आरोग्य एक ...
महाराष्ट्र शासन सार्वजननक आरोग्य नर्भाग
शासन क क्रमाांकः क - 2016 /प्र.क्र.251/आरोग्य-3 10 र्ा मजला, सांकुल इमारत,
गो.ते.रुग्णालय, मुांबई-400 001. तारीख: 22 ,2017.
:-
क क आरोग्य क क आरोग्य . एक आरोग्य
एक .
क आरोग्य क आरोग्य
क - क आरोग्य
- , , , इ. क . आरोग्य क , क आरोग्य क क , क आरोग्य - क ऊ आरोग्य , क
क क- (CSR) आरोग्य क
क क क क , आरोग्य क - - क , आरोग्य क - क , क ऊ . शासन क-
क आरोग्य क आरोग्य एक . .
शासन ननणवय क्रमाांकः क 2016/प्र.क्र.251/आरोग्य-3,
पषृ्ठ 5 पैकी 2
1. क क आरोग्य क - क क .
2. क आरोग्य क क क क , आरोग्य क क -2 क - . क क क, आरोग्य क . आरोग्य
आरोग्य क क , क क क - . क -1 क, , क
क . ( ).
3. क आरोग्य क क क क -
क क क , आरोग्य क क . इ क
क क - क क क, आरोग्य क .
4. एक , - क - आरोग्य . ( :
. , , , , - )
5. क - क आरोग्य क .
6. आरोग्य - क - क
क क क क /क - क ऊ क .
शासन ननणवय क्रमाांकः क 2016/प्र.क्र.251/आरोग्य-3,
पषृ्ठ 5 पैकी 3
7. - क -
क .
8. एक आरोग्य क क क क क क क क क
- क क ऊ क
क इ .
9. एक . .क / /
/ क (Inspection
Format)
. क - क क क :क क .
10. क आरोग्य क क -
क आरोग्य क क क क , क आरोग्य
क क क - क आरोग्य क क - क क .
/ / / क क क क . क
क - क क क - क क .
11. आरोग्य क क क क एक क क एक क, क . क आरोग्य आरोग्य क
क क , आरोग्य क क .
शासन ननणवय क्रमाांकः क 2016/प्र.क्र.251/आरोग्य-3,
पषृ्ठ 5 पैकी 4
12. क - क क क आरोग्य क क क आरोग्य क क क . क - - आरोग्य क . आरोग्य क क क , क क क क . क क आरोग्य
क, आरोग्य , आरोग्य क क .
13. /
क क क . क क
क क क क क क .
14. क आरोग्य क क क क - 2
3 क, , क
क ( ).
15. आरोग्य क 108, 102, 104 . क क .
16. क आरोग्य क - क - क क आरोग्य क . क , एए ए /ए ए ,
आरोग्य क इ. / ऊ आरोग्य क .
शासन ननणवय क्रमाांकः क 2016/प्र.क्र.251/आरोग्य-3,
पषृ्ठ 5 पैकी 5
17. आरोग्य (Inspection
Format) आरोग्य क
.
सदर शासन ननणवय महाराष्ट्र शासनाच्या www.maharashtra.gov.in या सांकेतस्थळार्र उपलब्ध करण्यात आला असून त्याचा सांकेताक 201703221039398517 असा आहे. हा आदेश निजीटल स्र्ाक्षरीने साक्षाांनकत करुन काढण्यात येत आहे.
महाराष्ट्राचे राज्यपाल याांच्या आदेशानुसार र् नार्ाने.
( . .क ) सनचर्, महाराष्ट्र शासन प्रत,
1. महालेखापाल, महाराष्ट्र-1/2 (लेखा पनरक्षा) ( लेखा र् अनुज्ञयेता), मुांबई/ नागपूर 2. , क, , . 3. सांचालक, आरोग्य सेर्ा, मुांबई. 4. सहसांचालक,आरोग्य सेर्ा ( ) 5. उपसांचालक, आरोग्य सेर्ा, ( ). 6. नजल्हा शल्य नचनकत्सक, सामान्य रुग्णालय, ( ).
6. आरोग्य क ( ) 7. क आरोग्य क ( ) क ( ) 8. /कायासन अनधकारी, आरोग्य-3/ आरोग्य-3 / आरोग्य-4/सेर्ा-2/
सेर्ा-3/ सेर्ा-5/अथवसांकल्प, सा.आ.नर्. मांत्रालय,मुांबई. 9. ननर्िनस्ती (आरोग्य-3)
Roshani Dinesh Kadam Patil
Digitally signed by Roshani Dinesh Kadam PatilDN: CN = Roshani Dinesh Kadam Patil, C = IN, S = Maharashtra, O = Government Of Maharashtra, OU = Public Health DepartmentDate: 2017.03.22 16:19:28 +05'30'
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7
Hospital lnspection
Form
II'q
ll o$n il!!I, I nsneltio n Fo r E!
