164.100.130.11:8091164.100.130.11:8091/pip2010-11/fund_guidelines/part-a/urban_rch.pdf · t 1. name...
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Cf>T1fW1fcpr <;:JT1T:Urban Health Centre through PPP
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SHSB/SPM/17/2008/7869 dated 15/10/2008SHSB/PMII 7/2008/8467 Dated 27111/2008 (Monthly Reporting Format)SHSB/PM/I7/2008/12616 Dated 22/10/2009 (Contract Attached)SHSB/PM/17/2008113572Dated 19/12/2009 SHSB/PM/I 7/2008/14 I74 Dated 21/01/2010SHSB/PMII7/2008/14991 Dated 05/03/20 I0 SHSB/PMII7/2008/15048 Dated 08/03/2010SHSB/PM/17/2008/15448 Dated 30/03/20I0 SHSB/PM/17/2008/15941 Dated 2704/20 I0
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1. Name of Town/City with District:
2. Name of Private Clinic/Party:
3. Name of UHC:
4. Name of Locality :
5. Closest Government Hospital :
6. Names of Slums covered - a)
7. Date of Opening of UHC:
8. Reporting Month :
9. Reporting Date:
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No. of OPOI
No. of Indoor
patients Patients
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MONTHL Y REPORTING FORMA T OF UHC UNDER PPP
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No. of Women Provided SP~~ClfiC ANC
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Signature of District Programme Manager(WithSeal)
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Signature of Civil Surgeon(WithSeal)
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Remarks (,f any) II!ii
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1 Nl1rno of Town/City with District
2. Name of Private Clinic/Party:
3. Name of UHC:
4. Name of Locality :
5. Closest Government Hospital:
6. Names of Slums covered - a)
7. Date of Opening of UHC :
8. Reporting Month:
9. Reporting Date:
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No. of Women Provided specific ANC
Signature of Departmental Staff posted by DHS(With Seal)
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Signature of Authorised Signatory of Private Clinic(With Seal) 0
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