The M.P. Upcharyagriha Tatha Rujopchar Sambandhi Sthapanaye (Registrikaran Tatha Anugyapan) Rules, 1997

Published vide Notification No. F-2-3-97-17-M-2, dated 23-7-1997, M.P. Rajpatra, Part 4 (Ga), dated 1-8-1997 at page 108

mp772

LEGISLATIVE HISTORY 6

In exercise of the powers conferred by Section 14 of the Madhya Pradesh Upcharyagriha Tatha Rujopchar Sambandhi Sthapnaye (Registrikaran Tatha Anugyapan) Adhiniyam, 1973 (No. 47 of 1973), the State Government hereby makes the following rules, the same have been previously published as required by sub-section (1) of Section 14 of the said Act and the same now published as required by the said sub-section thereof namely :-

Short title, extent and commencement.- (1) These rules may be called the Madhya Pradesh Upcharyagriha Tatha Rujopchar Sambandhi Sthapnaye (Registrikaran Tatha Anugyapan) Rules, 1997.

(2) These rules shall apply in local areas as defined herein.

Definitions.- In these rules, unless the context otherwise requires,-

(a) "Act" means the Madhya Pradesh Upcharyagriha Tatha Rujopchar Sambandhi Sthapanaye (Registrikaran Tatha Anugyapan) Adhiniyam, 1973 (No. 47 of 1973);

(b) "Form" means a form appended to these rules;

(c) "Infectious Disease" means a disease which a Registered Medical Practitioner is required to notify to the Medical and Health Officer of his area under the law for the time being in force;

(d) Keeper or Owner of Nursing Home or Clinical Establishment" means a person who has been duly registered by the supervising authority in respect of Nursing Home or a Clinical Establishment under sub-section (3) of Section 4 of the Act and whose registration has not been cancelled under Section 5 of the Act;

(e) "Local area" means the area comprised within the local limits of Municipal Corporation or a Municipality or a Nagar Panchayat constituted under the Madhya Pradesh Municipal Corporations Act, 1956 or the Madhya Pradesh Municipalities Act, 1961, as the case may be or any other area declared to be a local area for the purposes of this Act by the State Government by notification in the Official Gazette;

(f) "Section" means a section of the Act;

(g) "Schedule" means a schedule appended to these rules.

Application for the registration and licence.- Any person intending to start or carry on a nursing home or a clinical establishment shall make an application to the supervising authority in Form A' at least one month before the date on which he intends to start or carry on such nursing home or clinical establishment.
Acknowledgement of application.- (1) Where an application for the grant or renewal of a registration is delivered personally, its receipt shall be acknowledged forthwith.

(2) Where such application is received by registered post, its receipt shall be acknowledged on the same day.

(3) In any other case, the receipt of such application shall be acknowledged within three days of its receipt.

Grant of certificate of registration and licence.- The supervising authority, after making such enquiry including inspection of the premises intended to be used for the nursing home or clinical establishment, as deemed necessary shall if satisfied that there is no objection to registration, register the applicant and issued to him a certificate of registration, in Form 'B' and a licence in Form 'BB' The supervising authority shall as far as possible, dispose of every application received under these rules within one month from the date of receipt of application.
Renewal of registration and licence.- (1) An application for the renewal of registration shall be made [every three years]in advance in Form 'A at least one month before the date on which the registration and the licence are to expire and shall be accompanied by the fee prescribed in Rule 7.

(2) On receipt of an application made under sub-rule (1) the supervising authority shall, if satisfied that the application is in order, issue a fresh certificate in Form 'B' and a licence in Form 'BB'.

Fees.- The fee for grant of certificate of registration and licence and for issue of duplicate certificate of registration and licence shall be as specified in the Schedule I and shall be credited to the receipt Head 0210-Medical. The fee chargeable for renewal of certificate of registration and licence shall be the same as for grant of a fresh certificate of registration and licence.
Refusal of application for registration and licence.- The supervising authority may, after giving an opportunity of being heard and for reasons to be recorded in writing and communicated to the applicant refuse to grant or renew the certificate of registration and licence.
Refund of fee.- (1) Where an application for the grant or renewal of a certificate of registration is refused, the lee paid by the applicant shall be refunded to the applicant.

(2) Notwithstanding anything contained in sub-rule (1), where an application for grant or renewal of a certificate of registration is refused on account of any lapse on the part of the applicant in suppressing any material information or in not furnishing any material information asked for by the Supervising Authority the fees paid by the applicant shall lie forfeited.