Name of Block:Name of District:
Catchment Population:
Sanctioned Beds -
Date of last supervisory visit:
Date of visit:
Name of'Hospital
Total Villages: Category ofHospital
Beds available by Additional specialty unirs -- Total Beds
Total beds occupied on date olvisit
Name& designation of monitor:
Write which is applicable withbudget fbr current financial ;-ear.
-]-___l
sent/Estimale awaitedLand
acquisition in progress.
Electricit-,- with power back up
in the fbrm olCenerator
Solar power packs
Rr*'*-s 24.i *at* srppl."
N*rt"rr.rt t.trph*"
C--leanliness inside
Cleanliness outside Hospital
Cleaning timetable displayed
and record ot'daily and weekly
cleaning time table available.
Boards ol hospital Fees, Board
of availability of free medicines,
services available displayed Y /N
Availability of complaint
register rvith register of action
taken on regarding complaints.
Citizen's Charter displayed -Whether board of RKS
Sepi.rrate fv{ale and Female
wards (at least by- partitions)
Avai lability of Nutritional
Rehabilitation Centre
I ;"ia.rrl Bl...l br"k
Date o[registration by FDA
Number of Blood collection
\\
Functional blood bag
refrigerators with chart tbr tenrp.
recording
Suft'icient no. of blood bags
available
Check register for number ofblood bags issued for BT in lastquarter
l. t4 Blood storage center operational
or not
Number of emergency bloodtransfusions since Apr l4
Number of planhed -blood
transfusions since Apr l4
l.l5 Blood component center
Date of registration by FDA
Date of Expiry
Number of Blood componentstransfused from Apr 14
PCV
Plateles
Fresh Frozen Plasma
Cryoprecipitate
r. l6 Separate room for ARSH clinicBMW
l.t7 Date of initial registration withMPCB
L18 Date of expiry
l. l9 Number of infection controlcommittee meetings this year
Number of accident reporting's
t.20 Color coded bags available
t.2l Needle burner
1.22 Puncture proof containers
1.23 Balance Stock of hypochloritesolution
Fire Safety protocols
t.24 Whether hospital registeredunder Maharashtra FirePrevention and Life SafetyMeasures Act. 2006
1.25 Whether fire safety audit carriedby District Fire Officer orLicensing agency
tI
2.8
2.9
2t0
3.7
-l.li
t9II
A
F--unctional of Lights, ceiling
Frnitioial o- lights. mobile
( ell counter 4 Parts
-ts
and resting Kits
I maging equiPment's
Functional C.T Scanner
f r-ct'ronal X-raY units
Mortuary cabinei
Bun with drill 2 sets
Eft--op.ratinginstruments2
--E\5
MeAical stori and F,Ss*irtiutibruss and lies:,'
EDL avai lable-nd dGplayed
Computerized inventoif management
IFA tablets
IFA tablets (blue)
l[iA syrup rvith dispenser.
Vit A sy'up
Ini Magnesium Sul
Availability of antibiotics
Labelled emergency tray at each workstationDrugs fbr hypertension, Diailments e.g PCM, metronidazole, anti-allergic
Adequate Vaccine Stock available
Pregnancy testing kits
Urine albumin and sugar testing kit
Gloves.Mckintosh@
Whether entries in softryare made on same daExpirydateregffiwhether any expiry dated medicines remainingin medical store.
Stock book updated and
Availability of function'at help dest<
wtrettre@Stethoscope, Hammer, Bp App, Auroscope,Tuning fork, torch, weighing machine
"t
Drugs - . .r -:'Yes:. No Remarks
5.1
5.2
5.3
5.4
5.5
5.6
5.7 ORS packets
5.8 Zinc tablets
5.9
5. t0 Ini Oxytocin5.1 I Misoprostol tablets5.12
5.r3
5. l4
5.15
S.No Supplies Yes No Remarks5.17
5.l8
5. l9 OCPs
5.20 EC pills
MMA kits5.21 IUCDs
5.22 Sanitary napkins
S.No Essential Consumables Yes No Remarks5.23
Medical store5.24 lMhether approved bv FDA5.2s
5.26
5.27
. . .;-,; :-;. :., ;...,1 .
