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Transcript of Standard Insp. Form-ug
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Form-MCI-12
MEDICAL COUNCIL OF INDIA
STANDARD INSPECTION FORM
“A”
General Information pertaining to :-
1. College and Teaching Hospital
2. Courses of Study leading to :-
M.B.B.S. Examinations
Name of Institution : ……………………………………………………………………….
Place and Address : …………………………………………………………………………..
Principal/DeanTel. No. Off. ……………………………Res.………………………Fax .………………….
email : ………..……….…………………………………………………………….……………
Name of Affiliating University : ……..……………………………………………………
Date : Signature of Dean/Principal
--------------------------------------------------------------------------------------------------
This form shall be precisely filled in by the Institution and handed over by the Dean/Principal, duly verified and signed to the conveyor of the team of Inspectors, who shall then examine the entries and send it with his observations to the Secretary, Medical Council of India. As far as possible, all information should be contained in the form and separate enclosures
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Form-MCI-12
avoided. The entries should be as required under the MCI regulations and norms. In case the college does not have the prescribed documents with them the same may be obtained from the MCI office by making necessary payment.
GENERAL INFORMATION
a) (i) Year of Foundation ……………………………………………………(ii) Year of Permission by MCI …………………………………………..
(In respect of new medical college please attach Letter of Intent, Letter of Permission and Yearly approval by Central Government/MCI).
b) Management – (Govt./Semi-Govt./Univ./Local Body/Private Trust/Society)
c) (i) Annual Admission ……………………………………………………..(ii) In case of renewal of permission of the medical college
permitted u/s 10A of the Indian Medical Council Act, please give a list containing the names of students, category wise, admitted during the preceding academic year.
d) Year to year increase (if any)…………………………………………………(Year and number of students admission permitted by MCI to be specified and copies of the MCI approval to be attached)
e) Year of recognition by MCI :
(i) Undergraduate :……………………………(ii) Postgraduate : ………….. Last inspection with date …………
-------------------------------------------------------------------------------------------------------------Sl. No. Course Degree/Diploma Degree/Diploma Degree/Diploma
Permitted by MCI recognised by MCI not permitted/not recognised by MCI
-------------------------------------------------------------------------------------------------------------1.2.3.4.5.6.7.8.9.10.-------------------------------------------------------------------------------------------------------------
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Form-MCI-12
(iii) Qualification not yet recognised : …………………………………………..
Annual Budget
(a) Pay and Allowances ……………………………………………………………………
(Pay scales and allowances of various categories of staff i.e. teaching, technical & administrative Staff) –(Please attach separate sheet).(b) Contingency : (i) recurring : …………………………….
(ii) Non-recurring : ………………………
Administrative set up for looking after :
(a) Admission :-(Please attach a copy of the current prospectus of the college/university/Govt.)
b) Particulars of Dean/Principal :
-------------------------------------------------------------------------------------------------------------------------Full Qualifications Teaching Administrative Part/Full Scale Name with college, Experience Experience time
of Pay University Designation Designation
and year & duration & durationas Dean/PrincipalProfessorReader/Assoc. ProfessorLecturer/Asst. ProfessorTutor/Demons.
-------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------
(c) Accommodation : -
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Form-MCI-12
(i) Principal/Dean’s office size :(ii) Staff room size :(iii) College Council room size :(iv) Office Superintendent room –size :(v) Office Space Size :(vi) Intercom & Public address
system in the college : Present/Absent(vii) Record room size :
COURSES OF STUDY
(a) Pre-requisites for admission :…………….
(b) Method of selection :……………
(i) Strictly on the basis of performance at the qualifying public examination.
or
(ii) Competitive entrance examination.
(iii) Minimum percentage of marks for admission to MBBS course.
(i) Open Merit :
(ii) Reserved categories :
(c) (i) No. of actual working days :
College Hospital
(ii) Daily working hours :
(b) year of introduction of the new curriculum (of 1997)
GROUPING OF SUBJECTS FOR EXAMINATION :
(if it differs from Council recommendations, bring that out clearly)
---------------------------------------------------------------------------------------------------Number of Subjects Duration of Study
---------------------------------------------------------------------------------------------------
First M.B.B.S.
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Form-MCI-12
Second M.B.B.S.
---------------------------------------------------------------------------------------------------
Final M.B.B.S.
Part – I
Part - II
Practical Theory Total
Attendance (MinimumAttendance percentage forappearing at the Univ. examination :-
Percentage of marks for Internal Assessment included in the total marks of Univ. examination.
COLLEGE COUNCIL
(a) Composition :
(b) Functions :
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Form-MCI-12
(c) No. of Sessions per year :
BUILDING
(A) Layout & floor area
(i) Year & Cost of construction :
(ii) Cost of Equipment and Furniture :
(B) Location of Departments :
(a) Pre-clinical
(b) Para-clinical
(c) Clinical
(d) No. of Lecture theatres College Hospital
Number :
Type :
Gallery :
Level :
Seating Capacity :
(e) Type of Audiovisual aids :(each lecture theatre)
(f) Auditorium :(Accommodation)
(g) Examination Hall :(Sitting Capacity)
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Form-MCI-12
(h) Common room for - Size (a) Boys (b) Girls
Facilities of attached toilets :-
Present or not
(i) Central Laboratories :
(1) Staff :
(2) Equipment :
(3) Management of Central &Experimental Laboratories
ANIMAL HOUSE
Accommodation : No. of rooms with size :
STAFF :
1. Veterinary Officer :
2. Animal Attendants :
1. Technician for Animal Operation Room :
4. Sweepers :
SECTIONS :
1. No. of animals kept and bred :
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Form-MCI-12
2. Facilities for experimental work :
CENTRAL LIBRARY
(a) Layout and floor area :
(b) Reading Rooms :
(i) No.:-(a) for U.G. :(b) for P.G. :(c) for Staff :
(ii) In each accommodation :
(c) Working hours :
(d) No. of shifts :
(e) No. of Books :(i) Text :(ii) Reference :
(f) No. of Journals Subscribed annually :(i) Indian (ii) Foreign
(g) No. of Journals actually received annually :(i) Indian (ii) Foreign
(h) No. of Journals with back Numbers : (i) Indian : (ii) Foreign
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Form-MCI-12
(i) No. of books purchasedduring the last 3 years :
Ist Year IInd Year IIIrd Year
(J) Staff with qualifications :
Names Qualifications
Categories
Librarian
Dy. Librarian
Documentalist
Cataloguer
Library Assistants
Daftaries
Peons
Any other
(K) System of Cataloguing
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Form-MCI-12
(L) Details of facilities available like Medlar, Internet, T.V., V.C.R., Xerox & Microfilm reading.
Whether these areas are air-conditioned? :
(m) MEDICAL EDUCATION UNIT :
Number (a) Staff :
Hon. Director/Coordinator
Hon. Faculty
Supportive Staff
Stenographer
Computer Operator
Technicians in Audio-Visuals aids, Photographer& Artist.
(b) Equipment available
(c) Teaching & training material available
(d) No. of training courses conducted by Medical EducationUnit
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Form-MCI-12
(i) Categories of personnel trained
(ii) Number trained in each category
(n) STATISTICAL UNIT :
Yes No.
Composition :
DESIGNATION No
1) Staff :
2) Equipment
3) Scope of work
(o) CENTRAL PHOTOGRAPHIC CUM AUDIO-VISUAL UNIT :
(a) Staff : No.
Photographer
Artist
Modeler
Dark Room Assistant
Audio-Visual Technician
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Form-MCI-12
Store Keeper Clerk
Attenders
(b) Equipment(in each section)
(c) Type of Control – Central/Department
(p) HEALTH CENTRES - RURAL/URBAN R.H.C./P.H.C. URBAN------------------- HEALTH I II III CENTRE
(a) Name of the center :
(b) Location of each center :
(c) Population covered by each center :
(d) Distance from college :
(e) Transport facilities for :
1. (i) Students + Interns :
(ii) Staff :
(iii) Supportive Staff :
2. (i) Number of Vehicles :
(ii) Capacity of each Vehicle :
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Form-MCI-12
3. Control of Vehicles :-
Departmental :
Central :
(f) Staff of the Centers :
(g) Hostel facilities at the Rural Health Centers :
(h) Messing facilities available or not.
(i) Working arrangement/type of control of Health Centres :
(i) Total (Admn. & Financial) control with the college
(ii) Partial (only for training) control
WORKSHOP FOR EQUIPMENT & INSTRUMENT REPAIR
(a) Staff No.
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Form-MCI-12
Supdt
Sr. Technician
Jr. Technician
Carpenter
Black smith
Attendants
(b) Facilities for work
HOSTELS
(a) Layout :
(b) Distance from the college & Hospital :
(c) Total No. of rooms & seats :
Rooms Seats
Undergraduate (i) Boys
(ii) Girls
Postgraduate (i) Boys
(ii) Girls
No. of students on the roll :
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Form-MCI-12
Percentage of Students accommodated :
(d) Supervisory arrangement :
(e) Messing & canteen arrangement :(Dining hall should have accommodation for 25% of the occupants at a given time).
(f) Availability of visitors room, reading room TV room and indoor games
RESIDENTIAL QUARTERS :
(a) Categories :
(b) Number :
(c) Percentage of Staff accommodated in each category :
SPORTS AND RECREATION FACILITIES :
(a) Playgrounds and games played :
(b) Gymnasium facilities and arrangement:
(c) Management :
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Form-MCI-12
Sports Officer/Physical instructor
N.C.C.
(a) Compulsory/Optional :
(b) Duration of Training :
(c) Training set up :
(d) Type of certificates :
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Form-MCI-12
TEACHING HOSPITAL (MAIN & SUBSIDIARY)
(a) Type of Management - Govt./Autonomous/Local body/Private Trust/Society
(b) Owner of the Hospital -
(c) Hospital is in possession of -
(d) Administrative set up -
(i) Particulars of Hospital/Hospitals :
……..……..……..……..……..……..……..……..……..……..……..……..……..……..……..……..……..…….Name of No. of No. of Name & Qualification Full time/Part timeHospital teaching special of Medical --------------------- -------------------
Beds wards Superintendent Teaching Non- Tel. No.
Beds/paid teaching O. / R. Fax No.
Beds.……..……..……..……..……..……..……..……..……..……..……..……..……..……..……..……..……..…….
……..……..……..……..……..……..……..……..……..……..……..……..……..……..……..……..……..…….
(ii) Medical Superintendent’s Office - Size
(iii) Principal/Dean’s Office in the Hospital - Size
(iv) Hospital Office space - Size
(v) Nursing Superintendent’s Office - Size (vi) Waiting space for visitors - Size
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Form-MCI-12
(vii) Enquiry/office – Size
(viii) Reception area – Size
(ix) Store rooms – No. & Size
(x) Central Medical Record Section - Size
(x) Linen rooms – No. & Size
(xi) Hospital & Staff Committee Room – Size
(e) Indoor Facilities (in each ward)Is there
(i) Nurses duty room available with each ward?(ii) Examination & Treatment Room(iii) Ward Pantry(iv) Store Room for linen & equipment(v) Resident doctor’s duty room(vi) Student’s duty room
DISTRIBUTION OF BEDS
(a) Medicine & allied No. of No. of Average bed
Specialties teaching units occupancy/dayBeds (percentage of
Teaching beds)
(i) Gen. Medicine(ii) Paediatrics(iii) Tuberculosis &
Respiratory Diseases(iv) Dermatology,
Venereology & Leprosy
(v) Psychiatry
Total
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Form-MCI-12
(b) Surgery & allied No. of No. of Average bedSpecialities teaching unitsoccupancy/day
Beds (percentage of Teaching beds)
(i) Gen. Surgeryincluding Pediatric Surgery
(ii) Orthopedics
(iii) Opthalmology
(iv) Oto-rhino-laryngology
Total
(c) Obstetrics & ANC No. of No. of Average bed
Gynecology teaching units occupancy/dayBeds (percentage of
Teaching beds)
GRAND TOTAL
ANNUAL BUDGET OF THE HOSPITAL(last 3 yrs) (I) (II) (III)
(a) Pay of Staff & establishment :
(b) Medicine & Stores :
(c) Diet :
(d) Non-recurring contingency :
CLINICAL MATERIAL (HOSPITAL WISE)(attach a separate sheet if needed)
Outdoor – Average Daily patient Attendance
(a) Old Patients (b) New Patients (c) Total
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Form-MCI-12
Indoor - (a) Annual admissions :_________________
(b) Average bed occupancy per day (percentage of teaching beds)
TEACHING/TRAINING FACILITIES (DEPARTMENT WISE)
(a) In O.P.D.(b) In Indoor
REGISTRATION, MEDICAL RECORDS & STATISTICS DEPARTMENT
(a) Central and/or Departments :
(i) For in-patients :
(ii) For O.P.D. :
(b) Staff :
Medical Record Officer :
Statistician :
Coding Clerk :
Record Clerk :
Daftry :
Peons :
Stenographer :
(c) System of Indexing :
Computerized :
Manual :
(d) Follow up service :
CENTRAL CASUALTY SERVICES
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Form-MCI-12
(a) Whether working : Yes No
(b) Accommodation for staff on duty :-
(a) Doctors
(b) Nurses
(c) Students
(d) Other paramedical staff
(c) No. of emergency beds in casualty
(d) Working arrangement of casualty services
(i) No. of casualty medical officers
(ii) Consultants services
(iii) Nature of services
(iv) Average daily attendance of patients
(e) Resuscitation services facilities :-
(i) Oxygen supply
(ii) Ventilation
(iii) Defibrillator
(v) Fully equipped disaster trolleys
(f) Facilities provided :-
(i) X-ray
(ii) Operation theatre
(iii) Laboratory facilities
(g) Ambulance service Yes/No Number
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Form-MCI-12
(h) Whether facilities for medico-legal examination exist or not?If yes, whether separate staff is posted or not.
(i) Posting of interns in casualty - Yes or NoIf yes, No. of days
CLINICAL LABORATORIES
No. Speciality
(a) Central
(b) Departmental
(c) Ward side Laboratory
(a) Total no. of investigations Bio Clinical Micro Any (Average daily) Chemistry Pathology Biology other
-----------------------------------------------------------------------------------------------------------
(i) O.P.D.
(ii) In-patients
-----------------------------------------------------------------------------------------------------------
(b) Staff & Supervision in each Laboratory
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Form-MCI-12
(i) Teaching Staff Number :
(ii) Non-teaching Staff Number :
(c) Equipment in each laboratory
OPERATION THEATRE UNIT
(1) Operation theatres -
(a) Number :
(b) Arrangement & Distribution :
(c) Equipment : (including Anesthesia equipment)
(d) Facilities available in each O.T. unit -
Present/Absent
(i) Waiting room for patients
(ii) Soiled Linen room
(iii) Sterilisation room
(iv) nurses duty room
(v) Surgeons & Anaesthetists room -
For Males
For Females
(vi) Assistants room
(vii) Observation gallery for students
(viii) Store room
(ix) Washing room for surgeons & Assistants
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Form-MCI-12
(x) Students washing up and dressing up room
(2) Arrangement of Anesthesia
(a) Pre-anaesthetic care :
(b) Nature of anesthesia used :
(c) Post-anesthetic care :
Pre-operative ward (no. of beds) :
Post-operative ward (no. of beds) :
Resuscitation facilities and special equipment :
If any super specialty exists :Give details
Intensive Care Area No. of Beds Specialized equipment’s in each
ICU/ICCU
I.C.U. of Burn Unit
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Form-MCI-12
Surgical intensive care area
No. of Beds Specialised equipments in each
Paediatrics Intensive Care area
ICU for others like Respiratory Diseases etc.
Labour Room
Clean with number of beds :
Septic with number of beds :
RADIOLOGICAL FACILITIES
(a) Radio Diagnosis
No. of rooms & their Size :
Machine Strength Fixed Mobile
(b) Workload per day Nos. per day
i. Screening
ii. Radiographics
iii. Special Radiographs
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Form-MCI-12
(for example, Barium and Dye studies)
iv. Ultrasonographs
v. C.T. Scans
vi. Any other like mammographs etc
(c) Protective Measures
Adequate per BARC specification
InadequatePHARMACY
Organization set up (a) Supervised by whom
Staff :
(b) Qualification of pharmacist Incharge :
(c) No. of other staff
(d) No. of prescription dispensed a day
(i) Wards
(ii) O.P.D.
