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APPLICATION

FOR
ACCREDITATION OF AYURVEDA
HOSPITALS

Issue No.: 03
Issue Date: April 2012

NATIONAL ACCREDITATION BOARD FOR


HOSPITALS & HEALTHCARE PROVIDERS

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NATIONAL ACCREDITATION BOARD FOR
HOSPITALS & HEALTHCARE PROVIDERS
Assessment criteria and Fee structure-Ayurveda Hospitals
Assessment Criteria Accreditation Fee
Size of
Hospitals Pre- Application Annual
Assessment Surveillance Fee
assessment Fee
10-49 Two man-day Four man days Two man days 20,000 60,000
(2x2) (2x1)
50-99 Two man-day Six man days Two man days 30,000 1,00,000
(3x2) (2x1)
100-200 Four man- Nine man days Four man days 40,000 1,30,000
day (3x3) (2x2)
>200 Four man-day Twelve man days Four man days 60,000 1,60,000
(4x3) (2x2)
NOTE: The man days given above for assessment and surveillance are indicative and may change depending on the facilities and size of the hospital.

Service Tax: w.e.f. 01.06.2015 a service tax of 14% will be charged on all the above fees.
You are requested to please include the service tax in the fees accordingly while sending to
NABH.

Guidance notes:
1. Fees to be paid through Demand Draft/ local cheque in favour of Quality Council of India
payable at New Delhi.
2. Five copies of this application form duly filled in are to be submitted along with necessary
documents and fees.
3. The accreditation fee does not include expenses on travel, lodging/ boarding of assessors,
which will be born by the hospital on actual basis.
4. The application fee includes pre-assessment charges.
5. The accreditation, once granted will be valid for three years, after which hospital may apply
for renewal as per NABH policy.
6. The first annual fee is payable after pre-assessment visit and before assessment visit.
7. 10% discount will be admissible in case hospitals pay the accreditation fee for three year in
one installment.
8. The surveillance visit will be planned during 2nd year of accreditation which is usually after
18 months.
9. NABH may call for un-announced visit, based on any concern or any serious incident
reported upon by any individual or organization or media.

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1. Name of the Hospital:
_________________________________________________________________________________
2. Type of Hospital: Teaching/Service

Affiliation details:

3. Clinical trial services: Available/ Not available

4. Address:
_________________________________________________________________________________
_________________________________________________________________________________

5. Ownership:
Is the organization a public/ government establishment or an independent/ private sector provider?

_________________________________________________________________________________

6. Year in which established:


_________________________________________________________________________________

7. Contact person(s):
(Please indicate [] with whom correspondence to be made)

Chief Executive Officer/Medical Superintendent: (or equivalent)


Mr./Ms./Dr. __________________________________________________________________
Designation: __________________________________________________________________
Tel: ______________________________ Mobile: ____________________________________
Fax: _________________________________________________________________________
E-mail: _______________________________________________________________________
Accreditation Coordinator:
Mr./Ms./Dr. ___________________________________________________________________
Designation: __________________________________________________________________
Tel: _____________________________ Mobile: _____________________________________
Fax: _________________________________________________________________________
E-mail: _______________________________________________________________________

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8. Is the Hospital registered with Local Authorities:
(Where applicable as per the State Norms)

_________________________________________________________________________________
9. Number of Inpatient Beds: (number currently in operation) (please exclude emergency, day-care, recovery room beds etc.)
_________________________________________________________________________________
10. OPD & IPD data:

OPD DATA (Past two years)


Period Total Number of Patients % of curative patients (out
of total)

IPD DATA (Past two years)


Total Number of Patients % of curative patients (out
Period
Admitted of total)

11. Scope of Accreditation (Clinical services being provided by the hospital)

Service
Clinical Service Number of Beds
Provided?
Available

Anaesthesia Sagyaharana YES/NO


Burn Unit Dagdha YES/NO
Cardiology YES/NO
Cardiothoracic Surgery YES/NO
Care of the Elderly Jara - Rasayana YES/NO
Coronary Care Unit YES/NO
Dentistry Dantaroga YES/NO
Dermatology Tvak vikara YES/NO
Dialysis YES/NO
Emergency Medicine- Atyayika chikitsa YES/NO

