STATE AAMC CONTROL & COMMAND CELL

PROFOMA FOR MONITORING of AAMCs

Date of Inspection:………/………/202

Time of inspection:                              

1. Details of AAMC:

District Name of AAMC AAMC Code Average daily OPD Rental/ Porta cabin

2. Details of Empanelled Doctor/Pharmacist/Mohalla Clinic Assistant/Multi Task Worker:

Name Login Reasons if Absent Working Wearing Apron Designation

Time if on Tablets (Yes/No) written on Apron
present (Yes/No) (Yes/No)

Doctor

Pharmacist

MCA

MTW

3. Board of AAMC:

Board Condition of Board Visibility of Condition of Flex Sheets Citizen IEC Signage Separate Complaint
Displayed Board from Charter Displayed for Fire Queue for Box
(Y/N) Road Displayed (Y/N) Exit Senior Availability
(Good/Not (Yes/No) Citizens (Y/N)
Visible) (Y/N)
Good Needs Good Needs
replacement replacement
4. Registers maintained at AAMC (Whether available, maintained properly up to date of visit and verified by incharge doctor on daily basis):

OPD Lab Lab Stock Register Daily Indent Expiry Assets Complaint Visitor Register Any other
Register Register Stock Consumption Register Register Register for /Feedback register
Register Register Non- Register
consumables
Consumable Non-
Consumable

5. Verification of OPD:

Number of phone calls made on the day of No. of OPD/patients verified on telephonic call No. of OPD/patients not verified on
visit telephonic call

6. Laboratory Tests:

Total number Number of lab Are blood & other Are logistics required for sample Are Reports delivered Remarks
of OPDs during investigation samples being supplied in sufficient quantity in time next day by
last billing during last billing collected in time by by outsourced lab (Y/N) outsourced lab (Y/N)
cycle cycle outsourced lab (Y/N)

7. Medicines:

Are medicines Is timely indent being Date of last Duration at Discrepancy in Expired drug Arrangement of
available as per taken by AAMC I/C indent which indent Stock Register available (Yes/No) medicines
EDL (Y/N) Yes/No has been taken
8. IT Equipments:

3 Tablets Available Working Online Reasons if not working Printer available Printout of prescription Internet Issues, Technical
(Yes/No) (Yes/No) online (Yes/No) given to patients (Y/N) if any Issues, if any

9. Equipments:

Sl. No. Type of Equipment Quantity Working Not working

1 AC
2 Refrigerator
3 Inverter
4 Water Dispenser
5 Medicines Rack
6 Examination Table
7 Chairs
8 CCTV Cameras
9

10. Whether doctor found examining patients: Yes No

Arrangement of Examination Bed Yes No

11. MCA:

Found doing duties Yes / No

Doing Registration Yes / No

Taking Blood Samples Yes / No

 Entering Reports Yes / No

12. Pharmacist:

Found doing duties Yes / No

Maintaining Records Yes / No

Explaining prescription properly Yes / No

13. MTW:

Found working Yes / No

Assisting Yes / No

Dressing Yes / No

14. Cleanliness:

In side AAMC Premises Satisfactory/Not-satisfactory

Toilet condition Satisfactory/Not-satisfactory

View out side AAMC Premises Satisfactory/Not-satisfactory

Availability of shed at Waiting Satisfactory/Not-satisfactory

area (Y/N) Required

15. Availability of Water:

Availability of water dispenser:

Location of water Dispenser:
Availability of drinking water/refill water bottle:
16. Any repair work required:

17. Bio Medical Waste Disposal

Registration (Yes / No)

BMW Bags Available (Yes / No)

BMW Bins Availability (Yes / No)

Sharp Waste Container Available (Yes / No)

Labeling & Bar coding done (Yes / No)

BMW Collection Register maintained (Yes / No)

Is BMW collected regularly? (Yes / No)