te/3gefa - nwr.indianrailways.gov.in

NORTH WESTERN RAILWAY Office of Medical Director

Central Hospital, NWR Jaipur Date: 29.06.2021

No. NWR-HQOCHJP(AnG)58/2021-O/o ACHD (AnGCH/NWR/JIP

To, Chief Public Relation officer

HQ Office/ NWR

Jaipur

Subject: Publicationof "Expression of Interest" (EOI).

Copies of advertisement to be published on or before 01.07.2021 are being sent herewith for publishing in Newspapers. 15. Name & designation of the Authority

issuing advertisement/Open Tender :Dr. M.L. Choudhary

Medical Director Central Notices Hospital NWR, Jaipur

Central Hospital, Jaipur Invitation for " Expression of

Interest"(EOI) For Empanelment of CGHS/ ECHS/ ESIC recognized and Non- recognized Private Hospitals,

Imaging Diagnostic Centres and

Pathological Laboratories with Central Hospital North Western Railway Jaipur

:Central Hospital NWR, Jaipur

: PFA/NWR/JP

16. Place of Work 17 Name of Work

18 Executive Unit 19 Accounting Unit

20. Approximate cost of Work

21. Provision of Funds for Releasing these Advertisement/ Tender Notice

NIL (EO1)

Funds available in current financial year 2021-2022

22. Head of Allocation 23. Specific area to be covered by

publishing these advertisement/ Tender

:110-215-21

Jaipur

Notice 24.. Head of insertions desired

25. Desired date/ dates of insertion

26. Date of submission of EOI

27. Date of Uploading EOl or documents

on NWR's website

28 Text material provided in Hindi an

:One

:01.07.2021

:On or before 26.07.2021 :01.07.2021

:Yes (02 copies) English

-o62 Medical Director

Central Hospital NWR, Jaipur

File No. NWR-HQ0CHJP(AnG)/68/2021-O/o ACHD (AnG)/CH/NWR/JP (Computer No. 60254 )Receipt No : 459023/2021/O/o ACHD(A&G)/CH/NWR/JP

Generated from eOffice by SITARAM BUNKER, ACHD (A&G)/CH/NWR/JP, Medical Department on 05/07/21 12:49 PM

1467395/2021/O/o ACHD(A&G)/CH/NWR/JP

1

North western Railway

No. NWR-HQOCHJP(AnG)/58/2021-O/o ACHD (AnGyCH/NWR/JP

Notice Inviting for Expression of Interest

For Empanelment of CGHS/ ECHS/ ESIC Recognized and Non- recognized Private Hospitals, Imaging Diagnostic Centres and Pathological Laboratories

with Central Hospital North Western Railway Jaipur.

Medical Director, Central Hospital North western Railway Jaipur acting for and on behalf of The President of Union India invites Expression of Interest (EOI) in prescribed application format from CGHS/ ECHS/ ESIC Recognized and Non- recognized Private Hospitals, Imaging Diagnostic Centres and Pathological Laboratories located in Jaipur areas for empanelment with Central Hospital North western Railway Jaipur for referral medical services (Hospital for treatment and Diagnostic Centres for Investigation) of railway medical beneficiaries at CGHS Jaipur rates on cashless basis for a period of two year, up to closing time 17:00 Hrs. of 26.07.2021

For further clarification, if any please contact on mobile No.9414646647 & Landline No.

141-2221641 and for more detail please visit NWR public website

http://www.nwr.indian railwavs.gov.iApplication form may obtain from public website or office and the response on the prescribed format to be submitted to Medical Director Central Hospital North Western Railway office, Room No 06, Ground floor, Hasanpura Road, Ganapati Nagar, Jaipur- 302006.