CENTRAL STERLISATION SERVICES DEPARTMENT :
(a) Exclusive or with substeriliation centres also :
(b) Equipment scope and inservice arrangement :
(c) volume of work/day :
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Form-MCI-12
(d) Arrangement for sterlisation of mattresses & blankets :
(d) Staff available in CSSD :
Matron
Staff Nurses
Technical Assistants
Technicians
Ward boys
Sweepers
CENTRAL LAUNDRY :
(a) Equipment :
(i) Mechanised - Bulk washing machine, Hydroextractor, Flat & Rolley Steam Press.
(ii) Manual
(b) Volume of work/day :
(c) Staff available :
Supervisor :
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Form-MCI-12
Dhobi/Washermen/Women :
Packers :
KITCHEN
(a) Type : (i) Electrical :
(ii) L.P.G.
(iii) Coal/Wood(b) Nature of food supplied :
(c) Daily No. of meals :
(d) Percentage of patients provided with free diet :
(e) Per capita expenses/day :
CANTEEN
(a) Type of catering :
(b) Whether susidised ?
(c) For staff only or for others also :
INCINERATOR
(a) No. :
(b) Capacity :
(c) Type :
PARA MEDICAL/OTHER SERVICES STAFF IN THE WHOLE HOSPITAL
No. of posts sanctioned No. in position
Nursing Superintendent
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Form-MCI-12
Dy. Nursing Supdt.
Matron
Asstt. Nursing Supdt.
Nursing sisters
Staff Nurses
Lab. Technicians
Lab Assistants Lab Attendants
Ward boys
Ward Attendant
Safaiwala/Swepers
Any other Category
QUARTERS
Categories (a) Residents : Sanctioned No. No. provided with quarters
(b) House Staff : Sanctioned No. No. provided with quarters
Nursing Staff (i) Sisters : Sanctioned No. No. provided with quarters
(ii) Staff Nurses : Sanctioned No. No. provided with quarters
(iii) Pupil Nurses : Sanctioned No. No. of provided with quarters
Other Categories Staff
Percentage of staff provided with quarters
………………………………. Teaching
……………………………….. Non-teaching
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Form-MCI-12
INTERCOM AND PUBLIC ADDRESS SYSTEM IN THE HOSPITAL CAMPUS
Present/ Absent
Result of examination – given number and percentage of passes during proceeding years
YEAR YEAR YEARREGULAR SUPPLEMENTARY REGULAR SUPPLEMENTARY REGULAR SUPPLEMENTARY
NO. %AGE
NO. %AGE NO. %AGE NO. %AGE NO. %AGE NO. %AGE
(a) First Professional :
(b) Second Professional :
(c) Final Professional :
(a) Part I (b) Part II
_______________________________________________________________________________________________
PARTICULARS OF PRE-REGISTRATION INTERNSHIP :
(a) Period in each Department/discipline :
(b) Period of posting in a Rural Health Centre/PrimaryHealth Centre/Urban Health Centre
(c) Method of assessment (Please attach a copy of the log book/assessment sheet)
(d) Whether MBBS degree is conferred only after successful completion of 12 months compulsory rotating internship.
OTHER INFORMATION :
1. Yearly research publications by the teaching staff :
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Form-MCI-12
Ist Year IInd Year IIIrd Year
National journals (No.) ________International journals (No.) ___________(during the last 3 years)
Ist Year IInd Year IIIrd Year
2. National Seminars/Conferences conducted by the Institution in the last 3 years
3. National Awards/recognition received by the college Faculty :
4. Any associated Institutions/Training courses : Yes No.
5. If yes, No. of Admissions/Yrs.
(i) Dental
(ii) Nursing
(iii) Pharmacy
(iv) Physiotherapy
(v) Lab Technician
(vi) Any other
For the medical colleges which are running other courses as mentioned above besides the undergraduate courses leading to MBBS, they will be required to have extra staff, space, laboratories and equipment’s as per the norms laid down by the bodies governing such courses.
6. Total No. of PG students No. of students admittedAdmitted yearwise (in previous ------------------------------3 years) (please attach separate Ist Yr. IInd Yr. IIIrd Yr.statement) Dip./Degree Dip./Degree Dip./Degree
Subjects
(i)
(ii)
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Form-MCI-12
(iii)
(iv)
Date of Inspection Signature of Dean/Principal
OBSERVATIONS OF THE INSPECTORS/VISITORS
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Form-MCI-12
Signature of the Inspector/Visitor
33
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Form-MCI-12
(SIF B-1)
MEDICAL COUNCIL OF INDIA
STANDARD INSPECTION FORM
FORM – B
On the Facilities for teaching in the subject of
ANATOMY
For the Course of study leading up to M.B.B.S. Examination
Name of Institution ………..………..………..………..………………...………..
Place ………..………..………..………..………..………..………..………..………..
Affiliated to the University of …………………………………………………….
Name of the Head of the Department ………………………………………….
Signature of the Dean/Principal Signature of the (with seal) Head of the Department
(This form shall be first filled in by the Principal/Dean of the college in collaboration with the Head of the Department and handed over to the Inspector, who shall examine the information already furnished &
1
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Form-MCI-12
gather such additional information as may be necessary to fill in the spaces provided for within)
1. Date of Inspection/Visitation :
2. Names of Inspectors or Visitors :
3. Date of last Inspection/Visitation :
4. Names of last Inspectors/Visitors :
Defects pointed out in the last Inspection / To what extent remediedVisitation
2
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Form-MCI-12
Signature of Inspectors/Visitors
3
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A. Teaching Staff : In case this space is less a statement showing the following information may be attached in this format. (to be filled in by the Dean/Principal of the college).
Department of Anatomy
Post No. Name Qualification with dates thereof & Where obtained
Experience
As Demonstrator/Tutor As Asst. Professor/Lecturer
Date College
Univ. Instt. From
To Total Instt.
From To Total
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Professor
Associate/
Professor/
Reader
Asst. Prof.
/Lecturer
Demonstrato
r/Tutor
Any other
Category
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(cont.)
Post Experience Grand Total of Teaching Experience
Remarks if any,
As Assoc. Professor/Reader As Professor15 16 17 18 19 20 21 22 23 24
Professor Institution
From To Total Institution From To Total
Associate/Professor/
Reader
Asst. Prof. /Lecturer
Demonstrator/Tutor
Any other Category
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B. List of non-teaching staff :
Name(s) of staff members
a. Technical Assistant
b. Technicians
c. Modellers
d. Dissection Hall Attendants
e. Steno typist
f. Store Keeper – cum – clerk
g. Sweepers
h. Any other category
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C. Give the various sub-section in the Department, if any, like Gross Anatomy, Neuro-Anatomy, Embrology and Histology.
Is the teaching staff rotated in these sections and if so up to what level
D. BUILDINGS :
(j) Demonstration Room :
a) Number
b) Accommodation (of each demonstration room)
i) Size
ii) Capacity
c) Audio-visual equipment available.
ii) Departmental Library-cum-Seminar Room :
a) Is there a separate departmental library?
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b) Accommodation
i) Size :
ii) Capacity :
c) Number of books in Anatomy and allied subjects :
d) List of Journals :
(iii) Practical Laboratories :
A) Dissection Hall :
a) Accommodation :
i) Size :
ii) Capacity :
B) Number and arrangement of tables
i) Big :
ii) Small :
C) Hygiene and Drainage facilities for Disposal of Discarded parts. Is there a burial ground ?
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a) Washing arrangement :
b) No. of wash basins provided :
c) No. of lockers provided for students :
d) Light and exhaust arrangements :
e) Special Instruments other than routine Dissection sets, such as Electric saw etc. :
f) Extra Learning Aids provided in the Dissection Hall :(Skeleton, Charts, Black Board etc.)
g) Cadaver Preservation Facilities :
i) Embalming room
Size Location
ii) Storage Tanks
Number Size
iii) Cold room/cooling cabinets
Size Capacity
iv) No. of Cadavers available
v) No. of students allotted per cadaver
B) Histology Laboratory
a) Accommodation
Size Capacity
C) Working arrangement
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Seats available
Cupboard for storage of microscope slides etc.
Number of Microscopes with 1/3, 1/6, & 1/12 objectives
D) Number of students to each Microscope
E) Preparation room
Size
Location
F) Whether Laboratory Manuals kept by students?
Yes
No
G) Close circuit TV/Demonstration Microscope/any other teaching aids :
IV) Research Laboratory
a) Size
b) Equipment
c) Are there any students taken for M.S. or M.Sc. or Ph.D in Anatomy?
If so how many per year during the last three years?
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1) Diploma
2) Degree
d) List of publications by the members of the staff during the last 3 years?
e) Current problems on which research work is going on and by whom?
(a statement may be furnished)
f) Do Undergraduate students in any way participate in them ?
V) Museum :
a) Size :
b) How are the specimens arranged? :
c) Give Number of each :
(d) Coverage of various fields in Anatomy by Specimens
e) No. of catalogues of the specimens available to the students.
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f) Specimens in Embroyology, Neuro-Anatomy, Histology, Gross Anatomy :
g) Display of Microscopic sections of normal developing tissues – system wise.
h) Are the microscopic sections of the specimens available for study to the students.
i) Number of Microscope & X-ray view Boxes available to students in the Museum.
j) List of exhibits other than the specimens and their arrangement.
k) Radiological & specialized imaging exhibits :
Number
Type
l) Charts, Skeletons etc.
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m) Seating arrangement for students
Number
Type
n) Preparation and storage rooms
o) Attached rooms
(VI) OFFICE ACCOMMODATION
a) Professor and HOD :
b) Associate Professors/Readers :
c) Asst. Professors/Lecturers :
d) Tutors/Demonstrators :
e) Non-teaching and clerical staff :
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E) TEACHING PROGRAMME :(For duration of the entire course)
I. Curriculum of studies(To be filled by the Dean/Principal along with Head of the department). Curriculum in the subject as prescribed by MCI (a copy of the detailed curriculum along with the departmental and educational objectives of the subject may be appended).
Is the above curriculum followed in totality?
If not, what are the variations and reasons thereof?
(To be filled in by the Inspectors/Visitors). Does the curriculum of studies adopted by the training center differ materially from that recommended by the Medical Council of India.
If so what are the variations and what are your observations regarding them ?
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II. Methodology(for duration of the entire course)
Number
1) Didaetic Lectures
2) Demonstrations
3) Tutorials
4) Seminars conducted during the yearNumber of students attending each
5) Practical
6) Any other teaching/training activities :
7) Is there any integrated teaching?If yes, details thereof :
8) Records Methods of Assessment thereof :
(Time table of lectures, demonstrations, seminars, tutorials, practical and dissection may be given).
Signature of Head of the Department
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F. OBSERVATIONS OF THE INSPECTORS/VISITORS :
Signature of Inspectors/Visitors
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(SIF B-2)
MEDICAL COUNCIL OF INDIA
STANDARD INSPECTION FORM
FORM – B
On the Facilities for teaching in the subject of
PHYSIOLOGY INCLUDING BIO-PHYSICS
For the Course of study leading up to M.B.B.S. Examination
Name of Institution ……..………..………..………..………..………..………..
Place ………..………..………..………..………..………..………..………..………..
Affiliated to the University of …………………………………………………..
Name of the Head of the Department …………………………………………
Signature of the Dean/Principal Signature of the Head of the(with seal) Department
(This form shall be first filled in by the Principal/Dean of the college in collaboration with the Head of the Department and handed over to the Inspector, who shall examine the information already furnished &
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gather such additional information as may be necessary to fill in the spaces provided for within)
1. Date of Inspection/Visitation :
2. Names of Inspectors or Visitors :
3. Date of last Inspection/Visitation :
4. Names of last Inspectors/Visitors :
Defects pointed out in the last Inspection / To what extent remediedVisitation
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Signature of Inspectors/Visitors
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A. Teaching Staff : In case this space is less a statement showing the following information may be attached in this format. (to be filled in by the Dean/Principal of the college).
Department of Physiology including Bio-physics
Post No. Name Qualification with dates thereof & Where obtained
Experience
As Demonstrator/Tutor As Asst. Professor/Lecturer
Date College
Univ. Instt. From
To Total Instt.
From To Total
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Professor
Associate/Professor/
Reader
Asst. Prof. /Lecturer
Demonstrator/Tutor
Any other Category
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(cont.)
Post Experience Grand Total of Teaching Experience
Remarks if any,
As Assoc. Professor/Reader As Professor15 16 17 18 19 20 21 22 23 24
Professor Institution
From To Total Institution From To Total
Associate/Professor/
Reader
Asst.Prof. /Lecturer
Demonstrator/Tutor
Any other Category
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B. List of non-teaching staff :
Name (s) of staff members
a. Technical Assistant
b. Technicians
c. Store Keeper-cum-Clerk
d. Laboratory Attendance
e. Steno-typist
f. Sweepers
g. Any other category
C. Buildings :
(i) Demonstration Room :
a. Number
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b) Accommodation of each demonstration room :
Size
Capacity
c) Audio-Visual equipment available :
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(ii) Practical Laboratories :Amphibian Mammalian Hematology
Clinical Laboratory Laboratory Laboratory
Physiology
Laboratory
a) Accommodation
Size
Capacity
b) Working arrangement
Seats available
Water supply
Sinks
Electrical Points
Cupboard for storage of microscopes slides etc
c) Main Equipment available
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d) Number of Microscopes
e) No. of students to each microscope
f) Preparation room :
Size
Location
g) Whether Laboratory Manuals kept by students?
Yes
No
(h) Close circuit TV/demonstration Microscope/any other teaching aids.
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III) DEPARTMENTAL LIBRARY-CUM-SEMINAR ROOM :
a. Is there a separate departmental library?
b) Accommodation
Size
Capacity
c) Number of Books in Physiology including Biophysics :
d) List of Journals :
IV) RESEARCH LABORATORY :
a) Size
b) Equipment
c) Are there any students taken for M.D. or Ph.D. in Physiology Including Bio-physics?
If so, how many per year during the last three years.
1) Diploma
2) Degree
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d) List of publications by the members of the staff during the last 3 years ?
e) Current problems on which research work is going on and by whom?(a statement may be furnished)
f) Do Undergraduate students in any way participate in them?
V) OFFICE ACCOMMODATION
a) Professor and HOD :
b) Associate Professors/Readers :
c) Asst. Professors/Lecturers :
d) Tutors/Demonstrators :
e) Non-teaching and clerical staff :
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D. TEACHING PROGRAMME :(For duration of the entire course)
I. Curriculum of studies(To be filled by the Dean/Principal along with Head of the department). Curriculum in the subject as prescribed by MCI (a copy of the detailed curriculum along with the departmental and educational objectives of the subject may be appended).
Is the above curriculum followed in totality?
If not, what are the variations and reasons thereof?
(To be filled in by the Inspectors/Visitors). Does the curriculum of studies adopted by the training center differ materially from that recommended by the Medical Council of India.
If so what are the variations and what are your observations regarding them ?
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E. METHODOLOGY(for duration of the entire course)
Number1) Didaetic Lectures
2) Demonstrations
3) Tutorials
4) Seminars conducted during the year. (Number of students attending each)
5) Practicals
6) Any other teaching/training activities :
7) Is there any integrated teaching?If yes,
8) Records Methods of Assessment thereof :
(Time table of lectures, demonstrations, seminars, tutorials, practical and dissection may be given).
Signature of Head of the Department
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F. OBSERVATIONS OF THE INSPECTORS/VISITORS :
Signature of Inspectors/Visitors
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(SIF B-3)
MEDICAL COUNCIL OF INDIA
STANDARD INSPECTION FORM
FORM – B
On the Facilities for teaching in the subject of
BIOCHEMISTRY
For the Course of study leading up to M.B.B.S. Examination
Name of Institution ………..………..……….………..………..………..………..
Place ………..………..………..………..………..………..………..………..………..
Affiliated to the University of …………………………………………………..
Name of the Head of the Department …………………………………………
Signature of the Dean/Principal Signature of the (with seal) Head of the Department
(This form shall be first filled in by the Principal/Dean of the college in collaboration with the Head of the Department and handed over to the Inspector, who shall examine the information already furnished &
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gather such additional information as may be necessary to fill in the spaces provided for within)
1. Date of Inspection/Visitation :
2. Names of Inspectors or Visitors :
3. Date of last Inspection/Visitation :
4. Names of last Inspectors/Visitors :
Defects pointed out in the last Inspection / To what extent remediedVisitation
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Signature of Inspectors/Visitors
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A. Teaching Staff : In case this space is less a statement showing the following information may be attached in this format. (to be filled in by the Dean/Principal of the college).
Department of Biochemistry
Post No. Name Qualification with dates thereof & Where obtained
Experience
As Demonstrator/Tutor As Asst. Professor/Lecturer
Date College
Univ. Instt. From
To Total Instt.
