Hospital Management Form

Registration for giving online consultation by a Registered Doctor through the hospital for the support of a health worker Form

    I am the Manager / Director of a registered hospital whose registration certificate issued by the office of the District Chief Medical Officer is enclosed here with

    The doctors registered in my hospital will give online consultation as per the Tele Medicine Practice Guidelines (2020) issued by the Government of India and the National Medical Commission (2022) for which I will be fully responsible.

    My hospital has all the necessary facilities for treatment through tele doctor.
    During treatment of the patient by tele doctor with the help of health worker of my hospital (patient to RMP through health work at sub centre or peripheral centre) full support will be given to the patient and the health worker.
    All the doctors doing e-OPD in my hospital are registered under the Indian Medical Council Act 1956, full details of which are attached here.
    All the information given by me is true and correct. No facts have been hidden. If any information given by me is found to be false, then any person affected can take legal action against me.
    The treatment done by my hospital to the patient through e-OPD will be my complete responsibility. The Gramin Tele Medicine health kalyan sansthan lucknow ( U.P.)will not be responsible for it.

Name Of Hospital
Registration Number


Name of Hospital Director/Manager
Hospital Director/Manager Whatsapp No.


Established Year


Specialization
Hospital Facilities


Whatsapp No.(E- O.P.D. NUMBER)
Landline No.


Email Id
Website


Hospital Full Address


upload csv file (Docter Name, Specialization,Reg. No., Online OPD Day/Time ,Offline OPD Day/Time ,consultation Fees)



Upload hoapital Photograph
Upload hospital Reg. Certificate