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Fresh Request
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Know your Request Status (KRS)
Enter your Refernce Code
Enter Pan Card Number
Search Result
Step 1 - Hospital Information
Hospital Information
General Information
Hospital Information
Hospital Name
*
Hospital Category
*
-----Select Category----
Government
Private
Day Care
AYUSH
Address1
*
Address2
State Name
*
-----Select State----
ANDAMAN AND NICOBAR
ANDHRA PRADESH
ARUNACHAL PRADESH
ASSAM
BIHAR
CHANDIGARH
CHHATTISGARH
DADRA AND NAGAR HAVELI
DAMAN AND DIU
DELHI
GOA
GUJARAT
HARYANA
HIMACHAL PRADESH
JAMMU AND KASHMIR
JHARKHAND
KARNATAKA
KERALA
LAKSHADWEEP ISLANDS
MADHYA PRADESH
MAHARASHTRA
MANIPUR
MEGHALAYA
MIZORAM
NAGALAND
ORISSA
PONDICHERRY
PUNJAB
RAJASTHAN
SIKKIM
TAMIL NADU
TELANGANA
TRIPURA
UTTAR PRADESH
UTTARAKHAND
UTTARANCHAL
WEST BENGAL
City Name
*
Select City
Pin Code
*
STD Code
*
Phone No
*
Fax No
*
Landmark_1
*
Landmark_2
Email ID
*
PAN No
*
Service Tax No
*
Reg. No
*
TAN No.
*
GSTIN / UIN No.
ROHINI Code
Legal Constitution of Hospital
*
-----Select Type of Organization-----
INCORPORATED COMPANY- Public Limited Or Private Limited(Pvt. Ltd./ Ltd.)
SOLE PROPRIETORSHIP- Business That Are Owned & Operated By A Single Business Owner
PARTNERSHIP PROPRIETORSHIP- A Partnership Is Two Or More People Agreeing To Operate A Business
PUBLIC TRUST- The Beneficiaries Make Up A Large Or Substential Body Of Public
PRIVATE TRUST- When It Is Constituted For The Benefit Of One Or More Individuals Who Are Ascertained
LIMITED LIABILITY PARTNERSHIP- A Partnership In Which Some Or All Partners Have Limited Liability
TPA Timings
*
Mon-Sat
to
TPA Timings Sun
to
Contact Information
TPA Co-Ordinator
*
Mobile No
*
Email ID
*
Billing Person
*
Mobile No
*
Email ID
*
Medical Director
*
Mobile No
*
Email ID
*
Administrator
*
Mobile No
*
Email ID
*
Medical Superintendent
*
Mobile No
*
Email ID
*
CEO
*
Mobile No
*
Email ID
*
Marketing Head
*
Mobile No
*
Email ID
*
Bed Strength Details
Bed Strength Details
No. of Beds
Rent per Day
Total Beds
*
Semi Private/ Twin
*
Triple sharing
*
Private
*
NICU
ICU Beds
*
Deluxe Beds
*
Suite Beds
*
General Ward Beds
*
Operation Theatre Facilities
No. of Operation Theaters
*
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Operating hours
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
Recovery Rooms
--Select--
Yes
No
Portable ECG, Cardiac Monitor
--Select--
Yes
No
Boyle's Apparatus
--Select--
Yes
No
Portable x-ray within OT
--Select--
Yes
No
Centralized Oxygen Connections
--Select--
Yes
No
Separate Sterilization Area
--Select--
Yes
No
Finance Details
*
More Information please fill Mandate form & attach scan copy of Cancelled Cheque
Cheque In Favour
*
Bank Name
*
Branch MICR Code
*
IFSC Code NEFT
*
Account Type
*
--Select type--
Saving
Current
Account No
*
A simple security check