Navi Mumbai Municipal Corporation

Health Department
PCPNDT Quarterly Inspection Format
Name of Inspecting Authorised Medical Officer : Dr. Sachin M. Chitnis
Name of UPHC : Urban Primary Health Center, Airoli
Date of Visit : 2 - 8 - 2023
Date of Last visit : 4 - 5 - 2023
Schedule dates given by Appropriate Authority : 1 - 8- 2023 to 15 - 8 - 2023

A) Details of the Center

Name of the Center : ASHA HOSPITAL

Address of the Center : Ground floor, Asiatic CHS, Sector -4, Airoli
Phone No. of the Center : 022-27790784 Email : ashahospitalairoli@gmail.com
Mobile Number of the Applicant : 9821254077
Type of the Center : Encircle Approriate
1) Government / Semi Government / Private
2 ) Genetic Clinic / Genetic Counselling Centre / Genetic Laboratory / Genetic
Centre / Combined / Any Other (Specify)
3) Type of Facility approved for the center : USG 2 D Echo CT Scan MRI
Obstetric Procedures : Cordocentesis Amniocentesis Chorionic Villous Bipopsy
Inferility Related Procedures : Intra Uterine Insemination ( IUI ) Oocyte Retrieval Procedure
Implantation Of Fertilized Ovum fertilised through In Vitro Fertilization, etc.
Registration
Registration Number : NMMC / PNDT / 137
Registration Valid upto : 19 / 10 / 2024
Applied for Renewal : Yes / No / Not Applicable
Details of Applicant (as per certificate) -

Sr Name of Applicant/s Qualification of MMC Registration Validity of Renewal

No. Applicant number if of MMC
Applicable Registration
1 Dr Rajeev Chandra M S ( Gen Surgery) 77804 28/02/2027

Two Original Copies of Registration Certificates displayed : Yes / No.

Place of Display 1. 2.
If No, then Reason for it -
C. Radiologists / Persons doing Sonography –
Details of Approved Radiologists as per certificate

Sr Name of Approved Doctor Qualification MMC Renewal Due on

No. Registration (Valid Till)
Number
28/02/2027
1 Dr Balbirsingh Kohli M D (Med) 76243
28/02/2027
2 Dr Priya Jaydevan Pillai M D ( Radiodiagnosis) 75108
 Details of Radiologists / Gynecologists actually performing Obstetric Sonography at Center
(as per Scrutiny of F Forms) -

Sr Name of Approved Doctor Qualification MMC Registration Renewal Due on

No. Number (Valid Till)

1
2
3

Is there any Discrepancy in the names sanctioned by AA & Actual performing Doctors ? Yes / No

Machine :

Number of Machines as per certificate : 1

Number of Actual Machines Available : 1
Number of Machines Not being Used : 0
Whether Each Machine has MRC Sticker pasted / Attached on it ? Yes / No / Not Available for
Inspection
Number of Machines on which MRC Sticker has not been Pasted ? NIL
Reason for Machine not having MRC Sticker :
Machine Details
Triangulation of Machine Details as per certificate , MRC and Actual Availability
Portable Machines :
1) USG / MRI / Any Other (Specify)
Registration As per As per MRC As per Actual If Discrepancy , Whether
Registration Availability Reason for It Being
Certificate Used / Not
Make

Model
Serial
Number

Details of the
Probes
Make
Model
Serial Number

Check whether any Discrepancy in Approved & Actual Attached Probe Details in respect of
Numbers & Reason for Discrepancy if Any

Nominated Place for the Portable Machine :

Location of The Portable Machine at The Time of Inspection : Same as Nominated / At Different Place
than Nominated If Different –Mention Place at Which it is Found :
Check Whether Any Procedure Done in the Immediate Preceding Period if Found at Other
Place than the Nominated Place :
Fixed Machines :
 1) USG / MRI / Any Other (Specify)
Registration As per As per MRC As per Actual If Discrepancy , Whether
Registration Availability Reason for It Being
Certificate Used / Not
Make

Model
Serial
Number

Details of the
Probes of the
Machines
Make
Model
Serial Number

Check whether any Discrepancy in Approved & Actual Probe Details Details in respect of
Numbers & Reason for Discrepancy if Any

Nominated Place for the Portable Machine :

Location of The Portable Machine at The Time of Inspection : Same as Nominated / At Different
Place than Nominated If Different –Mention Place at Which it is Found :
Check Whether Any Procedure Done in the Immediate Preceding Period if Found at Other place than
the Nominated Place :

E. Record Checking :
I Monthly Report -
Mahaonline generated monthly report available Yes /No.
(if No, then take the Print out of Mahaonline report and compare the data)
Details of Monthly report since last visit till date
Sr Month No. of Total No of No. of F forms No. of Entries
No. Sonography Sonography available of ANCs in
performed as performed as per Five Column
per Report Mahaonline Register
Monthly Report.
1

Reason for Any Discrepancy in the Abovementioned Tabulated Data if Any -

II . F Form
Number of F Forms cross checked during the visit No F Forms Available at the Center
 Out of these ANC Mothers having previous 1 or 2 female issues – because No Sonographies
Whether Referral slips available with each F form are being done, only 2 D Echos
Does each referral slip has following details? are done

Name of Referring Doctors Yes / No

Sign of Referring Doctor Yes / No
Stamp of Referring Doctor Yes / No
Registration Number of Referring Doctor Yes / No
Purpose of Referring Patient Yes / No
All Columns in F Form are filled up Yes / No
Online print in each F form taken Yes / No
Print of Online F form completely filled Yes / No
Radiologist signature available on print of online F Form Yes / No

Number of Sonographies done 3 days before the visit and number of Online F forms filled

Date Number of Sonographies Done No. of Online Print Available

Does following documents are available for with each and every ANC Patient ?
a. Manually filed F form with Sign of Patient and Doctor Yes / No
b. Print of Completely filled Online F Forms Yes / No
c. Completely Filled up referral slip Yes / No
d. USG Plate Yes / No
e. USG Report signed by Radiologist Yes / No

III) FIVE COLUMN REGISTER ( Old 18 Column register Available , NIL Entries are being Done)
a. Does all columns in register are available? Yes / No
b. Whether All Columns are filled up properly and completely ? Yes / No
c. Number of F forms cross checked with register
d. Is there any discrepancy found ? Yes / No
If any discrepancy has been found , Give Details

B) Other Observations :
a. Whether Schedule of each radiologists is displayed ? Yes / No
b. Whether Board showing NMMC Authorities is displayed ? Yes / No
c. English / Regional Language Copy board showing penalty under
the act is displayed at reception. Yes / No
d. PCPNDT Act Copy available at the center Yes / No

e. Whether Center is Approved for Genetic Laboratory Yes / No

 f. If approved for Genetic Laboratory, then whether E forms submitted
along with monthly Report - Yes / No / Not applicable

Observations of the visiting Officer –

1.

2.

C) Copy of this Report is handed over to the Center Owner Yes / No

a. Name of the person to whom the copy was handed over

b. Date on which copy is handed over

c. Signature of the person to whom the copy is handed over

Sign of Center Owner

Date - - 2023
Name of the Owner of Center
MMC Registration No.
Stamp
Sign of Medical Officer
Date - - 2023
Name (Dr. Sachin M Chitnis )
Stamp