From To Total
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Professor
Associate/Professor/
Reader
Asst. prof. /Lecturer
Demonstrator/Tutor
Any other Category
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(cont.)
Post Experience Grand Total of Teaching Experience
Remarks if any,
As Assoc. Professor/Reader As Professor15 16 17 18 19 20 21 22 23 24
Professor Institution
From To Total Institution From To Total
Associate/Professor/
Reader
Asst. prof. /Lecturer
Demonstrator/Tutor
Any other Category
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B. LIST OF NON-TEACHING STAFF :Name (s) of staff members
a. Technical Assistant
b. Technicians
c. Store Keeper-cum-Clerk
d. Laboratory Attendance
e. Sweepers
f. Any other category
C. BUILDINGS :
(i) Demonstration Room :
a) Number
b) Accommodation
Size
Capacity
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c) Audio-Visual equipment available :
II) PRACTICAL CLASS ROOM/LABORATORIES :
a) Accommodation Size Capacity
b) Working arrangement Seats available Water supply Sinks Electric points Cupboard for storage of microscopes
c) Preparation room Size Capacity
d) Whether laboratory manual kept by students? Yes No
e) Close circuit T.V./Any other teaching aids.
III) DEPARTMENTAL LIBRARY-CUM-SEMINAR ROOM : a) Is there a separate departmental library?
b) Accommodation Size Capacity
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c) Number of Books in Biochemistry and allied subjects.
d) List of Journals
(IV) RESEARCH LABORATORIES
a) Size
b) Equipment
c) Are there any students taken for M.D. or M.Sc. or Ph.D. in Biochemistry?
If so how many per year during the last three years.
1) Diploma
2) Degree
d) List of publications by the members of the staff during the last 3 years.
e) Current problems in which research work is going on and by whom? (a statement may be furnished)
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f) Do Undergraduate students in any way participate in them?
(V) OFFICE ACCOMMODATION
a) Professor and HOD :
b) Associate Professors/Readers :
c) Asst. Professors/Lecturers :
d) Tutors/Demonstrators :
e) Non-teaching and clerical staff :
D. TEACHING PROGRAMME :(For duration of the entire course)
I. Curriculum of studies(To be filled by the Dean/Principal along with Head of the department). Curriculum in the subject as prescribed by MCI (a copy of the detailed curriculum along with the departmental and educational objectives of the subject may be appended).
Is the above curriculum followed in totality?
![Page 76: Standard Insp. Form-ug](https://reader033.fdocument.pub/reader033/viewer/2022061120/546cd609b4af9f19438b458a/html5/thumbnails/76.jpg)
If not, what are the variations and reasons thereof?
(To be filled in by the Inspectors/Visitors). Does the curriculum of studies adopted by the training center differ materially from that recommended by the Medical Council of India.
If so what are the variations and what are your observations regarding them ?
II. METHODOLOGY(for duration of the entire course)
Number1) Didactic Lectures
2) Demonstrations
3) Tutorials
4) Seminars conducted during the year. (Number of students attending each)
![Page 77: Standard Insp. Form-ug](https://reader033.fdocument.pub/reader033/viewer/2022061120/546cd609b4af9f19438b458a/html5/thumbnails/77.jpg)
5) Practical
6) Any other teaching/training activities :
7) Is there any integrated teaching?If yes,
8) Records Methods of Assessment thereof :
(Time table of lectures, demonstrations, seminars, tutorials, practical and dissection may be given).
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E. SERVICE LABORATORY IN THE TEACHING HOSPITAL/COLLEGE :
a) Is there separate biochemistry laboratory in the hospital?
Yes No
b) If yes, control and supervision
i) Whether departmental (college)
ii) Under Medical Superintendent (Hospital)
iii) If departmental, method of posting and rotation of medical & non-medical staff
c) Size of the laboratory :
d) Investigative equipment available (Attach list)
e) Staff Names Qualifications Designation
1. Medical
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Names Qualifications Designation
2. Non-Medical
f) Report giving details of work done during the last 1 year to be attached :
g) Are the students (UG/PG) posted in the hospital laboratory?
Yes
No
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F. IS THERE ANY EMERGENCY HOSPITAL BIOCHEMISTRY SERVICE
If so give details of
a) Staff employed
b) Average no. of tests done during one month (in emergency laboratory)
c) Is a record of these test maintained
Signature of Head of the Department
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G. OBSERVATIONS OF THE INSPECTORS/VISITORS :
Signature of Inspectors/Visitors
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(SIF B-4)
MEDICAL COUNCIL OF INDIA
STANDARD INSPECTION FORM
FORM – B
On the Facilities for teaching in the subject of
PATHOLOGY
For the Course of study leading up to M.B.B.S. Examination
Name of Institution ………..………..……….………..………..………..………..
Place ………..………..………..………..………..………..………..………..………..
Affiliated to the University of …………………………………………………..
Name of the Head of the Department …………………………………………
Signature of the Dean/Principal Signature of the (with seal) Head of the Department
(This form shall be first filled in by the Principal/Dean of the college in collaboration with the Head of the Department and handed over to the Inspector, who shall examine the information already furnished &
![Page 83: Standard Insp. Form-ug](https://reader033.fdocument.pub/reader033/viewer/2022061120/546cd609b4af9f19438b458a/html5/thumbnails/83.jpg)
gather such additional information as may be necessary to fill in the spaces provided for within)
1. Date of Inspection/Visitation :
2. Names of Inspectors or Visitors :
3. Date of last Inspection/Visitation :
4. Names of last Inspectors/Visitors :
Defects pointed out in the last Inspection / To what extent remediedVisitation
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Signature of Inspectors/Visitors
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A. Teaching Staff : In case this space is less a statement showing the following information may be attached in this format. (to be filled in by the Dean/Principal of the college).
Department of Pathology
Post No. Name Qualification with dates thereof & Where obtained
Experience
As Demonstrator/Tutor/Sr. Res./Registrar
As Asst. Professor/Lecturer
Date College
Univ. Instt. From
To Total Instt.
From To Total
1 2 3 4 5 6 7 8 9 10 11 12 13 14
ProfessorAssociate Professor/
ReaderAsst. Prof. /LecturerRegistrar/
Sr. Resident/Demonstra-tor/Tuto
rAny other
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Category
(cont.)
Post Experience Grand Total of Teaching Experience
Remarks if any,
As Assoc. Professor/Reader As Professor15 16 17 18 19 20 21 22 23 24
Professor Institution
From To Total Institution From To Total
Associate Professor/Rea
der
Asst. Prof. /Lecturer
Registrar/ Sr. Resident/Demonstrator
/TutorAny other Category
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B. LIST OF NON-TEACHING STAFF :Name (s) of staff members
a. Artist
b. Technical Assistant
c. Technicians
d. Laboratory Attendants
e. Steno-typist
f. Clerk
g. Store Keeper
h. Record Clerk
i. Sweepers
j. Any other category
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C. Give the various sub-section in the department like Morbid Anatomy, Hostopathology, Cytopathology, Clinical Pathology/Haematology and any other specialized section.
Is the teaching staff rotated in these sections?
If so, upto what level?
D. BUILDINGS :
(I) Demonstration Room :
a) Number
b) Accommodation
Size Capacity
c) Audio-Visual equipment available
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(ii) PRACTICAL LABORATORIES :Morbid/ Histo-/ Cyto-/ Clinical/ HaematologyAnatomy Pathology Pathology Pathology
________________________________________________________________________________________________________
a) Accommodation
Size
Capacity
b) Working arrangement
Seats available
Water supply
Sinks
Electrical Points
Cupboard for storage of microscopes slides etc
c) Main Equipment available
d) Number of Microscopes
e) No. of students to each microscope :
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f) Preparation room :
Size Location
g) Whether Laboratory Manuals kept by students?
Yes No
h) Close circuit TV/demonstration Microscope/any other teaching aids.
iii) Service Laboratory in the teaching hospital/college :
Histopathology Cytopathology Haematology Any other
Specialized Section like immunology
a) Are there separate service laboratories?
Yes No
b) If yes, control and supervision :
i) Whether departmental (college)
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ii) Under Medical Superintendent (Hospital)
iii) If departmental, method of posting and rotation of medical & non-medical staff :
c) Size of laboratory
d) Investigate equipment available (Attach list)
e) Staff Name(s) Qualifications Designation
1. Medical
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Name(s) Qualifications Designation
2. Non medical
f) Report giving details of work done in each service laboratory separatelyduring the last 1 year (to be attached).
g) Are the students (UG/PG) posted in the hospital laboratory.
Yes No
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(iv) Is there any emergency hospital Pathology service?If so give details of –a) Staff employed
b) Average no. of tests done during one month in emergency hospital pathology laboratory.
c) Is a record of these tests maintained.
V) Is there a separate
a) Balance room
Yes
No
b) Store room
Yes
No
c) High speed centrifuge room
Yes
No
VI) MUSEUM :
a) Size
b) How are specimens arranged ?
c) Give number of each :
Mounted
Unmounted
d) Are the microscopic section of
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Specimens available for study tothe students?
If so, in the museum or in some other room
e) No. of microscope available to the students in the museum.
f) List of charts, photographs, models and other exhibits other than the specimens and their arrangements.
g) No. of catalogues of the specimens available to the students.
h) seating arrangement for students –
Type
Number
i) Ante-room
Yes
No
VII) AUTOPSY BLOCK
a) distance from the department
b) size
c) student observation facilities
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1. level type2. gallery type3. capacity
d) No. of autopsy tables available :
e) Light, ventilation and exhaust arrangements:
f) Water supply, drainage, washing arrangements & disposal of waste.
g) Fly proofing
h) cold room/cooling cabinets :
1. size2. Capacity
i) Equipment’s
j) No. of pathological autopsies 1st year 2nd Year 3rd Year Per year for the last 3 years :
k) Is there an emergency autopsy service?
l) How are the autopsy reports maintained in the department?
m) Do undergraduate students in any way participate in the conduction of autopsies?
n) Ante-room
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Yes
No
o) Waiting hall and office
VIII) DEPARTMENTAL LIBRARY-CUM-SEMINAR ROOM :
a) Is there a separate departmental library?
b) Accommodation
Size
Capacity
c) Number of books in Pathology and allied subjects.
d) List of Journals
IX) RESEARCH LABORATORY :
a) Size
b) Equipment
c) Are there any students taken for Diploma in Pathology, M.D. or Ph.D. in Pathology?
If so, how many per year during the last three years.
1) Diploma
2) Degree
d) List of publications by the members of the staff during the last 3 years
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e) Current problems on which research work is going on and by whom?(a statement may be furnished )
f) Do Undergraduate students in any way participate in them?
X) OFFICE ACCOMMODATION
a) Professor & H.O.D.
b) Associate Professor/Reader
c) Asst. Professor/Lecturers
d) Tutors/Demonstrators
e) Non-teaching and Clerical Staff
X) BLOOD BANK
a) Is there any blood bank in the hospital?
Yes
No
b) If yes, is it approved and licensed by competent authority?
Please mention the validation period of the license :
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c) Is it air-conditioned
No Partly Completely
d) Control of Blood Bank
i) Is it under the department of pathology?
ii) Is it under the Medical Superintendent?
e) If departmental – method of posting and rotation of Medical and non-medical staff.
f) Number of issued units of blood per month :
g) Number of donors blood per month
h) Staff – details of both medical and non-medical.
i) List the number of tests done in the blood bank Hepatitis –B, Hepatitis –C, Syphilis, Malaria, Rh-testing, HIV, blood grouping etc. (Report giving details of work done during the last 1 year to be attached).
E) TEACHING PROGRAMME :(For duration of the entire course)
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I. Curriculum of studies(To be filled by the Dean/Principal along with Head of the department). Curriculum in the subject as prescribed by MCI (a copy of the detailed curriculum along with the departmental and educational objectives of the subject may be appended).
Is the above curriculum followed in totality?
If not, what are the variations and reasons thereof?
(To be filled in by the Inspectors/Visitors). Does the curriculum of studies adopted by the training center differ materially from that recommended by the Medical Council of India.
If so what are the variations and what are your observations regarding them ?
II. Methodology(for duration of the entire course)
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Number1) Didaetic Lectures
2) Demonstrations
3) Tutorials
4) Seminars conducted during the year. (Number of students attending each)
5) Practicals
6) Any other teaching/training activities :
7) Is there any integrated teaching?If yes, details thereof.
8) Records Methods of Assessment thereof :
(Time table of lectures, demonstrations, seminars, tutorials, practical and dissection may be given).
Signature of Head of the Department
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F. OBSERVATIONS OF THE INSPECTORS/VISITORS :
Signature of Inspectors/Visitors
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(SIF B-5)
MEDICAL COUNCIL OF INDIA
STANDARD INSPECTION FORM
FORM – B
On the Facilities for teaching in the subject of
MICROBIOLOGY
For the Course of study leading up to M.B.B.S. Examination
Name of Institution ……..………..………..………..………..………..………..
Place ………..………..………..………..………..………..………..………..………..
Affiliated to the University of …………………………………………………..
Name of the Head of the Department …………………………………………
Signature of the Dean/Principal Signature of the (with seal) Head of the Department
(This form shall be first filled in by the Principal/Dean of the college in collaboration with the Head of the Department and handed over to the Inspector, who shall examine the information already furnished & gather such additional information as may be necessary to fill in the spaces provided for within)
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1. Date of Inspection/Visitation :
2. Names of Inspectors or Visitors :
3. Date of last Inspection/Visitation :
4. Names of last Inspectors/Visitors :
Defects pointed out in the last Inspection / To what extent remediedVisitation
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Signature of Inspectors/Visitors
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A. Teaching Staff : In case this space is less a statement showing the following information may be attached in this format. (to be filled in by the Dean/Principal of the college).
Department of Microbiology
Post No. Name Qualification with dates thereof & Where obtained
Experience
As Demonstrator/Tutor As Asst. Professor/Lecturer
Date College
Univ. Instt. From
To Total Instt.
From To Total
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Professor
Associate Professor/
ReaderAsst. Prof. /LecturerDemonstrator/TutorAny other Category
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(cont.)
Post Experience Grand Total of Teaching Experience
Remarks if any,
As Assoc. Professor/Reader As Professor15 16 17 18 19 20 21 22 23 24
Professor Institution
From To Total Institution From To Total
Associate Professor/Rea
der
Asst. prof. /Lecturer
Demonstrator/Tutor
Any other Category
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B. List of non-teaching staff :Name (s) of staff members
a. Technical Assistant
b. Technicians
c. Laboratory Attendance
d. Store keeper
e. Record clerk
f. Steno-typist
g. Sweepers
h. Any other category
C. Buildings :
(i) Demonstration Room :
a) Number
b) Accommodation
Size
Capacity
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c) Audio-Visual equipment available :
ii) Practical laboratories:a) Accommodation
Size Capacity
b) Working arrangement Seats available Water supply Sinks Electric points Cupboard for storage of microscopes
c) Main equipment’s available
d) Number of Microscopes
e) Number of students to each microscopes
f) preparation room Size Location
g) Whether laboratory manual kept by students? Yes No
h) Close circuit T.V./any other teaching aids.
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iii) SERVICE LABORATORY IN THE TEACHING HOSPITAL/COLLEGE :
BacteriologySerology Virology Para-Serology Mycology Tuber- Immuno Any Including culosis logy otherAnaerobic
a) Are there separate Service Laboratories
Yes No
b) If yes, control and supervision :
i) Whether departmental (college)
ii) Under Medial Superintendent (Hospital)
iii) If departmental, method of Posting and rotation ofMedical & non-medical Staff
e) Size of the laboratory
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c) Investigative equipment available(Attach list)
e) Staff Names Qualifications Designation
1. Medical
Non-Medical
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Name(s) Qualifications Designation
f) Report giving details of work done during the last 1 year to be attached.
g) Are the students (UG/PG) posted in the hospital laboratory.
Yes
No
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IV) Is there any emergency hospital microbiology service.
If so give details of –
a) Staff employed
b) Average no. of tests done during oneMonth in the emergency hospitalMicrobiology laboratory.
c) Is a record of these test maintained
V) a. Is there a separate media preparation and storage area?
Yes Size
No
b. Autoclaving room
Yes Size
No
c. Washing and drying room
Yes
(VI) Departmental Library-cum-Seminar Room :
a) Is there a separate departmental Library-cum-Seminar room?
b) Accommodation
Size
Capacity
c) Number of Books in Microbiology and allied subjects.
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d) List of Journals
VI) RESEARCH LABORATORIES :
a) Size
b) Equipment
c) Are there any students taken for M.D. or M.Sc. or Ph.D. in Microbiology?
