,,;; with SeQ',iQn as . 41 (4) (5) (6) (T) and seeeoe 42 (4) (5) (6) {7j ef Ihe Act, any pe' $On Of clinica' estaciishment. ~ aggrieved by the oeoisioFl c! the A,"""ority uMe' sectces 2;1 anc 34 of the Aa, may fhe an aepe al In an"",X! SG-S 10 the s-e-e Cour>eil w'Wn tr.iny (3::1) days from the ;:la~e of recect of such e-ee- a~Onll' with a fee of Rs 'OO()I-
(2) The al=~a l aga;lI$t a po.:bl'c f-ea'mcare establlshmet11
5na.1 De fi'ed in loom SGA a ~d shall be seot 10 tne State Counci l by registefed peS! cr irt person ,
(3) Every appea! shall be 8ccerr.;:anied by a tea of -ccees one thO'~sa ~cl.
(3) After receipt of the appeal. the State COllncil shall Ii;( the t me enc elate 10" hea,;ng and inform lI>e s.aone to e-e a~ella~t aflCl 0\I1efS ececereee bi' a rl!9is:ered letter giving at le a51 15 days ::'''1\8 for hearing el the casa.
(3) The a o~el l arl may represent by h 'mse~ or ault\Ol'Q;eP ..efllon 0" a Legal pra::btione' ar.d su:YTI,t the reI"va~t dOCl.'mentary materal d any in suppa'! It' the appeal
(4) Th e State Co,,~ cil s1a'i hear "II u' e conc ~m.. ;:l . receive ttle re:..vant ora~ocul1'en:a1)' e'o'idenoe slIbmitted Dy 1."em. consider thf.t appea' an;;! co.....""nica:e its decision preferabty Wilt1iFl 90 days from the oat.. of fil:"g the Appea' If the state Council cc r- s.oers ttl at an interim order is. .....cessery in the matter. it. may pass sue" Otde,.
pending f.~a :t's.cosal of tne ecceet The Stale Cou~cil w.~ neve I"e a;rtncrity to sl ay the operation of the ereer of t"e Ois~ct Reg,stenng Endsl NQ' /34IFU(5}I2D131 :;;r:ed. tr-e A copy is forwarded 10 the Con!TQner, ?lin~l1g & Stationery Department. UT Cnam:ligarh with the reouest to "et tt'le afc:resa ,d notifica tion published in lt1e eKtrilordina-y c"riClal gazette 01Cna ndigam Adm'''Ii.l;trati:l''l a r>d :0 SllPply 2S copes 'tlereo~ for re<:ord and use in lt1e departm ent.
/ Joont Se7ll'taIy -iea'lr1 Chand;gam AdmmistrBtion ",. , ·JS3It r;"h AUIl10lity till so.d1 time as it ceoo-s :'\&Cessary. The cecece of State COlJrlcil sr.;:\11 be r''''"lan:l bi~il1g,
(5) If no IIppeal Is filed agains.t Iha cec'eee of tile Oistri c::l Reg 'slerit1g Autl1ori:y in ll>e preSCfload period i.8, W<~ 30 cays ~om the dale of ree:e:~ of !he OfOer , the e-ee-s of tile Autrlority shafl be "'. (s) Tt,fl lIpeeal fees eceee-ee snaU be oeccs-tee In • r.a!io" alizeo Dank ltC=ourt: OPe'1ed in I/Ie " arne of 018 oIfl6al d~ig"'atiQl'; or tre S~ate CounCI l Brld sh a ~ 1 be uti lized by the ccuecu and Au'~~o'ity mr the activ.t 'es co-nectes wd1 the ir"p;e 'T'.., :3;1Qn of tre prov:s -ons c1":'le Ad and rulu made th",e unC.. , as lI;>P-::vec: b}' tIllI state C,,;mcil,
35. Ge ,."lra l. . "",,'v oI/ler matter whICh '. "<>Quire(! to be Of may ce prescribed by the State Govern'Tler.t.
Anil "<~""ar. "'5 Secretary Hearn Chandigartl Admln istraliOn • p .
'',~' \1 . , " .~'\".\, '\ --------------- S Gl Fo rm k::pllcali on Form (Of P!Rvisional Registration orCl/nical Es~bl/stzm"n!!
\ ~ _~ame of the' Es(ab/islzm"nt.
2. Addross '.
V11~crwn, OoTd - - - T., No~ STO coce !