(M Ae2

Medical Director Central Hospital North Western Railway Jaipur For and on behalf of President of Union of India




2

No. NWR-HQOCHJP(AnG)/58/2021-0/o ACHD (AnG)/CH/NWR/JP

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f T TR RaH Td yfa7 àavHTEE http://www.nWr.indianrailways.gov.in

TUTYT TR, TYR-302006 wKgT I




3

Comprehensive procedure Guideline for Empanelment of Private Hospitals

The empaneled hospitals have been broadly categorized into two group:

A. CGHS/ ESI/ ECHS/ empaneled hospitals and Government of India/ Public

Sector Undertaking Hospitals like SAIL, BHEL, Coal India etc. B. Other private hospitals which are neither empaneled by CGHS, ECHS, &

ESI nor are run by Government of India Public Sector Unit. (PSU).

Guideline for Empanelment of Private Hospitals

A. CGHS/ ESi/ ECHS empanelled hospitals and Government of India/ Public Sector Undertaking hospitals like SAIL, BHEL, Coal India etc.

These hospitals shall be empaneled as per CGHS at CGHS rate of Jaipur

City and rates as and when revised by CGHS can be agreed to.

B. Other Private Hospitals which are neither empanelled by CGHS, ECHS &

ESI.

a. An open advertisement shall be floated once a year or as per requirement for empanelment of private hospitals.

b. Empanelment of such hospitals shall be considered only if there is no other CGHS/ ECHS/ ESI nor any hospital run by Government if India- Public Sector Undertaking like SAIL, BHEL, Coal India etc. empanelled hospital, preferably within a vicinity of 5 Kms from the Hospital already

empanelled. C. Search committee shall be constituted by Medical Director of Central

Hospital, consisting of 03 doctors of at least JAG level and they may co- opt another doctor of particular speciality when required. They will visit the hospital and give clear justification for approving this hospital.

d. The empanelment shall be for a period two years. e. These hospitals shall also be empaneled at CGHS rate of Jaipur City and

rates as and when revised by CGHS can be agreed to

<<<>>>>

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467403/2021/O/o ACHD(A&G)/CH/NWR/JP4

NORTH WESTERN RAILWAY

Application for empanelment of hospitals with Central Hospital NWR Jaipur 1. NAME OF THE HOSPITAL & ADDRESss

HOSPITAL ADMINISTRATION: (Private/ Institutional/Corporate/Trusts):.

2.

(Attach registration certificate from appropriate authority)

3. cONTACT DETAIL OF HOSPITAL 3.

4. TELEPHONE/FAX/Email

EMPANELMENT APPLIED FOR: (A) Multi-speciality Hospital

5.

(Attach list of speciality)

(B) Single Speciality Hospital (Name of Speciality)

(C) Whether hospital recognised by CGHS/ECHS/ES: (Attach Copy of MoU & latest list issued by CGHS/ECHS/ESI through Website)

(D) Whether Accredited (NABH/NABL/Qci/JCI etc.): (Attach certificate with scope)

(E) Whether already empanelled with Central Hospital Jaipur

(Details 6. DISTANCE FORM RAILWAY HOSPITAL

7. TOTAL NO. OF BEDS.

CATEGORY-WISE NUMBER OF BEDS AVAILABE:

(i) Casualty/Emergency Ward: (ii) ICCU/ICu/NICU (ii) General

(iv) Semi Private ward

(v) Private ward:

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8. Staff Pattern:

(a) Doctors with Qualification

(i) Full Time Specialist:

(Attach list) (i) Visiting Specialist:.

(Attach list) (ii) RMO with Qualification:

(Attach list)

(b) Nursing Staff Nos. with Qualification:

(Attach list)

(c) Other Para Medical Staff

(Category wise) (Attach separate sheet if necessary)

9. Laboratory facility available (In-house)

Status of Laboratory (NABL/Non NAB1)

(Attach certificate with scope)

(a) Pathology (b) Microbiology (c) Biochemistry

(Attach list of investigation)

Imaging Facility

(Yes/ No) (Yes/ No) (Yes/No)

10.