If so how many per year during the last three years.
1) Diploma
2) Degree
d) List of publications by the members of the staff during the last 3 years.
e) Current problems on which research work is going on and by whom?(a statement may be furnished)
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f) Do Undergraduate students in any way participate in them?
(VII) OFFICE ACCOMMODATION
a) Professor and H.O.D.
b) Associate Professor/Reader
c) Asst. Professor/Lecturers
d) Tutors/Demonstrators.
e) Non-teaching and Clerical staff
D. TEACHING PROGRAMME.(for duration of the entire course)
I. Curriculum of studies(To be filled by the Dean/Principal along with the Head of department). Curriculum in the subject as prescribed by MCI (A copy of detailed curriculum along with the departmental and educational objectives of the subject may be appended).
Is the above curriculum followed in totality?
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If not, what are the variations and reasons thereof?
(To be filled in by the Inspectors/Visitors). Does the curriculum of studies adopted by the training center differ materially from that recommended by the Medical Council of India.
If so what are the variations and what are your observations regarding them ?
II. Methodology(for duration of the entire course)
Number1) Didactic Lectures
2) Demonstrations
3) Tutorials
4) Seminars conducted during the year. (Number of students attending each)
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5) Practicals
6) Any other teaching/training activities:
7) Is there any integrated teaching?If yes,
8) Records Methods of Assessment thereof :
(Time table of lectures, demonstrations, seminars, tutorials, practical and dissection may be given).
Signature of Head of the Department
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F. OBSERVATIONS OF THE INSPECTORS/VISITORS :
Signature of Inspectors/Visitors
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(SIF B-6)
MEDICAL COUNCIL OF INDIA
STANDARD INSPECTION FORM
FORM – B
On the Facilities for teaching in the subject of
PHARMACOLOGY
For the Course of study leading up to M.B.B.S. Examination
Name of Institution ………..………..……….………..………..………..………..
Place ………..………..………..………..………..………..………..………..………..
Affiliated to the University of …………………………………………………..
Name of the Head of the Department ………………………………………..
Signature of the Dean/Principal Signature of the (with seal) Head of the Department
(This form shall be first filled in by the Principal/Dean of the college in collaboration with the Head of the Department and handed over to the Inspector, who shall examine the information already furnished &
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gather such additional information as may be necessary to fill in the spaces provided for within)
1. Date of Inspection/Visitation :
2. Names of Inspectors or Visitors :
3. Date of last Inspection/Visitation :
4. Names of last Inspectors/Visitors :
Defects pointed out in the last Inspection / To what extent remediedVisitation
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Signature of Inspectors/Visitors
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A. Teaching Staff : In case this space is less a statement showing the following information may be attached in this format. (to be filled in by the Dean/Principal of the college).
Department of Pharmacology
Post No. Name Qualification with dates thereof & Where obtained
Experience
As Demonstrator/Tutor As Asst. Professor/Lecturer
Date College
Univ. Instt. From
To Total Instt.
From To Total
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Professor
Associate Professor/
ReaderAsst. Prof. /Lecturer
Demonstrator/Tutor
Any other Category
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(cont.)
Post Experience Grand Total of Teaching Experience
Remarks if any,
As Assoc. Professor/Reader As Professor15 16 17 18 19 20 21 22 23 24
Professor Institution
From To Total Institution From To Total
Associate Professor/Rea
der
Asst. prof. /Lecturer
Demonstrator/Tutor
Any other Category
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B. List of non-teaching staff :Name (s) of staff members
a. Pharmaceutical Chemist
b. Technical Assistant
c. Technicians
d. Store keeper-cum-clerk
e. Steno-typist
f. Laboratory Attendants
g. Sweepers
h. Any other category
C. Buildings :
(i) Demonstration Room :
a) Number
b) Accommodation
Size
Capacity
c) Audio-Visual equipment available :
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(ii) PRACTICAL LABORATORIES :
Experimental Pharmacology Clinical Pharmacology & Pharmacy
a) Accommodation Size Capacity
b) Working arrangement
Seats available
c) Main Equipment available
d) Ante-room/preparation room
Size Location
e) Whether Laboratory Manuals Kept by students?
Yes No
f) Close circuits TV/any other teaching aids
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(iii) Museum :
a) Size :
b) How are the drug sample
arranged?
c) Number of catalogues of the samples available to the students :
d) Total number of drug samples :
e) List of charts, photograph and other exhibits and their arrangement
f) Is there any section depicting “History of Medicine”?
IV) Departmental Library-cum-Seminar Room :
a) Is there a separate departmental library?
b) Accommodation
Size
Capacity
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c) Number of Books in Pharmacology?
d) List of Journals
(VI) Research Laboratory :
a) Size
b) Equipment
c) Are there any students taken for M.D. or Ph.D. in Pharmacology?
If so how many per year during the last three years.
1) Diploma
2) Degree
d) List of publications by the members of the staff during the last 3 years?
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e) Current problems on which research work is going on and by whom?(a statement may be furnished)
f) Do Undergraduate students in any way participate in them?
(VII) OFFICE ACCOMMODATION
a) Professor and HOD :
b) Associate Professors/Readers :
c) Asst. Professors/Lecturers :
d) Tutors/Demonstrators :
e) Non-teaching and clerical staff :
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D. TEACHING PROGRAMME :(For duration of the entire course)
I. Curriculum of studies(To be filled by the Dean/Principal along with Head of the department). Curriculum in the subject as prescribed by MCI (a copy of the detailed curriculum along with the departmental and educational objectives of the subject may be appended).
Is the above curriculum followed in totality?
If not, what are the variations and reasons thereof?
(To be filled in by the Inspectors/Visitors). Does the curriculum of studies adopted by the training center differ materially from that recommended by the Medical Council of India.
If so what are the variations and what are your observations regarding them ?
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II. Methodology(for duration of the entire course)
Number1) Didaetic Lectures
2) Demonstrations
3) Tutorials
4) Seminars - conducted during the year. - Number of students attending each
5) Practicals
6) Any other teaching/training activities :
7) Is there any integrated teaching?If yes,
8) Records Methods of Assessment thereof :
(Time table of lectures, demonstrations, seminars, tutorials, practical and dissection may be given).
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Signature of Head of the Department
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F. OBSERVATIONS OF THE INSPECTORS/VISITORS :
Signature of Inspectors/Visitors
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(SIF B-7)
MEDICAL COUNCIL OF INDIA
STANDARD INSPECTION FORM
FORM – B
On the Facilities for teaching in the subject of
FORENSIC MEDICINE
For the Course of study leading up to M.B.B.S. Examination
Name of Institution ………..………..……….………..………..………..………..
Place ………..………..………..………..………..………..………..………..………..
Affiliated to the University of …………………………………………………..
Name of the Head of the Department ………………………………………..
Signature of the Dean/Principal Signature of the (with seal) Head of the Department
(This form shall be first filled in by the Principal/Dean of the college in collaboration with the Head of the Department and handed over to the Inspector, who shall examine the information already furnished &
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gather such additional information as may be necessary to fill in the spaces provided for within)
1. Date of Inspection/Visitation :
2. Names of Inspectors or Visitors :
3. Date of last Inspection/Visitation :
4. Names of last Inspectors/Visitors :
Defects pointed out in the last Inspection / To what extent remediedVisitation
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Signature of Inspectors/Visitors
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A. Teaching Staff : In case this space is less a statement showing the following information may be attached in this format. (to be filled in by the Dean/Principal of the college).
Department of Forensic Medicine
Post No. Name Qualification with dates thereof & Where obtained
Experience
As Demonstrator/Tutor As Asst. Professor/Lecturer
Date College
Univ. Instt. From
To Total Instt.
From To Total
1 2 3 4 5 6 7 8 9 10 11 12 13 14
ProfessorAssociate Professor/
ReaderAsst. Prof. /LecturerDemonstrator/TutorAny other Category
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(cont.)
Post Experience Grand Total of Teaching Experience
Remarks if any,
As Assoc. Professor/Reader As Professor15 16 17 18 19 20 21 22 23 24
Professor Institution
From To Total Institution From To Total
Associate Professor/Rea
der
Asst. Prof. /Lecturer
Demonstrator/Tutor
Any other Category
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B. List of non-teaching staff :Name (s) of staff members
a.. Technical Assistant
b. Technicians
c. Laboratory Attendants
d. Steno-typist
e. Store keeper-cum-clerk
f. Sweepers
g. Any other category
C. Buildings :
(i) Demonstration Room :
a) Number
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b) Accommodation
Size
Capacity
c) Audio-Visual equipment available :
Video Camera, TV & VCR etc.
ii) Museum :
a) Size
b) How are specimens arranged ?
c) Give number of each :
Mounted
Unmounted
d) Proto-type fire and other arms.
e) Wax Models
f) Poisons
g) List of charts, photographs, models and other exhibits other than the specimens and their arrangements.
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h) No. of catalogues of the specimens available to the students.
i) seating arrangement for students –
Type
Number
(iii) Department of Radiology
a. Do adequate facilities exist for taking skiagrams of living and dead persons.
b. Do adequate facilities in the department of Biochemistry, Histopathology, Bacteriology & Serology exist for Undertaking the examination of medico-legal materials?
(IV) Casualty Department :
a) Accommodation
b) Are the facilities for reception, Examination, treatment of medico-legal emergencies and cases of poisoning adequate?
c) The number of cases of medico-legal Trauma, Sexual assault, age
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and poisoning etc. dealt by the casualty department during the last one year may be indicated.
(V) Mortuary Block
a) Distance from the department
b) Size
c) student observation facilities
1. level type
2. gallery type
3. capacity
d) No. of autopsy tables available :
e) light, ventilation and exhaust arrangements :
f) Water supply, drainage, washing arrangements & disposal of waste.
g) Fly proofing
h) Cold room/cooling cabinets:
1. Size
2. Capacity
i) Equipment’s
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j) No. of medico – legal 1st year 2nd year 3rd yearpostmortems done during the last 3 years :
k) No. of students attending one postmortem
l) No. of postmortem done bya students during the course
n) Whether record of postmortem Cases kept by students?
(VI) Laboratory :
a) Accommodation
Size
Capacity
b) Working arrangement
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Seats available
Water supply
Sinks
c) Main equipment available
d) Number of Microscopes
e) Any other teaching aids
(VII) Departmental Library-cum-Seminar Room :
a) Is there separate departmental library?
b) Accommodation
i) Size :
ii) Capacity :
c) Number of books in Anatomy and allied subjects :
d) List of Journals :
(VIII) Research Laboratory
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a) Size
b) Equipment
c) Are there any students taken for D.F.M./M.D. or Ph.D. in Forensic Medicine?
If so how many per year during the last three years?
1) Diploma
2) Degree
d) List of publications by the members of the staff during the last 3 years?
e) Current problems on which research work is going on and by whom?
(a statement may be furnished)
f) Do Undergraduate students in any way participate in them ?
IX) OFFICE ACCOMMODATION
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a) Professor and HOD :
b) Associate Professors/Readers :
c) Asst. Professors/Lecturers :
d) Tutors/Demonstrators :
e) Non-teaching and clerical staff :
D) TEACHING PROGRAMME :(For duration of the entire course)
1. Curriculum of studies(To be filled by the Dean/Principal along with Head of the department). Curriculum in the subject as prescribed by MCI (a copy of the detailed curriculum along with the departmental and educational objectives of the subject may be appended).
Is the above curriculum followed in totality?
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If not, what are the variations and reasons thereof?
(To be filled in by the Inspectors/Visitors). Does the curriculum of studies adopted by the training center differ materially from that recommended by the Medical Council of India.
If so what are the variations and what are your observations regarding them ?
II. Methodology(for duration of the entire course)
Number1) Didactic Lectures
2) Demonstrations
3) Tutorials
4) Seminars conducted during the year. (Number of students attending each)
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5) Practicals
6) Any other teaching/training activities :
7) Is there any integrated teaching?If yes, details thereof.
8) Records Methods of Assessment thereof :
(Time table of lectures, demonstrations, seminars, tutorials, practical and dissection may be given).
Signature of Head of the Department
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E. OBSERVATIONS OF THE INSPECTORS/VISITORS :
Signature of Inspectors/Visitors
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(SIF B-8)
MEDICAL COUNCIL OF INDIA
STANDARD INSPECTION FORM
FORM – B
On the Facilities for teaching in the subject of
COMMUNITY MEDICINE/PREVENTIVE AND SOCIAL MEDICINE
For the Course of study leading up to M.B.B.S. Examination
Name of Institution ………..………..………..……….………..………..………..
Place ………..………..………..………..………..………..………..………..………..
Affiliated to the University of …………………………………………………..
Name of the Head of the Department …………………………………………
Signature of the Dean/Principal Signature of the (with seal) Head of the Department
(This form shall be first filled in by the Principal/Dean of the college in collaboration with the Head of the Department and handed over to the Inspector, who shall examine the information already furnished &
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gather such additional information as may be necessary to fill in the spaces provided for within)
1. Date of Inspection/Visitation :
2. Names of Inspectors or Visitors :
3. Date of last Inspection/Visitation :
4. Names of last Inspectors/Visitors :
Defects pointed out in the last Inspection / To what extent remediedVisitation
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Signature of Inspectors/Visitors
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A. Teaching Staff : In case this space is less a statement showing the following information may be attached in this format. (to be filled in by the Dean/Principal of the college).
Department of Community Medicine/Preventive and Social Medicine
Post No. Name Qualification with dates thereof & Where obtained
Experience
As Demonstrator/Tutor/Sr. Res./Registrar
As Asst. Professor/Lecturer
Date College
Univ. Instt. From
To Total Instt.
From To Total
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Professor
Associate/Professor/
ReaderAsst.Prof. /Lecturer
Registrar/Sr. Resident/Demonstrato
r/TutorAny other Category
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(cont.)
Post Experience Grand Total of Teaching Experience
Remarks if any,
As Assoc. Professor/Reader As Professor15 16 17 18 19 20 21 22 23 24
Professor Institution
From To Total Institution From To Total
Associate Professor/Rea
der
Asst. Prof. /Lecturer
Registrar/Sr. Resident/Demonstrator
/TutorAny other Category
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B. List of non-teaching staff :Name (s) of staff members
a. Medical Social Worker
b. Technical Assistant
c. Technicians
d. Stenographer
e. Record Clerk
f. Storekeeper
g. Sweepers
h. Any other category
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C. STAFF FOR RURAL TRAINING HEALTH CENTRE :(including field work and epidemiological studies)
Name(s) of staff members
a. Medical Officer of Health –cum-Lecturer/Assistant Professor
b. Lady Medical officer
c. Medical Social Worker
d. Public Health Nurse
e. Health Inspectors
f. Health Educators
g. Technical Assistant
h. Technician
i. Peon
j. Van-driver
k. Store keeper
l. Record Clerk
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m. Sweeper
n. Any other category
D.) STAFF FOR UBRAN TRAINING HEALTH CENTRE (Including field work and epidemiological studies.)
Name(s) of staff members
a. Medical Officer of Health –cum-Lecturer/Assistant Professor
b. Lady Medical officer
c. Medical Social Worker
d. Public Health Nurse
e. Health Inspectors
f. Health Educators
g. Technical Assistant
h. Technician
i. Peon
j. Van-driver
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k. Store keeper
l. Record Clerk
m. Sweeper
n. Any other category
E. BUILDINGS :
(j) Demonstration Room :
a) Number
b) Accommodation (of each demonstration room)
i) Size
ii) Capacity
c) Audio-visual equipment available.
(ii) Laboratory :
a) Accommodation
Size
Capacity
b) Working arrangement
Seats available
Water supply
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Sinks
Electric points
Cupboard for storage of microscope, slides etc
c) Number of Microscopes
d) Whether Laboratory Manuals kept by students?
Yes
No
d) Close circuit TV/any other teaching aids.
(iii) Museum :
a) Size :
b) How are the specimens arranged?:
c) Give Number of each :
d) Coverage of various fields in Community Medicine by charts, Models etc.
e) No. of catalogues of the specimens available to the students.
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f) List of exhibits, Charts, Photographs & other materials and their arrangement.
g) Seating arrangement for students
Type
Number
(IV) Departmental Library-cum-Seminar Room :
a) Is there a separate departmental library?
b) Accommodation
i) Size
ii) Capacity
c) Number of Books in Community Medicine and allied subjects.
d) List of journals
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(V) Research Laboratory :
a) Size
b) Equipment
c) Are there any students taken for DPH/M.D./Ph.D. in Community Medicine?