Er-.~ ;D Tal"""" S':3le : _ Mobl. Fv :
....'e0Sl\e ( l . "Y):
Pin <;I><le f. Location ' :J Rura IO Uf1Jan a Metropolitan J. OwnlfShip F'lIblic Sec/or Cl Clin lfal govemmenr 0 511,119 governmont :J Local government- pl(Jfls" Sf)6cifr :J Public Seelor Un dertaking ~ Railways 0 Emoloyee Slate Imurunce COtp'"Allion ( ES /C) o Autonomous Gt!j'an;zat~ :J Any oIh~ (pIellse s;;6Cify):/ o Any omer ( Pin code Fax :
Pin(;OdB Fu :
TalulW:
Mobile.
Mcbiie ' Ta/llke:
State:
State:
6 Name eftfle owner of Clinical Es tab li:shmcnt· Edvcaoon 31Ou8Jifi~tio" "'-de...u.
Vlil'agsITo,vn.;
DlSlrict:
rei No (~;iin sib' (;OOe) EtrnlJ/ Ie;
7. Name of pefSon ir--eharpe o( ttl e Clinical c :S labUshm l De!$IgI'Iarioo, EduCli tiona l O<:armcli ~io.'l;
ArjdrtlSS VillagelTown.
District' Tel No (with STD' code). EmaillD .-
8. System:s of Medicine offend: (1)>1*$ '' bck NfIic/le ....' IS a;>pJiceb1e) IJ Allopathy 0 Ayurvedll :J Unani o Homao.c8thy i:J Yoga & Naturo pathy o Siddha i. Type of ESfebfis lzm ent : (please tick wtzichevef I'll ;rpp licabl. , Pfoviding Out Patienf Care CJ SngSe pt'8ClitIGner 0 PoIyc/itli:; :J S ll>Calltrl! 1J Physiotherapy CJinit:
:J Occupational Thefilpy :J Inre"tihly :::J Dental clinjc CJ Dispenss."Y o Dialysis Centm 0 Ill/eg rs /ed !;o~'"se!ing arrd Tes/ing Cen/fi (ICTC) a W9l1nesslfi/Jless centre :J Any cmer (pJ",asa sp ecofy) _ o MateTrliTy Home o Community Health Centre :J BIO:;i1em,stry CI Collection Centre ::J ser- e DenSitometry a cr Sca n ::J Mult, Specially :::l S'lOOhan Cn,Kitsa o Vya V3s11a Providjng ln Patient Care :l l"Iascola; 0 Nurs;n" j-, c;me o Prirnary Healtt> ceeee 0 Sanatorium o Any other (please s~ ecify): _ Provlding Testi ng & Ciagnosti c: Servi cK :
ubo.. to ry !:1 Patholo,n' ::J HaernalO'Ogy ::J Micro~lOlogy 0 Genetics o Any «he' (plen e specify}: _ Oiaa"oslic and Imag;n a Cont~ o X Ray eee-e :J Mammcg~p"Y o Scnography ::J Ccbr Dopplll ' :l Magnet;': Resonance Imaging (MRI) I:J Pos itron Emissio:l TomCllraphy (PEl) Scan :J Elect ro My() Grapf1y {EMG} [J A"" other (pleeee speciry) _ Any «he- ("" ase speedy): _ 10, Nat.lrv of Servicea (please tick whichever ;5 applica ble) For all S)'1Itams of Medicine o GCf1e<aT :J Single SpeC'alty I:J scce- SpeCIalty 0 Mobileo A"" ottl", . o;"ase soec Tfy: _ I) Allopathy a General PraC(;ce 0 Ou'-p:;t~ent a 'n-oatien:
o Day cere centre 0 Emergency I Caso.:any 0 leu o ICCU I:J Blood Barlk ::J Organ (TiS'>l>1I Bank o Soeclal c a-e Se~ices forcl'l8l: .....,g~ ee-scos :J Any O\t'e t p lease SpllCi!y: _ b) Ayu rveda o Ausadll Ct1 ;~;:sa 0 Snl!.1yll Cn,kils.:i :J Resayana 0 Pethya o My other p'ease specify _ .:) Unan i o Mal aD ':J Hitzan-e-Sebat d} Siddha :::l Je-abet :::l rarDi(-Tadbee' a Any other please speci'y. _ Q M:;tru:hwam :J Siracpu l.1arulhuv am I:J Vermam T~Okk r"lam & Yoga a M y othe' pleaSII SPecify _ I j Homeopa thy Q Ger>eral Homeopa~hy CI Any Otr.e' please s.."ll~ f) Naturop iithy U In:err.a l Th erapieso Exts m al Therapies with na(ural moda lit ies o Any ether p lease sp ec;fy". _ 9) Yoga o p leas" specify,. _ INFRASTRUCTURE DETAILS 1 f . Area o f the estab lishment (in sq, me ters):