Register.- The supervising authority shall maintain a register in Form 'C' showing the names of persons registered under sub-section (3) of Section 4 of the Act.
Change of address.- The keeper or owner of nursing home or clinical establishment shall communicate to the supervising authority any change in his address or in the situation of the nursing home or clinical establishment in respect of which he is registered not later than [thirty days]after such change.
Change in staff.- Changes in the Medical, Nursing, Midwifery or Technical stall' together with the dates on which such changes have taken place shall be communicated to the supervising authority immediately and in any case not later than [thirty days]of such change.
Loss of certificate or licence.- In the event of a certificate of registration or licence or both being lost or destroyed, the hold may apply to the supervising authority for issue of a duplicate certificate of registration or licence and the supervising authority, if it thinks fit, issue such certificate and/or licence upon payment of a fee specified in Schedule-I. A certificate of registration or licence issued under this rule shall be marked 'Duplicate'.
Record of patients admitted or children born in the Nursing Home.- (1) The keeper of a nursing home shall keep,-

(a) in Form 'D' a register of patients admitted into the nursing home;

(b) a correct [xxx] index of the names of the patients admitted to the nursing home;

(c) record of health case sheet of every patient containing the following information in addition to any other information, that may be required by the supervising authority :-

(i)Year.......................................................................

(ii) Register No. ..............................................................

(iii) Name.....................W/o, S/o, D/o...........................

[(iv) Omitted]

(v) Sex.......................................................................

(vi) Caste....................................................................

(vii) Age..................................................

(viii) Date of Admission...................................

(ix) Date of discharge....................................

(x) Disease...............................................

(xi) Result of treatment ................................

(xii) Date History and treatment Diet......................

(2) Where an entry made in the register referred to in clause (a) of sub-rule (1) relates to a woman who has been admitted for delivery, and share a child born to such woman is removed with the consent of the keeper of nursing home and of the parents, or mother or near relative, the keeper of such nursing home shall in addition to the particulars specified in sub-rule (1) also specify in the register the name and address of the person to whose custody and the date on which and the reasons for which the child was so removed.

Record of patients examined or treated in the clinical establishment.- The keeper or owner of a clinical establishment shall prepare and keep in Form 'E' a register of patients examined or treated or in respect of whom any tests are carried out:

[Provided that it shall not be necessary to write the patient's name in alphabetical order.]

Intimation of death of a patient occurring in Nursing Home.- If any death occurs in the nursing home, the keeper of the nursing home shall within 24 hours from the occurrence of the death furnish the following information is respect of such death to the supervising authority together with any other information that may be required by it and to the Medical and Health Officer having jurisdiction over the area in which a nursing home is situated,-

(i) Date of death

(ii) Name of deceased (in block letters)

(iii) Male or Female

(iv) Name of father or of the husband of the deceased (in block letters)

(v) Age or deceased

(vi) Occupation of the deceased

(vii) Cause of death

[17. Requirements of Nursing Home. - (1) The keeper or owner of the nursing home shall fulfil at all times the requirement of a nursing home as specified in Schedule-II ;

Provided that the nursing homes already registered prior to the date of commencement of these rules shall fulfil the requirements within a period of ninety days from the dale of coming into force of these rules.

(2) Subject to the conditions specified in sub-section (1) of Section 7 of the Act, any officer authorized to inspect nursing home and clinical establishment, shall do so normally between 8.00 to 18.00 hours :

Provided that if there is any exigencies to make esscncial inspection in the opinion of authority, he may do so after taking prior permission from District Collector.

(3) No Nursing Home, Private Hospital or Clinical Establishment shall deny necessary first aid and/or such other life saving or stabilizing emergency measures, appropriate to that establishment, on the ground that police/statutory formalities are not completed to any accident victim, seriously injured, burn and the cases of criminal assault and poisoning.]

Requirements of Clinical Establishment.- The keeper or owner of the clinical establishment shall fulfil at all times the requirements of a clinical establishment as specified in Schedule-III.

