Empanelment of Dental Clinic - ECHS

Ser Name of Documents Applicable(Yes/No)16. REGISTRATION CERTIFICATE UNDER PNDT ACT(FOR US FACILITY)17. COPY OF LICENSE (FOR BLOOD BANKFACILITY)/IF OUTSOURCED – UNDERTAKINGAND LICENSE OF OUTSOURCED BLOOD BANK18. COPY OF NABH ACCREDITATION CERTIFICATEWITH SCOPE OF ACCREDITATION ATTESTEDBY NOTARY PUBLIC (FOR NABH ACCREDITEDHOSPITAL)19. COPY OF NABL ACCREDITATION CERTIFICATEWITH SCOPE OF ACCREDITATION ATTESTEDBY NOTARY PUBLIC (FOR NABL ACCREDITEDLABS/DIAGNOSTICS CENTRE)20. COPY OF CGHS OFFICE MEMORANDUM FORCGHS EMPANELLED MEDICAL FACILITIESDULY SIGNED BY AUTHERISED SIGNATORY21. COPY OF MOA WITH CGHS DULY SIGNED BYAUTHERISED SIGNATORY22. CERTIFICATE OF UNDERTAKING AS PER PARA27 OF TERMS AND CONDITIONS OFAPPLICATION FORM.23. CERTIFICATE OF ACCEPTANCE OF RATES PARA28 OF TERMS AND CONDITIONS OFAPPLICATION FORM.Note :-Attached(Yes/No)-2-Validity ofCertificatesIf attached thenpage numberFrom ToRemarks1. If any of the certificates mentioned in Sl No 01 to 23 is not applicable to any applicant medical facility, a certificate to that effect to be attached. The Check List &certificates to be countersigned by authorized signatory.2. Director, Regional Centre ECHS to scrutinise the Check List with the application and authenticate it. Remedial action, if any, to be taken before forwarding to CentralOrganisation ECHS.