Oral Health Innovation & Incubation

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Title

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Mobile No *

Alternate Mobile No

Email Id *

Alternate Email Id

Telephone

Alternate Telephone

SDC Registration No

Address

Area *

Country *

State *

County *

SubCounty *

City *

Pincode

Marital Status

Addhar No

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Contact Person Details

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Basic Information

Name of Dental Clinic
Clinic Address
Clinic Phone Number
Clinic Email ID

Services

Amenities Details

	Amenities	Availability
A	Equipment
1	Number of dental chairs	1-2 >3
2	Autoclave	Yes No
3	RVG	Yes No
4	Patient management system	Yes No
B	Infrastucture
1	Reception Area	Yes No
C	Human Resources
1	Associate Dentists	1-2 >3
2	On-board Specialists	1-2 >3
3	Dental Assistant	1-2 >3
4	Receptionist	Yes No
D	Emergency
1	Are the staff aware of the protocol to be followed in terms of
a )	Medical Emergency	Yes No
b )	Natural Calamities	Yes No
2	Does the clinic have a:
a )	Medical Emergency Kit	Yes No
b )	Fire-extinguisher	Yes No

Registration

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Name : {{DObj.PracticeName}}

Name : {{DObj.PracticeId}}

Mobile No : {{DObj.mobile}}

Alternate Mobile No : {{DObj.alternate_mobile}}

Email-Id : {{DObj.email_id}}

Alternate Email-Id : {{DObj.alternate_email}}

Telephone {{DObj.telephone}}

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Registration Number : {{DObj.registration_no}}

Address : {{DObj.Address}}

Area : {{DObj.Location}}

Country : {{DObj.Country}}

State : {{DObj.State}}

County : {{DObj.County}}

City : {{DObj.City}}

SubCounty : {{DObj.SubCounty}}

Marital Status : {{DObj.MaterialStatus}}

Aadhar No : {{DObj.adhar_no}}

Password : {{DObj.Password}}

Brief Info : {{DObj.AboutMe}}

Basic Information

Name of Dental Clinic : {{Fac.ClinicName}}
Clinic Address : {{Fac.Address}}
Clinic Phone Number : {{Fac.Mobile}}
Clinic Email ID : {{Fac.EmailId}}

Services

{{serv.AttVal}}

Amenities Details

	Amenities	Availability
A	Equipment
1	Number of dental chairs	{{Fac.NoOfDentalChair}}
2	Autoclave	{{Fac.Autoclave}}
3	RVG	{{Fac.RVG}}
4	Patient management system	{{Fac.PMS}}
B	Infrastucture
1	Reception Area	{{Fac.ReceptionArea}}
C	Human Resources
1	Associate Dentists	{{Fac.AssociateDentists}}
2	On-board Specialists	{{Fac.OnBoardSpecialists}}
3	Dental Assistant	{{Fac.DentalAssistant}}
4	Receptionist	{{Fac.Receptionist}}
D	Emergency
1	Are the staff aware of the protocol to be followed in terms of
a )	Medical Emergency	{{Fac.MedicalEmergency}}
b )	Natural Calamities	{{Fac.NaturalCalamities}}
2	Does the clinic have a:
a )	Medical Emergency Kit	{{Fac.MedicalEmergencyKit}}
b )	Fire-extinguisher	{{Fac.FireExtinguisher}}

Registration

Dentist Registration

{{Registration}} Registration

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Dentist Registration

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