Navi Mumbai Municipal Corporation

Health Department
PCPNDT Quarterly Inspection Format

Name of Inspecting Authorised

Dr. Sachin M. Chitnis
Medical Officers
Name of UPHC Urban Primary Health Center, Airoli

Date of Visit : - - 2023

Date of Last visit : - 9 - 2023
Schedule dates given by Appropriate Authority : 1 - 12 - 2023 to 20 - 12 - 2023

A) Details of the Center

Name of the Center : INDRAVATI HOSPITAL & RESEARCH CENTER

Address of the Center : Plot NO PHC, Near Airoli Bus Depot, Sector 3, Airoli , Navi Mumbai
Phone No. of the Center : +912261617702 Email : care@indravatihospital.com
: 022 - 30857722 :
uteltumbade@indravatihospital.com
Mobile Number of the Applicant : +91-9867367836
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 (Encircle Applicable) : USG 2 D Echo
CT Scan MRI PET Scan
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 / 236
Registration Valid upto : 08 / JUN / 2026
Applied for Renewal : Yes / No / Not Applicable

Details of Applicant (as per certificate) -

Sr Name of Applicant/s Qualification of MMC Registration Due Date of
No. Applicant number if Registration of
Applicable Renewal
1 Dr UMESH TELTUMBADE MBBS, M D (Gen Med) 69868 28-2-2027
 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
1 Dr Kshitij Bedmutha DM (Cardio) 2010/04/1271 19-04-2025

2 Dr Manish Shirsat DMRE (CPS) 2014/04/1434 21-04-2024

3 Dr Suresh Sirvi DMRE (CPS) 2015/03/0830 09-03-2025

4 Dr Amol Banait DNB (Radiodiagnosis) 2008/04/1359 15-04-2023

5 Dr Ravindra Bangar DNB (Radiodiagnosis) 2013/06/2184 14-06-2023

6 Dr Prasad Kandalgaonkar M D (Radiodiagnosis) 2004/03/1790 28-02-2027

7 Dr Mayur Jain DM (Cardio) 2007/04/0818 17-04-2027

8 Dr Vikram Chavan M D (Radiodiagnosis) 2005/07/3007 08-01-2025

9 Dr Mangesh Shankhpale DMRE 90270 28-02-2027

10 Dr Sushilkumar Patil M D (Radio) 2007/08/3218 17-08-2027

11 Dr Dattatraya Patil DNB (Radiodiagnosis) 2013/06/2185 14-06-2023

12 Dr Prakash Kudale DNB (Radiodiagnosis) 2013/04/1136 26-04-2023

13 Dr Adsul Shrikant DNB (OB & GY) 2005/04/2408 13-04-2025

14 Dr Himanshu Singh M D (Radio) 2017/04/1192 18-04-202 .

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
4
5

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

B) Machine :

Number of Machines as per certificate :

Number of Actual Machines Available :
Number of Machines Not being Used :
Whether Each Machine has MRC Sticker pasted / Attached on it ? Yes / No
 Number of Machines on which MRC Sticker has not been Pasted ?
Reason for Machine not having MRC Sticker :

Triangulation of Machine Details as per certificate , MRC and Actual Availability

1) USG / MRI / Any Other (Specify) - Fixed / Mobile
Registration As per Whether
As per Actual If Discrepancy ,
Registration As per MRC Being
Availability Reason for It
Certificate Used / Not
Make

Model
Serial
Number

2) USG / MRI / Any Other (Specify) - Fixed / Mobile

Registration As per Whether
As per Actual If Discrepancy , Being
Registration As per MRC
Availability Reason for It Used / Not
Certificate

Make

Model
Serial
Number

3) USG / MRI / Any Other (Specify) - Fixed / Mobile

Registration As per Whether
As per Actual If Discrepancy , Being
Registration As per MRC
Availability Reason for It Used / Not
Certificate

Make

Model
Serial
Number

If Any Discrepancy , Reason for the Same -

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

Total No of
No. of No. of Entries
Sonography
Sr Sonography No. of F forms of ANCs in
Month performed as per
No. performed as available Five Column
Mahaonline
per Report Register
Monthly Report.
1

Reasons for Discrepancy in the Above mentioned Data :

II . F Form
Number of F Forms cross checked during the visit
Out of these ANC Mothers having previous 1 or 2 female issues –
Whether Referral slips available with each F form
Does each referral slip has following details?
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
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

1.

2.

3.

4.

5.

6. .

C) 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.

3.
 D) 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 Sign of Medical Officer

Date - - 2023 Date - - 2023
Name (Dr. Sachin M Chitnis ) Name (Dr. Sachin M Chitnis )
Stamp Stamp