Application

 

APPLICATION FOR REGISTRATION

OF HEALTHCARE SERVICE PROVIDERS

 

Healthcare Service Provider is required to complete this form as per the requirements of the provisions of Punjab Healthcare Commission Act 2010.

Incomplete forms will not be entertained.

Provision of incorrect information/documents will result in rejection of the Application.

Return the completed form to:

Directorate of Licensing & Accreditation,

Punjab Healthcare Commission

Office # 1 & 2, 4th FloorShaheen Complex38-Abbot Road, Lahore

 

Questions regarding completion of this application may be directed to: Ph. 042 36376371  8

For further information, please visit our web site:  www.phc.org.pk

 

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HEALTHCARE SERVICE PROVIDER

Name:

Designation: _________________________

 

 

Status:    Owner  Manager  In-charge

Qualification:

 

 

CNIC Number:

 

Registration No. PMDC/ PNC/ NCH/ NCT:

 

 

Mailing Address:

 

 

Town:

 

City:

District:                                Punjab

Telephone (landline & mobile)

 

Fax:

Email:

.

HEALTHCARE ESTABLISHMENT

Name:

Date of establishment at present location:

(Day/Month/Year)

 

Previous Name (If any):

 

 

Mailing Address:

 

 

Town:

 

 

City:

District:                             Punjab

Telephone (landline & mobile)

 

Fax:

Email:

 

 

 

 

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TYPE OF ORGANIZATION

Type of Ownership (please check the appropriate box)

 

Government

Others

  £ District Government

     £ Sole Proprietary

£ Voluntary Non- Profit

  £ Provincial Government*

     £ Partnership

£ Association

  £ Federal Government

     £ Corporation

£ Limited Liability Company (Private)

  £ Autonomous Institution

     £ Trust

£ Limited Liability Company (Public)

  £ CMH/ Cantonment Hospital

 

 

If incorporated or registered, date of incorporation/No & organization it is registered with:

 

 

*Provincial government includes Social Security, Auqaf department & family planning department etc

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TYPE OF HEALTHCARE ESTABLISHMENT (please check the relevant box)

               

£ Teaching

 

           £ Non-Teaching

 

          £ Single Specialty (please specify): _____________________________________________________

 

          £ Multiple Specialty

 

           £ Others

               GP Clinic/ Homeopath/ Hakim/ Lab/ Radiological or Imaging/Maternity or Nursing homes/

               Dental clinic/ Cosmetic Surgery/ Laser Clinic/ If any other please specify: ____________________

 

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BED STRENGTH

£ Number of Beds: ____________

 

ATTESTATION

I, the undersigned, do hereby solemnly affirm and declare that the information provided above is truand correct to the best of my knowledge and belief and that nothing has been concealed therefrom. I also state that if any false or incorrect information is provided to the Commission, it may result in rejection of my application for registration and I may also be found liable to pay fine to the Commission.  

Signature

Name of Applicant

 

Date

 

Designation

 

 

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About Me

Dr. Muhammad Iqbal is a board certified Homeopathic Skin and Beauty Specialist

Working Hours

Morning: 9.00 am - 2.00 pmEvening: 6.00 pm - 10.00 pm
Subscribe to My Newsletter


About Me

Dr. Muhammad Iqbal is a board certified Homeopathic Skin and Beauty Specialist

Working Hours

Morning: 9.00 am - 2.00 pmEvening: 6.00 pm - 10.00 pm