4
- c Cf>T1fW1f cpr <;:JT1T: Urban Health Centre through PPP ff\JIC/~o~o3TRo ~ (~~-1 ~ 3lltIR "tR): Urban RCH Services SPIP 2010-11 ~~ ~ ~ 20 ~ "{-CJR~ ~ c;ITcp f.1\JfT xil~ctl~ct ~ ~d ~ \JWIT t I c ~ "{-CJR~ ~, ~ SRI ~ ct 02 ~ (Xi~X~~'< ~ lTC'lT) ~~ f.1\JfT xil~ctl~ ct ~ ~ "{-CJR~~ C/?14~~x-j.t;Hlc1d t I~ 4R~.i)\J1rJl Cf)T ~- :CP) Quality Primary Health Care Services cpT4§-qlrJl t I ~) ~ 3TIolfro-tto ~, 3T~ ~ -5lctc~~ ~ fcpm\JfT~ t I 'Tr) ~ (~oitoito~o) (f:m<=Rt ~-~ /~o~o~o $I mn- I :tT) ~ GCfT fcKRur I . ',~) ~C/?IC/?'<UI ~) ~ f1<.JI\J1rJ ~ m~ >mer cpI ~ (~mCItIR Optional Service t) 'u) ~ ~ \(i'<C/?I~ 3itYdlC'1 ~~ fcpm~ I . !:f2fJ1 ~ ~ lTC'lT ~ xi~\("(1I~'< B ~-~ ~ "{-CJR~ ~ (Urban Health Centre) ~ fcpit .-m -gI ~ ~ "{-CJR~ ~ f.1\JfT xiI~ctI~ ct SRI fcpm\JfRT t ~ ~ f.1fc'RT~C/?I~ld ~ mt<fc fctC'1If1C/? cpT -q<.Jf1d~ ct ~4'<1Y\1ftR;rr"{-CJR~~ ct m2T ~C/?'<I'<rJl~1 fcpm Tfm t I . ~ ~ ~ rJlC'1--G1 (3) ~ :!\J1I{\{),<~,< (2) cgc;r05 -=m~ "{-CJR~~ ~ fcpm \JfRT t I~ "{-CJR~ ~ x~ ~ ct ~ q?f ~ ~C/?'<I'<'1I~1 $I tPl<.Jl~fd~ "# ~ ~ Tfmt I ftR;rr ~ ~ SRI fctC'1If1C/? em- f.1fr1ffUT~ ~C/?'<I'<rJl~1 ~&1fuf fcpm ~ I 3RT:m fctC'1If1C/? ~4~ctd ~ ~ \1fffi -g en post verification ~ ~ lc1~d ~ ~ "{-CJR~ ~ cpT~ ~ '<jf1~-qd~ I . fuc;n- lTC'lT~03~ ~ "{-CJR~ ~ ~ ~ ct ~ \JITf5 cpt -q<.Jf1d~ ~ Tfm t ~ -q<.Jf1d \JITf5 1R ~ ~ ~ x-j-qllc1d ~ ct ~ ~ "{-CJR~ ~, ~ SRI RI~14rJ ~C/?I~ld fcpm ~ (f:m fctC'1If1C/? cpT-q<.Jf1d~ ftR;rr "{-CJR~~, lTC'lT (fiT ~ ~ ~ ~ I . ~ "{-CJR~ ~ ct SRI ~ 3TI.lfr.-tt..~C/?IC/?'<UI. ~~~CC'1 cB<R,tttt c"1C/?1C/?'<UI, ~. ~.~. 4R~I~,.~ -wttft ~. 1m] ct "iJF+f ct ~ ~ Cf)T ~II~RC/? l:IiIlffUT. ~ "9:fR~, ll'4 ~ 1m] $I ft~ ~ ~~ Cf)T~ ~, ~ ct ~ cpI ~. ~ l1<fi 3RT ~, 1m] "{-CJR~ mn- (x"(1rJ4IrJ, CIC/?IC/?'<UI), -51<.JR<.J1 Cf)T~, "WJ " () ,. $I ~, >mer mn- (f:m ~ f1<.JI\J1rJmn- Cf)Tc/?1<.Jl.-cj<.JrJ fcpm \JWIT t I >mer (f:m ~ f1<.J'J'JjrJ mn- 3ilq~<.JCP mn- ~ t (f:m ~ f.1\JfT fctC'1"If1C/?cpT optional Service ct dR ~ ~ t I . ~"{-CJR~ ~ ~ ft!fc)c;r ~ ct m2Tm m (f:m~ ~ ~~ ~ ~ ~ ~ ct x-j-qIC'1rJf1~?lul -4 Nrfr I ~ m\Ob\\O