If so how many per year during the last three years?
1) Diploma
2) Degree
d) List of publications by the members of the staff during the last 3 years?
e) Current problems on which research work is going on and by whom?(a statement may be furnished)
f) Do Undergraduate students in any way participate in them ?
VI) OFFICE ACCOMMODATION
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a) Professor and HOD :b) Associate Professors/Readers :
c) Asst. Professors/Lecturers :
d) Statistician-cum-Lecturer :
e) Epidemiologist-cum-Lecturer :
f) Tutors/Demonstrators/Sr. Residents:
g) Departmental Office-cum-Clerical room :
h) Non-teaching staff :
(vii) HEALTH CENTRES (Rural and Urban)
R.H.C./P.H.C. URBAN-------------------- HEALTH
CENTRE I II III
a) Names of the Centers :
b) Location of each Center :
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c) Population covered by each center :
d) Distance from the college :
e) Transport facilities for :
1. Students & Interns
Staff
Supportive Staff
2. (i) Number of Vehicles
(ii) Capacity of each Vehicle
3. Control of Vehicles
Departmental
Central
f) Staff of the Centers :
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g) Hostel facilities at the Rural Health Centres :
h) Messing facilities available or not.
(i) Working arrangement/type of control of Health Centres :
(i) Total (Admn. & Financial) control with the college
(ii) Partial (only for training) control
F.) TEACHING PROGRAMME :(For duration of the entire course)
I) Curriculum of studies(To be filled by the Dean/Principal along with Head of the department). Curriculum in the subject as prescribed by MCI (a copy of the detailed curriculum along with the departmental and educational objectives of the subject may be appended).
Is the above curriculum followed in totality?
If not, what are the variations and reasons thereof?
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(To be filled in by the Inspectors/Visitors). Does the curriculum of studies adopted by the training center differ materially from that recommended by the Medical Council of India.
If so what are the variations and what are your observations regarding them ?
II. Methodology(For duration of the entire course)
Number1st yr. 2nd yr. 3rd yr. 4th yr.
1) Didaetic Lectures
2) Demonstrations
3) Tutorials
4) Seminars conducted during the year. (Number of students attending each)
5) Practicals
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a) Rural Practice Field :
Subject Time Spent
Year of the student in Medical College
Type of instructionObservation Demonstratio
nParticipation
b) Urban Practice Field :
Subject Time Spent
Year of the student in Medical College
Type of instructionObservation Demonstratio
nParticipation
c) What field visits and of what duration are organized by the department for the
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following subject and how far the following subjects and how far have the students participated in the program?
1. Vital statistics
2. Environmental sanitation
3. Communicable/non-communicable Diseases.
4. Public Health Laboratory Service
5. Maternal & Child Health & Family Welfare planning
6. School Health Service
7. Others (Specify)
d) Clinical Social Case reviews – How many are reviewed by a student during his/her career in the Medical College – How are the records kept?
e) Study of Family & Community Health Survey
f) Family case studies
6. TEACHING HOSPITAL1. In patient department No. of Beds used in
each specialty for teaching the subject of preventive and Social Medicine/Community Medicine.
a. Tuberculosis
b. Venereal Diseases
Leprosy
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Poliomylitis
Infectious & Communicable diseases
Non-Communicable diseases
Hypertension
Diabetes
Goiter
Rheumatism
Cancer &
Other
2. Is the hospital teaching program in Community Medicine/Preventive & Social Medicine organized and Co-ordinate by the Dean/Principal of the college and other college staff?
3. Average no. of students posted at a time : To which year do they belong?
(a list of posting for clerkship in preventive and social medicine/community medicine may be furnished)
4. Clinical Teaching
a. bedside clinics
b. by whom given
c. How often during a week?
d. Do students writes case histories in a prescribed book?e. Are they corrected, if so by whom?
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f. Do students conduct clinical social case reviews by actual visit to the family?
If so, how many and how they are supervised?
g. Are these reviews assessed by the staff of the department?
h. Are there facilities for teaching and demonstration for preventive health services in any infectious diseases?
i. If so what type of cases are available for teaching and demonstration and how much time is allotted for this during the course of study?
5. Record and filing system at the rural and urban field practice areas.
Are family folders introduced or in the maintenance of records?
6. Outpatient Department
a. Arrangement for case study for students
b. Clinical outpatient teaching
c. No. of demonstrations given by the Preventive and Social Medicine/Community Medicine department in collaboration with other clinical departments in the outpatient department and on what subjects.
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d. Is the department running immunization clinic?
Yes
No.
If yes, frequency per week.
Are Undergraduate students posted in the clinic?
7) Any other teaching/training activities:
8) Is there any integrated teaching/If yes, details thereof.
9) Records : Methods of Assessment thereof :
(Time table of lectures, demonstrations, seminars, tutorials, practical and field activities may be given)
10) INTERNSHIP TRAINING
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1. Period of posting in the department
2. Pattern of posting Period
a. Rural Health Centre/Primary Health Centre
b. Urban Health Centre
c. Other postings like
National Health Programmes
Clinics
Immunization
School Health
Family Welfare Planning
Any other postings
3. Method of Assessment for Internship(Please attach a copy of logbook/assessment sheet).
Signature of Head of the Department
G. OBSERVATIONS OF THE INSPECTORS/VISITORS
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Signature of Inspectors/Visitors
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(SIF B-9)
MEDICAL COUNCIL OF INDIA
STANDARD INSPECTION FORM
FORM – B
On the Facilities for teaching in the subject of
GENERAL MEDICINE
INCLUDING TURBERCULOSIS AND RESPIRATORY DISEASES, DERMATOLOGY, VENEREOLOGY AND LEPROSY & PSYCHIATRY
For the Course of study leading up to M.B.B.S. Examination
Name of Institution ………..………..………..……..………..………..………..
Place ………..………..………..………..………..………..………..………..………..
Affiliated to the University of …………………………………………………..
Name of the Head of the Department ………………………………………..
Signature of the Dean/Principal Signature of the (with seal) Head of the Department
(This form shall be first filled in by the Principal/Dean of the college in collaboration with the Head of the Department and handed over to the
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Inspector, who shall examine the information already furnished & gather such additional information as may be necessary to fill in the spaces provided for within)
1. Date of Inspection/Visitation :
2. Names of Inspectors or Visitors :
3. Date of last Inspection/Visitation :
4. Names of last Inspectors/Visitors :
Defects pointed out in the last Inspection / To what extent remediedVisitation
Signature of Inspectors/Visitors
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A. Teaching Staff : In case this space is less a statement showing the following information may be attached in this format. (to be filled in by the Dean/Principal of the college).
A1 : Department of General Medicine
Post No. Name Qualification with dates thereof & Where obtained
Experience
As Sr. Resident/Registrar
As Asst. Professor/Lecturer
Date College
Univ. Instt. From
To Total Instt.
From To Total
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Professor
Associate Professor/
Reader
Asst. Prof. /Lecturer
Registrar/Sr.
Resident
Jr. Resident
Any other Category
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(cont.)
Post Experience Grand Total of Teaching Experience
Remarks if any,
As Assoc. Professor/Reader As ProfessorInstitution
From To Total Institution From To Total
15 16 17 18 19 20 21 22 23 24Professor
Associate Professor/
Reader
Asst.Prof. /Lecturer
Registrar/Sr. Resident
Jr. Resident
Any other Category
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A. Teaching Staff : In case this space is less a statement showing the following information may be attached in this format. (to be filled in by the Dean/Principal of the college).
A2 : Department of Tuberculosis & Respiratory Diseases
Post No. Name Qualification with dates thereof & Where obtained
Experience
As Sr. Resident/Registrar
As Asst. Professor/Lecturer
Date College
Univ. Instt. From
To Total Instt.
From To Total
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Professor
Associate Professor/Re
ader
Asst. Prof. /Lecturer
Registrar/Sr. Resident
Jr. Resident
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Any other category
(cont.)
Post Experience Grand Total of Teaching Experience
Remarks if any,
As Assoc. Professor/Reader As ProfessorInstitution
From To Total Institution From To Total
15 16 17 18 19 20 21 22 23 24Professor
Associate Professor/
Reader
Asst. Prof. /Lecturer
Registrar/Sr. Resident
Jr. Resident
Any other Category
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A. Teaching Staff : In case this space is less a statement showing the following information may be attached in this format. (to be filled in by the Dean/Principal of the college).
A3 : Department of Dermatology, Venercology and Leprosy
Post No. Name Qualification with dates thereof & Where obtained
Experience
As Sr. Resident/Registrar
As Asst. Professor/Lecturer
Date College
Univ. Instt. From
To Total Instt.
From To Total
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Professor
Associate Professor/
Reader
Asst. Prof. /Lecturer
Registrar/Sr. Resident
Jr. Resident
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Any other Category
(cont.)
Post Experience Grand Total of Teaching Experience
Remarks if any,
As Assoc. Professor/Reader As ProfessorInstitution
From To Total Institution From To Total
15 16 17 18 19 20 21 22 23 24Professor
Associate Professor/
ReaderAsst. Prof. /Lecturer
Registrar/Sr. Resident
Jr. Resident
Any other
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category
A. Teaching Staff : In case this space is less a statement showing the following information may be attached in this format. (to be filled in by the Dean/Principal of the college).
A4 : Department of Psychiatry
Post No. Name Qualification with dates thereof & Where obtained
Experience
As Sr. Resident/Registrar
As Asst. Professor/Lecturer
Date College
Univ. Instt. From
To Total Instt.
From To Total
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Professor
Associate Professor/
Reader
Asst. Prof. /Lecturer
Registrar/Sr. Resident
Jr. Resident
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Any other Category
(cont.)
Post Experience Grand Total of Teaching Experience
Remarks if any,
As Assoc. Professor/Reader As ProfessorInstitution
From To Total Institution From To Total
15 16 17 18 19 20 21 22 23 24Professor
Associate Professor/
Reader
Asst. Prof. /Lecturer
Registrar/Sr. Resident
Jr. Resident
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Any other category
B. List of non-teaching staff :
Nomenclature Name(s) of staff membersGeneral Medicine
TB & Resp. Diseases
Derm., Ven. & Lep.
Psychiatry
a. E.C.G. Technician
b. Technical Assistant
c. Technician
d. Lab. Attendants
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Nomenclature Name(s) of staff membersGeneral Medicine
TB & Resp. Diseases
Derm., Ven. & Lep.
Psychiatry
e. Steno-typist
f. Record Clerk
g. TB & Chest Diseases Health visitor
h. Psychiatric Social Workers
i. Any other category
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C. BUILDINGS :
Gen. TB Derm., Psychiatry Medicine Resp. Dis. Ven. &
Lep.
(i) Clinical Demonstration Room
a) Number
b) Accommodation (ofeach demonstrationroom)
.i) Sizeii) Capacity
c) Audio-visual equipmentavailable.
(ii) Departmental Library-cumSeminar Room :
a) Is there a separate Departmental library?
b) Accommodationi) Sizeii) Capacity
c) Number of Books in General Medicine.
TB & Resp. dis. Derm., Ven. & Lep. Psychiatry and
allied subjects
Gen. TB Derm., Psychiatry
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Medicine Resp. Dis. Ven. & Lep.
d) List of Journals
(iii) Research Laboratory
a) Size
b) Equipment
c) Are there any studentstaken for Diploma/M.D./Ph.D. in Gen. Med./TB & RD/DVD/Psy?
If so how may per year During the last three years
i) Diploma
ii) Degree
d) List of publications by the members of the staffduring the last 3 years.
Gen. TB Derm., Psychiatry
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Medicine Resp. Dis. Ven. & Lep.
e) Current problemsResearch work is going onand by whom? (a statementmay be furnished)
f) Do Undergraduate studentsIn any way participate in them?
(iv) OFFICE ACCOMMODATION
a) Professor and HOD :
b) Associate Professors/Readers :
c) Asst. Professors/Lecturers :
d) Registrars/Sr. Residents :
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Gen. TB Derm., Psychiatry Medicine Resp. Dis. Ven. &
Lep.
e) Jr. Residents
f) Non-teaching and Clerical staff.
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D. TEACHING HOSPITAL
1) Inpatient department : Number of Number of Units Number of beds Unit wise
Teaching Beds staff composition With names Qualification
& Designation of staff
____________________________________________________________________________________________________________
Medicine and allied specialisites :
a) General Medicine A separate sheet may be attached
b) Tuberculosis & RespiratoryDiseases ----do----
c) Dermatology, Venereology & Leprosy ----do----
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d) Psychiatry ----do----
2. Indoor admissions General TB & RD DVD Psychiatry
_______________________________________________________________________
1. Annual admissions
2. Average Bed occupancy per day(Percentage of Teaching beds)
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3) INTENSIVE CARE
No. of beds Equipment’s available
a) Intensive Care Unit (I.C.U.)
b) Intensive Coronary Care Unit (I.C.C.U.)
c) Intensive Care in TB & Respiratory diseases
d) Other intensive CareAreas, if any.
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4) MAJOR EQUIPMENT AVALIABLE IN THE DEPARTMENT :
Names of equipment
a) General Medicine
b) Tuberculosis & RespiratoryDiseases
c) Dermatology, Venearology & Leprosy
d) Psychiatry
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5) OUT-PATIENT DEPARTMENT :
a) Building – General layout
b) Is outpatient service Department wise
c) Arrangement for clinical Instructions to student inGeneral Medicine & Allied specialties
d) Average Daily OPD Attendance General TB & RD DVD PsychiatryMedicine
____________________________________________________________
1. Old Patients
2. New Patients
3. Total
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Teaching and training facilities :
General TB & RD DermPsy.
Ven. & Lep.
________________________________________________
A. In O.P.D.
a) Clinical demonstration room :
b) Number of rooms in the OPDFor seeing the patientsby various faculty membersand resident staff
B. In-door
a) Bedside teaching
b) Clinical demonstration room/seminar room
A. TEACHING PROGRAMME :(For duration of the entire course)
1. Curriculum of studies(To be filled by the Dean/Principal along with Head of the department). Curriculum in the subjects of Gen. Med., T.B. & RD, Derm., Ven. & Leprosy and Psychiatry as prescribed by MCI (a copy of the detailed curriculum along with the departmental and educational objectives of the subject may be appended).
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Is the above curriculum followed in totality?
If not, what are the variations and reasons thereof?
(To be filled in by the Inspectors/Visitors). Does the curriculum of studies adopted by the training center differ materially from that recommended by Medical Council of India.
If so what are the variations and what are your observations regarding them?
II. Methodology(for duration of the entire course)
Number__________________________________________________________
General TB & RD DVD PsychiatryMedicine
______________________________________________________
1) Total of clinical postings
2) Didactic Lecturers
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3) DemonstrationsNumber
__________________________________________________________
General TB & RD DVD PsychiatryMedicine
______________________________________________________
4) Tutorials
5) Seminars conductedduring the year
Number of studentsAttending each
6) Practical
7) Bedside Clinics
8) How may hours does a Student spend daily in the wards for clerkship.
9) Average Number of studentsPosted at a time for indoor/OPDPostings.
10) Do students write case historiesIn a prescribed book?
11) Are they corrected ?
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Number__________________________________________________________
General TB & RD DVD PsychiatryMedicine
______________________________________________________
12) If so, by whom
13) Is the clinical work doneIn the wards by the Students assessed Periodically?
14) If so, how often and by whom?
15) Total period of attendancein OPD by a student throughout clinical training.
16) Is it done concurrently with The inpatients ward postings?
17) Who gives them training to attend to casualties?
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Number__________________________________________________________
General TB & RD DVD PsychiatryMedicine
______________________________________________________
18) How is the outpatientsTeaching organized?
19) Do students attend Clinicoathological Conferences?
20) If so, on an average, howOften during the whole periodOf medicine and allied specialties postings?
21) Any other teaching/trainingactivities:
22) Is there any integrated teaching?If yes, details thereof.
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Number__________________________________________________________
General TB & RD DVD PsychiatryMedicine
______________________________________________________
23) Records Methods ofAssessment thereof
(Time table of lecturers,demonstrations, seminars,tutorials, practicals, OPD and indoor postings etc. may begiven).
24) Internship Training Programme
a) Period of postingIn the department
b) Method of assessment ofInternship (please attach a Copy of log book/assessment Sheet)
Signature of Head of the Department Signature of Dean/Principal
General Medicine :
Tuberculosis and Respiratory diseases :
Dermatology , Venerecology & Leprosy
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Psychiatry
F. OBSERVATIONS OF THE INSPECTORS/VISITORS :
Signature of Inspectors/Visitors
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(SIF B-10)
MEDICAL COUNCIL OF INDIA
STANDARD INSPECTION FORM
FORM – B
On the Facilities for teaching in the subject of
PAEDIATRICS
For the Course of study leading up to M.B.B.S. Examination
Name of Institution ………..………..……….………..………..………..………..
