NURSING FACILITY TO HOSPITAL TRANSFER SHEET

NURSING FACILITY TO HOSPITAL TRANSFER SHEET

Date

Patient name   ________________________________MR No______________________________

Transferring facility ___________________________Transferring facility phone ________________

Facility contact person _____________________________________________________________

Receiving hospital ________________________________Hospital contacted?       Yes          No

Destination:          emergency department      /      admitting         /           outpatient        /           clinic

Patient’s primary physician___________________     Has physician been notified? Yes          No

Family member/guardian name____________   Family member/guardian contacted?   Yes          No

Phone number________________

The following information must be attached:      Medication sheet      History and physical (H & P)   Face sheet

ADLs:             independent               assisted            dependent

Vision:             no identifiable problem           blind                  contacts and/or                    glasses

Hearing:          with in normal limits               hard of hearing          deaf                 hearing aid

Mentation:       alert.oriented                combative                        confused            unresponsive

Speech:            with in normal limits         hard to understand          aphasic                   equipment

Feeding:          independent                            assisted                 dependant                           dentures

Respiratory:     Trach                 vent settings                    risk of aspiration    Yes       No

Allergies: ______________________________________________________________________

Skin assessment: _________________________________________________________________

Vitals and baseline:

Temp ________Pulse ________Resp ________BP ________Age _______Height ________ Weight________

Date taken_______________________

Resistant organism?        Yes       No __________________________________________________

Communicable disease?          Yes       No      ____________________________________________

Flu vaccine?       Yes       No   ____________________________________________________

Immunization?            Yes       No      ______________________________________________

Chief complaint/problem: ___________________________________________________________

_________________________________________________________________________________

Physician order(s): _______________________________________________________

________________________________________________

Nurse’s Name & signature ______________Date _________Time ____________Phone __________

Private ambulance preference for return transfer ________________________Phone ____________

Discharge Against Medical Advice

Discharge Against Medical Advice

MR No. : __________________________________________ IPD No ________________________________

Patient Name: ______________________________________ DOA _________________________________

I, Mr. / Ms. ___________________________________ Son / Daughter / Wife of ________________________ take the full responsibility in having Mr. / Ms. ____________________________________________________ to ______________________________________________________________________________________ Son / daughter / Wife of _____________________________________________________________________ discharged against medical advice at his / her own risk.

The condition of the patient and the consequence have been explained to me and no one (not even the patient) will ever hold ____________Hospital or its staff in any way responsible for any out come whatsoever.

Date :                                                                                       Time :

Duty Doctor’s Name :                                                             Signature :

Duty Nurse’s Name :                                                               Signature :

Patient Name                                                                            Signature :

Attendant Name                                                                        Relationship :

Signature

EXIT INTERVIEW QUESTIONNAIRE

EXIT INTERVIEW QUESTIONNAIRE

Employee Name: ____________________    Current position: __________________

Initial employment date: ______________    Date of Resign: ___________________

Last date of employment: ____________

1.      At approximately what point in time did you begin making your decision to resign?

 6-9 months ago                                              3-5 months ago

 1-2 months ago                                              other ________________

__________________________________________________________________________________________________________________________________________________

2.      Please indicate reason(s) below, which contributed to your decision to resign your current position?

 Salary                                                Family Responsibilities

 Job Advancement                             Dissatisfied/Management

 Personal                                             Benefits

 Job Eliminated                                  Relocation                                    

 Health Retirement                             Other – (please explain) ________________

3.      Was there a specific event of issue that prompted your resignation?

Yes    No 

         If yes, please briefly explain: 

__________________________________________________________________________________________________________________________________________________

           

        If yes, did you discuss this matter with your manager/ director?

         Yes    No

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

On a scale of 1 to 5, with “1” being poor and “5” being outstanding, please rate the   following:

4. Quantity and quality of training received for your position(s) here at _________.

1     2     3     4     5

__________________________________________________________________________________________________________________________________________________

5. Working relationship with your departmental in-charge.

1     2     3     4     5

__________________________________________________________________________________________________________________________________________________

6. Working relationship with fellow employees.

1     2     3     4     5

__________________________________________________________________________________________________________________________________________________

7. Behavior of Top Management.

1     2     3     4     5

_________________________________________________________________________________________________________________________________________________

8. Salary for your position.

1     2     3     4     5

__________________________________________________________________________________________________________________________________________________