164.100.130.11:8091164.100.130.11:8091/pip2010-11/Fund_Guidelines/Part-A/Urban_RCH.pdf · t 1. Name of Town/City with District: 2. Name of Private Clinic/Party: 3. Name of UHC : 4

Embed Size (px)

Citation preview

-c

Cf>T1fW1fcpr <;:JT1T:Urban Health Centre through PPP

ff\JIC/~o~o3TRo ~ (~~-1 ~ 3lltIR "tR): Urban RCH Services

SPIP 2010-11 ~ ~ ~ ~ 20 ~ "{-CJR~ ~ c;ITcp f.1\JfTxil~ctl~ct ~ ~d~ \JWITt I

c

~ "{-CJR~ ~, ~ SRI ~ ct 02 ~ (Xi~X~~'< ~ lTC'lT) ~ ~ f.1\JfTxil~ctl~ ct~ ~ "{-CJR~~ C/?14~~x-j.t;Hlc1dt I ~ 4R~.i)\J1rJl Cf)T ~-

:CP) Quality Primary Health Care Services cpT4§-qlrJl t I~) ~ 3TIolfro-tto~, 3T~ ~ -5lctc~~ ~ fcpm\JfT~ t I'Tr) ~ (~oitoito~o) (f:m<=Rt~-~ /~o~o~o $I mn- I:tT) ~ GCfTfcKRur I .',~) ~C/?IC/?'<UI

~) ~ f1<.JI\J1rJ~ m~ >mercpI ~ (~mCItIR Optional Service t)'u) ~ ~ \(i'<C/?I~3itYdlC'1~ ~ fcpm~ I

. !:f2fJ1~ ~ lTC'lT~ xi~\("(1I~'<B ~-~ ~ "{-CJR~~ (UrbanHealthCentre)~ fcpit .-m -gI ~ ~ "{-CJR~~ f.1\JfTxiI~ctI~ ct SRI fcpm\JfRTt ~~ f.1fc'RT~C/?I~ld ~ mt<fc fctC'1If1C/?cpT-q<.Jf1d~ ct ~4'<1Y\1ftR;rr "{-CJR~~ct m2T ~C/?'<I'<rJl~1fcpm Tfm t I

. ~ ~ ~ rJlC'1--G1(3) ~ :!\J1I{\{),<~,< (2) cgc;r05 -=m~ "{-CJR~~ ~ fcpm\JfRTt I ~ "{-CJR~~ x~ ~ ct ~ q?f ~ ~C/?'<I'<'1I~1$I tPl<.Jl~fd~ "#~ ~ Tfmt I ftR;rr ~ ~ SRI fctC'1If1C/?em-f.1fr1ffUT~ ~C/?'<I'<rJl~1~&1fuf

fcpm ~ I 3RT:m fctC'1If1C/?~4~ctd ~ ~ \1fffi -g en post verification ~ ~lc1~d ~ ~ "{-CJR~ ~ cpT~ ~ '<jf1~-qd~ I

. fuc;n-lTC'lT~ 03 ~ ~ "{-CJR~~ ~ ~ ct ~ \JITf5 cpt -q<.Jf1d~ ~

Tfm t ~ -q<.Jf1d \JITf5 1R ~ ~ ~ x-j-qllc1d ~ ct ~ ~ "{-CJR~ ~,

~ SRI RI~14rJ ~C/?I~ld fcpm ~ (f:m fctC'1If1C/?cpT-q<.Jf1d~ ftR;rr "{-CJR~~,

lTC'lT (fiT ~ ~ ~ ~ I

. ~ "{-CJR~ ~ ct SRI ~ 3TI.lfr.-tt..~C/?IC/?'<UI.~~~CC'1 cB<R,tttt c"1C/?1C/?'<UI,~.~.~. 4R~I~,.~ -wttft ~. 1m] ct "iJF+fct ~ ~ Cf)T ~II~RC/? l:IiIlffUT. ~