(Status of Lab. NABL/Non NABL):

(Yes/ No) (Yes/ No) (Yes/ No) (Yes/ No)

(Yes /No)

(a) (b)

X-ray Sonography

(c) (d)

CT Scan

MRI

(e) Portable X-ray Unit: (Attach list of investigation)

11. Supportive Service

(a) Boilers/ Steriliser

(b) Ambulance

(Attach consent letter to provide ambulance service for railway beneficiaries form & to

railway hospital Jaipur.) (c) Canteen

(d) Waste Disposal System as per prescribed rules:

(e) Blood Banks

() Pharmacy (in-house) (8) Physiotherapy (h) No. Of Operation Theatres

(i) Availability of fire fight system in hospital :Yes/No (Attach NOC). Authorization form RSPCB Yes/No (Attach document)

(k) Availability of Help desk for Government organisation separately 0)

Yes/ No (Preference must be given to railway beneficiaries

(Attach consent letter).

3/7


12. Cardiological Facilities

NON INVASIVE

(a) 2D-ECHO

(b) TMT

(c) Other (Specify)

:(Yes/No) :(Yes/No)

(d) INVASIVE:

(e) Cath Lab : (Yes/No)

(f) Cardiac Surgery OOT : Yes/No

(s) Other (Specify)

13. Haemodialysis/ Urology/ Uro-surgery /Nephrology/ Renal Transplant:

(a) Whether the Hospital has in-house Urologist

(b) Renal Transplantation Surgeon

(c) Nephrologists (d) Certificate for renal transplant from competent authority

(Yes/No) (Yes/No) :(Yes/No)

:(Yes/No)

(e) Haemodialysis UJnit (f) Trained Paramedical Staff

:(Yes/No) : (Yes/No)

14. TRUP/LITHOTRISY : (Yes/No)

15. ENDOSCOPIC/ LAPROScOPIC SURGERY: : (Yes/No) : (Yes/No) (Yes/No)

(a) Endoscopy (b) Laparoscopy Surgery (c) Back Up Open Surgery

16. Orthopaedic: (a) Whether the Hospital has aseptic

operation theatre for Orthopaedic procedure :(Yes/No)

(b) Whether having required instrumentation

:(Yes /No) : (Yes/No) : (Yes/No)

:(Yes/No) :(Yes/No) :(Yes/No)

for both Hip and Knee Joint replacement

(c) Facilities for Arthroscopy

(d) Facilities for Arthroscopy surgeries

(e) C Arm facility

(1) Physiotherapy Unit

g) X-ray Unit

17. E.N.T. ESSENTIAL INFORMATI ON

Whether it has required Instrumentation for ENT Surgery and diagnostic procedures .

(Yes /No)

Facilities for Nasal Endoscopy:(Yes/No) Facilities for reconstruction Surgery: (Yes /N).

ii.

ii.

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18. OBSTETRIES & GYNAECOLOGY

(ESSENTIAL INFORMATION) Whether the Hospital has aseptic operation theatre for Gynae &Obst. Procedure : (Yes/No) Whether having required Gynae & Obst. Instrumentation for both: (Yes /No) Facilities for Caesarean Section: (Yes/No) Facilities for Septic& Aseptic Labour: (Yes/No)

i.

ii.

ii.

iv.

19. Paediatric:

NICU/PICU :(Yes /No). (Yes /No)

:(Yes/No) :(Yes /No) :(Yes/ No)

ii Paediatric Monitor ii Paediatric Ventilator

iv Hours Back-up of

v Paediatric/Neonatologist

20. Neurology/ Neuro Surgery: i Barrier nursing for isolation patients.

ii Facility for Gama knife Surgery. (Yes/No) (Yes/No)

ii Facility for Trans sphenoidal endoscopic Surgery. : (Yes /No) iv Facility for Steriotatic Surgery:(Yes /No) v Facility of ITCU

vi Facility of EFG vii Facility for Electrophysiology study: (Yes /No)

21. Gastro-enterology/ G. I. Surgery:

iRequired instrumentation for G.E./6.I. :(Yes /No) Facility for Endoscopy-Specify details: (Yes /No)

:(Yes/ No) :(Yes /No)

ii 22. Ophthalmology:

