B4 12 Standard B5 Standard E13 Standard G5 Area of Concern C Inputs Overall Score - Standard E14 Standard G6 Standard E15 Standard G7 Standard E16 Standard G8 Standard C1 Standard E17 Area of Concern H Outcome Indicators Overall Score Standard C 2 Standard E18 Standard H1 Standard C 3 Standard E19 Standard H2 Standard C 4 Standard E20 Standard H4 Standard C 5 Standard E21 Standard H4 Standard C 6 Standard E22 Standard E23 Department wise score card Accident & Emergency Accident & Emergency Score Card Area of Concern Wise Score Accident & Emergency Score A Service Provision 0% 0% B Patient Rights 0% C Inputs 0% D Support Services 0% E Clinical Services 0% F Infection Control 0%
G Quality Management 0% H Outcome 0% Major Gaps Observed 1 2 3 Evidences (if any….) 1 2 3 Out-patient Department Out-patient Department Score Card Area of Concern Wise Score Out-patient Department Score A Service Provision 0% 0% B Patient Rights 0% C Inputs 0% D Support Services 0% E Clinical Services 0% F Infection Control 0% G Quality Management 0% H Outcome 0% Major Gaps Observed 1
Pediatrics ward Score Card Area of Concern Wise Score Pediatrics ward Score A Service Provision 0% 0% B Patient Rights 0% C Inputs 0% D Support Services 0% E Clinical Services 0% F Infection Control 0% G Quality Management 0% H Outcome 0% Major Gaps Observed 1 2 3 Evidences (if any….) 1 2 3 Sick Newborn Care Unit Sick Newborn Care Unit Score Card Area of Concern Wise Score Sick Newborn Care Unit Score A Service Provision 0% 0% B Patient Rights 0% C Inputs 0% D Support Services 0%
E Clinical Services 0% F Infection Control 0% G Quality Management 0% H Outcome 0% Major Gaps Observed 1 2 3 Evidences (if any….) 1 2 3 Nutritional Rehabilitation Centre Nutritional Rehabilitation Centre Score Card Area of Concern Wise Score Nutritional Rehabilitation Centre Score A Service Provision 0% 0% B Patient Rights 0% C Inputs 0% D Support Services 0% E Clinical Services 0% F Infection Control 0% G Quality Management 0% H Outcome 0%
1 2 3 Post-Partum Unit Post-Partum Unit Score Card Area of Concern Wise Score Post-Partum Unit Score A Service Provision 0% 0% B Patient Rights 0% C Inputs 0% D Support Services 0% E Clinical Services 0% F Infection Control 0% G Quality Management 0% H Outcome 0% Major Gaps Observed 1 2 3 Evidences (if any….) 1 2 3
B Patient Rights 0% C Inputs 0% D Support Services 0% E Clinical Services 0% F Infection Control 0% G Quality Management 0% H Outcome 0% Major Gaps Observed 1 2 3 Evidences (if any….) 1 2 3 Blood Bank Blood Bank Score Card Area of Concern Wise Score Blood Bank Score A Service Provision 0% 0% B Patient Rights 0% C Inputs 0% D Support Services 0% E Clinical Services 0%
F Infection Control 0% G Quality Management 0% H Outcome 0% Major Gaps Observed 1 2 3 Evidences (if any….) 1 2 3 Laboratory Laboratory Score Card Area of Concern Wise Score Laboratory Score A Service Provision 0% 0% B Patient Rights 0% C Inputs 0% D Support Services 0% E Clinical Services 0% F Infection Control 0% G Quality Management 0%
H Outcome 0% Major Gaps Observed 1 2 3 Evidences (if any….) 1 2 3 Radiology Radiology Score Card Area of Concern Wise Score Radiology Score A Service Provision 0% 0% B Patient Rights 0% C Inputs 0% D Support Services 0% E Clinical Services 0% F Infection Control 0% G Quality Management 0% H Outcome 0% Major Gaps Observed 1 2 3
Auxiliary services Auxiliary services Score Card Area of Concern Wise Score Auxiliary services Score A Service Provision 0% 0% B Patient Rights 0% C Inputs 0% D Support Services 0% E Clinical Services 0% F Infection Control 0% G Quality Management 0% H Outcome 0% Major Gaps Observed 1 2 3 Evidences (if any….) 1 2 3 Mortuary Mortuary Score Card Area of Concern Wise Score Mortuary Score
A Service Provision 0% 0% B Patient Rights 0% C Inputs 0% D Support Services 0% E Clinical Services 0% F Infection Control 0% G Quality Management 0% H Outcome 0% Major Gaps Observed 1 2 3 Evidences (if any….) 1 2 3 General Administration General Administration Score Card Area of Concern Wise Score General Administration Score A Service Provision 0% 0% B Patient Rights 0% C Inputs 0% D Support Services 0% E Clinical Services 0%