a) Toral Area. b) Constwc;led area. _
12. Out Patient Department:
No, of Room~ -
13.1 Total no. of OPO Clinics.. ~C;C;""'''''''"------------- 132 Specialty- wise dislribution of OPD Ciinic I I P - t,
13. In Patient Departm en t:
13. I . TO lal rwmber of beds..;c=-"''''"CCCC" CC" ,,;c-- - - - - - - _
13.2. Specialty-wise distribution of beds, please specify ' 'Sr. No S;:;eciall' No. of Beds
14. Wlle ther Clin jc;al Waste Disp osal Licens e obtaine d from Panchaya l/Mun ic ipa lilylMunicipa[ Corporation etc?
::J Yes o No o Applwd For 15 Whether clearance from Pollu tion Control Boa rd/Authority ob tained?
D Yes HUMAN RESOU RCES o No o Applied For
16. Tota l num ber of Staff (as on date of app licat ion) :
No, of permanent staff . No. of t"milo ,a ry staff'.• _ P leas e fu rni s h t h e f a ll owing deta ils :- Cale gmy of Name Qualification Reg istration Natu re of Staff Number (where service app lica ble) Tempc ,aryl Perm anent.
Doctors , ~ursi r.g Staff Paramedical , Staff Pharmacists I - -- Suo err s:.sF.
oeers. please LgI - - - -7---- -------~----' Separate annexure :"r.ay be attaetle-:1 ,"
17. Payment options fo r Rflg.stlaticm Fus:
o Posta l Order I. __ '" , , ,... on behalf of myse lf and me com;>anylsocletylassocia~orJb<xly hereoy tredal" lIlat the sta:emeNS ebcve a'" correct ar'\d true 10 lh ., be!: m:f knowle<:119 a.~(! I 'ShaL a~ iC" by ar. 1he 'ule$ and ds ::larsti ons ...:noer!tle Clinical Establisht'l'lel1 t (Registraton and Regulation) Act 201 O.
I uooertake rtiet I sl'lan mllmate to the apPfOptia~e reijLSle 'tng au'florr.y any chaose in tI>e "a~-uIa;,; given eecve.
p Dale:
Signa:ura oftt>e Authori.re:l Signatory OffICe $ea l ,~.
4~·r>..· _'1~%' .~.\" . .,...,,-' ~ " " ' ~~ J/,'"
411."". "."
SG2 Ann&lre AC/{NOWlEOGEl'lENT REGISTRATlON OF CLINICAL ESTABLIS HMENT Pie a::v.:A'catiofl f' Form for Grant I Re'1ewal of Provis'onal l Perma nent req.stranen of lhe ClJniC3! Establishment submilled oy c::CC-;;::::;:;-;;::::::CC;:;
(Name and addres s of Own er) has been received by Ih e Dis trict Registering Aclthority on (date) and found to be cc-ic.ee '"Incompr!:!!e rns a:Xrow'edgement ceee not confer any rigt1tS on u-e appl icant for grant or -e-iewal of reg s tration.
S.gnatu'e and Cesignat'cn of O,strict Registering Authority O' aJth coi%ec:! pel'$CO il' t"le oece ct me Authc ' c:y.
SEAL Designation of the Issu ing Authority (Computer Generated) P'ace & Date: (Oo movter Ge"leraled) SG J Ann .,..
PROVISIONAL CERTIFICATE FOR REGISTRATION OFCf.JNIC,IIL Es TAE U SHMENT Provision. 1regis rr.llion N,,: (Compcrter Gener.te~l ~ale o f Issue: (CctrW"ter ~o",~;-ed) V~id up to: {Co"'olllerG_",,;e~ 1 Na"'e 01the Clinrcal £It.~liI.~'''enl _
2. AOdress
3. Owner of \t1e CiirlCal ES'abIL$h ment 4 "lame cJo"""n '" C""rge 5_ Systen ofMI!ld 'cit'1e: -:====================-6 Type et# Esl. b,is,""' IIrl\" IS ,,",ret!\' pro...~I"",, :ly ragistered ur"M' :he prOviSIOns 01 C' -nl~ =~t.l).'; .h"""' tS {Re . 'stratian and !<.egu'_J Aa 2010 and ~~ e Rutes rr.ad<! It.. "" LJ'de< This i"Mo:uat~n is sul:jec;t10 ':Ile CC<"Id,to1S al sp ,of ied in tr'te ru les in fo ree LlI'>O'ef the CliniC11 Es:~lis~"".'>IS (Res-,.n:,::>;> 11'"<1 R~u1.li::m ) A<:t 2010 and l~e R:.oles ma1e !l'ete una '" Ol s ignation cf Ihelssu"ng,o.u'.n.or'ty (Co'N l\JIeCGerereted ) ?ace & Datl- (Com>lu'~ Ge-.-.cl) O·, tri<:tReaistralio n A.nhority Add..... ' P/'l oni n...m ber in ca n 01Grll " i n<: . ' :n '..~p" AwO","" uO'I~*n~'Il PUISIO (pe;1lJa""~ J.l"d"'~) :8;"0 'i a>~ld (pe\l!'_&"I~:J) .()u04\rl'l' tiJ!nsSI~ /J UOOl....S,.":;l JallU"~ &1" '" ~"'I"b 8'il P'-" OWl: "'" (",,~elnaal> I'L' UOlla<lS.5al;l)~"""4"1""~;
,lIJ:l jlJ1l:) ' ~l ,,,pun ~j"j '" "am, ;l;jl Uj pauteoos ee SUO'~PJOO a ul 01parq,~. S' UO':lr.e<;I"f SIIU.
,aOLJr1 aJ04l ape w .a;n'll ....1p..le 0.0l: PY (Uo.,e1'Ba<:! Pu~ <IO!I&llS:Sa'll) .:"a<J-'Ili!'ClI!IS:l ln ,"'O. /0 WO'SIMIJCl Sill "'PU n P'~i~ AltU=ou r lJ.U 1Id Aq....'9u ..
- ======================~1U'OW\jS'JOI!" :liO ad.~.L i_'''~P8Vf JO ",alsf s " . a",'C '" 1: 0..... 0 10 _eN ,.
:1lAWI#S roel13 ;eo''''I:) 'l~11" '.""'0 £ " ..,jOPY Z :P&:~ ' '''''''WOO} :>l d ll Pll f !l (P'l", ;U l f) J"lI' dwOOl :a n"' l JO 'I~Q (pell'.< ""'~ -'J;ndwO:;l) :0 " 1I01l"'1.!8~ ItI. ..~=.d J.r.; 1'f11 S1I8"lS3 l'o'::IINilO ~O NOU."\fa!SI~3'1l 'IlO~
3.1." OWJ.'Il30 J.H3"''' '''Il3dn.w",. ~S l I I I I I I I I 1Me«o , not . polla ble fQr 1 I l~' 0'<"'1" I o._'''".ls n Of MOlro 1 "" V 1.i, Out PII'e"" ca...
I~n.nt j Proot>.;o~11 I P• ....,,~e"' Prov;<i(>~li 1"""""~etrt 1250~ :00 I sao I zcc f 1000 '~ Plue nt tint 1 100 i soc i 200 fTooo--[ I L--L -----l-- 11100 i 1000 I .:00 12000 = - -1zoo !''''- I'" I '000 I ! I I I se '*,to be tN'Ced 'i~ "'!He.)
I ~.n~ OLl( Of MLl"IitiPll C~"",..~ Urbo~ f .....t~'-I ....
I ..,itl I M""i,.pal Corpou ,ion', ~.
I L.lbc..• I 100 i500 1200 ] lOCO I 400 I 2000 1: ; Oot;c: I ~O 650 ~oo hs:lO-~ 5CO \,=..c-~ & 1.....1"<1 I I I I I" .,. ~ I J I [ Olner Fe ." , " Fof ~ ' '''' WI' ....,.of to. Imo~n; of reliwllion I, e IP,,,,,i.'c ' I I/ " . ", .ne~li \ " fa" 1.I~ . PP' ;Cllic~ tile ."'0""t1'OlJJ4 bt doouble <If,'e "'5" .... , "', "H !P""';';onll / I o...,....ner.t!
" ~or OypIIClTe C<!r<:ifieate the Imo ....~1 .........d be ..... 200 /· I" klTthlnle Of O""lOe' ship m.~./lemen' 0' ....me of ..Ubli"'",en, WOUld b.... 100/· I" >'or" '" Ippel l1M ".,,'Wl! wou41i>e tU. IOCO/·.
If. Ilt>O rotor-y ord i ' l~o ,ri< "' , ,,. IJ • ".., of V' "'\lbl;'''''''~l prO'llcHn/l Oy,patlel'lt/l""":~~t are no ,,"Plnlte ""I'''''''''";, '.o"...d, . --', -- - - I r~~~I~ I 5td, 130 to 100I Above 100 1150 I'" I TntwlC & C."",<>rtI< - - ,,\ --. -.
_ ·~ '}>:!'t''''· ,~r ......... . . _ , ~", ,~->: '''" " 'L ·_ '1<.
