MIS FORMAT FOR SUBMITTING DATA BY

GOVERNMENT MEDICAL COLLEGES & HOSPITALS

 

Name of College/Hospital

 

Month Ending

 

1.        General Information

Telephone no (STD code)

 

Fax no

 

E mail address

 

 

Name and designation of the Head

 

Name of Superintendent

 

 

No of  beds

 

No of wards

 

No of Major OTs

 

No of Minor OTs

 

Blood bank

Yes/No

2.        Out Patients

No. of OPD days

No. of OPD registrations

Old

New

BPL

Govt.

Senior Citizen

Casualty + MLC

 

 

 

 

 

 

 

 

3.         

a)  In Patients

Total no of admissions

 

BPL

Admission

 

Average length of stay of patients *

 

Average bed occupancy (%) ¨

 

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)

Ward (Department)

Bed Strength

No. of days when occupancy was > 100%

Average daily number of excess beds

 

 

 

 

 

 

 

 

 

c) Operations carried out during the month

Department

Unit no. with name of Unit head

Unit Head Designation

Honorary /Full Timer

No. of major surgeries*

No. of minor surgeries*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

* 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

Total no

 

Percentage of death against no. of admissions

 

Total no. of autopsies

 

Total no. of forensic PM's.

 

Total no. of Police Surgeon's PM's

 

 

4.        Blood Bank

No of blood units used this month

 

No of blood units used without replacement

 

No of blood units collected with voluntary replacement

 

No of blood units bought from other blood banks

 

No of blood units found HIV positive

 

No of blood units found positive for Hepatitis B and C

 

No of blood donation camps

 

Component separation

 

No of blood units collected in camps

 

 

 

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)

Tablet

 

 

 

 

 

Injection

 

 

 

 

 

Liquid / Ointment

 

 

 

 

 

Disinfectant

 

 

 

 

 

Surgical Items

 

 

 

 

 

I.V. Fluid

 

 

 

 

 

X-ray films

 

 

 

 

 

Other

 

 

 

 

 

 

c) Drug / Surgical items /x-ray films etc. purchased from outside

Drug

Quantity

Cost

Local Purchase

Poor box fund/PLA

From Imprest ?

Tablet

 

 

 

 

Injection

 

 

 

 

Liquid / Ointment

 

 

 

 

Disinfectant

 

 

 

 

Surgical

 

 

 

 

I.V. Fluid

 

 

 

 

X-ray films

 

 

 

 

Other

 

 

 

 

 

 

d) Drug not used for more than 6 months:

Name of Drug

Quantity

Cost

No. of months not in used

Action suggested

 

 

 

 

 

 

 

 

 

 

 

6. Linen (no. of pieces)

Linen

Opening balance

Received during the month

Issued to wards

Closing balance

i) Operation Linen

 

 

 

 

ii) Bed linen

 

 

 

 

iii) Patient's linen

 

 

 

 

iv) Surgeon's linen

 

 

 

 

 

7. Major Equipment in the hospital (Over Rs. 5 lakhs): Like MRI, CT, USG, Heart Lung machine, Biochemistry auto analyser, X-ray machine etc. (List is only illustrative)

Department

Equipment

No. of investigations

No. of breakdowns with days

Reason for breakdown

 

 

 

 

 

 

 

 

 

 

 

8. Other Equipments not in working condition

 

Department

Equipment

Days not in use

Any follow up initiated for repair

Reason for non use

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9. Other machinery in non-working condition like O2 supply system, lifts, AC plants, incinerator, vehicles, ambulances etc. (List is only illustrative)

 

Department

Machinery

Days not in use

Any follow up initiated for repair with current status

Reason for non use

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 10. Staff Details

a) Attendance

     Teaching:

Category

Nos.

Total man days available *

Total man days present

No of Lectures

No of Clinic / Practical taken

Remarks by Dean

Required as per Time Table

Taken

Professors

 

 

 

 

 

 

 

Associate professors

 

 

 

 

 

 

 

Lecturers

 

 

 

 

 

 

 

 

    Non-Teaching:

 

Category

Nos.

Total man days available *

Total man days present

Remarks by Dean

Resident Doctors

 

 

 

 

Honoraries

 

 

 

 

Nursing Staff

 

 

 

 

Paramedical Staff

 

 

 

 

Administrative Staff

 

 

 

 

Class IV employees

 

 

 

 

 

Note:

* = To calculate man-days available, find the no. of working days during the month for each category of staff and multiply by no. of filled staff in that category.

¨ = To calculate man days present, add the number of days absent for the employees of each category and subtract from total man days available for that category.

