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    Department of Medical Health and Family Welfare: Application Number: MEE0054172 To

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    Abhishek Kumar
    Yuvraj Singh submitted an online application for registration of his pathology lab called Pushpanjali Pathology Center in Prayagraj, Uttar Pradesh. The application provided details of the lab's address, facilities offered, owner and medical director information. It specified that the lab offers pathology testing services and is located in a commercial building in the urban area of Prayagraj. Relevant documents including address proof, medical licenses and qualifications were attached for verification. The application sought approval from the Chief Medical Officer of Prayagraj to legally operate the medical establishment.

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    Download as PDF, TXT or read online from Scribd

    Department of Medical Health and Family Welfare: Application Number: MEE0054172 To

    Uploaded by

    Abhishek Kumar
    34 views4 pages
    Yuvraj Singh submitted an online application for registration of his pathology lab called Pushpanjali Pathology Center in Prayagraj, Uttar Pradesh. The application provided details of the lab's address, facilities offered, owner and medical director information. It specified that the lab offers pathology testing services and is located in a commercial building in the urban area of Prayagraj. Relevant documents including address proof, medical licenses and qualifications were attached for verification. The application sought approval from the Chief Medical Officer of Prayagraj to legally operate the medical establishment.

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    Yuvraj Singh submitted an online application for registration of his pathology lab called Pushpanjali Pathology Center in Prayagraj, Uttar Pradesh. The application provided details of the lab's address, facilities offered, owner and medical director information. It specified that the lab offers pathology testing services and is located in a commercial building in the urban area of Prayagraj. Relevant documents including address proof, medical licenses and qualifications were attached for verification. The application sought approval from the Chief Medical Officer of Prayagraj to legally operate the medical establishment.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    34 views4 pages

    Department of Medical Health and Family Welfare: Application Number: MEE0054172 To

    Uploaded by

    Abhishek Kumar
    Yuvraj Singh submitted an online application for registration of his pathology lab called Pushpanjali Pathology Center in Prayagraj, Uttar Pradesh. The application provided details of the lab's address, facilities offered, owner and medical director information. It specified that the lab offers pathology testing services and is located in a commercial building in the urban area of Prayagraj. Relevant documents including address proof, medical licenses and qualifications were attached for verification. The application sought approval from the Chief Medical Officer of Prayagraj to legally operate the medical establishment.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 4

    7/30/2021 Department of Health and Family Welfare

    Department of Medical Health and Family Welfare


    Government of Uttar Pradesh

    Online Application Form for Registration of Medical Establishment

    To, Application Number : MEE0054172


    The Chief Medical Office,
    Distt : Prayagraj
    Uttar Pradesh
    Sir,
    Kindly Register my Clinic/medical establishment details of which are given as below

    1 Details of Establishment :

    Establishment Area Urban Place of Establishment Own

    Type Of Land Commercial Establishment Name Pushpanjali Pathology


    Center

    Category Pathology labs Operated By Individual Person

    Name of Individual Person Yuvraj Singh Building Structural Layout

    2 Address of Medical Establishment :

    Telephone / Mobile No. NA Website NA

    Address Kalindipuram Chauraha District Prayagraj


    Rajrooppur Prayagraj

    State Uttar Pradesh Pincode 211011

    Address Proof Address is same

    3 Medical facilities:

    Details of Medical facilities Pathology Labs


    offered

    4 Details of Owner :

    Name Yuvraj Singh Age 28

    1/4
    7/30/2021 Department of Health and Family Welfare

    Father Name Sri Mahesh Singh Mobile Number 9838965986

    E-mail Id [email protected] Address Kalindipuram Chauraha


    Rajrooppur Prayagraj

    State Uttar Pradesh District Prayagraj

    Pin Code 211011 Photo

    Signature Owner & Person in charge No


    are same?

    5 Details of Person Incharge :

    Name Dr Akhilesh Kumar Mobile Number 9838965986

    E-mail [email protected] Relevant Qualification MBBS

    Institution Name GSVM Medical College Registration No(MCI/SMF). 19671


    Kanpur

    Name of Central/ State UP State Medical Council Address 815 Bharat Clinic
    Council Rajrooppur Prayagraj

    State Uttar Pradesh District Prayagraj

    Pincode 211011 Photo

    MCI/SMF Certificate

    6 Doctor's Details :

    Doctor Father Relevant Registration Registration Part/Full


    Sl.No. Name Name Qualification Foundation Type No. Time Attachme

    1 DR SRI MBBS GSVM MCI 19671 Part 


    AKHILESH BHARAT MEDICAL Time
    KUMAR PRASAD COLLEGE
    KANPUR

    7 Paramedical Staff Details :

    Note:- Please fill details and upload records up to 5 ParaMedical Staff through Add more option &
    Furnish details of rest ParaMedical
    Staff in affidavit in same format as mentioned below. Submit
    hardcopy of all the remaining records (qualification document) of ParaMedical Staff to the CMO
    2/4
    7/30/2021 Department of Health and Family Welfare

    Office/ Committee.
    Father Relevant Registration Registration Part/Full
    Sl.No. Name Name Qualification Institution Type No. Time Attachm

    1 YUVRAJ SRI DMLT GOVERNMENT SMF LT 8466 FULL 


    SINGH MAHESH MEDICAL TIME
    SINGH COLLEGE
    JALAUN

    8 Type Of Facility Offered :

    InPatient No

    OutPatient No

    Laboratory Yes Other Laboratory NaN

    Laboratory Type Pathology


    ,
    Biochemistry

    Imaging No

    NOC from Pollution control Yes Certificate Number P250


    Board

    NOC from Pollution control


    Board Certificate

    Certificate from agency to Yes Certificate Number P2504PH


    Disposal of Medical Waste

    Certificate from agency to


    Disposal of Medical Waste

    Firefighting System in the No


    Establishment

    9 Attachment :

    Address Proof

    Upload MCI/SMF Certificate

    Attach Qualification Document

    3/4
    7/30/2021 Department of Health and Family Welfare

    Notarized Affidavit from Person Incharge of Establisment

         
    Date Place Signature of Person Incharge

    4/4

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