Place ………..………..………..………..………..………..………..………..………..
Affiliated to the University of …………………………………………………..
Name of the Head of the Department …………………………………………
Signature of the Dean/Principal Signature of the (with seal) Head of the Department
(This form shall be first filled in by the Principal/Dean of the college in collaboration with the Head of the Department and handed over to the Inspector, who shall examine the information already furnished &
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gather such additional information as may be necessary to fill in the spaces provided for within)
1. Date of Inspection/Visitation :
2. Names of Inspectors or Visitors :
3. Date of last Inspection/Visitation :
4. Names of last Inspectors/Visitors :
Defects pointed out in the last Inspection / To what extent remediedVisitation
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Signature of Inspectors/Visitors
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A. Teaching Staff : In case this space is less a statement showing the following information may be attached in this format. (to be filled in by the Dean/Principal of the college).
Department of Pediatrics
Post No. Name Qualification with dates thereof & Where obtained
Experience
As Resident/Registrar
As Asst. Professor/Lecturer
Date College
Univ. Instt. From
To Total Instt.
From To Total
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Professor
AssociateProfessor/
Reader
Asst. Prof. /Lecturer
Sr. Resident/ Registrar
Jr. Resident
Any other Category
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(cont.)
Post Experience Grand Total of Teaching Experience
Remarks if any,
As Assoc. Professor/Reader As ProfessorInstitution
From To Total Institution From To Total
15 16 17 18 19 20 21 22 23 24Professor
Associate/Professor/
ReaderAsst. Prof.
/LecturerSr.
Resident/Registrar
Jr. Resident
Any other category
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B. List of non-teaching staff :Name (s) of staff members
a. Child Psychologist
b. Health Educator
c. Technical Assistant
d. Technician
e. Laboratory Attendants
f. Store Keeper
g. Steno-typist
h. Record Clerk
i. Social Worker
j Any other category
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C. Buildings :
(i) Clinical Demonstration Room :
a) Number
b) Accommodation (of each demonstration room)
i) Size
ii) Capacity
c) Audio-Visual equipment available.
(ii) Departmental Library – cum- Seminar Room :
a) Is there a separate departmental library?
b) Accommodation
i) Size :
ii) Capacity :
c) Number of books - in Pediatrics including Neonatology :
d) List of Journals :
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iii) Research Laboratory
a) Size
b) Equipment
c) Are there any students taken for Diploma/M.D. in Pediatrics
If so how many per year during the last three years?
1) Diploma 2) Degree
d) List of publications by the members of the staff during the last 3 years?
e) Current problems on which research work is going on and by whom? (a statement may be furnished)
f) Do Undergraduate students in any way participate in them ?
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(IV) OFFICE ACCOMMODATION
a) Professor and HOD :
b) Associate Professors/Readers :
c) Asst. Professors/Lecturers :
d) Registrars/Sr. Residents :
e) Jr. Residents
f) Non-teaching and Clerical Staff :
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D. TEACHING HOSPITAL
1) Inpatient department : Number of Number of Units Number of beds Unitwise
Teaching Beds per unit staff composition With names Qualification
& Designation
of staff
____________________________________________________________________________________________________________
Pediatrics
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2). Indoor admissions
a. Annual admissions
b. Average Bed occupancy per day(Percentage of Teaching beds)
3) INTENSIVE CARE
No. of beds Equipment’s available TemperatureControlled
Yes/No
a) Pediatric Intensive Care Unit (I.C.U.)
b) Intensive Care (Nursery)
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4) MAJOR EQUIPMENT AVALIABLE IN THE DEPARTMENT :
5) OUT-PATIENT DEPARTMENT :
a) Building – General layout
b) Is outpatient service Department wise
d) Arrangement for clinical Instructions to student inGeneral Medicine & Allied specialties
d) Average Daily OPD Attendance
1. Old Patients
2. New Patients
3. Total
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6) CLINICS :
Frequency Are U.G.Per students Week posted in
these Clinics
__________________________________________
1. Well Baby/Child Welfare Clinic
2. Immunization Clinic
3. Child Guidance Clinic
4. Child Rehabilitation Clinic including Facilities for speech therapyand occupational therapy.
5. Any other clinic
7) NEW BORN NURSERY:
i) No. of beds :
ii) Does it have facilities for temperatureand humidity control?
iii) Staff posted
Medical
Staff Nurses
iv) Equipment available
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(v) Are the undergraduate students posted in delivery room?
If yes, who supervises their training for neonatal resuscitation?
a) Deptt. of Obst. & Gynae. Faculty
b) Faculty of Pediatrics
c) Any other
8) TEACHING AND TRAINING FACILITIES :
A. In OPD
a) Clinical demonstration room :
b) Number of rooms in the OPD for seeing the Patients by various faculty members and Resident staff :
B. In-door
a) Bedside teaching
b) Clinical demonstration room/seminar room
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D. Teaching Programme : (for duration of the entire course)
1. Curriculum of studies(To be filled by the Dean/Principal along with Head of the department). Curriculum in the subject of Paediatrics including Neonatology as prescribed by MCI (a copy of the detailed curriculum along with the departmental and educational objectives of the subject may be appended).
Is the above curriculum followed in totality?
If not, what are the variations and reasons thereof?
(To be filled in by the Inspectors/Visitors). Does the curriculum of studies adopted by the training center differ materially from that recommended by the Medical Council of India.
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If so what are the variations and what are your observations regarding them ?
II. Methodology(for duration of the entire course)
Number
1) Total duration of Clinical Postings
2) Didactic Lectures
3) Demonstrations
4) Tutorials
5) Seminars conducted during the year. (Number of students attending each)
6) Practicals
7) Bedside Clinics
8) How many hours does a studentspend daily at the wards for clerkship
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9) Average Number of students posted at a time for indoor OPD postings :
10) Do students write case histories in a prescribed book.
11) Are they corrected?
12) If so, by whom?
13) Is the clinical work done in the wards by the students assessed periodically?
14) If so, how often and by whom?
15) Total period of attendance in OPD by a student throughout clinical training.
16) Is it done concurrently with the inpatients ward postings?
17) Who gives them training to attend to causalities?
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18) How is the outpatients teaching organized?
19) Do students attend clinico-pathological conferences?
20) If so, on an average, how often during the whole period of pediatrics postings?
21) Any other teaching/training activities :
22) Is there any integrated teaching? If yes, details thereof :
23) Records : Methods of Assessment thereof :
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24) Internship training programme
a) Period of posting in the department
b) Method of assessment of internship(Please attach a copy of log book/assessment sheet).
Time table of lectures, demonstrations, seminars, tutorials, practical, OPD and indoor postings etc. may be given.)
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Signature of Head of the Department Signature of Dean/Principal
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E. OBSERVATIONS OF THE INSPECTORS/VISITORS :
Signature of Inspectors/Visitors
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(SIF B-11)
MEDICAL COUNCIL OF INDIA
STANDARD INSPECTION FORM
FORM – B
On the Facilities for teaching in the subject of
SURGERY(INCLUDING GENERAL SURGERY, ORTHOPAEDICS, OTO-RHINO-LARYNGOLOGY, OPHTHALMOLOGY, RADIO-DIAGNOSIS, RADIO-
THERAPY, ANAESTHESIOLOGY, PHYSICAL MEDICINE & REHABILITATION AND DENTISTRY
For the Course of study leading up to M.B.B.S. Examination
Name of Institution ………..………..……….……..………..………..………….
Place ……….………..………..………..………..………..………..………..…………
Affiliated to the University of …………………………………………………..
Name of the Head of the Department ………………………………………..
Signature of the Dean/Principal Signature of the (with seal) Head of the Department
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(This form shall be first filled in by the Principal/Dean of the college in collaboration with the Head of the Department and handed over to the Inspector, who shall examine the information already furnished & gather such additional information as may be necessary to fill-in the spaces provided for within)1. Date of Inspection/Visitation :
2. Names of Inspectors or Visitors :
3. Date of last Inspection/Visitation :
4. Names of last Inspectors/Visitors :
Defects pointed out in the last Inspection / To what extent remediedVisitation
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Signature of Inspectors/Visitors
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A. Teaching Staff : In case this space is less a statement showing the following information may be attached in this format. (to be filled in by the Dean/Principal of the college).
A1 : Department of General Surgery (Including Pediatric Surgery)
Post No. Name Qualification with dates thereof & Where obtained
Experience
As Sr. Resident/Registrar
As Asst. Professor/Lecturer
Date College
Univ. Instt. From
To Total Instt.
From To Total
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Professor
Associate Professor/
Reader
Asst. Prof. /Lecturer
Registrar/Sr. Resident
Jr. Resident
Any other Category
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(cont.)
Post Experience Grand Total of Teaching Experience
Remarks if any,
As Assoc. Professor/Reader As ProfessorInstitution
From To Total Institution From To Total
15 16 17 18 19 20 21 22 23 24Professor
Associate Professor/Rea
der
Asst. Prof. /Lecturer
Registrar/Sr. Resident
Jr. Resident
Any other Category
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A. Teaching Staff : In case this space is less a statement showing the following information may be attached in this format. (to be filled in by the Dean/Principal of the college).
A2 : Department of Orthopedics
Post No. Name Qualification with dates thereof & Where obtained
Experience
As Sr. Resident/Registrar
As Asst. Professor/Lecturer
Date College
Univ. Instt. From
To Total Instt.
From To Total
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Professor
AssociateProfessor/
Reader
Asst. Prof. /Lecturer
Registrar/Sr. Resident
Jr. Resident
Any other category
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(cont.)
Post Experience Grand Total of Teaching Experience
Remarks if any,
As Assoc. Professor/Reader As ProfessorInstitution
From To Total Institution From To Total
15 16 17 18 19 20 21 22 23 24Professor
Associate Professor/
Reader
Asst. Prof. /Lecturer
Registrar/Sr. Resident
Jr. Resident
Any other Category
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A. Teaching Staff : In case this space is less a statement showing the following information may be attached in this format. (to be filled in by the Dean/Principal of the college).
A3 : Department of Ophthalmology
Post No. Name Qualification with dates thereof & Where obtained
Experience
As Sr. Resident/Registrar
As Asst. Professor/Lecturer
Date College
Univ. Instt. From
To Total Instt.
From To Total
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Professor
Associate Professor/
Reader
Asst. Prof. /Lecturer
Registrar/Sr. Resident
Jr. Resident
Any other
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Category
(cont.)
Post Experience Grand Total of Teaching Experience
Remarks if any,
As Assoc. Professor/Reader As ProfessorInstitution
From To Total Institution From To Total
15 16 17 18 19 20 21 22 23 24Professor
AssociateProfessor/
Reader
Asst. Prof. /Lecturer
Registrar/Sr. Resident
Jr. Resident
Any other category
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A. Teaching Staff : In case this space is less a statement showing the following information may be attached in this format. (to be filled in by the Dean/Principal of the college).
A4 : Department of Oto-Rhino-Laryngology
Post No. Name Qualification with dates thereof & Where obtained
Experience
As Sr. Resident/Registrar
As Asst. Professor/Lecturer
Date College
Univ. Instt. From
To Total Instt.
From To Total
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Professor
Associate Professor/
Reader
Asst. Prof. /Lecturer
Registrar/Sr. Resident
Jr. Resident
Any other
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Category
(cont.)
Post Experience Grand Total of Teaching Experience
Remarks if any,
As Assoc. Professor/Reader As ProfessorInstitution
From To Total Institution From To Total
15 16 17 18 19 20 21 22 23 24Professor
Associate/ Professor/
Reader
Asst. Prof. /Lecturer
Registrar/Sr. Resident
Jr. Resident
Any other category
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A. Teaching Staff : In case this space is less a statement showing the following information may be attached in this format. (to be filled in by the Dean/Principal of the college).
A5 : Department of Radio-diagnosis
Post No. Name Qualification with dates thereof & Where obtained
Experience
As Sr. Resident/Registrar
As Asst. Professor/Lecturer
Date College
Univ. Instt. From
To Total Instt.
From To Total
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Professor
Associate Professor/Re
ader
Asst. Prof. /Lecturer
Registrar/Sr. Resident
Jr. Resident
Any other Category
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(cont.)
Post Experience Grand Total of Teaching Experience
Remarks if any,
As Assoc. Professor/Reader As ProfessorInstitution
From To Total Institution From To Total
15 16 17 18 19 20 21 22 23 24Professor
Associate Professor/
Reader
Asst. Prof. /Lecturer
Registrar/Sr. Resident
Jr. Resident
Any other
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category
A. Teaching Staff : In case this space is less a statement showing the following information may be attached in this format. (to be filled in by the Dean/Principal of the college).
A6 : Department of Radio-therapy
Post No. Name Qualification with dates thereof & Where obtained
Experience
As Sr. Resident/Registrar
As Asst. Professor/Lecturer
Date College
Univ. Instt. From
To Total Instt.
From To Total
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Professor
Associate Professor/
Reader
Asst. Prof. /Lecturer
Registrar/Sr. Resident
Jr. Resident
Any other Category
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(cont.)
Post Experience Grand Total of Teaching Experience
Remarks if any,
As Assoc. Professor/Reader As ProfessorInstitution
From To Total Institution From To Total
15 16 17 18 19 20 21 22 23 24Professor
Associate/ Professor/
Reader
Asst. Prof. /Lecturer
Registrar/Sr. Resident
Jr. Resident
Any other
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category
A. Teaching Staff : In case this space is less a statement showing the following information may be attached in this format. (to be filled in by the Dean/Principal of the college).
A7 : Department of Anesthesiology
Post No. Name Qualification with dates thereof & Where obtained
Experience
As Sr. Resident/Registrar
As Asst. Professor/Lecturer
Date College
Univ. Instt. From
To Total Instt.
From To Total
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Professor
Associate Professor/
Reader
Asst. Prof. /Lecturer
Registrar/Sr. Resident
Jr. Resident
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Any other Category
(cont.)
Post Experience Grand Total of Teaching Experience
Remarks if any,
As Assoc. Professor/Reader As ProfessorInstitution
From To Total Institution From To Total
15 16 17 18 19 20 21 22 23 24Professor
Associate Professor/
Reader
Asst. Prof. /Lecturer
Registrar/Sr. Resident
Jr. Resident
Any other category
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A. Teaching Staff : In case this space is less a statement showing the following information may be attached in this format. (to be filled in by the Dean/Principal of the college).
A8 : Department of Physical Medicine & Rehabilitation
Post No. Name Qualification with dates thereof & Where obtained
Experience
As Sr. Resident/Registrar
As Asst. Professor/Lecturer
Date College
Univ. Instt. From
To Total Instt.
From To Total
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Professor
Associate Professor/Re
ader
Asst. prof. /Lecturer
Registrar/Sr. Resident
Jr. Resident
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Any other Category
(cont.)
Post Experience Grand Total of Teaching Experience
Remarks if any,
As Assoc. Professor/Reader As ProfessorInstitution
From To Total Institution From To Total
15 16 17 18 19 20 21 22 23 24Professor
Associate Professor/
Reader
Asst. prof. /Lecturer
Registrar/Sr. Resident
Jr. Resident
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Any other category
A. Teaching Staff : In case this space is less a statement showing the following information may be attached in this format. (to be filled in by the Dean/Principal of the college).
A9 : Department of Dentistry
Post No. Name Qualification with dates thereof & Where obtained
Experience
As Sr. Resident/Registrar
As Asst. Professor/Lecturer
Date College
Univ. Instt. From
To Total Instt.
From To Total
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Professor
Associate Professor/Re
ader
Asst. Prof. /Lecturer
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Registrar/Sr. Resident
Jr. Resident
Any other Category
(cont.)
Post Experience Grand Total of Teaching Experience
Remarks if any,
As Assoc. Professor/Reader As ProfessorInstitution
From To Total Institution From To Total
15 16 17 18 19 20 21 22 23 24Professor
Associate Professor/
Reader
Asst. prof. /Lecturer
Registrar/Sr. Resident
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Jr. Resident
Any other category
B. LIST OF NON-TEACHING STAFF :
Nomenclature Names of staff members
General Surgery Orthopedics Oto-Rhino-Laryngology
Ophthalmology
Technical Assistant
Technician
Lab Attendant
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Reception
Nomenclature Names of staff members
General Surgery Orthopedics Oto-Rhino-Laryngology
Ophthalmology
Steno-typist
Record Clerk
Audiometry Technician
Speech therapist
Retractions
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Any other category
Nomenclature Names of staff members
Radio-Diagnosis
Radio-Therapy
Anaesth. Phy. Med. & Rehab.
