STAR HEALTH AND ALLIED INSURANCE CO.

Ltd
No.1, New Tank Road, Valluvarkottam High Road,
Nungambakkam, Chennai – 34. www.starhealth.in
Toll free No: 1800 425 2255 BOARD No: 044 - 28263300

Network Hospital Grading Proforma Ver: G\N -1.0

General Information 24Hrs. Indoor YES \ NO
Name of Healthcare Unit NIRMAL NURSING HOME
Registration Number (If Registered) THN-C-208
Registering Authority THANE DISTRICT CIVIL SURGEON
Owner / CMD’s Name & Qualification DR.UMESH A.PATKAR M.S,D' ORTHO

Address Parshuram Plaza CHS, Station road, Gandhi Chowk, Kulgaon, Badlapur(E)

Landmark, if any (Location) Opp. Maruti Mandir, Gandhi Chowk

City /Taluk Tal- Ambarnath
District THANE
State MAHARASHTRA
Pin 4 2 1 5 0 3
Telephone(s) with STD Codes 0251-2690607
Fax Number(s)
Mobile Phone/s 9422476780
E-mail Id patkarhospital@gmail.com
Website www.nirmalnursinghome.com
Other Details:
Whether your Organization is a Non Profit Organization? YES \ NO
Are you registered with Income Tax Dept. for IT Exemption? YES \ NO
PAN No.AAWPP9864D
Bank Details:
Name of Bank Dombivali Nagari Sahakari Bank
Branch & Address Keshav Kosh, station rd; Kulgaon, Badlapur(E),dist. Thane
Account Number 01201110003633
Account in the Name of NIRMAL NURSING HOME
IFSC Code: DNSB0000012
Hospital Details:
Type of Ownership Proprietary Charitable Trust Private Limited Public Limited

Leased Partnership Corporate

Total Land Area 1118.73 sq.mts , Super Built up Area 5725 (Area in Sq. Feet)
Hospital Type: Multi Specialty Single Specialty Clinic Other (specify
(Please tick the appropriate box)
If single specialty please mention the specialty: ORTHOPAEDICS Number of Total Beds in the 16
Hospital:

Contact Details:
Contact Person for Name Tel. No. Ext. Mobile No.
Head of Operation/ admin DR.UMESH PATKAR 0251-2690607 - 9323281410
Accounts and Billing MRS.PRACHI U.PATKAR 0251-2690607 - 9321281410
Admission MR.NANDKUMAR DHULE 0251-2690607
Clinical Information DR.U.A PATKAR/RMO 0251-2690607 9323281410
Interaction with Star DR.U.A PATKAR/RMO/ MS 0251-2690607 9422476780
SHWETA.
Medical Records MRS.PRACHI PATKAR 0251-2690607 9321281410
ICU
Casualty DR.U.A PATKAR 0251-2690607 9323281410
Operation Theater/Labour Room DR.U.A PATKAR 0251-2690607 9323281410

1 Date:
Form Confidential Signature & Seal
 STAR HEALTH AND ALLIED INSURANCE CO. Ltd
No.1, New Tank Road, Valluvarkottam High Road,
Nungambakkam, Chennai – 34. www.starhealth.in
Toll free No: 1800 425 2255 BOARD No: 044 - 28263300

OT – COMPLEX:

Number of OT: Major  Minor 

EQUIPMENT DESCRIPTION WITH DATE OF MANUFACTURE

Laminar Air Flow (Yes \ No) April- 2012

Hepa Filter (Yes \ No) April 2012

Epoxy flooring April 2012

Type of OT STAN Automatic with ortho attachment

Table/Ortho
attachment
Light LED / Halogen / Tube-light STAN DOUBLE DOME 2017

Multiparameter Monitor With EMCO

Capnography
C-Arm – Specification ALLENGERS_59

Laparoscopy Unit ( Brand & ----NA----

Specification)
Boyle’s Apparatus / Defibrillator AEOMED brought in april 2019 with SEVO FLORINE VAPORISER
AEOMED UNI-EM
Operating Microscopy / Diathermy ENERTEG*

Radiant Warmer ----NO----

Autoclave SURGICAL INDIA LTD/ VERTICA2

Others 2018-MEDISTER
ETO sterilizer
Ultrasonic sterilizer 2014

2 Date:
Form Confidential Signature & Seal
 STAR HEALTH AND ALLIED INSURANCE CO. Ltd
No.1, New Tank Road, Valluvarkottam High Road,
Nungambakkam, Chennai – 34. www.starhealth.in
Toll free No: 1800 425 2255 BOARD No: 044 - 28263300