(a) 1OL with phaco-Surgery Facility :(Yes /No) (b) Well-equipped OT

(c) Laser Facility (Yes /No) :(Yes /No)

23. CANCER HOSPITAL

(Infrastructure & Tech. Details):

Onco-Medicine. : (Yes/No) ii Name of Oncologist with qualifications:ii Facility of Chemotherapy. (Yes/No):_ iv Onco- Surgery.

vNames of Onco-surgeon (with qualification): vi Whether it has required instrumentation for Oncology Surgery: (Yes/ No) vii Facilities for Radio Therapy:(Yes/No) vii Names of Radio-Oncologist (with qualification):_ ix Radio Therapy Facilities & Manpower Shall be as per guidelines of BARC. (Yes/ No) x In house pathology Haematology.

:(Yes/No)

(Yes /No)

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24. Diagnostic Centres:

1) Radiology: iRoutine X-Ray (Yes /No)

ii Sonography :(Yes /No)

ii Doppler study (Yes /No)

iv CT Scan :(Yes /No

V MRI (Yes /No)

vi PET Scan :(Yes /No)

vii Others

vii Doctor Qualification

ix Experience

x Working Hours

xi Any other facility

(Attach separate sheet if necessaryv)

2) Pathology & Microbiology:

iRoutine Haematology (Yes /No)

ii Histopathology :(Yes /No)

ii Routine biochemistry (Yes /No)

iv Immuno-assay :(Yes /No)

V Hormone-assay :(Yes /No)

(Yes /No) :(Yes /No)

vi Routine Microbiology

vii PCR

vii Any other (please specify)

ix Doctors with qualification

xExperience

xi Working Hours

(Attach separate sheet if necessary)

6/7 (


25. Other Information: Name of Hospital.

Detail of Registration

GSTIN Registration with No.

PAN Number:

1.

2.

3. 4.

5. Bank Account Details: Income Tax returns for last financial years: Details of the organisations who have empanelled with your hospitals (Enclose copy of agreement with full particulars like state Govt./ TPA Etc.) Whether Doctors are available during night time to attend any Emergency or to

undertake operation? Attach hospital prospectus/ Brochure Attach Rate list of CGHS with all amendment, corrections & hospital rate list.

Attach all other supportive document relevant of service/ certificates. Attach declaration letter to intimate to railway immediately if any changes status, service, or any change after information provided in application. Attach consent letter to provide regular feedback to railway.

6.

7.

8.

9.

10.

11.

12.

13.

(Copy of document required is to be enclosed) If required separate sheet may be

used to give details of the hospitals.

Conditional offers will not be entertained from the applicant.

** Only applicable columns are to be filled by different applicant.

Enclose the attested copy of relevant documents.

UNDERTAKING

I hereby certify that all the information furnished above are true to my knowledge. I have no objection to North Western Railway for verifying any or all the information furnished in this document with concerned authority, if necessary.

I hereby agree to provide cashless treatment service on credit to railway beneficiaries if

empanelled with Central Hospital North Western railway as per the CGHS Rate of Jaipur; in case

CGHS rate for a particular investigation is not available then AlIMS rate or any other Government

rate shall be applicable. In case no government rate is available then rate offered by hospital with

minimum 10% discount. Shall be applicable.

Date:

Place: Signature of the authorized sign of the Organization

Office Seal

End of Document]

7/7


VIG.JTY CRITVRIA FOR DIAGGNOSTIC IMAC;ING CENTRES FOR EMPANELMENT: The dingostie imaging centres must fulil the Crileria as specificd and must attach the copics of the requircd docunnents The centre ustl huve it prcmises cstablished in Jaipur arca & operational at time of ubmision of application. . Copy of NABI,/ NABI Acereditation in ease of NABI,/ NABH Aceredited Diagnostic iping cCntre, . Copy of NABL/NAB/OI application in casec of Non-NABI/Non-NABI, accredited

iugimg ccnlrox ,Lt of investigntion laciliticn available with diagnostic inaging centre is to be attached. DiugOstie Imaging C'entrc must bave been registered with State Giovernment/ ILocal bodics,

wlierever upplieable.

