e-Hospital On-boarding Request

Request for e-Hospital^@NIC

Facility Name^*:

Facility Abbreviation(if any):

Facility Type^*:

About^*:

Central/State Govt.^*:

State^*:

District^*:

Address^*:
(max 100 characters)

Pin^*:

Website:

Average Number of (patients/day):

New OPD:

Casualty:

Follow-up OPD:

Patients Admitted:

Patients Discharged:

Other Infrastructure Details:

No. of Bed:

No. of General Ward:

No. of Private Ward:

No. of ICU:

No. of Doctor:

No. of Nurse:

No. of Clinic:

No. of Department:

Number of Counters:

OPD Registration:

Casualty Counter:

IPD Admission:

No. of Billing Counters:

Pharmacy Counters:

Laboratory Details:

No. of Laboratory:

No. of Sample Collection Centre:

Radiology Details:

No. of Radiology Equipment:

Store Details:

No. of Stores:

No. of Sub-stores:

Blood Bank Available:

Any other relevant information:

Availability of Local Area Network (LAN):

No. of Nodes:

Desktop PCs:

Number:

Configuration:

No. of Printers:

Availability of Internet Connectivity:

Bandwidth (MBPS):

Availability of Redundant Connectivity (different ISP):

Bandwidth (MBPS):

Technical Manpower Details:

No. of Technical Manpower resources:

Details of Technical Manpower resources:

Availability of UPS:

Capacity (KVA):

Availability of Generator :

Capacity (KVA):

Previous HMIS Application:

Any HMIS application already implemented:

Name of the organization and details of modules implemented:

Date of implementation of the HMIS application:

Platform of the HMIS application:

Initials ^*:

First Name^*:

Middle Name:

Last Name^*:

Designation^*:

Phone Number:

Mobile Number^*:

Email^*:

Fax:

Initials ^*:

First Name^*:

Middle Name:

Last Name^*:

Designation^*:

Phone Number:

Mobile Number^*:

Email^*:

Fax:

I agree to the terms & conditions

Enter the OTP Sent on your mobile number ^*

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Type the text:

Hospital Log In Download On-boarding Form

Steps to adopt e-Hospital^@NIC platform :

e-Hospital^@NIC is offered on As-Is Features Basis.
First time user may Request for DEMO Access or request for an assisted DEMO over Video Conferencing.
End-User is suggested to examine and evaluate thoroughly the e-Hospital^@NIC features whether meeting the requirements of the targeted hospital.
Once fully satisfied with features, please contact nearest NIC office at District/State or National level as well as may submit your request through e-Hospital^@NIC Portal by filling up the online FORM for access and provisioning of e-Hospital^@NIC Software.
e-Hospital^@NIC State/National administrator shall examine /accept the request based on readiness of resources at the hospital premises as well as at the respective SDC or NIC NDC Cloud.
Once accepted and approved, New Hospital Details are added onto e-Hospital^@NIC Platform and User ID/Password is generated for hospital level administrator.
Client (Hospital Admin) logs in to e-Hospital^@NIC with the generated credentials.
Hospital Admin adds all master data (department, unit etc), employee details etc. and hospital starts using the software.
User to engage rollout agency for implementation support. Click here for details of Empanelment letters/Rate contract issued to the Roll Out Agency (region wise) for Implementation of e-Hospital/e-Bloodbank of NIC.
First time user may contact nearest NIC office for assistance/ guidance.
For Contact details click here :

Note:

After submitting the form, access credentials will be sent to the nodal officer by SMS. Nodal officer needs to upload signed on-boarding form for verification.
After verification, Nodal Officer will receive an SMS confirmation.
Finally, Nodal Officer will receive another SMS with administrator details for e-Hospital^@NIC.
If your organization does not feature in the list, please get in touch with us here: