Inspection proforma for



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III. HOSPITAL: Requirement of the 100 bedded general hospital for teaching BDS students drawn up in accordance with the parameters prescribed by the Bureau of Indian Standards








Own Hospital







Medical College




Govt. General Hospital




Whether the permission of the attached 100 bedded hospital is issued by the competent authority?

:

Yes / No










Name and Full Address of Hospital:




















Name of the CMO with Tel No. & Mobile No.:


















Name of the Issuing Competent Authority:





















Distance of the hospital from the Dental College

:




by Road (please clarify as to whether you have physically verified/taking the reading of Taxi/Car Meter)











Number of Beds

:

Total: ___________________



Department

Required

Allotted

Occupancy

During last 6 months

On the day of inspection

General Ward – Medical including allied specialities


30










General Ward –Surgical including allied specialities


30










Private Ward (A/C & Non A/c)

9










Maternity Ward

15










Paediatric Ward

6










Intensive Care Services

(4% of bed strength)




4










Critical Care Services

(6% of bed strength)




6











Area Requirements (As per Bureau of Indian Standards)





Required

Available

Covered Area

20 sq.m./bed




Inpatient Services

40%




Outpatient Services

35%




Department and supportive services

25%





Man Power Requirement

(The consultants in the various departments should have atleast 8 years teaching experience after post graduation)
Medical Staff

Department

Required

Available

General Surgery

2




General Medicine

2




Obstetrics & Gynaecology

2




ENT

2




Paediatrics

2




Anaesthesia

2




Orthopaedics

2




Pharmacologist

1




Radiologist

1




GDMO

1




Community Medicine

1




Hospital Administration

1



Nursing Staff



Designation

Required

Available

Matron

1




Sister Incharge

6




O.T. Nurses

6




General Nurses

20




Labour Room Nurses

4



Health Staff



Designation

Required

Available

Female Health Assistant

1




Extension Educator Paramedical Staff

1




Lab Technician/Blood Bank Tech

4




ECG Technician

1




Pharmacist

4




Sr. Radiographer

1




CSSD

2




Medical Records

1



Engineering Staff



Designation

Required

Available

Civil

2




Mechanical

2




Electrical

2




Engineering Aid

4



Other Staff



Designation

Required

Available

Drivers

2




Carpenter

1




Cooks

2




Barber

1




Class IV including chowkiders

55




Administrative Staff


Designation

Required

Available

Office Superintendent

1




Head Clerk

1




Cashier

1




Stenographer

1




UDC

2




LDC

4





CLINICAL MATERIAL:

(Attendance Register to be checked)


ATTACHED HOSPITAL

Attendances

:

During Inspection: _____________________







Average (Last 6 months): _____________________














DENTAL COLLEGE HOSPITAL Attendances

:

During Inspection: _____________________







Average (Last 6 months): _____________________

*Minimum requirement of new patient’s is 75-100 patients per day in Dental College Hospital



IV. DENTAL TEACHING STAFF


S.

No.


Designation

Faculty Name/ Speciality

DOB

Original Affidavit with date

ID CARD No

Form 16

Total Service college wise in all the previous Institutes (attach appendix)

DOJ & Experience in present institute

Total Experience as on 15th June of current year

*Present during Inspection

1.

PRINCIPAL

With speciality

































PROSTHODONTICS


1.

PROFESSOR






























1.

READER






























2.

READER






























CONSERVATIVE DENTISTRY


S.

No.


Designation

Faculty Name

DOB

Original Affidavit with date

ID CARD No

Form 16

Total Service college wise in all the previous Institutes (attach appendix)

DOJ & Experience in present institute

Total Experience as on 15th June of current year

*Present during Inspection

1.

PROFESSOR






























1.

READER






























2.

READER
































ORAL PATHOLOGY


1.

PROFESSOR






























1.

READER































ORAL & MAXILOFACIAL SURGERY


S.

No.


Designation

Faculty Name

DOB

Original Affidavit with date

ID CARD No

Form 16

Total Service college wise in all the previous Institutes (attach appendix)

DOJ & Experience in present institute

Total Experience as on 15th June of current year

*Present during Inspection

1.

PROFESSOR






























1.

READER































PERIODONTICS


1.

PROFESSOR






























1.

READER































ORTHODONTICS


1.

PROFESSOR






























1.

READER
































PEDODONTICS


S.

No.


Designation

Faculty Name

DOB

Original Affidavit with date

ID CARD No

Form 16

Total Service college wise in all the previous Institutes (attach appendix)

DOJ & Experience in present institute

Total Experience as on 15th June of current year

*Present during Inspection

1.

READER































ORAL MEDICINE


1.

READER































COMMUNITY DENTISTRY


1.

READER































LECTURERS/TUTORS Lecturers MDS (25%) : ________ Tutors BDS (75%): ________


S.

No.


MDS with speciality/BDS

Faculty Name

DOB

Original Affidavit with date

ID CARD No

Form 16

Total Service college wise in all the previous Institutes (attach appendix)

DOJ & Experience in present institute

Total Experience as on 15th June of current year

*Present during Inspection


































































































































































































































































































































































































































































































































































































































































































































































































































































































Note:- All affidavits of the teaching staff and their requisite documents should be in the same order as mentioned above

*If the teaching staff is not present, whether the sanctioned leave certificate is attached?


(As per Dental Council of India (Miscellaneous) Regulations, 2007)

1. Faculty ID Card issued by the Dental Council of India is mandatory.

2. The appointment of faculty in private dental colleges should be made through proper selection committee (as per University Act of the concerned State).

V. MEDICAL TEACHING STAFF (Eligibility will be as per MCI Regulations)
ANATOMY

S.

No.


Designation

Faculty Name

DOB

Original Affidavit with date

ID CARD No

Form 16

Total Service college wise in all the previous Institutes (attach appendix)

DOJ & Experience in present institute

Total Experience as on 15th June of current year

*Present during Inspection

1.

Reader




























1.

Lecturer




























2.

Lecturer





























PHYSIOLOGY & BIOCHEMISTRY


1.

Reader




























1.

Lecturer




























2.

Lecturer





























PHARMACOLOGY


S.

No.


Designation

Faculty Name

DOB

Original Affidavit with date

ID CARD No

Form 16

Total Service college wise in all the previous Institutes (attach appendix)

DOJ & Experience in present institute

Total Experience as on 15th June of current year

*Present during Inspection

1.

Reader




























1.

Lecturer




























2.

Lecturer






























PATHOLOGY & MICROBIOLOGY


1.

Reader




























1.

Lecturer




























2.

Lecturer





























GENERAL MEDICINE


S.

No.


Designation

Faculty Name

DOB

Original Affidavit with date

ID CARD No

Form 16

Total Service college wise in all the previous Institutes (attach appendix)

DOJ & Experience in present institute

Total Experience as on 15th June of current year

*Present during Inspection

1.

Reader




























1.

Lecturer




























2.

Lecturer






























GENERAL SURGERY


1.

Reader




























1.

Lecturer




























2.

Lecturer




























3.

Lecturer






























ANESTHESIA


S.

No.


Designation

Faculty Name

DOB

Original Affidavit with date

ID CARD No

Form 16

Total Service college wise in all the previous Institutes (attach appendix)

DOJ & Experience in present institute

Total Experience as on 15th June of current year

*Present during Inspection

1.

Reader




























1.

Lecturer



























Note:- All affidavits of the teaching staff and their requisite documents should be in the same order as mentioned above



*If the teaching staff is not present, whether the sanctioned leave certificate is attached?


VI. SUMMARY - DENTAL TEACHING STAFF


Department

Professor

Reader

Lecturer

Required

Available

Required

Available

Required

Available

Prosthodontics

1




2




4




Oral Pathology

1




1




2




Conservative Dentistry

1




2




3




Oral & Maxillofacial Surgery

1




1




3




Periodontics

1




1




3




Orthodontics

1




1




2




Pedodontics

-




1




2




Oral Medicine

-




1




2




Public Health Dentistry

-




1




2




Dental Materials

-




-




1




Dental Anatomy

-




-




1




Total


6*




11




27



* Including one Principal from any speciality

Attach list of entire faculty department-wise in attached DCI prescribed proforma as Annexure-I.



VII. SUMMARY - MEDICAL TEACHING STAFF

Departments

Number of Readers

Number of Lecturers

Required

Available

Required

Available

Anatomy

1




2




Physiology & Biochemistry

1




2




Pharmacology

1




2




Pathology & Microbiology

1




2




General Medicine

1




2




General Surgery

1




2




Anesthesia

1




1




Total

7




13




Attach list of entire faculty department-wise in attached DCI prescribed proforma as Annexure-I.
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