7. Conplinee witlh statutory requiremenls including that of Waste Management. 8. Documents to establish that fire salcty mechanis1n is in placc. 9, Registration under PNDT Aet, if Ultrasonography facility is available. 10. AFRI3 upprovnl for imaging facilities, wherever applicable. 11. Diupnostie Imuging C'entre must submit the rates for all investigations services available with

it nd as ehurged by it from other paticnts. 12, Dingnostie lab / Imaging Centre must give an undertaking accepting the terms and conditions

Npelt out in the Menmorandum of Agreement (Dralt at Anncxure V) which should be read as part of this upplication document.

13. Diugnostic lmuging Centre must certify that they are fulfilling all special conditions that have been imposed by any authority in lieu of spccial concessions such as but not limited to concessional allotnent of land or customs duty exemption.

14. The Diugnostie Imaging centre must fulfil the above eriteria, wherever applicable and annex

copies of relevant documents. 15. In addition, the imaging centres shall meet the following criteria:

MRI Centre Must have MRI machine with magnet strength of 1.5 Tesla or more. The

machine should be of updated to currently used technologies and of internationally reputed manufacturer. (Altach documents) CT Centre must have CT Scan machine of latest standard and software of minimum

i.

.

of 64 slices. The machine should be of updated to currently used technologies and of

internationally reputed manufacturer. Must have been approved by AERB. (Attach documents) X-ray Centre /Dental X-ray/OPG centre X- Ray machine must have a minimum current rating of 500 MA with image intensifier TV system Portable X-ray machine must have a minimum current rating of 60 MA Dental X-ray machine must have a minimum

current rating of 6 MA OPG X-ray machine must have a current rating of 4.5 -10 MA Must have been approved by AERB.

Mammography Centre Standard quality mammography machine with low radiations and biopsy attachment. USG/Colour Doppler Centre It should be of high-resolution Ultrasound standard and of equipment having convex, sector, lincar probes of frequency ranging from 3.5 to 10 MHz should have minimum three probes. and provision/facilities of trans Vaginal/ Trans Rectal Probes. Must have been registered under PNDT Act. Bone Densitometry Centre Must be capable of scanning whole body. Nuclear Medicine Centre Must have been approved by AERB/ BARC.

ii.

iv.

i.

vii.

16. The party shall keep offer open for a minimum of period of 90 day form the last date of submission of application.

17. The duration of MoU shall be for two (02) years. 18. The Centre must accept the term and conditions spelt out in MoU.

Y OS4.2


19. The duration of the empanelment may be extended for further six month (25% of total duration)

if required. 20. Medical Director Central Hospital North Western Railway Jaipur reserves the right to terminate

the MoU without citing any reason before the stipulated time.

21. A team of doctors from central hospital, NWR/Jaipur reserve the right to inspect the Centre as

and when required. 22. The rates to be paid by the railway to the Centre shall be as per CGHS Jaipur rates, in case the

CGHS rates for particular investigation is not available then rates of SMS hospital, Jaipur or

AlIMS New Delhi shall be applicable. In case no government rate is available then rate offered

by empanel led Centre with minimum 10% discount shall be applicable. 23. Diagnostic Imaging Centre must certify that they shall charge Railway beneficiaries as per

CGHS Jaipur rates and that the rates charged by them are not higher than the rates being

charged from their patients who are not CGHS beneficiaries. 24. Non CGHS/Non Gov. rates quoted shall remain unchanged during the period of contract.

25. Payment shall be on billing system. Bills shall be submitted on monthly basis for all tests

conducted by the Centre during the month. The Centre shall provide cashless service to the referred patient. No payment of any kind shall be charged from patient.

26. Bills should be submitted in favour of Medical Director Central Hospital North Westem

Railway. Jaipur. A copy of the referral letter with signature of authorized persons along with medical/RELHS card (UMID) of railway beneficiaries should be attached with the bill.