:' arks,. , ,
6.1
6.2
6.3 whethert"tosiffi
Wh.tL* OPD p"pers has complaints, diagnosis
and treatment written
---If
r7
No. of sick children ret'erred
No. of Tubectomy
No. of Minilap
No. of children t'ully imnrunized
No. olchildren given ORS + Zini
No. olchildren given Vitamin A
No. of MTPs conducted in first trimester
No. of MTPs conducted in second trinrester
Number of Adolescents arrending ARSH clinic
Maternal deaths, if any
I births, if
Neonatal deaths, ifany
Infant deaths, ifany
according to GOI norms
Whether Z trays tipt as per guiEEiiiE
Whether partograph kept or not
Handwashing protocols displayeO anO
tbllowed
Whether stat}'nurses as per norms andtrained in SBA
Whether equiprne.,tras per norms.
Diet being provided free of charge
el t mottrers in-tiatea breast feeaingwithin one hour of normal deliZero dose BCG, Hepatitis B and OpV
Counseling on IYCF done
Coffil'rng o" FamilY Planning done
Mothers asked to stay for 72 hours
"t.Sqayrrrcnt bcing gircn bclirrc
lvlodc ot'JSY paynlcnt (Cashi bearer
checluclAccttunt Pu)"ce
Account Transl'er)
A"y .-f.ditrre incurred bY Mothers
on travel, drugs or diagnostics(P/ease
sive details)
tih orobins auestions and demotqllglilrL".
l.l Yci:: ,ii
Manage high risk Pregnancy
Frou iO" ess.ntial nervborn
care(thernttlrcgu lation. breastt'cedin g
ttaan'ae sick neonates and infants
Correctly uses Partograph
Correctly insert tUCD
?lroclroc t l,u ad m i n i s tcr v acc i nes
G*g^t'on orW*te in colour coded
Mhc'r.nce to IMEP (lnfection
Management and Environment
Bio medical waste
in the MCP Cards
.Stt"!,IrT'. R-ord lMaintenanll: ;.,l:.q.. .?i": .:-..-.-.. ,. : " i -.: :. ..
:,n" ..- :: - . :+ a+r
6PD Register of each doctor
including specialists
Li d littlrrg "t'
s"verelY anaem ic
R3 and R4
l1
A-
]I
Security services
Driver services
Apfipt'tat. dt"g ttorage facilities such as
Cri""*.e Redt*sal mechanisms
Tally lmplemented
Section XIIIAdditional
SCctio
fl"*".t Addttional ipegialty :Unit -
Trauma unit
Hospital training centre
r3.6
t].7
ll3 | Burn Ward
R.t*tG"t*Eiphvtt*l lv handicapped
Sec .il,l
SriNo ''- Namdofmedtinf ' r:l j- r'tt__i__;
t4. I l) Diet committee,l '', 2) [nt'ection control commtttee
3) Death audit -4 I Transtusion commlttee
5l Clinical meeting
4.3
4A4.5
4.6 @oth"rhosPituls4.7
4.8
4.9 9) Maternal death review commtnee
',:l:'
Secttion,X-: -- - - - - -- - --- - -- - - - -
Sr No r)rr2rlerlv medlcal cnecKup ur slrtPtwfv""
-N,,-h.r
ol fbod samples to [email protected] ,-t,urt disPlayed in kitchen
I 5.:I 5.-j
I 5.4 niet teslrnp Keqlster avallaurs
wfif,I k't"fi *ctstered under The food Safety &
s,*auia Act 2006;ith registration number or licenseI ).)
n X\/iCri;ic"i:i"'r!Iffil'E:M
Sr 'No'16. I OPD
6.2
6.3 Maior Surgeries
6.4 Minor Surgeries
6.5 Deliveries
6.6 LSCS
t6.7 Lab investigations
r 6.8 X - Rays
r6.9 CT Scan Exams
16. l0 Sonographiej;
l6. r I MLCs
16.12 Post Mortems
6. J Dog bite cases
6 + Deaths due to Rabies
6 5 Snake bites
6 6 Deaths due to Snake bitesA 7 Scorpion sting
6. 8 Deaths due to Scorpion stine
'?-l
Sectior{..XVIf,.i,t -.,, :,.1 ''.- ..' ,:,.-',,i.,;,ii.'.i ,tj.,i.,,1,i.;,.,,;,
Impo'rtant indicatoryalues of tastm'dnttr.lri,tar: :'l : r :., :.