'1!It/' .f 'lJf:'l 4~...•', ..~ SG 6 A..nexe OUPWCATE CERTIFICATE FOR REGISTRATION OF CLINICAL ESTABLISHMENT Perm anent r, gistretion No: (Computer Ge~erated) Dale of Issue: {Cc>lT ;:oIltI!'~t~ Val id liP to- (Computer Generated) 1 Na:". Ql~;";,,";.~;';';';';';'~;_~;.~====================L Ad~'e"" 3 0-..,01 et.. Clinical ES1 8b!'sh'T\4"1t ~ "'...,. of Pe<"$Ol\ ;1\C'la rge _ 5Syat"", 01 MedICI'18;:;=========================6 Type 01 Er-a!Jlisr.rr...t\t '" ne'Ely ",OVIslOt\;llly / pcnn.ne~lIy r&glS\e~ "n~e< 'J>e P'O"ls '<><11 of -C,;"iC<o, ~ta.:lIis.~m_ (Reglwalon anOR~ulatlon) ACl lela a nd u'e Ruin mat e (he,,, u.-.de- , Til's i <Jtt:or,.., :,Ol'1 JS su lllr>et to t~. "OnOitiol".' a s . ;>6Clfle1 in \"Ie ruIN in /0.'". u~a.-.~ em"""t £st..tl ;.~me"lt (Reg'st1'll~".rod Reg,,:aUlnj A::! 20 ' 0 and ll'e R'ules made th.".. unjar Design_ticn oI l1>e IOSUi'19 A:.thorit}' (Compute' Generaled) P\ilce & Oa~: (Comp '-'ler G.....erated/ OisDiet R,.g, s traU 01"I Allth o ri ty Addrns:
Ph on, nu mber In en. of Grl...ances SG 1 Anoe"ll Format for SLlbmission of I~"pe<::tiollReport Names ami details of mem~rs cf U1e inspection team Alldress and conteel details of clinical es!a t),iis" ,..,enr .,.;sited
(1) To me C~nio;aj Eslablishrr ent
(2) To t~ e DisllJct Registering Autr.Olily "In case of lack of consensus amo~. t membe' s of the '''spection team , t!l e $ame may loa kindly indica :.i (l -·/:lOOl>!l,0lj"J'•4~'~" Ju~"'0,'N"<~'~UJI'lilJ!"~4:.u~....~•JO;noAf'~j.q,.""'~.01iU~I''''lUI, ._.•.._._..l'l!
(~ " .:.o.o'aq~O!l.''''',u04~Wl'l";.~lJfd.."C<101~OOI.....,f;>i•...., 01rtCM1<0'\0"I.~~~lou'""ll-o_'~o.........pJlS!Ca<r.;0uo,"'.o••oql''i.J.
···,····_··'.'1'0AU'<'(~ PV....'1H:>U~aou....OulJ<lJAl:IUfOdI........~Il.''''....I,....1"1 l.,,,,,,,,,ql.," I"'~P)Oi,,·uu"-,.4'4''''-uo~u<!w"W<l'1',"U'".''',.<4.1.I"l PfI,.>uc",UC""-'lSJb.A"l.:.II!
p.~I'J"UO!>"'J~~11,u,1OU.tl!
,...,..···-\>f:Oo..-'-.-.-.~t-I,.....J.d10...~~."1'I:lUll-(J....II-.'lP,:Hou!Un"''''C'n..., ._--,.
P-;>l0101---A...JOjOllJl...,...$lU....'I"!i••lSl!*='IU!O,.;:U"·---••o...nuuo.;....".....'P'''- "Po04;O<U"lIl1'!O"'VU~"ulf,~.',oJ~.:dd'0'".."W',,,.•.--._..Ie', .~ ,0'U.WW""O'[l P"'c).,~s"'-U lti9n·'sJ ,O,G<!II>CljUOl'"'!r\l~l' 2
4. Preside~t 'ndian Medical Association, Chandigarh
5. Pfi~cipai Mecrcat Officer, Government Multi-Specialty Hospital, Ssctof-16, Ch"ndigarh Member Convenor ANURAG AGARWAL, lAS., Secretary Health, Chandigarh,Admin,istr~tw.
4471 CCUT-Gov! Press, u.T.. Chd Legislative001 4.pdf Legislative001 5 Legislative001 6 Legislative001 7 Legislative001 8 Legislative001 9 Legislative001 10 Legislative001 11 Legislative001 12 Legislative001 13 Legislative001 14 Legislative001 15 Legislative001 16 Legislative001 17 Legislative001 18 Legislative001 19 Legislative001 20 Legislative001 21 Legislative001 22 Legislative001 23 Legislative001 24