"9:fR~, ll'4 ~ 1m] $I ft~ ~ ~ ~ Cf)T~ ~, ~ ct ~ cpI~.~ l1<fi 3RT ~, 1m] "{-CJR~ mn- (x"(1rJ4IrJ, CIC/?IC/?'<UI),-51<.JR<.J1Cf)T~, "WJ" () ,. $I ~, >mer mn- (f:m ~ f1<.JI\J1rJmn- Cf)Tc/?1<.Jl.-cj<.JrJfcpm \JWIT t I >mer

(f:m ~ f1<.J'J'JjrJmn- 3ilq~<.JCPmn- ~ t (f:m ~ f.1\JfT fctC'1"If1C/?cpT optional

Service ct dR ~ ~ t I

. ~"{-CJR~ ~ ~ ft!fc)c;r~ ct m2Tm m (f:m~ ~ ~~

~ ~ ~ ~ ct x-j-qIC'1rJf1~?lul -4 Nrfr I~m\Ob\\O

c

o

Optional Service (<:r~ f.1\#t rct('jlf.1cp8m ~ cpp:f M ~ t)1) ~1\,(ilC;1mr: m=rcr ( -qftrl1ffi 55 m=rcr ~~) 10t ~ f.1~1\Jj1 3I14~~11( -qftr

l1ffi 40 3I14~~11 ~ ~) cf>~ ~1\'(i1C;1mr ~O 10,0001- -qftr l1ffi -qftr ~x=crR~~ ~ m<nI

2) \jftf ~ f.1~"1\Jj1~ +RT<:rT ~ ~ ~ ~ 1f 4 GfurR 0. .A., .

(~-~ -qftr~) cf>~ ~ cpT~O 80001- ~ m1fiI ~ ~ \fq) ~ cj)~ ~ m~ cf> ~ ~O 10001- -qftr~ cf;~ ~mr ~ ~I

3) \jftf ~ ~ W~ ~ 10t GfurR f:1~1\Jj1~ M ~ crm ..'mr \R ~ cpT~ x=crR~~ 1f ~ m<nI Cln:fctT7T<tTmr ctT 1ftrr ctT

~ ctT~ 1:R~ ftR;nx=crR~~ 'TlCfR cRtfi, ~ GfurR f.1~"1\Jj1<:IT~ ~ W~ ~ l1G~ I ~ WIT/cpp:f optional Service cf>~ 1f M\jfFfT t, ~ rctc11f.1cP \j4~Ict\1WITm x=R~ 1f ~ ~ 51ffiI cpq<:fT~ ~c.

fcn ~ WIT cf> 3TI'CIR 1:R rct('j"111cP Cf)Tcpp:f~ 'ltt M \TIT~ t I'WITCR' ftR;n x=crR~~ IDXT~ M \jfFfTt I~ x=crR~ ~ cpT:fI\fR ~ ftR;n ~ ~ IDXT~ rd f.1-;;ct\1~i~CPI~ ~ cf>r-" cf; 3TI'CIR1:R fcn<:rT~ I ~ ~ ~ cpTf.1kf "q'\Jfi~ m<n - ~~,

31T01frO~O Wfi, ~ Wfi, m=rcr, ~ ~, ~ 1ir6c1I~10t GfurR 0...'3I14~~11 (x=:ft10t~), ~ m=rcr (~) I~ x=crR~ ~ cf;~ ~/~ ~ cpT~ IDXT ~ ~ cf>~5 M) ~ ctT Wr \J!+ITctT~ t IClJ<:r ctT 1f4T mr Cf)T:fI\fR q I«1 rcJcP ~ <:IT~ 1:R M ~ M'{icp1 ~i\~ 141 cf;~ ~ ~ ~rd~~1\J!+IT~ ~ I~ l1ffi CP14wli.ctT WTfu ~rd~~1 ~ \ifR ~rd~~1 Cf)T>rRf)q- ~ I

~ ~ 1=f~ 1=f-c1~ ~ ( ~ 0 x=ro ~ <t ~ ~ftsro "CPt):!"' SHSB/SPM/17/2008/7770 Dated 01110/2008 (Contract Attached)

SHSB/SPM/17/2008/7869 dated 15/10/2008SHSB/PMII 7/2008/8467 Dated 27111/2008 (Monthly Reporting Format)SHSB/PM/I7/2008/12616 Dated 22/10/2009 (Contract Attached)SHSB/PM/17/2008113572Dated 19/12/2009 SHSB/PM/I 7/2008/14 I74 Dated 21/01/2010SHSB/PMII7/2008/14991 Dated 05/03/20 I0 SHSB/PMII7/2008/15048 Dated 08/03/2010SHSB/PM/17/2008/15448 Dated 30/03/20I0 SHSB/PM/17/2008/15941 Dated 2704/20 I0

- -D cppfW1T~ /<&.