[19. [(1) Immediate report about contagious or communicable/ notifiable diseases. - The keeper of the nursing home or clinical establishment shall submit a report immediately to the Chief Medical and Health Officer of the District and/or the Chief Medical Officer of the Hospital, if any, maintained by the Municipal Corporation or Municipal Council as the case may he, and the supervising authority as soon as it comes to his notice that any person, who has been admitted or examined as an indoor or outdoor patient in the nursing home or the clinical establishment, is suffering from or has been attacked with Tetanus, Gas Gangrene, Chickenpox, Cholera, Gastroenteritis (in the event of reporting of at least 5 cases in 24 hrs.), Measles, Infective Hepatitis (in the event of reporting of at least 5 cases in 24 hrs.), Poliomyelitis or Meningitis or such communicable/notifiable diseases and the premises shall be disinfected in a proper manner.]

(2) Monthly report of contagious or communicable/notifiable diseases. - The keeper of the nursing home or clinical establishment shall submit monthly report of communicable/notifiable diseases on the prescribed proforma to the Chief Medical and Health Officer of the district and/or the Chief Medical Officer of the Hospital, if any, maintained by the Municipal Corporation or Municipal Council, as the case may be, and the supervising authority.

(3) Report of National Programmes. - The keeper of the nursing home or clinical establishment shall submit on the prescribed proforma, the reports of such National Health Programme in which thier participation is desired such as Vaccination, Family Welfare etc.; to the Chief Medical and Health Officer of the District concerned.]

Application for appeal.- Any person aggrieved by an order made by the supervising authority in exercise of the powers conferred on it by the Act or these rules may within sixty days from the dale of communication of the order to him, appeal to the State Government by filing the same in triplicate against the order. The application for appeal should be accompanied by a treasury receipt showing that fee of Rs. 100/- has been paid in Government treasury to the credit of State Government and a copy of the order against which the appeal is made :

Provided that any such application may be entertained after the said period of sixty days, if the applicant satisfies the State Government that he has sufficient cause for not making the application within time.

Order on appeal application.- (1) On receipt of an application for appeal, and after considering the records referred therein the State Government may confirm, modify or set aside the order or pass such other order in relation thereto as it may deem just and proper.

(2) Pending final disposal of an appeal, the State Government may, for sufficient cause, stay the execution of the order against which appeal has been made.

[Schedule I]

[See Rule 7]

Schedule of Fees

S.No.	Item	Registration Fee (in Rupees)	Fee for issue of a duplicate certificate of registration licence (in Rupees)
(1)	(2)	(3)	(4)
(1)	For Nursing Home and Maternity Home -
	(i) Upto 10 beds	600.00	100.00
	(ii) Above 10 beds but upto 20 beds	1050.00
	(iii) Above 20 beds but upto 30 beds	1350.00
	(iv) For each additional bed above 30 beds	45.00
(2)	For Physio Therapy establishment	600.00	100.00
(3)	For Out-door Clinics	600.00
(4)	For Clinical Laboratory	600.00

Schedule II

[See Rule 17]

Requirements Of Nursing Home

[(a) Location and Surroundings. - The nursing homes to be established shall not be adjacent to an open sewer, drain or public lavatory or to a factory emitting smoke or obnoxious odour.]

(b) Building. - (i) The building used for the nursing home shall comply with the relevant municipal bye-law in force from time to time.

(ii) The rooms of the nursing home shall be well ventilated and lighted and shall be kept in clean and hygienic conditions.

(iii) The wall of the labour room and operation theatre upto a height of four feet from the floor shall be of such construction as to render it water proof. The flooring shall be such as not to permit retention or accumulation of dust. There shall be no chinks or crevices in the walls or floors.

(iv) Aseptic conditions shall be maintained in labour room and the operation room.

(v) Adequate arrangements shall be made for isolating specific and infectious cases.

(c) Space accommodation for the patients etc. - (i) The floor space in nursing home shall be 100 square feet for one bed and additional [60 square feet] for every additional bed in the room.

(ii) A labour room/operation theatre shall be provided with minimum floor space of [160 square feet].

(iii) A duty room shall be provided for the nursing staff on duty.

(iv) Adequate space for storage of medicines, food articles, equipments etc. shall be provided.

(d) Water supply. - The water used in the nursing home shall be pure and of drinkable quality.

(e) Health, clothing and sanitary requirements of staff. - (i) The staff, employed shall be free from any contagious disease and shall be provided with clean uniforms suitable to the nature of their duties.

(ii) The workers shall be medically examined at the time of employment and periodically so examined thereafter.

(f) Equipment and linen, etc. - The nursing home shall provide and maintain :-

(i) Adequate number of commodes, bed-pans and slop sinks with flushing arrangements;

(ii) High pressure sterilizer and instrument sterilizer;

(iii) Oxygen cylinder or cylinders and necessary attachment for giving oxygen;

(iv) [xxx];

(v) Adequate equipments, instruments and apparatus;

(vi) Adequate quantity of bed-sheets, mattresses, pillows, blankets, draw sheets and other linens, and

(vii) An almirah under lock and key for poisonous substances;

(viii) The in-patients shall be provided with minimum furniture and lined as below :-

For each in-patient:
Cot with mattress	one
Bed side-locker	one
Chair/Stool	one
Blanket	one
Bed Sheet/Counter pane	Two to be changed everyday
Pillow with case counter pane	one
[omitted]

[(ix) Proper arrangements for prevention of moquitoes and fly etc. shall be provided by nursing home.]

(g) Food. - If the nursing home provides diet to the patients, it shall be prepared and served under hygienic condition.

(h) Nursing staff and Midwives. - (i) Services of nurse shall be provided at the scale of four nurses for 20 beds with a minimum of three nurses in a nursing home/maternity home of 10 beds. In case of a nursing home having 50 beds or more services of one nursing sister for every 50 beds or part thereof shall also be provided.

(ii) 2 Midwives for 1 to 10 beds in case of maternity homes only.

(i) Records. - Separate stock register shall be maintained by the nursing home for (i) equipments, (ii) instruments, and (iii) linen.

(j) Services of Registered Medical Practitioners shall be provided at the scale indicated below ;-

[(i) One qualified medical practitioner for every 15 patients bed strength or part thereof, two for every' 30 patients bed strength or part thereof with a minimum of 3 qualified medical practitioners in a nursing home having less than 45 beds.]

(ii) One Medical Practitioner for every forty new out patients or part thereof per day.

(iii) One Medical Practitioner for every 50 old patients or part thereof per day.

(k) Services of one Medical Practitioner on duty shall be available at all time for attending to emergency call of the indoor patients.

(l) Services of one Pharmacist if drug store is maintained.

(m) Services of one qualified Medical Practitioner and X-ray Technician if X-ray facility is provided.

(n) Services of qualified Medical Practitioner and Technician if pathological and lab facility is provided.

(o) Services of Physiotherapist if physio-Therapy facility is provided.

(p) Certificate of Registration and Licence shall be displayed in the nursing home at a prominent place.

(q) All records and registers maintained shall bear Registration and Licence number of the nursing home. Similarly all documents and stationery including treatment charts, reports, cash memos, bills etc., used by the nursing home shall bear this number.

(r) The keeper of the nursing home shall maintain a complaint book and make it available to the complainant for recording complaint. The complaint book shall be made available to the supervising authority or a person authorised on his behalf for inspection.

[(s) Rate list of various medical services being provided by the nursing home shall be kept compulsorily on the counter and on demand it shall be shown to the patient or his/her family member. [The information to this effect shall also be displayed prominently at registration counter.] The supervising authority shall also be kept informed of the rate list and of the amendments, if any, made therein.]

(t) The keeper of the nursing home shall not engage any Government servant for any work including consultation without express permission of the Government obtained by such Government servant in this behalf and in the event of engagement of any Government servant in the nursing home the keeper thereof shall furnish to the supervising authority details of engagements of such Government servant on full-time/part-time basis alongwith the emoluments paid to him by the nursing home.

(u) The keeper of the nursing home shall take care and ensure that the nursing home or the clinical establishment is not used for unsocial or immoral purposes or both.

Schedule III

[See Rule 18]

Requirements of Clinical Establishment

(1) Locution, building and surroundings. - [(i) The clinical establishments to be established shall not be adjacent to an open sewer, drain or public lavatory or to a factory emitting smoke or obnoxious odour.]

(ii) The clinical establishment shall not be located in a dingy, dump or otherwise unsuitable building. The building used for clinical establishment shall be kept in clean and hygienic conditions.

(iii) The building used for clinical establishment shall have adequate water and electricity supply arrangements. Drainage shall be so provided as not to pose any risk or danger to any person.

(iv) The building shall have lavatory facility with flushing arrangements.

(2) Equipment. - (1) The equipment used in the clinical establishment shall be maintained in safe working condition. Where any testing or diagnostic or other equipment requires certification/approval from a statutory or executive agency appointed by Government of India or the State Government, no equipment without such certification/approval shall be installed and/or used.

(3) Stock Register. - Stock register shall be maintained in the clinical establishment for equipments, instruments and other articles used in carrying out tests, examination etc.

(4) Services of Medical Practitioners and Technicians. - (i) The clinical establishment shall be provided with the services of a Medical Practitioner having [recognised qualification] in the field in which diagnostic tests or examination are carried out. Having regard to the work-load in the clinical establishment, services of adequate number of such qualified Medical Practitioners shall be provided.

(ii) Services of qualified technician or technicians to operate the equipments or to carry-out tests/examination shall be provided.

(iii) In case the clinical establishment provides physiotherapy facilities, services of a qualified physio-therapist shall be provided.

(5) (i) The keeper or owner of the clinical establishment shall maintain a complaint book and make it available to the complainant for recording complaint. The complaint book shall be made available to the supervising authority or a person authorised on his behalf for inspection.

[(ii) Rate list of various medical services being provided by the clinical establishment shall be kept compulsorily on the counter and on demand shall be shown to the patient or his/her family members. [The information to this effect shall also be displayed prominently at registration counter.] The supervising authority shall also be kept informed of the rate list and of the amendments, if any, made therein.]

(6) The keeper or owner of the clinical establishment shall not engage any Government servant for any work including consultation without express permission of the Government obtained by such a Government servant in this behalf and in the event of engagement of any Government servant in the clinical establishment, the keeper or owner thereof shall furnish to the supervising authority details of engagement of such Government servant on full-time/part-time basis alongwith the emoluments paid to him by the clinical establishment.

Form 'A'

[See Rules 3 and 6]

Application for Registration/Renewal of Registration under sub-section (1) of Section 4 of the Madhya Pradesh Upcharyagrah Tatha Rujopchar Sambandhi Sthapanaye (Registrikaran Tatha Anugyapan) Adhiniyam, 1973

Part A

General

(1) Full name of the applicant

(2) Full residential address of the applicant

(3) Technical qualifications, if any, of applicant

(4) Nationality of the applicant

(5) Situation of the registered or principal office of the Company, Society, Association or other body corporate.

(6) Name and other particulars of the nursing home or the clinical establishment in respect of which the registration is applied for.

(7) Place where the nursing home/clinical establishment is situated.

(8) Whether the applicant is interested in any other nursing home/clinical establishment or business and, if so, the place where such nursing home/clinical establishment is situated or where such business is conducted.

Part B

Nursing Home

(9) Brief description of construction side and equipment of the nursing home or any premises used in connection therewith as detailed below:-

(i) Moor space of bed rooms provided for patients giving number of beds.

(ii) Arrangements made for medical check-up and for immunization of the employees.

(iii) Floor space of kitchen, servant rooms and other rooms giving details of user and area of each room.

(iv) Details of arrangements made for sanitary convenience for patients and employees giving their numbers.

(v) Details of arrangements made for storage and service of food.

(10) Whether the nursing home or any premises used in connection therewith are used or are to be used for purposes other than that of carrying on a nursing home.

(11) (a) Number of beds for maternity patients.

(b) Number of beds for other patients.

(12) Names, ages and qualifications of the members of the nursing stall in the nursing home.

(13) Place where the nursing staff is accommodated.

(14) Names, ages and qualifications of the resident or visiting physicians or surgeons in the nursing home.

(15) (a) Whether the nursing home is under the supervision of a qualified medical practitioner and if so his or her name, age and qualifications.

[(b) Omitted.]

(16) (a) Whether the maternity home being maintained within the nursing home is under the supervision of a qualified nurse or a midwife and if so, her names, age and qualifications.

(b) Whether any unregistered medical practitioner or unqualified nurse unqualified midwife is employed for nursing and patient in the nursing home.

(17) Whether any person of alien nationality is employed in the nursing home and if so, his name and other particulars.

(18) Fees charged to patients.

[Note. - The desired information under various clauses shall be attached as annexure in appropriate clause.]

Part C

Clinical Establishment

(19) Description, location, size and type of the building to be used for clinical establishment.

(20) Type of clinical establishment.

(21) Facilities for carrying out tests/examination or giving treatment available in the clinical establishment.

(22) Details of equipment.

(23) Name/s, age/s and qualifications of the medical practitioner under whose overall charge the clinical establishment shall function.

(24) Name/s, age/s and qualifications of the technicians employed in the clinical establishment.

(25) Fees charged from patients.

[Note. - The desired information under various clauses shall be attached as annexure in appropriate clause.]