) trt-'5
\r--r
il\-t (tq..6-f- r\ -s:.ssiA.. $+\ \&*\:i.J
7o of Deliveries to IPD
% of LSCS to deliveries
% of MIS
Cash book wheth6iuplolatElWhethercashbookveffi
PLA cash book availabG and maliGined
After verificatioofDHS.
9.1 Whetherpostmgrtemffi9.2 Record room9.3 Mourner room9.4 ooctof sloom withlEiitreO toi tet9.5 lnfection controt protocoGEttoweO or not9.6 [email protected] Yhether functional mortuary cibinetivii 6EiE
-'':'.. .::::=:-'::-::,' -:.a :; ' . -.- -:.:.,.:r-:'iiir.::::,i;;1..,;._:. , ; :t:i:.,.;:
Xli,fIOf Ar.i.'' :''.' ;::;:tt;;,r;;,i;fi.a;;;', ..: :rii;i
Whether
notC(Non transplant organ@
<.sr-r<="rn-t:+<q<E \\s\Er+S:_*a\
*\ a- j- \a=-r,.r-\
Section XXItr: Previou-s supervisory.
Note: E .rare lhat necessat! correctire ,neeilre,t are highlighted and iJ'possible, action taken on the spoL The
,\.lonthlt, t.eporl tf' monitoring visits und action poinls must be submitted to the appropriate authority tor
upltxrcling on Stute I'lolll ll' wehsite
To be filled by monitor(s) at the end of activity
Signature of Inspecting officer Signature of CS/MS
PHC lnspection Form
--u
E -:.-'.-a6l//
i'RII!'iARY I{EAX.-[H CENTER: INSPECTIO1Y I'ORMAT
I, GENERAL INF'ORMATION
Name of tl're Priman'health center ........
Taluka District
i\umber Of sub centers Nunrber olyfllqgqll4:i 7 PHC (Yesilrlo) IPHS PU_Q_(Ys!Al9l__RKS Formed (Yes/lrlo) RKS registerecl ( Yes/[rlo)
itv of RI(S Meetinss (Total meeting in the year 201 5- 16
Executive committee
meetings
Governing board meetings
TI. CONSTRUCTION
A. Vlain Building
/-\' Own building / other (Specify). .. ..:.. .
ln Case of no. building tbr PHC
a. Land available : Yes / No
b. Construction in Progress : Yes / No
c. Any Problems related to construction
d. Any repairs required for PHC :
e. If yes, give particulars
Yes / No
f. Efforts made to make available land for construction
g. Rarnp constructed :
h. Any Legal Matter
Yes / No
B. Quartersa- Availability of quarters for staff :
b. if yes, give number of quarters available:
c. If quarters not available
1. Land available :
2. Construction in progress :
3. Any problems related to construction / legal
Yes / No
Other:
Yes / No
Yes / No
Fartic ular R.ernarksNo.
1n r."
" t;."." nr r tcide PHC
2 C leanliness inside PHC
-) eoardJaisptayea in OPD about timing,
"--,i^e< r o? 1 n4 108 available etc
Biometricni"^1.r, ^f n^nthlv wnrk nlan
4
5
6 Condition of fumiture, curtains etc'
1 Trrbelighilf*t t. OPD, ward, labour
rotrm : adequate & working with
attached toilets / washrooms / Hand
wash
8 Disp@lauachedcopy)
9
UX. GEI{ER,AL ASPECTS
IV. BASIC FACILITIES AVAILABLE
Finlionul LuondryAVashing
Services
Mtl"ttttty & *-kt.g.""dition where applicable
/ Status (Ditails about any problem is to be
Water supply to PHC
Dii-ni.ing *"ter in oPD / ward
Telephone
Generator / Inverter
Solar Water Heater SYstem
Elbow TaP
t{anA*ashirlg facilitY in each with
soap to cleaned toilets with running
water facility.
-tr:riiat'iirt) oi dierary sen tcesi
Facility
--f 1)
V. T{{'MAN RtrSOURCES
A" Regular posts
St"Virg iIHQ i'l'es iNo)
f *,i#;sB8ivroc I sllA iNSSK / 1VCD /
PPIUCD /Tuhecto
B: Contractual posts
VI. OTTTER FACILITIES
(Give information about availability, working condition, cleanliness, repairs if an.v r6quired etc)
Designation Number of posts
Medical OfficersHealth Assistant {MHealth Assistant
No. Designation Number of posts Staying at HQ(Yes / No)Sanctioned Filled Vacant
i Staff nurse t
2 .{NIvl at sub centersa1 Other (Specifv)
No. Particular Remarks1 Operation Theater2 Labour room -
f\ Plastic curtains
B Labour table with foammattress.
C Colour coding of BMWD Patient examination traVs
E Protocols
F Revolving stoolG Fumigation
1 Separate Labour roomtla MO room
A Examination table withcurtains
B Examination tray
CT-Hand wash facilit
5 Laboratory
6 Nledical store
7 Ward (ltzlale/Female
separate)
8 Toilets (clean with adequate
running water suPPlY)
v{[. MAJOR & ivlINOR EQUIPVIENTS / SETS
No.
I
Equipments Available (Yes / No) If available,
functioning or not
PDA
2
)
Qtoth
ENT examination sgt ,
I Torch
5 Thernrometer
6 Hemoglobin meter
7 ILR
8n--^ tr
Oxygen cylinder9
10 S,r.tbn machine foot operated
-n.rus. itutio n t i(errrUuUag,o-'lntranheq{ tr rhec etc
11
12 IUD _Tubectomyi3
14 Vo..ctnrnv qet If available
15 MTP set MVA16 lVgfghirg *"chi."17 Radiant warrner
18tr^t- \l/amcr tnr.rrel t
lv Needle Cutter
VIII. PERFORMANCE
Durins month ProgressiveNo. Performance
1 OPD
Z IPD
Deliveries / Referred
4 Sterilization (TubectomY,
VasectomY)
5(Planerl & F{eld')
6 MTP / MVA
17 Immunization schedule,
E'?r)
{X. STOCK OF TMPORTANT I!{EDICINES
IConductec! sessioirs tiillyimmunizati on ?'0. \
oo r\{DRo II,{Rr0
iT
IyJCTS entry on percenta_ee ofwonlen registered in the firsttrimester
RTYSTI Treatecl1a
_Allcl legistration
No. Medicinc Present stock1
2-I Tab Paracetamol
i I ab septran1J Tab ciproiloxacintl- Tab cholroquine5 ORS
5 IV Ringer Lactate1 Inj. ASVa
!nL.qnV9 Other vaccines
a\
X. COMPLETENESS OF IIUPORTANT REGISTERS
No. Name of register Remarks1 Nluster roll2 Movement registera1 R3
I R4
_5 Lasn oooK
6 Dead Stock register7 Daily tabler register8 Medicine Stock register9 Expiry date register10 Master File1l Visir Bookt2 Biometric
13 RCH Registers
t4 Wqrk plan availabie MO/ANMl5 rru reglsters / partograph
16 Payment under JSy
XI. Quality paramet,er of the facilify
No. Essential Skill set R.,ernarks (Yes / No)
I klanage high risk pregnancY
2 Provide essential newborn
3care(thermoregulation, breastfeeding
and a sep s isl
) Manage sick neonates and infants
4 Co rrectly Uses PartograPh
5 Co rrectly insert IUCD
6 Co rre ctly administer vaccines'1 Alternate Vaccine DeliverY (AVDJ
syste m lu nctio nal
8 Segregation of waste in colour coded
9 Adherence to IN'IEP p ro tocols
No. Particulars Remarks
I Vector Bonne Disease
Surveillance Frogram
Malaria clinic functioned / DaYs
B MF registers
C BS taken in last quarter
D BS Positive
2 Waterborne Disease
Epidemic prone villages
B Action plans prepared
c
D
Epidemics in last 3 Years
Water / TCL samPle sent
(Quarterly)
3
A
Leprosy
Leprosy patients identifi ed
B
e
Nolt tewiOta Patients under PX
NIB
D
4
PB
Blindness progranc.
A No. of Cataract care done.
xII. OTI{ER DISEASE SURVEILLANCE PROGRAMS.
,-
XtrV. EXPENDITURE
B'.rdget
)(V. MIS
Whether regular data entry is done in web based MIS:
Any other important observation:
-1-1l
Sub Center'
Yes i No
;{xI{. gEC DISPLAY
l=rlo.
I
h{ateriai il.emarksApproach roads have directions to the healtlrfacility
2 Citizen Charter
Tirnings of the Health Facility.1a List oi services available
) Essential Drug List6 Protocol Poster.s
7 jSSK entitlemenrs
8 Immunization Schedule
9 ISY entitlements10 Other related IEC material
Plimaiy Health Center
POL / Repairs
Suggestions given for improvement:
Date of previous inspection
Actions taken on pervious suggestions given
Name & Signature of Officer
irto.
Received Expendi Received ExpenditureI OE
2,11 AMG4 RKS funds
5 Untied fund
Date of visit & inspection