Payment shall be made through cheque or ECS by FA&CAO/NWR/Jaipur. 27. Reporting has to be done and signed by competent and qualified Radiologist. 28. In case of emergency investigation has to be done outside the routine hours also on getting a

call from the Railway Hospital and opinion has to be given and conveyed as soon as possible. 29. Centre must be well equipped to manage any complication arising during procedure and

expenditure incurred upon shall be borne by Centre itself. 30. Centre must have backup office arrangement to supply required printed report duly singed by

qualified doctor. Reports of the investigation must be stored in computer/cloud and to be supplied on specific demand. Necessary hardware requirement for the web reporting may be made available if required.

31. If there is any legal dispute/medico legal complaint on the investigation report, the Centre will be fully responsible for the same.

.2 Sr. DMO (Radiology)

Central Hospital NWR Jaipur (Signature of party/Applicant)

<<<O>>>

212


NORTII WESTERN RAILWAY

Application for empanelment of Diagnostic Imaging Centre with

entral Hospital NWR Jaipur

. Diagnostic Imaging Centre & Address

2. Diagnostic Imaging Centre Administration:

(Private/ Institutional/Corporate/Trusts): (Attach registration certificate from appropriate authority)

3. Contact Details of Imaging Centre

4. Telephone/ Fax/ Email

5. Fmpanclment

(a) Whether Centre recognised by CGHS/ECHS/ESI: (Attach Copy of MoU & latest list issued by CGHS/ECHS/ESI through Website)

(b) Whether Aceredited (NABH/NABI/QCI/JCI etc._ (Attach certificate with scopc)

(c) Whether already empanelled with Central Hospital Jaipur: (Altach Copy of MoU)

Distance form railway hospital .

Staff Pattern: (a) Doctors with Qualilication

(i) Full Tinme Specialist:

(Attach list)

(i) Visiting Specialist: ((Atach list)

(ii) RMO with Qualification:

(Atuach list)

(6) Paramcdical and Technical statf with Qualification:

(Attach list).

(c) Other Stafl:

(Atach list).

1/3


8. Imaging Facility

(Status of Diagnostie Imaging Centre NABL/Non NABL):

(a) X-ray (Yes/ No)

(b) Sonography (Yes/ No)

(c) Dopplers study (Yes/ No)

(d) CT Scan (Yes/ No)

(c) PET Scan (Yes/ No)

( MRI (Yes/ No)

Working Hours

(h) Other facilities.

(Atach separate sheet if necessary)

(Atach list of investigation)


(b) Ambulance

(Attach consent letler to provide ambulance service for railway beneficiaries form & to

railway hospital Jaipur.)

(c) Cantecen

(d) Availability of fire fight system in Centre :Yes/No

(e) Authorization form RSPCB : Yes/No (Attach document)

() Availability of llelp desk for Government organisation separately :Yes/ No

(Preference must be given to railway beneficiaries)

Ycs

2/3


10. Other Information:

Name of Diagnostic Imaging Centre. Detail of Registration GSTIN Registration with No. PAN Number

. Bank Account Details Income 1as returns for last linancial years (If applicable):| Atach hospital prospectus/ Brochure (if Available)

6.

S. Alach Rate list of CGHS with all amendment, corrections & hospital rate list.

Atach all other supportive document relevant of service/ certificates. Alach declaration letter to intimate to railway immediately if any changes siatus, service. or any change afier information provided in application.

11. Atach consent letter to provide regular feedback to railway.

10.

(Copy of document required is to be enclosed.

UNDERTAKING

Ihercby cetity that all the information furnished above are true to my knowledge. I have no objection to North Wcstern Railway for verifying any or all the information furnished in this document with concerned authority. if necessary.

