL GHOLSE Obstetrics And Gynaecologist MBBS MS OBGY 2017/ 06 / 2592
Whether the nursing home is under the supervision of a qualified medical practitioner or qualified nurse and if so
Full Name Designation Qualification MMC / MNC
DR RAHUL ASHOK GHOLSE MD MEDICINE MD ( Doctor Of Medicine ) 2015/ 05 / 28
Proportion of The qualified and unqualified nurses on The nursing staff
Enter Total Number of Qualified Staff Enter Total Number of Non Qualified Staff
5 0
Enter Total Number of GNM Qualified Staff Enter Total Number of ANM Qualified Staff
1 4
Whether The Nursing Home is Under The Supervision of A Qualified Nurse or Midwife and if so
Yes
Qualified nurse or midwife details
Full Name Designation Qualification Registration Number with Date of Validity Upto
ANITA BRIJLAL PADWAR ANM ANM XII- 8200
Whether any Unregistered Medical Practitioner or Unqualified Midwife is Employed for Nursing any Patient in The Nursing Home
No
Whether any Person of Foreign Nationality is Employed in The Nursing Home and if so, His Name and Other Particulars
No
On Campus Chemist Shop Available
No
On campus chemist shop details
Name of Chemist Shop
License No of Chemist Shop
Upload Documents Details
7/ 12 Extract / Property Tax Certificate / Owner Possession Certificate
NOC of Society / Owner / Appropriate Authority with Respect to Premises
Fire Audit Report *
Fire Saftey NOC Certificate From Government Authority *
Occupation Certificate ( O.C. ) From Appropiate Authority *
Nursing Home Signing Authority Aadhaar Card *
List Of Visiting Doctors with Qualification and Registration Details *
List of nursing staff with Qualification and Registration Details *
List of Other Staff with Qualification and Designation and job Details *
Rate List *
List of Equipment *
MPCB Authorized Certificate / Acknowledgment for New Registration *
No Pending Negligence Case Certificate from Medical Council *
Affidavit Describing that Working Doctor / Staff is not A Government Employee / Officer *