Burns care Providers in India (do not repeat if already submitted)

Request edit access

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

collection of database of burn care providers in india

Which state does burn care unit belong to *

City *

Name of the Hospital with burn care facility *

Postal address *

Funded by *

Name of Unit Head *

Total number of beds in the burn unit *

Mobile number ( do not put + 91 ) *

Email id of Unit *

No. of Doctors working in the Unit (names not required ) *

Number of Trainees working in the Unit *

Do you have OPD service *

Yes

In Bed service? *

Yes

Do you have Burns ICU *

Yes

number of ICU Beds (i,e 1,2 3.....) pls write numbers only *

number of Non ICU Beds (i,e 1,2 3.....) pls write numbers only *

Number of Nurses ( total numbers only ) *

Number of Skin Banks Facility *

yes

Name of Skin Bank Facility, write NA if you dont have *

address of Skin Bank Facility, write NA if you dont have *

Mobile or permanent number of Skin Bank Facility, write NA if you dont have *

Email id of Skin Bank Facility, write NA if you dont have *

Do you have Lab services? *

Yes

Do you have Physiotherapy services? *

Yes

Do you provide ventilator support ? *

Yes

Do you provide Dialysis support ? *

Yes

Do you have inhouse dietician? *

Yes

Are you willing to participate in national disaster management programme *

Yes

Form filled by (Name and designation) *

Mobile number *

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms