Award Category: Maximum Outreach Hospital of the Year

  1. What is the ownership structure of your hospital?

Government

Partnership

Co-operative

Trust

Corporate

Proprietorship

Armed Forces

Others

  1. What is the location of your hospital?

Urban

Rural

  1. Please indicate the ratio of patients in urban to rural regionscatered by your hospital.

Please provide supporting document (s) to support the same. In case documents are not available, provide the information on hospital’s letter head duly stamped by the COO

  1. Please indicate the ratio of patients in semi-urban to ruralregionscatered by your hospital.

Please provide supporting document (s) to support the same. In case documents are not available, provide the information on hospital’s letter head duly stamped by the COO

  1. What has been the growth percentage in the number of patients catered by the hospital in urban regions last year?

5%

5% to 10%

10% to 20%

20%

Please furnish the proof for the same.

  1. What has been the growth percentage in the number of patients catered by the hospital in semi-urban regions last year?

< 5%

5% to 10%

10% to 20%

> 20%

Please furnish the proof for the same.

  1. What has been the growth percentage in the number of patients catered by the hospital in rural regions last year?
  2. 5%
  3. 5% to 10%
  4. 10% to 20%
  5. 20%

Please furnish the proof for the same.

  1. How many cities in the country are covered by your hospital?

1 to 5 cities

6 to 10 cities

11 to 20 cities

 20 cities

  1. How many states in the country are covered by your hospital?

1 to 5 states

6 to 10 states

11 to 15 states

 15 states

  1. Is your hospital associated with any NGO for providing outreach facilities?

Yes

No

If yes, please furnish details about the same

  1. Does your hospital have programs to cater to global patients or patients inother countries?

Yes

No

If yes, provide the details about the same

  1. If yes, what has been the growth percentage in the number of patients catered by the hospital in other countries last year?

 5%

5% to 10%

10% to 20%

 20%

Please furnish the proof for the same.

  1. Does your hospital also provide outreach services through telemedicine?

Yes

No

If yes, please explain how does your hospital provide services through telemedicine. (Maximum word limit: 200)

  1. List any major outreach program undertaken by your hospital last year which you consider would help you in gaining dominance over other hospitals during award evaluation. (Maximum 200 Words)
  1. Would you like to give any other relevant information apart from the above points in the questionnaire to be considered for“Maximum Outreach Hospital of the Year Award”by the jury? (Maximum 300 words)