Fresh Empanelment
  

DOCUMENT REQUIRED FOR FRESH EMPANELMENT UNDER CGHS PUNE

1.        Check List

2.        Application Form

3.         NABH/QCI/NABL Certificate

4.       Audited Balance Sheet, Profit and Loss Account of the Last Financial Year

5.       CA certificate of Annual Turnover

6.       Proprietary/MOA Deed duly authorized by relevant statutory body or Notarized.

7.       Declaration for the capability to submit bills in electronic format

8.       EMR/EHR declaration

9.       State registration certificate/Registration with local bodies

10.   Shop Act

11.   Bio Medical Waste Management Certificate from authorized agents who is dealing with Bio Medical Waste

12.   MPCB registration certificate

13.   Fire Clearance Certificate from relevant Govt. Authorities

14.   Fire Safety Certificate from the Agency which is in operation with your hospital(relevant valid certificate)

15.   PCPNDT Registration Certificate

16.   AERB approval for imaging facilities/radiotherapy

17.   Certificate of registration for organ transplant(if applicable)

18.   Certificate of Undertaking(Annexure-2)

19.   Acceptance Letter(Annexure-4)

20.   Fall Clause

21.   HCO fulfilling any special condition

22.    (a) Demand Draft of Rs.1000/- (non-refunable) towards Application money in the name of “ Additional Director CGHS Pune” from any Nationalized Bank.  (b) Earnest Money Deposit (EMD) of Rs. 1,00,000/- (payment through only https://bharatkosh.gov.in ). Contact office for further details about payment through Bharatkosh.

23.   PAN Card & Bank Account Details

24.   Hospital Branches for which applied( if applying for more than one branch)

25.   License for running Blood Bank

26.   Rate-List of all treatment Procedures/Investigations/Facilities available with HCO  

Instruction for filling the application form:

1.  All the above documents should be in the name of  the same HCO who is applying for the fresh empanelment under CGHS Pune

2. HCOs are requested to send the scanned copies of all above documents duly attested by hospital authority which must be merged into one file (in pdf) strictly in the above sequence via E-Mail to this address: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it .

3. The Demand Drafts may be submitted to this office personally or by registered/speed post along with covering letter.

4. If HCO is recommended by empanelment committee only then the hard copies of the above documents along with MOU and PBG is to be submitted to this office.

5.  Meeting of the empanelment committee is held at the end of every quarter and the submitted documents remained valid for the concerned quarter only. If committee finds any deficiency in any aspect, the same will communicated to the HCO and all above mentioned documents along with demand draft of Rs. 1000/- are to be submitted afresh for reconsideration in the following quarter.

6. For any queries- HCOs can email to This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

7. If HCO is applying for more than one branches  then all the above documents to be submitted against each branch for which HCO has applied.

 

                  

 

  
 
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