 


b) Vacancy position of the College (Teaching posts)

 

 

Designation

Sanctioned posts

MCI requirement

Posts filled

Posts vacant

Vacant for > 6 months

Unauthorized absent

 

 

UG

PG

Regular

Adhoc

Contract

 

Professors

 

 

 

 

 

 

 

 

 

 

Associate professors

 

 

 

 

 

 

 

 

 

 

Lecturers

 

 

 

 

 

 

 

 

 

 

Resident Doctor

 

 

 

 

 

 

 

 

 

 

Honoraries

 

 

 

 

 

 

 

 

 

 

 

Note: Information about Posts, vacant and filled, should be as per sanctioned posts.

 

 

11. Budget: Figures in Rupees (Thousand) progressive (Cumulative) upto the end of the reporting month.

 

     College

 

Budget Head

Allocation for current financial year

Cumulative Booking end of reporting month

Cumulative Expenditure upto end of reporting month

Remarks, if any

 

%

 

%

Salary

 

 

 

 

 

 

Travel Expenses

 

 

 

 

 

 

Office Expenses

 

 

 

 

 

 

Petrol, Oil, Lubricant

 

 

 

 

 

 

Rent, Rates & Taxes

 

 

 

 

 

 

Publications

 

 

 

 

 

 

Advertising & Publicity

 

 

 

 

 

 

Professional & special services

 

 

 

 

 

 

Other Charges

 

 

 

 

 

 

Maintenance work

 

 

 

 

 

 

Motor Vehicles

 

 

 

 

 

 

Machinery & Equipment

 

 

 

 

 

 

Material & Supplies

 

 

 

 

 

 

Scholarship / Stipends

 

 

 

 

 

 

Grants-in-aid

 

 

 

 

 

 

Diet charges

 

 

 

 

 

 

Computer expenses

 

 

 

 

 

 

Total

 

 

 


11. Budget: Figures in Rupees (Thousand) progressive (Cumulative) upto the end of the reporting month.

    

Hospital

 

Budget Head

Allocation for current financial year

Cumulative Booking end of reporting month

Cumulative Expenditure upto end of reporting month

Remarks, if any

 

%

 

%

Salary

 

 

 

 

 

 

Travel Expenses

 

 

 

 

 

 

Office Expenses

 

 

 

 

 

 

Petrol, Oil, Lubricant

 

 

 

 

 

 

Rent, Rates & Taxes

 

 

 

 

 

 

Publications

 

 

 

 

 

 

Advertising & Publicity

 

 

 

 

 

 

Professional & special services

 

 

 

 

 

 

Other Charges

 

 

 

 

 

 

Maintenance work

 

 

 

 

 

 

Motor Vehicles

 

 

 

 

 

 

Machinery & Equipment

 

 

 

 

 

 

Material & Supplies

 

 

 

 

 

 

Scholarship / Stipends

 

 

 

 

 

 

Grants-in-aid

 

 

 

 

 

 

Diet charges

 

 

 

 

 

 

Computer expenses

 

 

 

 

 

 

Total

 

 

 

 

 

 

 

 

12. Services

 

Rating of quality

Service area

Name of agency

Satisfactory

Needs Improvement

Poor

Remarks

Repairs & Maintenance

 

 

 

 

 

Civil

 

 

 

 

 

Mechanical

 

 

 

 

 

AC & refrigeration

 

 

 

 

 

Other Services

 

 

 

 

 

Laundry

 

 

 

 

 

Ambulance

 

 

 

 

 

Security

 

 

 

 

 

Stores

 

 

 

 

 

Canteen

 

 

 

 

 

 

 


13. Complaints

 

Nature of Complaint/ suggestions

From whom?

Student/Patient/Public/ Staff/ Elected members (MP/MLA) or Anonymous

No. Received

No. Disposed

Remarks by Dean

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14. Results (for Regular batch only, as and when applicable)

 

Course

No. Appeared

No. Passed

Distinction / Award

I MBBS

 

 

 

II MBBS

 

 

 

III MBBS

Part - I

 

 

 

Part - II

 

 

 

PG

 

 

 

Superspeciality

 

 

 

Any other

 

 

 

 

 

15. Research and any other Academic / Non Academic Activities

(Attach detailed information)

Sr. No.

Name of the Activity

Number of activities during the current month

Remarks

1

SEMINARS

 

 

2

CME (Continued Medical Education)

 

 

3

Research projects

 

 

a) National

 

 

b) International

 

 

4

Papers Published

 

 

5

Workshops organized

 

 

6

Camps

 

 

7

Participation in Sports

 

 

8

Cultural Events

 

 

 

 

16. Remarks of the Dean / Superintendent (Only where Superintendent is Head of Hospital)

 

 

 

 

Signature of Dean / Superintendent (Only where Superintendent is Head of Hospital)

 

 

Date