Dentistry
Radiographic Technician
Dark Room Asst.
Stenographer
Steno-typist
Storekeeper
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Storekeeper-cum-clerks
Nomenclature Names of staff members
Radio-Diagnosis
Radio-Therapy
Anaesth. Phy. Med. & Rehab.
Dentistry
Record Clerk
Radiotherapy Technician
Physio-therapist
Occupational therapist
Speech Therapist
Prosthetic and orthodox
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Technician
Workshop workers
Clinical Psychologist
Nomenclature Names of staff members
Radio-Diagnosis
Radio-Therapy
Anaesth. Phy. Med. & Rehab.
Dentistry
Medio-Social worker
Public Health Nurse/Rehabilitation Nurse
Vocational Counsellor
Multi-rehabilitation worker (MRW)/Technician/therapist
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Class IV workers
Dental Technicians
Tech. Asst.
Technicians
Any other category
C. BUILDINGS :
Gen. Ortho. Oto- Ophth. Radio Surgery Rhino- Diag.
Laryngology____________________________________________________________________________________________________________
(i) Clinical Demonstration Room
a) Number
b) Accommodation (ofeach demonstrationTheatre)
i) Size
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ii) Capacity
c) Audio-visual equipmentavailable.
Gen. Ortho. Oto- Ophth. Radio Surgery Rhino- Diag.
Laryngology
(ii) Departmental Library-cum-Seminar Room :
a) Is there a separate departmental library?
b) Accommodation
Size
Capacity
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c) Number of Books in Physiology including Biophysics :
d) List of Journals :
GENERAL SURGERY AND ALLIED SPECIALITIES
(iii) Research Laboratory
a) Size
b) Equipment
c) Are there any students taken for M.S. or M.Sc. or Ph.D in Anatomy?
If so how many per year during the last three years?
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1) Diploma
2) Degree
d) List of publications by the members of the staff during the last 3 years?
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GENERAL SURGERY AND ALLIED SPECIALITIES
e) Current problems on which research work is going on and by whom?(a statement may be furnished)
f) Do Undergraduate students in any way participate in them ?
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Gen. Ortho. Oto- Ophth. Radio Surgery Rhino- Diag.
Laryngology
(IV) OFFICE ACCOMMODATION
a) Professor and HOD :
b) Associate Professors/Readers :
c) Asst. Professors/Lecturers :
d) Registrars/Sr. Residents :
e) Jr. Residents :
e) Non-teaching and clerical staff :
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C. TEACHING HOSPITAL
1) Inpatient department : Number of Number of Units Number of beds Unitwise
Teaching Beds staff composition With names Qualification
& Designation of staff
____________________________________________________________________________________________________________
Surgery and allied specialities :
a) General Surgery A separate sheet including Paediatric Surgery may be attached
b) Orthopaedics ----do----
c) Oto-Rhino-Laryagology ----do----
d) Ophthalmology ----do----
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Gen. Ortho. Oto- Ophth. Radio Surgery Rhino- Diag.
Laryngology
2. Indoor admissions
a) Annual admissions
b. Average Bed occupancy per day(Percentage of Teaching beds)
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3) INTENSIVE CAREIs there any Intensive Care UnitFor surgery and allied specialties :
If yes, please indicate a number ofBeds and equipment’s available for each specialty.
Names of speciality No. of beds Equipment’s available
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4) MAJOR EQUIPMENT AVALIABLE IN THE DEPARTMENT :
Names of equipment
a) General Surgery
b) Orthopedics
c) Oto-Rhino-Laryngology
d) Ophthalmology
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Names of equipment’s
e) Radio-diagnosis
f) Radio-therapy
g) Anesthesiology
h) Physical Medicine &Rehabilitation
i) Dentistry
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5) Outpatient Department :
a) Building – General layout
b) Is out patient service department wise
c) Arrangement for clinical Instructions to student in General Surgery & Allied specialties
d) Average Daily OPD Attendance
General Ortho. Oto- OphthSurgery Rhino-
Laryngology____________________________________________________________
1. Old Patients
2. New Patients
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3. Total6) Teaching and training facilities :
General Ortho. Oto- OphthSurgery Rhino-
Laryngology____________________________________________________________
A. In O.P.D.
a) Clinical demonstration room :
b) Number of rooms in the OPDFor seeing the patientsby various faculty membersand resident staff
B. In-door
a) Bedside teaching
b) Clinical demonstration room/seminar room
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7) FACILITIES AVALIABLE IN OUT-PATIENT DEPARTMENT :
1. In Surgery and allied speciality Yes No
a) Dressing room for men
b) Dressing room for women
c) Operation theatresFor out patient surgery
2. In Orthopedics
a) Plaster room
b) Plaster cutting room
c) Outpatient X-ray facilities
3. In Oto-Rhino-Laryngology
a) Sound proof air-conditioned audiometery room
b) ENG Laboratory
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c) Speech therapy facilities
4. In Ophthalmology
a) Refraction room
b) Dark room
c) Dressing room
8. OPERATION THEATRE UNIT :
(1) Operation theatres -
(a) Number :
(b) Arrangement & Distribution :
(c) Equipment : (including Anesthesia equipment)
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(d) Facilities available in each O.T. unit -
Present/Absent
(i) Waiting room for patients
(ii) Soiled Linen room
(iii) Sterilization room
(iv) nurses duty room
(v) Surgeons & Anesthetists room -
For Males
For Females
(vi) Assistants room
(vii) Observation gallery for students
(viii) Store room
(xi) Washing room for surgeons & Assistants
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(xii) Students washing up and dressing up room
(3) Arrangement of Anesthesia
(a) Pre-anaesthetic care :
(b) Nature of anesthesia used :
(c) Post-anaesthetic care :
Pre-operative ward (no. of beds) :
Post-operative ward (no. of beds) :
Resuscitation facilities and special equipment :
If any super specialty exists :Give details
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9) Number of surgeries performed during the last one year.
Names of the department MajorMinor
a) General Surgery including Pediatric Surgery
b) Vasectomies performed
c) Orthopaedics
d) Oto-Rhino-Laryngology
e) Ophthalmology
E) TEACHING PROGRAMME :(For duration of the entire course)
1. Curriculum of studies(To be filled by the Dean/Principal along with Head of the department). Curriculum in the subject of Gen. Surgery. Ortho., Oto-Rhino-Laryngology, Ophth., Radio-diag., Anaes. & Dentistry as prescribed by MCI (a copy of the
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detailed curriculum along with the departmental and educational objectives of the subject may be appended).
Is the above curriculum followed in totality?If not, what are the variations and reasons thereof?
(To be filled in by the Inspectors/Visitors). Does the curriculum of studies adopted by the training center differ materially from that recommended by the Medical Council of India.
If so what are the variations and what are your observations regarding them ?
III. Methodology(for duration of the entire course)
Number___________________________________________________________________________________
General Ortho. Oto- Ophth Radio Anaes. DentistrySurgery Surgery Rhino-
Laryngology___________________________________________________________________________________
1) Total of clinical postings
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2) Didactic Lecturers
Number___________________________________________________________________________________
General Ortho. Oto- Ophth Radio Anaes. DentistrySurgery Surgery Rhino-
Laryngology___________________________________________________________________________________
3) Demonstrations
4) Tutorials
5) Seminars conducted during the year. (Number of students attending each)
6) Practicals
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7) Duration of operation theatre postings.
8) Bedside Clinics.
Number___________________________________________________________________________________
General Ortho. Oto- Ophth Radio Anaes. DentistrySurgery Surgery Rhino-
Laryngology___________________________________________________________________________________
9) How many hours does a studentspend daily at the wards for clerkship
10) Average Number of students posted at a time for indoor OPD postings :
11) Do students write case histories in a prescribed book.
12) Are they corrected?
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13) If so, by whom?
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Number___________________________________________________________________________________
General Ortho. Oto- Ophth Radio Anaes. DentistrySurgery Surgery Rhino-
Laryngology___________________________________________________________________________________
14) Is the clinical work doneIn the wards by the Students assessed Periodically?
15) If so, how often and by whom?
16) Total period of attendancein OPD by a student throughout clinical training.
17) Is it done concurrently with The inpatients ward postings?
18) Who gives them training to attend to casualties?
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Number___________________________________________________________________________________
General Ortho. Oto- Ophth Radio Anaes. DentistrySurgery Surgery Rhino-
Laryngology___________________________________________________________________________________
19) How is the outpatients teaching organized?
20) Do students attend clinico-pathological conferences?
21) If so, on an average, how often during the whole period of pediatrics postings?
22) Any other teaching/training activities :
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Number___________________________________________________________________________________
General Ortho. Oto- Ophth Radio Anaes. DentistrySurgery Surgery Rhino-
Laryngology___________________________________________________________________________________
23) Is there any integrated teaching?If yes,
24) Records Methods of Assessment thereof :
(Time table of lectures, demonstrations, seminars, tutorials, practical and dissection may be given).
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Number__________________________________________________________________________________
General Ortho. Oto- Opath. Phy. Surgery Surgery Rhino- Med.
Laryngology & Reh.
___________________________________________________________________________________25) Internship training programme
a. Period of posting in the department
b. Method of Assessment for Internship(Please attach a copy of logbook/assessment sheet).
Signature of Head of the Department Signature of Dean/Principal
General Surgery
Oto-Rhino-Laryngology
Ophthalmology
Radio-Diag.
Radio-therapy
Anaesthesiology
Physical Medicine & Rehabilitation
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Dentistry
F. OBSERVATIONS OF THE INSPECTORS/VISITORS :
Signature of Inspectors/Visitors
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(SIF B-12)
MEDICAL COUNCIL OF INDIA
STANDARD INSPECTION FORM
FORM – B
On the Facilities for teaching in the subject of
OBSTETRICS AND GYNAECOLOGY
For the Course of study leading up to M.B.B.S. Examination
Name of Institution ………..………..……….……..………..………..………….
Place ……….………..………..………..………..………..………..………..…………
Affiliated to the University of …………………………………………………..
Name of the Head of the Department ………………………………………..
Signature of the Dean/Principal Signature of the (with seal) Head of the department
(This form shall be first filled in by the Principal/Dean of the college in collaboration with the Head of the Department and handed over to the Inspector, who shall examine the information already furnished &
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gather such additional information as may be necessary to fill-in the spaces provided for within)
1. Date of Inspection/Visitation :
2. Names of Inspectors or Visitors :
3. Date of last Inspection/Visitation :
4. Names of last Inspectors/Visitors :
Defects pointed out in the last Inspection / To what extent remediedVisitation
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Signature of Inspectors/Visitors
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A. Teaching Staff : In case this space is less a statement showing the following information may be attached in this format. (to be filled in by the Dean/Principal of the college).
Department of Obstetrics and Gynecology
Post No. Name Qualification with dates thereof & Where obtained
Experience
As Res./Registrar As Asst. Professor/Lecturer
Date College
Univ. Instt. From
To Total Instt.
From To Total
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Professor
Associate Professor/
Reader
Asst. Prof. /Lecturer
Registrar/Sr. Resident
Jr. Resident
Any other Category
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(cont.)
Post Experience Grand Total of Teaching Experience
Remarks if any,
As Assoc. Professor/Reader As ProfessorInstitution
From To Total Institution From To Total
15 16 17 18 19 20 21 22 23 24Professor
Associate/ Professor/
Reader
Asst. Prof. /Lecturer
Registrar/Sr. Resident
Jr. Resident
Any other category
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Nomenclature Name(s) of staff members
a. Antenatal Medical Officer- cum-lecturer/Asstt. Professor
b. Maternity and Child Welfare Officer –cum- Lecturer/Asst. Professor
c. Social Worker
d. Technical Assistant
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Nomenclature Name(s) of staff members
e. Technician
f. Lab Attendants
g. Stenographer
h. Record Clerk
i. Store Keeper
j. Any other Category
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C. Buildings :
(i) Clinical Demonstration Room :
a) Number
b) Accommodation (of each demonstration room)
i) Size
iii) Capacity
c) Audio-Visual equipment available.
(ii) Departmental Library – cum- Seminar Room :
a) Is there a separate departmental library?
b) Accommodation
i) Size :
ii) Capacity :
c) Number of books in Obstetrics & Gynecology and allied subjects
d) List of Journals :
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(iii) Research Laboratory
a) Size
b) Equipment
c) Are there any students taken for M.S. or M.Sc. or Ph.D in Anatomy?
If so how many per year during the last three years?
1) Diploma
2) Degree
d) List of publications by the members of the staff during the last 3 years?
e) Current problems on which research work is going on and by whom? (a statement may be furnished)
f) Do Undergraduate students in any way participate in them ?
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(iv) OFFICE ACCOMMODATION
a) Professor and HOD :
b) Associate Professors/Readers :
c) Asst. Professors/Lecturers :
d) Registrars/Sr. Residents :
e) Jr. Residents :
f) Non-teaching and Clerical Staff :
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D. TEACHING HOSPITAL
1) Inpatient department : Number of Number of Units Number of beds Unitwise
Teaching Beds staff composition With names Qualification
& Designation of staff
____________________________________________________________________________________________________________OBSTETRICS AND GYNAECOLOGYAND ALLIED SPECIALITIES :
a) Obstetrics A separate sheet may be attached
b) Gynaecology ----do----
c) Postmartum ----do----
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2. Indoor admissions General TB & RD DVD Psychiatry
_______________________________________________________________________
a. Annual admissions
b. Average Bed occupancy per day(Percentage of Teaching beds)
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3) INTENSIVE CARE Is there any Intensive Care UnitFor Obst. & Gynae.
If yes, please indicate number of beds and equipments available :
No. of beds Equipments available
4) Nursery
a) No. of cots
b) No. of beds
c) Does it have facilities for temperature and humidity control.
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c) Staff posted
Medical
Staff Nurses
d) Equipment available
5) MAJOR EQUIPMENT AVALIABLE IN THE DEPARTMENT : Names of equipment
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6) Outpatient Department :
a) Building – General layout
b) Is out patient service department wise
c) Arrangement for clinical Instructions to student in General Surgery & Allied specialties
d) Average Daily OPD Attendance
1. Old Patients
2. New Patients
3. Total
7) Teaching and training facilities :
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A. In O.P.D.
a) Clinical demonstration room :
b) Number of rooms in the OPDFor seeing the patientsby various faculty membersand resident staff
B. In-door
a) Bedside teaching
b) Clinical demonstration room/seminar room
8) FACILITIES AVALIABLE IN OUT-PATIENT DEPARTMENT :
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1. In Obst. & Gynae. and allied speciality Yes No
a) Antenatal Clinic Frequency and run by whom
b) Family Welfare Clinic Frequency and run by whom
c) Postnatal Clinic frequency and run by whom
d) Sterility Clinicfrequency and run by whom
e) Cancer Detection Clinicfrequency and run by whom
f) Are the Medical Studentsposted in these clinics?
9. OPERATION THEATRE (with Obst. & Gynae. Deptt.)
(a) Number :
(b) Size & design
(c) Equipment
d) Lightning arrangement,
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air-conditioning etc.
e) Arrangement for studentsto watch operations.
f) Anaesthetic room
g) Preparation room
h) Sterilizing room
i) Recovery room
j) Postoperative wards
k) Resuscitation & blood Transfusion service
l) Any other remarks.
10) Labour Room :
Number
a) Clean
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b) Septic
c) Number of beds in each
d) Arrangement of lights & for operative interference
e) Arrangement for Sterilization
f) Preparation room
g) Waiting wards
h) Anaesthesia staff &facilities for administrationOf anaesthesia
i) Baby room
11) POSTMARTUM UNIT
a) Is there a postmortem unit attached to the department ?
Yes
No
b) If yes, staff under the postmortem unit.
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Name Designation Qualification
1. Medical
2. Non-Medical
c) Number of beds
d) Population attached with the postmortem unit
e) Number of eligible couples inpopulation attached with the postmortem unit.
f) Couple protection rate in the Population attached with the Population unit.
12. OPERATIONS & LABOURS FOR THE LAST ONE YEAR :
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a) Gynecological Operations Major
Minor
b) Total number of labours
c) Abnormal labours
d) Antenatal cases seen in OPD
e) Total number of sterilization’s
1) Tubectomies
2) Medical Termination of Pregnancies (MTP)
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D. TEACHING PROGRAMME :(For duration of the entire course)
I. Curriculum of studies(To be filled by the Dean/Principal along with Head of the department). Curriculum in the subjects of Obst. & Gynae. as prescribed by MCI (a copy of the detailed curriculum along with the departmental and educational objectives of the subject may be appended).
