ð` Applicant Details
Application Number Type of Applicant Applicant Status
MH12383 Individual Pending
Applicant Name DOB ( DD/ MM / YYYY) Mobile Number
ANIL GANAPATRAO VANKUDRE 13 - 07 - 1966 9960439609
Email Id Technical Qualification Nationality
shreehosp@[Link] BHMS, MD (Homoeopathy) Indian
Residential Address of The Applicant
opposite power house camp Ramghat road Vengurla, 416516
Signing Authority Details
Name Designation Aadhaar Card No.
Anil Ganpatrao Vankudre Doctor 573808921945
Nursing Home Details
Name of The Nursing Home in Respect of Which The Registration is Type of Institutions for Which Registration is Being Applied Sub Type of Institutions for Which Registration is Being
Being Applied for
AYUSH Others
shree hospital and polyclinic
Whether Collection Centre Available ?
No
Firm/ Company Website Address Date of Establishment
NULL NULL
Type of Specialty
Multiple
Details of The Procedure/Services
Procedure / Services Details Remarks
No Data Found ...
Place where The nursing home situated
Plot No./ House No Colony / Area City
opposite power house camp Ramghat road Vengurla
District Taluka Pincode
Sindhudurg VENGURLA 416516
Brief Description of the Construction , the Nursing Home or any Premises Used in Connection Therewith Whether The Applicant is Interested in any Other Nursing Home or Business
Type Plan of the Nursing Home
No
The nursing home is constructed with RCC framed structure comprising Ground Floor plus
two upper floors (total 3 floors) with a total built- up area of approximately 6000 sq. ft. The
building is structurally sound and suitable for medical use. The nursing home is equipped with
separate toilet facilit
Infrastructure Details
Total Beds Proposed
No. of Maternity Beds [Link] ICU Beds( Adults ) [Link] ICU Beds( Paed )
0 0 0
Other Beds
Details of Equipments
Equipment Make Model No of Equipment
No Data Found ...
Sanitary Arrangement for Patients
Sanitary Arrangement No. of Arrangements Remarks
No Data Found ...
Detail of Rooms for Employees
Room Type Floor Space / Area ( In Sq. Ft) Number of Rooms Remarks
No Data Found ...
Sanitary Arrangement for Employees
Sanitary Arrangement No. of Arrangements Remarks
No Data Found ...
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 the interval of( in Month )
Yes 6 months
Whether The Nursing Home or any Premises Used in Connection There With are Used or are to be Used for Details for purposes other than that of carrying on a nursing home
Purposes Other than that of 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
Parab Smita Sakharam Nurse A.N.M 36508 - 2027
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 Number with Date of Validity Upto
No Data Found ...
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 Registration Number
No Data Found ...
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 3
Enter Total Number of GNM Qualified Staff Enter Total Number of ANM Qualified Staff
5 5
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
No Data Found ...
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
Acquired Inspection Control Committee Respects / Pathology Swab Reports for OT/ ICU/ Other Bed
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 *