PERFORMA FOR OPENING NEW SUB HEALTH CENTRE
1. Name of Village
2. Post Office
3. Area of Constituency
4. Tehsil
5. Block
6. Population of Village
7. The villages covered by proposed Sub-Health Centre and the population including whole population.
8. Name of Medical Institutions from where the villages are getting Medical Facility at present which are included in the proposed Medical Institutions.
9. The distance from present Medical Institution to the proposed Medical Institution.
10. Is the Gram Panchayat agree to provide land free of cost? If yes, send a copy of land resolution.
11. Is the Gram Panchayat agree to provide temporary sufficient building free of cost till the Govt. building are not constructed.
12. Are you in a favour to open the Sub-Health Centre in this village.
13. The name of PHC/CHC to which the proposed new Sub-Health Centre is to be attached.
14. The already open Medical Institutions from which the villages are getting Medical Facilities are not affected by the new proposed Sub-Health Centre.
15. Details of another facility are available in the village like water supply, electricity, concrete road etc.
PERFORMA FOR OPENING NEW PRIMARY HEALTH CENTRE
1. Name of Village
2. Post Office
3. Area of Constituency
4. Tehsil
5. Block
6. Population of Village
7. The villages/Sub-Health Centre covered by proposed Primary Health Centre and the population including whole population.
8. Name of Medical Institutions from where the villages are getting Medical Facility at present which are included in the proposed Medical Institutions.
9. The distance from present Medical Institution to the proposed Medical Institution.
10. Is the Gram Panchayat agree to provide land free of cost? If yes, send a copy of land resolution.
11. Is the Gram Panchayat agree to provide temporary sufficient building free of cost till the Govt. building are not constructed.
12. Are you in a favour to open the Primary Health Centre in this village.
13. The name of CHC to which the proposed new Primary Health Centre is to be attached.
14. The already open Medical Institutions from which the villages are getting Medical Facilities are not affected by the new proposed Primary Health Centre.
15. Details of another facility are available in the village like water supply, electricity, concrete road etc.
PERFORMA FOR OPENING NEW COMMUNITY HEALTH CENTRE
1. Name of Village
2. Post Office
3. Area of Constituency
4. Tehsil
5. Block
6. Population of Village
7. The Sub-Health Centre/Primary Health Centre covered by proposed Community Health Centre and the population including whole population.
8. Name of Medical Institutions from where the villages are getting Medical Facility at present which are included in the proposed Medical Institutions.
9. The distance from present Medical Institution to the proposed Medical Institution.
10. Is the Gram Panchayat agree to provide land free of cost? If yes, send a copy of land resolution. The date when PHC start.
11. Is the Gram Panchayat agree to provide temporary sufficient building free of cost till the Govt. building are not constructed.
12. Are you in a favour to open the Community Health Centre in this village.
13. The already open Medical Institutions from which the villages are getting Medical Facilities are not affected by the new proposed Community Health Centre.
14. Detail of another facilities or available in the village like water supply, electricity, concrete road etc.
15. Comparative statement of sanctioned posts in CHC according to norm and additional posts are to be created in CHC already open Medical Institutions which are presently to be upgraded.