Is the above curriculum followed in totality?
If not, what are the variations and reasons thereof?
(To be filled in by the Inspectors/Visitors). Does the curriculum of studies adopted by the training center differ materially from that recommended by the Medical Council of India.
If so what are the variations and what are your observations regarding them ?
II. Methodology
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(for duration of the entire course)
Number
1) Total duration of clinical postings
2) Didactic Lectures
3) Demonstrations
4) Tutorials
5) Seminars conducted during the year. (Number of students attending each)
6) Practicals
7) Duration of operation theatre postings
8) Duration of labour postings and the number of cases observed/conducted by a student
9) Bedside Clinics
10) How many hours does a student spendDaily in the wards for clerkship.
11) Average number of students Posted at a time for indoor/OPD postings
12) Do students write case histories &Delivery notes in a prescribed book.
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13) Are they corrected?
14) If so, by whom?
15) Is the clinical work done in the wardsby the students assessed periodically?
16) If so, how often and by whom?
17) Total period of attendance in OPD by a a student throughout clinical training
18) Is it done concurrently with the inpatientsWards postings?
19) Who gives them training to attend to casualties?
20) How is the outpatient teaching organised?
21) Do students attend clinico-pathological conferences?
22) If so, on an average how often during the whole period of Obst. & Gynae. Postings?
23) Any other teaching/training activities :
24) Is there any integrated teaching?If yes, details thereof :
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25) Records : Methods of Assessment thereof?
(Time table of lectures, demonstrations, seminars, tutorials, practical, OPD and indoor postings etc. may be given)
26) Internship training programme
a) Period of posting in the department
b) Method of assessment of Internship(please attach a copy of log book assessment sheet).
Signature of Head of the Department Signature of Dean/Principal
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E. Observations of the Inspectors/Visitors :
Signature of Inspectors/Visitors
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NAME OF THE COLLEGE : ________________________________
I II III IV
Date of Inspection
Accepted? (YES/NO/ABSENT)
Name of the Inspector
Signature of Inspector
DECLARATION FORM : 2010 – 2011 - FACULTY 1.(a) Dr. Name…..……………………………………………………………….
1.(b) Date of Birth & Age ………………………………………………………
1.(c) Recent Passport size photo of the Employee Signed by Dean / Principal of the college.
1.(d) Submit Photo ID proof issued by Govt. Authorities : Photo ID submitted : Passport copy / Driving Licence / PAN Card / Voter ID/MCI Smart ID Card/ State Medical Council ID.
Number ……………………….……Issued by ..………………………………..
………
(Without Photo ID, Declaration form will be rejected and will not be considered as teaching faculty)
1.(e) i. Present Designation:_______________________________________________________
1.(e)(i) Certified copies of present appointment order at present institute attached.
1.(e)ii. Department: _____________________________________________________________
1.(e) iii. College: __________________________________________________________________
1.(e)iv. City:_____________________________________________________________________
PHOTOGRAPH TO BE
COUTERSIGNED BY THE
DEAN/PRINCIPAL
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1.(e) v. Nature of appointment: Full-time/ Part-time.
1.(e) vi. Whether belongs to : SC / ST / OBC / Ex-service / Others.
1.(f )Residential Address of employee :
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
1.(g ) Copy of Passport /Voter Card / Ration Card / Electricity Bill / Driving License Attached as a proof of residence.
1.(h ) Contact Particulars: Tel (Office):____________________________(with STD code)
Tel (Residence): _______________________ (with STD code)
E-mail address: _______________________________________
Mobile Number: ______________________________________
1.(i ) Date of joining present institution : _______________ as ________________________
1.(i)a Joining report at the present institute attached.
2. Qualifications :
Qualification College University Year
Registration No. of UG & PG with date
Name of the State Medical
Council
MBBS
MD/MS( )
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DM/M.Ch.( )
Note: For PG-Post PG qualification additional Registration certificate particulars be furnished and subject be furnished within brackets after scoring out whichever is not applicable.
2.(a ) Copies of Degree certificates of MBBS and PG degree attached.
2.(b ) Copies of Registration of MBBS and PG degree attached.
3 (a). Details of the previous appointments/teaching experience
Designation Department
Name of Institution
FromDD/MM/
YY
ToDD/MM/YY
Total Experien
ce in years & months
Tutor/DemonstratorRegistrar/Senior Resident/ ResidentAssistant Professor
Associate Professor
Professor
Note:- Tutor/Registrar/Senior Residents working in Anesthesia and Radio-diagnosis must have 3 years teaching experience in the respective departments in a recognized/permitted medical institute as a Tutor/Resident.
3(b). To be filled in by Ex Army Personnel only:
S.No. Place of Posting Designation Period
From To
1.
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2.
3.
4.
5.
4 .(a ) Before joining present institution I was working at ________________________________ as ____________________________________ and relieved on _________________________ after resigning / retiring (Relieving order is enclosed from the previous institution).
4 .(b ) I am not working in any other medical college/dental college in the State or outside the State in any capacity full-time / part-time.
5 . Number of Research publications in Journals during the last 3 (Three) academic years :
5 .(a ) International Journals:_______________________________________________5 .(b ) National Journals:___________________________________________________5 .(c ) State/Other Journals:__________________________________________________________________
6. Number of Research Projects on hand:_______________________________________
7 .(a ) I am having PAN Card and my PAN is ______________________/ I am not having PAN Card.
7 .(b ) I have drawn total emoluments from this college as under:-
Amount Received TDSJune, 2009July, 2009August, 2009
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September, 2009October, 2009November, 2009December, 2009January, 2010February, 2010March, 2010April, 2010May, 2010
7 .(c ) (Copy of my PAN & Form 16 (TDS certificate) for financial year 2008-2009 are attached)
DECLARATION
1. I, Dr. _________________________________ am working as ________________________ in the Department of _________________________ at _____________________________ Medical College and do hereby give an undertaking that I am a full time teacher in _______________________________________, working from ______A.M. to ______ P.M. daily at the institute.
2. I have not worked at any other medical college/institution or presented myself at any inspection from 1st August, 2009 onwards till date.
3. I am not practicing anywhere or carrying out any other activity OR I am practicing at ________________________________________ in the city of ______________________ and my hours of practice are_____________.
4. It is declared that each statement and/or contents of this declaration and /or documents, certificates submitted along with the declaration form, by the undersigned are absolutely true, correct and authentic. In the event of any statement made in this declaration subsequently turning out to be incorrect or false the undersigned has understood and accepted that such misdeclaration in respect to any content of this declaration shall also be treated as a gross misconduct thereby rendering the undersigned liable for necessary disciplinary action (including removal of his name from Indian Medical Register).
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SIGNATURE OF THE EMPLOYEE
Date:
Place:
ENDORSEMENT
1. This endorsement is the certification that the undersigned has satisfied himself /herself about the correctness and veracity of each content of this declaration and endorses the abovementioned declaration as true and correct. I have verified the certificates/ documents submitted by the candidate with the original certificates/ documents as submitted by the teacher to the institute and with the concerned institute and have found them to be correct and authentic.
2. I also confirm that Dr. _________________________________ is not practicing or carrying out any other activity during college working hours i.e. from _______ to ________, since he/she has joined the Institute.
3. In the event of this declaration turning out to be either incorrect or any part of this declaration subsequently turning out to be incorrect or false it is understood and accepted that the undersigned shall also be equally responsible besides the declarant himself/herself for any such misdeclaration or misstatement.
Date: Place: Countersigned by the Director/Dean/PrincipalREMARKS
S.No Documents Submitted1.(c) Recent Passport size photo of the Employee, Signed by
Dean / Principal of the college.Yes / No
1.(d) Photo ID proof issued by Govt. Authorities : Passport / Driving Licence / PAN Card / Voter ID/MCI Smart ID Card/State Medical Council ID
Yes / No
1.(e)(i)a
Certified copies of present appointment order at present institute.
Yes / No
1.(g) Copy of Passport /Voter Card / Ration Card / Electricity Bill / Driving License Attached as a proof of residence.
Yes / No
1.(i)a Joining report at the present institute. Yes / No2.(a) Copies of Degree certificates of MBBS and PG
degree.Yes / No
2.(b) Copies of Registration of MBBS and PG degree. Yes / No
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3. Copy of experience certificate for all teaching appointments held before joining present institute.
Yes / No
4.(a) Relieving order from the previous institution. Yes / No7.(a) PAN Card Yes / No7.(c) Form 16 (TDS certificate) for financial year 2008-
2009Yes / No
8. Prescription letter (in case of teachers who are practicing)
Yes / No
Signed by the Teacher : Countersigned by Dean / Principal.
Date : Date :
Signed by the Inspector :
Date : NOTE :
1. The Declaration Form will not be accepted and the person will not be counted as teacher if any of the above documents are not enclosed / attached with the Declaration Form.
2. The person will not be counted as a teacher if the original of Photo ID proof, Registration Certificates / Degree certificates / PAN Card / MCI Smart ID Card /State Medical Council ID ( if issued ) are not produced for verification at the time of inspection.
3. All the teachers must submit the revised declaration form in this format only. (Any declaration form submitted in an old format will not be accepted and he will not be counted as a teacher.)
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NAME OF THE COLLEGE : _____________________________________________
I II III IVDate of InspectionAccepted? (YES/NO/ABSENT)Name of the InspectorSignature of Inspector
DECLARATION FORM : 2010 – 2011 - RESIDENT 1.(a) Dr. Name…..……………………………………………………………….
1.(b) Date of Birth & Age ………………………………………………………
1.(c) Recent Passport size photo of the Employee Signed by Dean / Principal of the college.
1.(d) Submit Photo ID proof issued by Govt. Authorities : Photo ID submitted : Passport copy / Driving Licence / PAN Card / Voter ID/MCI Smart ID Card/ State Medical Council ID.
Number …………………………… Issued by ..………………………………..
………
(Without Photo ID, Declaration form will be rejected and will not be considered as teaching faculty)
PHOTOGRAPH TO BE
COUTERSIGNED BY THE
DEAN/PRINCIPAL
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1.(e) i. Present Designation:_______________________________________________
1.(e)(i) Certified copies of present appointment order at present institute attached.
1.(e)ii. Department: _______________________________________________________
1.(e) iii. College: ___________________________________________________________
1.(e)iv. City:_____________________________________________________________________
1.(e) v. Nature of appointment: Full-time/ Part-time
1.(e) vi. Whether belongs to : SC / ST / OBC /Others.
1.(f ) Residential Address of employee :___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
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1.(g ) Copy of Passport /Voter Card / Ration Card / Electricity Bill / Driving License Attached as a proof of residence.
1.(h ) Contact Particulars: Tel (Office):____________________________(with STD code)
Tel (Residence): ________________________ (with STD code)
E-mail address: _______________________________________
Mobile Number: ______________________________________
1.(i ) Date of joining present institution : ______________ as ________________________
1.(i)a Joining report at the present institute attached.
2. Qualifications :
Qualification College University Year
Registration No. of UG & PG with date
Name of the State Medical
Council
MBBS
MD/MS( )
DM/M.Ch.( )
Note: For PG-Post PG qualification additional Registration certificate particulars be furnished and subject be furnished within brackets after scoring out whichever is not applicable.
2.(a ) Copies of Degree certificates of MBBS and PG degree attached.
2.(b ) Copies of Registration of MBBS and PG degree attached.
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3 (a). Details of the previous appointments/teaching experience
Designation Department
Name of Institution
FromDD/MM/
YY
ToDD/MM/YY
Total Experien
ce in years & months
Tutor/Demonstrator
Registrar/Senior Resident/ Resident
Note:- Tutor/Registrar/Senior Residents working in Anesthesia and Radio-diagnosis must have 3 years experience in the respective departments in a recognized/permitted medical institute as a Tutor/Resident.
3(b). To be filled in by Ex Army Personnel only:
S.No. Place of Posting Designation Period
From To
1.
2.
3.
4.
5.
4 .(a ) Before joining present institution I was working at ________________________________ as ____________________________________ and relieved on _________________________ after resigning / retiring (Relieving order is enclosed from the previous institution).
4 .(b ) I am not working in any other medical college/dental college in the State or outside the State in any capacity full-time / part-time.
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5 . Number of Research publications in Journals during the last 3 (Three) academic years :
5 .(a ) International Journals:_______________________________________________5 .(b ) National Journals:___________________________________________________5 .(c ) State/Other Journals:________________________________________________________
6. Number of Research Projects on hand:________________________________________
7 .(a ) I am having PAN Card and my PAN is ______________________/ I am not having PAN Card.
7 .(b ) I have drawn total emoluments from this college as under:-
Amount Received TDSJune, 2009
July, 2009
August, 2009
September, 2009
October, 2009
November, 2009
December, 2009
January, 2010
February, 2010
March, 2010
April, 2010
May, 2010
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7 .(c ) (Copy of my PAN & Form 16 (TDS certificate) for financial year 2008-2009 are attached)
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DECLARATION
1. I, Dr. _________________________________ am working as ________________________ in the Department of _________________________ at _____________________________ Medical College and do hereby give an undertaking that I am a full-time Resident in _______________________________________, and am staying in Room No. ________ in the Residents’ Hostel in the college premises.
2. I have not worked at any other medical college/institution or presented myself at any inspection from 1st August, 2009 onwards till date.
3. I am not practicing anywhere or carrying out any other activity OR I am practicing at ________________________________________ in the city of ______________________ and my hours of practice are_____________.
4. It is declared that each statement and/or contents of this declaration and /or documents, certificates submitted along with the declaration form, by the undersigned are absolutely true, correct and authentic. In the event of any statement made in this declaration subsequently turning out to be incorrect or false the undersigned has understood and accepted that such misdeclaration in respect to any content of this declaration shall also be treated as a gross misconduct thereby rendering the undersigned liable for necessary disciplinary action (including removal of his name from Indian Medical Register).
SIGNATURE OF THE RESIDENT
Date:Place:
ENDORSEMENT
1. This endorsement is the certification that the undersigned has satisfied himself /herself about the correctness and veracity of each content of this declaration and endorses the abovementioned declaration as true and correct. I have verified the certificates/ documents submitted by the candidate with the original certificates/ documents as submitted by the Resident to the institute and with the concerned institute and have found them to be correct and authentic.
2. I also confirm that Dr. _______________________________ is working as full-time Resident (i.e. for 24 hours) and is not practicing or carrying out any
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other activity and is staying in Room No. _________ of the Residents’ Hostel in college premises, since he/she has joined the Institute.
3. In the event of this declaration turning out to be either incorrect or any part of this declaration subsequently turning out to be incorrect or false it is understood and accepted that the undersigned shall also be equally responsible besides the declarant himself/herself for any such misdeclaration or misstatement.
Date: Place: Countersigned by the Director/Dean/Principal
REMARKS
S.No Documents Submitted1.(c) Recent Passport size photo of the Employee, Signed by
Dean / Principal of the college.Yes / No
1.(d) Photo ID proof issued by Govt. Authorities : Passport / Driving Licence / PAN Card / Voter ID/MCI Smart ID Card/State Medical Council ID
Yes / No
1.(e)(i)a
Certified copies of present appointment order at present institute.
Yes / No
1.(g) Copy of Passport /Voter Card / Ration Card / Electricity Bill / Driving License Attached as a proof of residence.
Yes / No
1.(i)a Joining report at the present institute. Yes / No2.(a) Copies of Degree certificates of MBBS and PG
degree.Yes / No
2.(b) Copies of Registration of MBBS and PG degree. Yes / No3. Copy of experience certificate for all
appointments held before joining present institute.
Yes / No
4.(a) Relieving order from the previous institution. Yes / No7.(a) PAN Card Yes / No7.(c) Form 16 (TDS certificate) for financial year 2008-
2009Yes / No
8. Prescription letter (in case of Residents who are practicing)
Yes / No
Signed by the Teacher : Countersigned by Dean / Principal.
Date : Date :
Signed by the Inspector :
Date :
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NOTE :
1. The Declaration Form will not be accepted and the person will not be counted as Resident if any of the above documents are not enclosed / attached with the Declaration Form.
2. The person will not be counted as a Resident if the original of Photo ID proof, Registration Certificates / Degree certificates / PAN Card / MCI Smart ID Card /State Medical Council ID ( if issued ) are not produced for verification at the time of inspection.
3. All the Resident must submit the revised declaration form in this format only. (Any declaration form submitted in an old format will not be accepted and he will not be counted as a Resident)