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Request for e-Hospital
@NIC
Do you know NIN of your Hospital?
What is NIN ID?
NIN is National Identification Number to Health Facilities of India.
NIN is a permanent unique 10-digit number for verification of health facilities and their attributes.
Do you have NIN ID?
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No
Enter NIN ID:
Health Care Facility Details
Module Requirements
Infrastructure Details
Officer Details
Facility Name
*
:
Facility Abbreviation(if any):
Facility Type
*
:
About
*
:
Central/State Govt.
*
:
State
*
:
District
*
:
--Select District--
Address
*
: (max 100 characters)
Pin
*
:
Website:
General Infrastructure Details
Average Number of (patients/day):
New OPD:
Casualty:
Follow-up OPD:
Patients Admitted:
Patients Discharged:
Other Infrastructure Details:
No. of Bed:
No. of General Ward:
No. of Private Ward:
No. of ICU:
No. of Doctor:
No. of Nurse:
No. of Clinic:
No. of Department:
Number of Counters:
OPD Registration:
Casualty Counter:
IPD Admission:
No. of Billing Counters:
Pharmacy Counters:
Laboratory Details:
No. of Laboratory:
No. of Sample Collection Centre:
Radiology Details:
No. of Radiology Equipment:
Store Details:
No. of Stores:
No. of Sub-stores:
Blood Bank Available:
Any other relevant information:
ICT Infrastructure Details
Availability of Local Area Network (LAN):
No. of Nodes:
Desktop PCs:
Number:
Configuration:
No. of Printers:
Availability of Internet Connectivity:
Bandwidth (MBPS):
Availability of Redundant Connectivity (different ISP):
Bandwidth (MBPS):
Technical Manpower Details:
No. of Technical Manpower resources:
Details of Technical Manpower resources:
Availability of UPS:
Capacity (KVA):
Availability of Generator :
Capacity (KVA):
Previous HMIS Application:
Any HMIS application already implemented:
Name of the organization and details of modules implemented:
Date of implementation of the HMIS application:
Platform of the HMIS application:
Head of the Hospital Details
Initials
*
:
--Select--
Mr.
Mrs.
Miss
Dr.
Prof.
First Name
*
:
Middle Name:
Last Name
*
:
Designation
*
:
Phone Number:
Mobile Number
*
:
Email
*
:
Fax:
Nodal Officer Details
Initials
*
:
--Select--
Mr.
Mrs.
Miss
Dr.
Prof.
First Name
*
:
Middle Name:
Last Name
*
:
Designation
*
:
Phone Number:
Mobile Number
*
:
Email
*
:
Fax:
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Module selection for eHospital
@NIC
Complete eHospital
@NIC
Suite
e-Hospital
1. Base Modules - Phase-1 (Mandatory)
Patient Registration (OPD)
Emergency Registration
IPD (Admission-Discharge-Transfer)
Billing
Clinic (order entry)
2. Advanced Modules - Phase-2
[On completion of Phase-1]
Path Lab (LIS)
Radiology /Imaging (RIS)
PACS Interface
OT Management
Pharmacy Management
Electronic Medical Records (EMR)
Care Provision
Stores & Inventory
3. Auxiliary Modules [Optional - Phase-3]
[On completion of Phase-1 and Phase-2]
Dietary Services
Laundry Services
Birth & Death Registration
e-Blood Bank Management (Independent)
Blood Bank Name
*
:
License No
*
:
Patient Portal
ORS (Online Registration System)
Compulsory Modules for e-Hospital
@NIC
Patient Registration
ADT
Billing
Clinic
Laboratory
Additional Modules for e-Hospital
@NIC
HR
Store & Inventory
Radiology & PACS Interface
MRD