HEALTH FACILITY REGISTRY (HFR) DATA COLLECTION
HEALTH FACILITY REGISTRY (HFR) DATA COLLECTION FORM FOR OPTOMETRISTS, DISPENSING OPTICIANS AND LENS SURFACING LABORATORY
*** NOTE: All clinics with multiple branches are required to fill different forms for each of the branches not just one ***
OPTOMETRISTS AND DISPENSING OPTICIANS REGISTRATION BOARD OF NIGERIA
Board No. (SAMPLE BOARD No. OOP/1234/5678) *
REGISTERED FACILITY NAME *
NATIONAL FACILITY UNIQUE IDENTIFIER (This is for Facilities owned by the Federal Govt.)
STATE UNIQUE IDENTIFIER (This is for Facilities owned by the State Govt.)
CORPORATE AFFAIRS COMMISSION REG. NUMBER *
DATE OF COMMENCEMENT OF OPERATION *
MM
/
DD
/
YYYY
ALTERNATIVE FACILITY NAME
STATE *
LOCAL GOVERNMENT AREA *
WARD *
FACILITY TYPE *
LOCAL GOVERNMENT SERIAL NUMBER
PRACTICE ADDRESS/ PHYSICAL LOCATION OF PRACTICE *
GPS COORDINATE (LONGITUDE)
GPS COORDINATE (LATITUDE)
FACILITY ADDRESS 1 *
FACILITY ADDRESS 2 *
CITY *
FACILITY POSTAL CODE
FACILITY STATE *
FACILITY COUNTRY *
PHONE NUMBER ( OFFICIAL) *
FAX
FACILITY EMAIL *
FACILITY WEBSITE
NUMBER OF EMPLOYEES *
DAYS OF OPERATION *
Required
HOURS OF OPERATION *
INDUSTRY TYPE *
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