J>tIi IR-c1 Cf)T <t:R 1 Rlrcb\,(il (oooo), O 38,0001

2 - Iooo 10t

1

x=rfcffi. O 7,0001-

t

1. Name of Town/City with District:

2. Name of Private Clinic/Party:

3. Name of UHC:

4. Name of Locality :

5. Closest Government Hospital :

6. Names of Slums covered - a)

7. Date of Opening of UHC:

8. Reporting Month :

9. Reporting Date:

OJiiiEOJu.

No. of OPOI

No. of Indoor

patients Patients

OJiiiEOJu.

I

i

!I

1_- _.

MONTHL Y REPORTING FORMA T OF UHC UNDER PPP

..,..N'c::>E.§c:..:2:;:o(;ciz

b)

. ".o'

ft.

No. of Women Provided SP~~ClfiC ANC

c:

I

" ~~ro-W .~

0>~

Signature of District Programme Manager(WithSeal)

c:.2iij

~ .~I-C:

::>EE

<IICOJ

..:Eu. OJ-0. a.::><II

d.c: c:

~~"5'::1Z 0

o

No. ofdeliveries

c)

..,..u;";;;<II«

..,oS'".!:! <II- OJ0.-E ~o >u=..o~~ I

To !Je subf/littn(/ 10 /lIe S/-15/3 flY /I/O UII:.,

d)

<II.c:1::iij..>:J(;oz

No. ofFamily

PlanningOperation

>-

1

>-E Eo 0U UOJ OJ<II .0ro ::>">

<IIOJ<IIroo"'..,OJ ..o 0>.c: ro~ c:; tois E"0oz

- ---.--.-

Signature of Civil Surgeon(WithSeal)

(;.:: 1:JE OJ- ..o OJOJ .:a. <II>--_ c:.., ..c: E..-o .~z

I

. I

Remarks (,f any) II!ii

- -

h

}

~.

1 Nl1rno of Town/City with District

2. Name of Private Clinic/Party:

3. Name of UHC:

4. Name of Locality :

5. Closest Government Hospital:

6. Names of Slums covered - a)

7. Date of Opening of UHC :

8. Reporting Month:

9. Reporting Date:

..0-o!z.,-- .,01"~~.. ..u u<::<::.. ...., <::<: ....-- <:< on;. E

~~0_.c.... ..EZo .,.::: E.,.a'E .,,:::: OJ.. <::0..2oc...~ E

No. of OPD

I

No. of Indoor

patients Patients

MtW 1111~ ,.." 'UI.., IN! d OI.'MI\, 01 IIlIe IINfI"'" 'I'j .

..,..NC"E.§<::~!!:cu'0c:iz

b)

No. of Women Provided specific ANC

Signature of Departmental Staff posted by DHS(With Seal)

<::o

>=~~w.!!!

~

<::.Q0;

I-.~~<::"

EE

O1

~

.': <::cc -00=- co:.:::= Q) U (U

3~fIJ~ ~.~

Z c...., xCIJ

.,cCIJ

<cE...CIJ-0.

0.".,

No. ofdeliveries

c)

..,'"in'iijII)<c

..,..0;.~ eno..!E ;o >u=..'0'"c:iz

/ () /" ./1/ III/"d /1' 11", / J//' /)~ fI" / '11v 1/' / lilli'

d)

II)J:1:i:D..>:::;'0c:iz

No. of

FamilyPlanning

Operation

j/),.,"J:"C_01<::<:: 0c E<:: CIJ..J:o:~,.,.-= "CE .... c:LL ..- .,ooC.0oz

.,...,..u,.. CIJo 01J:'..

:: ~i5 E-oc:iz

..o.5..,Eo!-..o CIJ..Z0..,,.,-- <::.., ..<::E.. -oa;z

Remarks (if any)

,., I ,.,EI

Eo 0'i3 U'"

I

CIJII) D.. :J,> t- I

IIIi

!

Signature of Authorised Signatory of Private Clinic(With Seal) 0

..

",

ICIJ

I I

CIJCIJ (ij '" (ij(ij E (ij E:::;; CIJ :::;; CIJ

... ...