I hercby agree to provide cashless treatment service on eredit to railway beneficiaries if

cmpanclled with Central Hlospital North Western railway as per the CGHS Rate of Jaipur; in case CGIIS rate for a particular invcstigation is not available then AlIMS rate or any other Government rate shall be applicable. In case no government rate is available then rate offered by hospital with

minimum 10% liscount. Shall be applicable.

Datc:

Place: Signature of the authorized sign of the Organization

Office Seal

End of Document|

3/3


Eligibility criteria for laboratories/diagnostic Centers/hospitals

1. The laboratories/diagnostic Centres/hospitals must fulfill the criteria as specified and must attach the copies of the required documents.

2. The Centre must have its premises established in municipal limit of Jaipur for at least three

years. 3. The Centre must have been in operation for at least three years. Copy of audited balance sheet,

profit and loss account for the last financial year (main documents only summary- sheet) is to be

attached.

4. The empanelment is for all type of pathological, Microbiological, Biochemical & Molecular

investigations with fully automation. The rates to be paid by the railway to the Centre shall be as

per CGHS rates, in case the CGHS rates for particular investigation is not available then rates of

SMS hospital, Jaipur and AllMS New Delhi shall be applicable. In case no government rate is

available then rate offered by empanelled Centre with minimum 10% discount shall be

applicable.5. Laboratory should provide EQAS/ILC reports of last 2 years for external quality control efficacy.

6. Laboratory should provide U chart of Hormone and Tumor markers for last 2 months.

7. If laboratories/diagnostic centre is NABL Accredited relevant certificate must be produce.

8. If Centre is already CGHS empanelled, certificate of same is to be submitted.

9 List of investigations available in Centre along with rates is to be attached.

10. Compliance with statutory requirements including that of waste management is must.

11. Documents to establish that fire safety mechanism is in place is to be attached.

12. Centre must certify that they shall charge CGHS beneficiaries as per CGHS rates and that the

rates charged by them are not higher than the rates being charged from other patients who are

not CGHS beneficiaries. 13. In case of emergency investigation has to be done outside the routine hours also on gettingga

cal from the Railway Hosptal and opinion has to be given and conveyed as soon as possible.

14, Reporting has to be done and signed by competent and qualified pathologist/ microbiologist/

biochemist.

15. Centre must be well equipped to manage any complication arising during procedure and

expenditure incurred upon shall be borne by Centre itself.

16. Centre must have backup office arrangement to supply required printed report duly singed by qualified doctor. Reports of the investigation must be stored in computer/cloud and to be supplied on specific demand. Necessary hardware requirement for the web reporting maybe

made available.

17. MD/CH/JP reserves the right to terminate the contract without citing any reason before the

stipulated time. 18. In case of unsatisfactory performance due to machine/technical failure the repetition of test

should be done at the cost of your institute, no extra charge will be paid.

19. Payment shall be on bill system. Bills shall be submitted on monthly basis for all tests conducted

by the Centre during the month. The Centre shall provide cashless service to the referred

patient. No payment of any kind shall be charged from patient.

N (Hwt Patd)

Onehtandduoa (CMP, Microbiologist)

Aush 2


20. Bills should be submitted in favour of MD/CH/NWR/JP. A copy of the referral letter with

signature of authorized persons along with medical/RELHS card of railway beneficiaries should

be attached with the bill. Payment shall be made through cheque or ECH by

FA&CAO/NWR/Jaipur. 21. The diagnostic Centre should have all valid licenses to conduct these tests as per government

policy. The copy of the same should be attached with offer.

22. Centre must give an undertaking accepting the terms and conditions spelt out in the

memorandum of agreement.

23. A team of doctors from central hospital, NWR/Jaipur reserve the right to inspect the Centre as

and when required.

24. Party shall keep its offer open for minimum period of 90 days.

25. Duration of contract will be two years from date of signing of contract.

26. Non CGHS/Non Govt. rates quoted shall remain unchanged during the period of contract.

27. If there is any legal dispute/medico legal complaint on the investigation report, the Centre will

be fully responsible for the same.

