MIS
FORMAT FOR SUBMITTING DATA BY
GOVERNMENT
MEDICAL COLLEGES & HOSPITALS
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Name of College/Hospital |
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Month Ending |
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1.
General Information
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Telephone no (STD code) |
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Fax no |
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E mail address |
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Name and designation of
the Head |
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Name of Superintendent |
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No of beds |
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No of wards |
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No of Major OTs |
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No of Minor OTs |
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Blood bank |
Yes/No |
2.
Out Patients
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No. of OPD days |
No. of OPD registrations |
Old |
New |
BPL |
Govt. |
Senior Citizen |
Casualty + MLC |
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3.
a) In Patients
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Total no of admissions |
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BPL Admission |
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Average length of stay of patients * |
|
Average bed occupancy (%) ¨ |
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Note:
* = Total no. of days of stay of discharged pts. / No.
of discharged patients during this month.
¨ = {Average no. of occupied beds per day
(in a month) / Total no. of available beds} ´ 100
b) Department wise information of Inpatients :-
Details of
wards with bed occupancy greater than 100% (Where floor beds are also used)
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Ward (Department) |
Bed Strength |
No. of days when
occupancy was > 100% |
Average daily
number of excess beds |
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c) Operations carried out during the month
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Department |
Unit no. with name
of Unit head |
Unit Head
Designation Honorary /Full
Timer |
No. of major
surgeries* |
No. of minor
surgeries* |
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* As per User Charges G. R. No.
GRF-10.00/P.No.90/2000/Health-3, dated 10/7/2001
d) Number of deaths during this month
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Total no |
|
Percentage of death
against no. of admissions |
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Total no. of autopsies |
|
Total no. of forensic
PM's. |
|
Total no. of Police
Surgeon's PM's |
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4.
Blood Bank
|
No of blood units used
this month |
|
No of blood units used
without replacement |
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No of blood units
collected with voluntary replacement |
|
No of blood units bought
from other blood banks |
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No of blood units found
HIV positive |
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No of blood units found
positive for Hepatitis B and C |
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No of blood donation
camps |
|
Component separation |
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No of blood units
collected in camps |
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5.
Drugs
a) Grant
|
Sanctioned grant (Rupees
in Thousand): Period… |
Total |
Plan |
Nonplan |
b) Drug / Surgical items /x-ray films etc.
Availability
|
Drug |
Stock at the
beginning of the month ( in numbers) |
Quantity received
during month ( in numbers) |
Quantity supplied
to OPD ( in numbers) |
Quantity supplied
to inpatients (Wards, OTs) ( in numbers) |
Stock at the end
of the month ( in numbers) |
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Tablet |
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Injection |
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Liquid / Ointment |
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Disinfectant |
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Surgical Items |
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I.V. Fluid |
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X-ray films |
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Other |
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c) Drug / Surgical items /x-ray films etc. purchased
from outside
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Drug |
Quantity |
Cost |
Local Purchase |
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Poor box fund/PLA |
From Imprest ? |
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Tablet |
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Injection |
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Liquid / Ointment |
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Disinfectant |
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Surgical |
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I.V. Fluid |
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X-ray films |
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Other |
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d) Drug not used for more than 6 months:
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Name of Drug |
Quantity |
Cost |
No. of months not
in used |
Action suggested |
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6. Linen (no. of pieces)
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Linen |
Opening balance |
Received during
the month |
Issued to wards |
Closing balance |
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i)
Operation Linen |
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