STEP 1: Hospital Registration Form for STEP UP Fellowship program

Hospital Registration Form for STEP UP Fellowship program

DakshamA Health will follow a systematic approach by first processing the hospital requirement form, ensuring that the hospital is eligible to have fellowship in place, before opening the application for fellows to apply through the hospital.
Please enter the name of your hospital*
Please enter your name*

First NameLast Name
Please enter your designation*
Please enter your official email address*
example@example.com
Please enter the address of your hospital*

Street Address

Street Address Line 2

CityState

Postal / Zip Code
Please enter the official URL of the hospital*
YesNo
YesNo
Can you please provide a short bio of the experienced ortho surgeon.

Cancelof
YesNo
Please mention your NABH/JCI certificate reference number
(eg H-2006-0029)
YesNo
YesNo
YesNo
Universal ProtocolWHO Safety ChecklistQCI
YesNo
YesNo
YesNo
ClassesMaterialsProtocol informing of risks
YesNo
Case managementDischarge planningMonitoring of transitions
YesNo
YesNo
< 250 surgeries250 - 300 surgeriesmore than 300 surgeries
YesNo
less than or equal to 3.5 daysbetween 4 - 5 daysmore than 5 days
less than or equal to 4 daysbetween 5- 6 daysmore than 6 days
YesNo
YesNo
For how long have you been running the fellowship program in your hospital?
mention the duration in years
If yes, please list all the fellowships offered in your hospital.
On an average how many fellows enroll in your present fellowship program?
What is the tenure of your present fellowship program?
Case presentations & discussionSeminarJournal clubGrand round presentation (by rotation departments and subspecialties)Faculty lecture teaching- once a monthClinical Audit-Once a Monthposter or oral presentation
req criteria calculation
Other criteria calculation
Process criteria calculation
V&O criteria calculation
Privacy Policy

At DakshamA Health, safeguarding your personal information is of utmost importance to us. We adhere to strict privacy and security protocols to ensure the confidentiality of your personal data.

When you visit our website, we generally do not collect any personal information from you. Instead, we obtain most of the information we require from the application you submit to us. We process your data to evaluate and process your application for study, as well as for other related purposes such as determining your eligibility for the STEP-UP program and establishing a partnership with DakshamA Health.

We will retain the hospital's data only after they have completed and submitted the application form and met all the necessary requirements (including those related to legal, accounting, or reporting) to establish the fellowship program at their facility.

www.dakshamahealth.org
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