ICU \ IMCU :---------NA---------

Man power: Doctors: 4 Staff Nurse 10 Assistant 3 Supporting Staff 11

EQUIPMENT DESCRIPTION WITH DATE OF

MANUFACTURE
Central Oxygen / Suction

Number of Ventilators with details

-----NIL-----

Monitor

Pulse oxymeter

Others

Details of Beds

Type of Bed No. of Beds No. of Toilets Staff

6 1 14
General Ward – Male
5 1 14
General Ward – Female
3 3 14
A.C./Deluxe/Suite
- - 14
Single Bed
1 1 14
Sharing
- - 14
ICU \ IMCU
1 - 14
Post Operative Ward
1 - 14
Day Care
- - NA
Dialysis
NA
- -
Burns Unit

3 Date:
Form Confidential Signature & Seal
 STAR HEALTH AND ALLIED INSURANCE CO. Ltd
No.1, New Tank Road, Valluvarkottam High Road,
Nungambakkam, Chennai – 34. www.starhealth.in
Toll free No: 1800 425 2255 BOARD No: 044 - 28263300

Diagnostic Services
Lab Services Yes No Description
Hematology 
Biochemistry 
Microbiology 
OUTSOURCED
Serology 
Histopathology 
Biomedical Department 

RADIOLOGY Yes No Description

Digital X-Ray In House


Contrast Studies

Portable X-ray In House

IMAGING Yes No Description

Ultra Sound 

Mammogram 
Color Doppler / Duplex
Scan 
OUTSOURCED
CT- Scan

MRI

PET Scan 

4 Date:
Form Confidential Signature & Seal
 STAR HEALTH AND ALLIED INSURANCE CO. Ltd
No.1, New Tank Road, Valluvarkottam High Road,
Nungambakkam, Chennai – 34. www.starhealth.in
Toll free No: 1800 425 2255 BOARD No: 044 - 28263300

Multi specialty Hospital - please indicate the specialties available in your hospital: (Please tick the appropriate box)

Anesthesia  Oncology  General Surgery  Neonatology

 GeneralMedicine  Endocrinology  Cardio Thoracic Surgery  Pediatrics
 Cardiology  Hepatology Orthopedics  Dental
 Pulmonology Rheumatology  SurgicalGastroenterology  Others (Specify)
 Urology  ENT  Neuro Surgery  
 Nephrology  Ophthalmology  Plastic Surgery  
 Neurology  Dermatology  Transplant Surgery  
 Psychiatry  Gastroenterology  Obstetrics & Gynecology

Please indicate the equipments available in your hospital:

Cardiology Yes No Description

ECG

ECHO

TMT

Holter Monitor

Cath Lab

Nuclear Scan

ENT Yes No Description
Audiometer

Triple Endoscopy

Gastroenterology Yes No Description
OGD

Colonoscopy

ERCP

Gynecology Yes No Description
Labour Room

Fetal Incubator

Neonatal resuscitation kit

Fetal Monitor

Neonatal ICU

Opthalmology Yes No Description
Phaco

Laser

Urology Yes No Description
5 Date:
Form Confidential Signature & Seal
 STAR HEALTH AND ALLIED INSURANCE CO. Ltd
No.1, New Tank Road, Valluvarkottam High Road,
Nungambakkam, Chennai – 34. www.starhealth.in
Toll free No: 1800 425 2255 BOARD No: 044 - 28263300
ESWL 
URS 
PCNL 
Cystoscope 
Radiation Oncology Yes No Description
Telecobalt 
Linac 
Brachy Therapy 
Others Yes No Description
PFT 
EEG 
EMG 
Others

Medical Records (Tick whichever is applicable)

1 Identification of indoor patient By Name

Number & Year of
Admission

Unique Identifier
2 Medical Records Maintained for <1 Year 1 to 3 Years > 3 Years 
3 Medical Records Management Person  Section Department

OTHER AMENITIES / Credits Available

S. No. Amenities Details
JCI (USA)/ ACHSI(Australia)/ TRENT (UK/Europe)/CCHSA(Canada) -
1
Accreditation
2
NABH  Accredited. waiting for certificate
number
3 NABL
4 Recognition for DNB
5
CSSD  TSSU AVAILABLE

6
ICD Coding / MRD  MRD AVAILABLE

7 Medical Audit
8
Blood Bank  OUTSOURCED

9
Fire Safety Mechanism  PRESENT

10
Ambulance  OUTSOURCED

11
In house 24 Hrs Pharmacy  OUTSOURCED

12
Computerized Billing with CGHS Available Billing 
13
IT Solutions (Software License) 
14
Backup Generator  30 KV KIRLOSKAR GENERATOR

15
Pantry  Only for tea.

16 Others
Form Confidential Signature & Seal
 (Any services existent in your organization but not mentioned above can be added in the blank spaces. Attach more sheets if
required.)

BACKUPS PRESENT
-N- COMPUTING PRESENT
-LAMINIAR AIR FLOO, LED LAMPS,EPOXY COATED OT AVAILABLE
-ETO, AUTOCLAVE,ULTRSONIC STERLIZER PRESENT.

6 Date:

Form Confidential Signature & Seal