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Ear Nose and Throat- Karna, Nasa evam
YES/NO
Galaroga
Eye and E N T - Shalakya Tantra YES/NO
Gastroenterology-Annavaha srotas vikara YES/NO
GI Surgery YES/NO
Anushastra Karma YES/NO
Minimal Invasive
Kshara Sutra YES/NO
Surgery
Rakta Mokshana YES/NO
General Medicine - Kayachikitsa YES/NO
General Surgery - Shalyatantra YES/NO
Gynaecology Streeroga YES/NO
Hyperbaric Medicine YES/NO
Nephrology YES/NO
Neurology YES/NO
Obstetrics Prasuti tantra YES/NO
Oncology Arbuda vibhaga YES/NO
Ophthalmology - Netraroga YES/NO
Oral Surgery YES/NO
Orthodontics YES/NO
Orthopaedic Surgery YES/NO
Pathology - Vikrit Vigyan YES/NO
Panchkarma -Penta Bio-Purification
YES/NO
Measures
Plastic Surgery Sandhana Shastra karma YES/NO
Paediatrics - Kaumarbhritya YES/NO
Paediatrics & Neonatology - Balaroga YES/NO
Paediatric Surgery YES/NO
Palliative Care Shushrusha vibhaga YES/NO
Preventive Health Screening Clinics YES/NO
Rasa Shastra YES/NO
Rehabilitation Punarvasana -
YES/NO
Vyavasthapana

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Respiratory Medicine Shvasana vikara YES/NO
Surgical ICU YES/NO
Toxicology- Agad Tantra YES/NO
Urology Mutravaha srotas vikara YES/NO
Others, please state YES/NO
Panchakarma (minimum service to be YES/NO
provided by hospital)

12. Scope of Accreditation (Diagnostic Services being provided by the hospital),as


applicable

Diagnostic Service In House Serves other Out sourced


organization
Diagnostic Imaging: Darshana Pariksha
CT Scanning YES/NO YES/NO YES/NO
DSA Lab YES/NO YES/NO YES/NO
MRI YES/NO YES/NO YES/NO
PET YES/NO YES/NO YES/NO
Gamma Camera YES/NO YES/NO YES/NO
Ultrasound YES/NO YES/NO YES/NO
X-Ray YES/NO YES/NO YES/NO
Laboratory Services:
Clinical Bio-chemistry YES/NO YES/NO YES/NO
Clinical Pathology YES/NO YES/NO YES/NO
Haematology YES/NO YES/NO YES/NO
Clinical Microbiology & YES/NO YES/NO YES/NO
Serology
Histopathology YES/NO YES/NO YES/NO
Cytopathology YES/NO YES/NO YES/NO
Genetics YES/NO YES/NO YES/NO
Molecular Biology YES/NO YES/NO YES/NO
Blood Bank YES/NO YES/NO YES/NO
Blood Transfusion services YES/NO YES/NO YES/NO

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Pharmacy: Aushadha Vitarana
Dispensary YES/NO YES/NO YES/NO
Manufacturing Total Parentral YES/NO YES/NO YES/NO
Nutrition Bhaishajya Shala
Professions allied to medicine:
Dietetics - Ahara YES/NO YES/NO YES/NO
Physiotherapy - Karmabhyasa YES/NO YES/NO YES/NO
Occupational Therapy YES/NO YES/NO YES/NO
Speech and Language Therapy YES/NO YES/NO YES/NO
Ambulance Service YES/NO YES/NO YES/NO
Social Work YES/NO YES/NO YES/NO

13. List Inpatient Care Units/ Wards, the Number and the type of care given in each Unit/
Ward.
Name of Unit/ Ward Number of Beds Type of Care Given Floor/ Location

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14. List of Ambulatory/ Out Patients Units, the number of visits and the Type of Service

Name of Ambulatory/ Out Average Visits per month Type of Service


Patient Unit of Clinic

15. List of Non clinical and Administrative Departments

Support service In House Serves other Out sourced


Organizations
Catering
Cleaning services
General
Administration
Laundry
Management of
clinical
Waste (as per BMW
Act and Rules)
Management of non-
clinical waste (as
per BMW Act and
Rules)
Mortuary Services
Occupational Health
Patient Advisory
Service
Security

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Technical
Department/
Equipment
Management
Other, please
specify

16. Staff Information (append the list for all )

Group Number Remarks if any


Managerial
Doctors
Resident Doctors
a) Visiting
Consultants b) Full Time
c) Part Time
d) Honorary
Nurses
Technicians
Paramedical
Out sourcing
Others

17. Furnish the list of applicable Statutory/ Regulatory requirements the organization is
governed by:
__________________________________________________________________________________
__________________________________________________________________________________

18. Litigation, if any:


__________________________________________________________________________________

19. Date of last Self-assessment:


_______________________________________________________

20. Date of Implementation of NABH


standards:___________________________________________
(Hospital shall apply at least 3 months after implementing NABH standards)

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21. Terms and Conditions for maintaining NABH accreditation submitted: Yes/No

22. Date Application Completed: _______ Day _____ Month ______Year

_________________________________
Authorized Signatory
Name: ___________________________
Designation: ______________________

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