9. Employee Benefits package.

1     2     3     4     5

Please offer any comments or suggestions for improvement related to the Benefits package. __________________________________________________________________________________________________________________________________________________

10. Overall workload for your position.

1     2     3     4     5

11. Overall satisfaction and enjoyment in your current position.

1     2     3     4     5

__________________________________________________________________________________________________________________________________________________

12. Did you encounter any problems in your current position? Yes    No

If yes, please briefly comment:

__________________________________________________________________________________________________________________________________________________

13.  What did you enjoy most about your employment with ________?

__________________________________________________________________________________________________________________________________________________

14.  What did you enjoy least about your employment with _______________?

__________________________________________________________________________________________________________________________________________________

15. Based upon your experiences here, would you recommend _____________ as a potential employer for your friends, relatives, etc.?            Yes    No

If no, please briefly explain:

__________________________________________________________________________________________________________________________________________________

15. Would you reapply to ______ if a future opportunity arose?            Yes    No

 If no, please briefly explain:

__________________________________________________________________________________________________________________________________________________

Please add any additional comments:

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Employee Sign: ______________

Exit interview conducted by: __________________ Date/Time: _________________

SOP for Condemnation Scrap disposal of Biomedical Equipment & Instruments.

List of Statutaries

List of Statutaries 

Legal Compliance Dashboard                          Reviewed On:-
Sr. No.	Name of the Law, Rule	Type of Document	Issuing Authority	Valid from	Valid till	Responsibility
1	Shop & Establishment Reg.	Shop License	Asst.Lab.Comm.
2	C Arm AERB Liscense	Registration	AERB
3	FIRE NOC	Fire NOC	FIRE DEPTT.
4	Fixed X ray AERB Liscense	Registration	AERB
5	Mobile X Ray AERB Liscense	Registration	AERB
6	PCB	Combined Consent	PCB
7	NMC (NURSING HOME REG.CERTIFICATE)	Registration
8	PCPNDT - Machine Reg	PNDT	CMO
9	PCPNDT - Reg	PNDT	CMO
10	PAN Card	PAN-Card	I T Dept.
11	Sanctioned Building Plan
12	DG Certificate	License	FIRE DEPTT.
13	CTO Certificate	Combined Consent	PCB
14	GST Certificate	License	STATE GOVT
15	TLD Badge		AERB
16	Drug License	License	CMO
17	Blood Bank	License	CMO
18	MTP License	License	CMO
19	Narcotic Drugs and Psychotropic Substances	License	CMO
20	Organ Transplant	License	CMO
21	Sprit License	License	Excise deptt
22	Occupancy Certificate	Registration	MC

LIST OF MANUAL

LIST OF MANUAL

SR. NO	DEPARTMENT	RESPONSIBILITY	POSSESSED BY	RECEIVED SIGNATURE	DATE
1	Apex Manual	Quality Department
2	CQI	Quality Department
3	HIC	Quality Department
4	Safety Manual	Quality Department
5	Front Office manual	Reception
6	Emergency Manual	Casualty Department
7	Labrotory Manual	Lab
8	Radiology Manual	Radiology Department
9	Medicine Manual	IP department
10	OT+Surgery Manual + Anaestheology	Operation Theater
11	CATH Lab	CATH Lab
12	ICU	ICU  department
13	Nursing Manual	Nursing Incharge
14	Maintenance+HVAC	Maintanance Department
14 (a)	BME	Maintanance Department
15	MRD	MRD Department
16	Stores manual	Stores
17	CSSD Manual	CSSD department
18	HRM Manual	HR Department
19	Pharmacy Manual	Pharmacy
20	Housekeeping Manual	Dempartment Incharge

LIST OF COMMITTEE MEETING

                                                                   LIST OF COMMITTEE MEETING

SLNO	NAME OF COMMITTEE	COMMITTEE MEMBER	Frequency	Register Available	Written/NOT
1	Hospital infection control committee		Monthly
2	Safety committee		Quarterly
3	MRD committee		Monthly
4	Grievance redressal		As an when required
5	Quality assurance committee		Quarterly
6	CPR Analysis Committee/ Clinical Audit Committee		Monthly
7	Purchase and condemnation committee		Half Yearly
8	Pharmacotherapeutic committee		Quarterly
9	Credentialing and privileging		Half Yearly