frm

I am a registered medical practitioner (R.M.P.)

I am registered in the State Medical Register under the Indian Medical Council Act 1956.

I have read and understood Guidelines for Practice of Telemedicine in India CGDL-E-14052020-219374 (12 May 2020) issued by the Government of India (Gazette of India).

I have read and understood the Public Notice (Guideline for Practice of Telemedicine in India 2022) by the National Medical Commission

I will provide treatment advice to the patient on my own responsibility as a teleconsultant through telemedicine (Patient And RMP, Care Giver And RMP ,Patient and RMP through Health Worker at a Sub Center or Peripheral Centar, RMP and another RMP/Specialist). Gramin Telemedicine Swasthya Kalyan Sansthan Lucknow (U.P.) will not have any responsibility.

I have provided my name and address, educational qualification, registration number etc. to the general public through Gramin Telemedicine Swasthya Kalyan Sansthan Lucknow (U.P.)The information provided is absolutely true and correct.

Name Of Doctor

Registration Number

Medical Qualification

Passing Year

Specialization

Experience

Whatsapp No.(E-OPD NUMBER)

Alternate No.

Email Id

Website

Full Address

upload csv file (Online OPD Day/Time ,Offline OPD Day/Time ,consultation Fees)

Upload Your Photograph

Upload Your Aadhar Front/back Photograph

Upload Certificate Self attested

Medical Qualification Certificate Self attested

I assure the general public through Gramin Telemedicine Swasthya Kalyan Sansthan Lucknow (U.P.)that I will treat and advise patients through telemedicine as per the Telemedicine Practice Guidelines and permission granted to a registered medical practitioner under the Indian Medical Council Act, 1956.