1. Hospital Basic Information
Hospital Type* Hospital Name*
Hospital Parent Type *   Door Number*
Street * State*
District * Mandal/Muncipality Name*
Village* Nearest Town/City Name*
Total Bed Strength* Hospital PAN*  
MD/CEO/COO/Superindent Name * MD/CEO/COO/Superindent Contact Number *
MD/CEO/COO/Superindent Email ID* Land Line Number *
2. Financial Details
Constitution of the hospital (Public/Private/Proprietary/Partnership)* Name of the authorized signatory to the hospital bank account*
Name of the Bank Account of Hospital* Hospital Bank Account number*
IFSC code* Cancel Cheque*  
Bank Name* Branch Name*
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