28. In case of failure to do some test at CH/JP due to machine being out of order or some other

unavoidable circumstances and also for counter checking of reports, in house available tests may also be done from empanelled outsource agencies on CGHS rates.

29. Empanelled Centre will make arrangement for collection of samples of indoor and outdoor

patients during specified time period from 10.00 to 13.00 hrs. on rotation wise in premises of

central hospital. For this arrangement of manpower and other necessary items for taking

samples and dispatching reports to patients will be made by empanelled lab.

30. The duration of the empanelment may be extended for further six month (26% of total

duration) if required.

202

ashilNhardeluos% Avt Atdart )

CCMf, Miaoblogist)

(Signature of pårty)

21


NORTH WESTERN RAILWAY

Application for empanelment of Private Diagnostic Pathological Centres/ laboratories

with Central Hospital NWR Jaipur

1. Name & address of diagnostic pathological centres/ laboratories:

2. Diagnostic Pathological Centre/ Laboratories Administration:

(Private/ lnstitutional/Corporate/Trusts):. (Attach registration certificate from appropriate authority)

3. Contact Details of Centre

4. Telephone/ Fax/ Email

5. Empanelment: (a) Whether hospital recognised by CGHS/ECHS/ESI:

(Attach Copy of MolU & latest list issued by CGHS/ECHS/ESI through Website) (b) Whether Accredited (NABH/NABL/QCi/JCI etc.

(Attach certificate with scope) (c) Whether already empanelled with Central Hospital Jaipur:

(Attach Copy of MoU) (d)

Distance form railway hospital 6.

7. Staff Pattern: (a) Doctors with Qualification

() Full Time Specialist:

(Attach list)

(i) Visiting Specialist:

((Attach list)

(ii) RMO with Qualification:

(Attach list)

(6) Paramedical and Technical staff with Qualification:

(Attach list).

(c) Other Staff:

(Attach list).

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Dlagnostic Pathologlcal facilitles 8.

(a) Status of Laboratory (NABL/Non NABL) (Attach certilicate with scope)

(b) Faeilities-

1) Pathology :(Yes/ No)

2) Microbiology :(Yes/ No)

3) Haematology :(Yes/ No)

4) Biochemistry :(Yes/ No)

5) Histopathology (Yes /No)

6) Immuno-assayy (Yes /No)

7) Hormone-assay. (Yes /No)

8) PCR. (Yes /No)

(Attach list of investigation)


(b) Ambulance

(Attach consent letter to provide ambulance service for railway beneficiaries form &

to railway hospital Jaipur.)

(c) Canteen

(d) Availability of fire fight system in Centre :Yes/No

(e) Authorization form RSPCB : Yes/No (Attach document)

() Availability of Help desk for Government organisation separately

(Preference must be given to railway beneficiaries)

Yes/ No

Yes.

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10. Other Information:

. Name of Diagnostic Pathological Centre/ Laboratories.

Detail of Registration 2.

GSTIN Registration with No. 5.

4. PAN Number

5. Bank Account Details

Income Tax returns for last three financial years Attach Centre's prospectus/ Brochure (if Available):_

6.

Attach Rate list of CGHS with all amendment, corrections & hospital rate list. 9. 3.

Attach declaration letter to intimate to railway immediately if any changes status, service, or any change after information provided in application. Attach consent letter to provide regular feedback to railway.

Attach all other supportive document relevant of service/ certificates. 10.

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(Copy of document required is to be enclosed.

UNDERTAKING

have no objection to North Western Railway for verifying any or all the information furnished in

this document with concerned authority, if necessary.

I hereby certify that all the information furnished above are true to my knowledge.

empanelled with Central Hospital North Western railway as per the CGHS Rate of Jaipur; in case

CGHS rate for a particular investigation is not available then AllMS rate or any other

Government rate shall be applicable. In case no government rate is available then rate offered

Ihereby agree to provide cashless treatment service on credit to railway beneficiaries if

by hospital with minimum 10% discount. Shall be applicable.

Date

Signature of the authorized sign of the Organization

Office Seal

Place:

End of Document]

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