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Employer Registration Form
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Name of Hospital / Clinic/ Organization
*
State
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ANDAMAN AND NICOBAR ISLANDS
ANDHRA PRADESH
ARUNACHAL PRADESH
ASSAM
BIHAR
CHANDIGARH
CHHATTISGARH
DADRA AND NAGAR HAVELI
DAMAN AND DIU
DELHI
GOA
GUJARAT
HARYANA
HIMACHAL PRADESH
JAMMU AND KASHMIR
JHARKHAND
KARNATAKA
KERALA
LAKSHADWEEP
MADHYA PRADESH
MAHARASHTRA
MANIPUR
MEGHALAYA
MIZORAM
NAGALAND
ODISHA
PONDICHERRY
PUNJAB
RAJASTHAN
SIKKIM
TAMIL NADU
TELANGANA
TRIPURA
UTTAR PRADESH
UTTARAKHAND
WEST BENGAL
City
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District
Address
Email ID
(It'll be your Login ID)
*
Contact Number
*
Organization Accredited By
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NABH
NABL
JCI
INC
MCI
State Bodies
ISO
Any Other
Organization Logo
Attached Demand Aggregation
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HR /Medical Superintendent/Nursing Superintendent
Name
Email Id
Mobile No
Organization HR
*
Nursing Superintendent
*
Medical Superintendent
*
Type Of organization
--Select--
Hospital/ Multi-speciality
Pharmaceutical Company
Clinic/ Centre(Dental/ Eye/ Oncology/ Dialysis)
Diagnostic Lab
Rehabilitative Center
Medical Equipment Manufacturer
Nursing Home
Teaching /Research Institute
Non-Government Organization
Medical College
Any other, please specify
Size Of organization / Hospital
Organization Other Than Hospital
Hospital
SMALL
> 10 lakh rupees but < 2 crore rupees
No. of beds below 100
MEDIUM
> 2 crore rupees but < 5 crore rupees
No. of beds between 100- 350
LARGE
> 5 crore rupees
No. of beds above 350
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