Part D

For Renewal

(26) No. and date of expiry of the certificate of registration.

(27) Details of the fee deposited.

I solemnly declare that the above statements are true to the best of my knowledge and belief.

Dated.......... 199...

............................. Signature of the applicant.

Form 'B'

[See Rules 5 and 6]

Certificate of Registration under sub-section (3) of Section 4 of the Madhya Pradesh Upcharyagrah Tatha Rujopchar Sambandhi Sthapanaye (Registrikaran Tatha Anugyapan) Adhiniyam, 1973

No. ..................

This is to certify that Shri/Smt................has been registered under the Certificate of Registration under sub-section (3) of Section 4 of the Madhya Pradesh Upcharyagrah Tatha Rujopchar Sambandhi Sthapanaye (Registrikaran Tatha Anugyapan) Adhiniyam, 1973 in respect of......................(here insert the name of nursing home/clinical establishment) situated at............... and has been authorised to carry on the said nursing home/clinical establishment [under the................. (here insert the name of recognized system of medical viz. Allopathy/Ayurvedic/Homocopathy/Unani/Siddha/Naturopathy) system of medicine.]

Registration No...................................

Name of Registration.........................

Place................

Date of issue of certificate...................

This certificate of registration shall be valid upto 31st March, 199.........

.......................... Signature of the Supervising Authority

Form 'BB'

[See Rules 5 and 6]

Form of Licence under Section 4 of the Madhya Pradesh Upcharyagrah Tatha Rujopchar Sambandhi Sthapanaye (Registrikaran Tatha Anugyapan) Adhiniyam, 1973

No. ..................

Licence is hereby granted to Shri/Smt. ........... Registered Vide No. ........... dated ................... under rule ............ of the Madhya Pradesh Upcharyagrah Tatha Rujopchar Sambandhi Sthapanaye (Registrikaran Tatha Anugyapan) Rules, 1995, in respect of .................. to carry on the said nursing home/clinical establishment [under the .............. (here insert the name of recognized system of medical viz. Allopathy/Ayurvedic/ Homocopathy/Unani/Siddha/Naturopathy) system of medicine] for a period from .............. to 31st March, 199.... subject to terms and conditions specified in Schedule II of the said rules.

Seal

.................... Supervising Authority.

[Form 'C']

Registration under sub-section (3) of Section 4 of the Madhya Pradesh Upcharyagrah Tatha Rujopchar Sambandhi Sthapanaye (Registrikaran Tatha Anugyapan) Adhiniyam, 1973

Name (in full) of the applicant	Full address of the applicant	Nationality of the applicant	Name and other particulars of the nursing home/clinical establishment in respect of which the applicant is registered	Place where the nursing home/clinical establishment is situated
(1)	(2)	(3)	(4)	(5)

Institution's bed strength and its distribution							Number and date of registration	Date of renewal of registration
	Specialty wise distribution						Number and date of registration	Date of renewal of registration
Maternity				ICU	Others	Total Beds
(6)	(7)	(8)	(9)	(10)	(11)	(12)	(13)	(14)

Form 'D'

[See Rule 14]

Register of patients admitted to .............. nursing home

S. No.	Reference No. of patient	Full name and address of patient	Date of admission	Nature of diseased at the time of admission
(1)	(2)	(3)	(4)	(5)

If the patient suffered from an infectious disease during his slay in the home, the nature of such disease and action taken	Additional particulars to be filled in respect of		Maturity cases the name and address of persons attending to delivery
	Date and hour of delivery/mis-carriage or abortion as the case may be	Sex of child whether born alive or dead
(6)	(7)	(8)	(9)

Method of feeding of each child in the nursing home and the period	In the case of patient or child the date and hour of the death	Date of discharge of the patient from the nursing home	Remarks
(10)	(11)	(12)	(13)

Form 'E'

[See Rule 15]

Registration of patients examined or treated or in respect of whom any test is carried out in ...........(clinical establishment)

S. No.	Reference No. of patient	Full name and Address of patient	Date or dates when examined or test carried out
(1)	(2)	(3)	(4)

Name and other particulars of the Doctor or hospital by whom/which referred for test	Type of test carried out	Fee charged for test/examination
(5)	(6)	(7)

Additional particulars to be filled in respect of physio-therapy clinic			Remarks
Particulars of the disease/ailment for which treated	Total period of treatment	Total fee charged	Remarks
(8)	(9)	(10)	(11)