Empanelment of Eyes Care Centres - ECHS
Empanelment of Eyes Care Centres - ECHS Empanelment of Eyes Care Centres - ECHS
(ix) (x) (xi) (xii) (xiii) (xiv) (xv) Autorefractometers 20 Synaptophone (basic type with antisuppresion) Prism Bars Stereo test (Randot/TNO) Red – Green Goggles Orthoptic room with distance fixation targets (Preferably child friendly) may have TV/VCR) Less/Hess chart Remarks of QCI (NABH) SIGNATURE OF THE AUTHORIZED APPLICANT
21 SECTION III INSPECTION REPORT AND RECOMMENDATIONS OF QCI (NABH) Recommendations of the QCI (NABH) 1…..…………………………………………………………………………………..(Name of Hospital/ Nursing Home/Diagnostic Centre/Hospice) is recommended/not recommended for empanelment for Ex-Servicemen Contributory Health Scheme (ECHS) for service offered by the institution. 2. The Specialities of ………………………………………………………………….. (Name of Hospital/ Nursing Home/Diagnostic Centre/Hospice) listed in the table below are recommended/not recommended for empanelment for Ex-Servicemen Contributory Health Scheme (ECHS). (Note: Mention R for Recommended and NR for Not Recommended. Strike out specialities not offered for empanelment with an X) (a) (b) General Services (i) Ophthalmology Specialised Services Remarks of QCI (NABH) (i) Cataract/Glaucoma (ii) Retinal – Medical – Vitreo – Retinal Surgery (iii) Strabismus (iv) Occuloplasty & Adneza & other specialised treatment Seal of NABH SIGNATURE OF THE AUTHORIZED OFFICER OF NABH/QCI
- Page 1 and 2: APPLICATION FORM (ECHS-02) FOR EMPA
- Page 3 and 4: SECTION I CHAPTER 1 GENERAL INFORMA
- Page 5 and 6: 3 S/No Town/City Name of Regional C
- Page 7 and 8: 5 Ser Type of City Minimum Bed Stre
- Page 9 and 10: 7 19. Non-NABH accredited hospitals
- Page 11 and 12: 9 CHAPTER 3 TERMS AND CONDITIONS Ca
- Page 13 and 14: 11 (e) (f) (g) (h) (j) (k) (l) (m)
- Page 15 and 16: 13 (c) Copy of legal status, place
- Page 17 and 18: 15 SECTION II PART I APPLICATION FO
- Page 19 and 20: 17 PART III: HOSPITAL INFORMATIONS
- Page 21: 19 4. (a) INVESTIGATIVE FACILITIES
- Page 25: Ser Name of Documents Applicable (Y
21<br />
SECTION III<br />
INSPECTION REPORT AND RECOMMENDATIONS OF QCI (NABH)<br />
Recommendations <strong>of</strong> the QCI (NABH)<br />
1…..…………………………………………………………………………………..(Name <strong>of</strong><br />
Hospital/ Nursing Home/Diagnostic Centre/Hospice) is recommended/not recommended for<br />
empanelment for Ex-Servicemen Contributory Health Scheme (<strong>ECHS</strong>) for service <strong>of</strong>fered<br />
by the institution.<br />
2. The Specialities <strong>of</strong> …………………………………………………………………..<br />
(Name <strong>of</strong> Hospital/ Nursing Home/Diagnostic Centre/Hospice) listed in the table below<br />
are recommended/not recommended for empanelment for Ex-Servicemen Contributory<br />
Health Scheme (<strong>ECHS</strong>).<br />
(Note: Mention R for Recommended and NR for Not Recommended. Strike out specialities<br />
not <strong>of</strong>fered for empanelment with an X)<br />
(a)<br />
(b)<br />
General Services<br />
(i) Ophthalmology<br />
Specialised Services<br />
Remarks<br />
<strong>of</strong> QCI<br />
(NABH)<br />
(i)<br />
Cataract/Glaucoma<br />
(ii) Retinal – Medical –<br />
Vitreo – Retinal Surgery<br />
(iii)<br />
Strabismus<br />
(iv) Occuloplasty & Adneza<br />
& other specialised treatment<br />
Seal <strong>of</strong> NABH<br />
SIGNATURE OF THE AUTHORIZED OFFICER<br />
OF NABH/QCI
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