SECOND SCHEDULE (Section 7)

FORMS
NURSES COUNCIL OF ZIMBABWE
(CHAPTER 27:19)
APPLICATION FOR REGISTRATION OF A HEALTH INSTITUTION
(To be completed in Block Letters)

The Registrar
Nurses Council of Zimbabwe
P O Box A830
AVONDALE
Harare
Non-refundable Fee of $__________________

1. Type of Health Institution ______________________________________________________

2. Date operative or proposed date of commencement ________________________________

3. Full name of Health Institution __________________________________________________

4. Physical address ______________________________________________________________

______________________________________________________________
______________________________________________________________
5. Postal address _______________________________________________________________

6. E-mail address_______________________________________________________________

7. Telephone number (s) _________________________________________________________

8. Name and address of owner of clinic _____________________________________________

___________________________________________________________________________
Profession __________________________________________________________________
Telephone number (s) ___________________________________
___________________E-mail _________________________________________
9. Name and profession of the Health Practitioner in charge/employed at the Health Institution
(a) Name ________________________________________________________
(b) Profession ________________________ Registration Number _______________
(c) Date of current Practising Certificate ___________________________________
(d) Years of Experience _______________
(e)
10. Service provided at the Institution (full explanation)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Page 1 of 4
11. Type of Proposed Institution ____________________________________________________
(i.e. Polyclinic, Nursing Home, Maternity, etc.)
Location ____________________________________________________________________
_____________________________________________________________________
Justification of operating such service ____________________________________________
___________________________________________________________________________
___________________________________________________________________________
__________________________________________________________________________
Did the Local Authority approve? YES/NO (Delete inapplicable)
If Yes, evidence of approval ___________________________________________________
Number and qualification of people to be employed _________________________________
___________________________________________________________________________
___________________________________________________________________________

I certify to the best of my knowledge and belief that the foregoing particulars are true and request
registration of the afore –mentioned premises.

Date ______________________ Signature _____________________________

Person in Charge of Health Institution

NOTE: *State Hospital, clinic, polyclinic, maternity unit, State nursing home, etc.

FOR OFFICE USE ONLY

Date application received _______________________ Receipt Number _________________

Fee received: (cash/postal order/money order) $ ___________________________________

Application approved/deferred Date ________________________________

Remarks: ___________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Page 2 of 4
 SPECIFIC REQUIREMENTS FOR REGISTERING A PRIVATE HEALTH INSTITUTION
1. Draw up a project proposal to support your application. The proposal should Include the following:
 Project title(Name of your Project)
 Background Information and justification. This describes briefly the population you want to
serve, their health care needs, your proposed services and justification-(Why you think it is
necessary to develop them, who will use your services).
2. Project description to include:
 Its location and size
 The organisational frame work
 Implementation of the programme
 Projects cost including cash flows and financial projections (you may need to seek
professional financial adviser to assist with this)
 Social and economic benefits i.e. provision of employment, affordable, accessible health
care services, complementing existing public health care services etc.
 Conclusion
3. Apply for a permit to establish your practice to the local town planning department of works or
engineering for
 Change of use or
 Use of designated land e.g. shops

The application should be accompanied by your proposal, a letter from your covering doctor
and a prescribed fee according to the requirement of each local authority.

For Harare, apply to the district officer of the location if the proposed institution is in the
low density area, and Town House (Shepperton House, Cameroon Street) for the high
density area.

The Council in accordance with section27 (3) of the regional town and country planning Act
1976, will either forward you a prescribed form of a public notice to appear in a local
newspaper, or reject your application. The cost of the notification is borne by the applicant.

Requirements in this regard:

Submit to relevant authorities in council within twenty one days of publication:

 Proof that the notice has been published in the local newspaper.
 Proof that neighbours that share your boundaries have indeed seen the notification and
signed to that effect to indicate that they have no objection for the establishment of the
health institution.

NB: You must not practice before the clinic has been inspected and approved for
registration. Operating an unregistered clinic is an offence.

Page 3 of 4
4. In accordance to subsection (1)(2) and (3) of the Health Professions Authority Act 27: 19, Individuals
or health practitioners should not practise in any health institution unless it is registered in
accordance with terms and any conditions attached to its registration.

4.1 Submit application form H.1 with the prescribed fee to register. Provide the following information:
 Name address of the institution
 Type of institution
 Name address of the registered person in charge of the institution
 Services to be offered by the institution
 Name and address and Tel No. of owner of the premises
 Name and profession of health practitioner in charge employed at the health institution
(Full names , Profession)
 Full explanation of services provided at the institution
 Proof of current practising certificate
 Experience in years
 Insurance cover.
 Health Report from the Environment Health Department of the relevant Local Authority.
 Permit from the Local Authority with building plans or proposed building plans where
applicable.
 Two recent passport size photographs of the practitioner in charge and
 A confirmation letter from the covering Doctor (for Nurse Practitioners)

The Practice Control Committee may consider your application if

 The institution meets the prescribed standards.

 The construction and location are suitable
 Equipment or facilities are adequate for intended use
 Persons who will practice or be employed are suitable qualified , and if
 It is for the public interest that the institution is to be registered.
 Recommendations for registering will be forwarded to the Health Professions
Authority.

5. When approved a Registration Certificate in form H.1.2. shall be issued. Then A renewal should be
submitted in form H.1.3 at least two months before expiry date, with a prescribed fee.

Page 4 of 4