CENTRAL COUNCIL OF INDIAN MEDICINE NEW DELHI.

Transcription

1 CENTRAL COUNCIL OF INDIAN MEDICINE NEW DELHI. PART- I VISITATION PROFORMA FOR ASSESSMENT OF AVAILABLE FACILITIES OF TEACHING AND PRACTICAL TRAINING OF UNANI COLLEGE (to be filled up by the Principal countersigned by Secretary or President of the Society) I. Information of College 1) Name of the College with Complete Address including pin code (mentioning taluka, dist. and other details) 2) Information of communication 3) Information of Principal Section A -General Information Contact No. of College Contact No. of Hospital Fax Website Name Office Tel. No. Residence Tel. No. Mobile No. 4) Whether Government / Grant-in-aid / Private / Statutory College of University 5) Year of Establishment of Society / Trust 6) Year of Establishment of College 7) Information of President/Secretary of Society/Trust of College (For Private / Private Aided college) 8) Information of State Govt. Health Secretary / AYUSH Secretary dealing with the education of Ayurved, Unani and Siddha 9) Information of State Govt. Director of Unani / AYUSH 10) Information of University where college is affiliated 1. Vice chancellor 2. Registrar Name & Address Office Tel. No. Residence Tel. No. Mobile No. Name & Address Office Tel. No. Residence Tel. No. Mobile No. Name & Address Office Tel. No. Residence Tel. No. Mobile No. Name Office Tel. No. Mobile No. Name Office Tel. No. Mobile No. Visitation Proforma Unani

2 11) Important information of connectivity Name of Nearest Airport & Distance (km) Name of Nearest Railway station & Distance (km) Name & Address Telephone Number 12a) Name of competent authority conducting entrance examination for Govt. seats b) Name of competent Name & Address authority conducting Telephone entrance examination for Number Management seats 13) Fee Structure For Management seats For Government seats Name of the fee fixation authority 14) 1 st affiliation of University. 15) Name of nearest Police Station Name of University Year of 1 st affiliation Name & Address Telephone Number 16) Year of 1 st permission of State Govt. 17) Date & Year of First Permission of CCIM with Intake Capacity 18) Previous year permission of Dept. of AYUSH, New Delhi. 19) Present Intake Capacity Course Intake UG PG (Subject wise) Visitation Proforma Unani

3 II. DETAILS OF LAND Upto 60 (3 Acres) 1. Total area of land with Society/Trust (in acres) 2. Ownership of land (Own/Lease/Rented) 5. Whether entire land is in one plot or more than one. If more than one, then size and distance between these plots 6. Whether the land available with the Society/Trust is entirely for Unani College and attached Hospital or for any other Institute also, if so, details thereof. 7. Information regarding other institutions/colleges run by the same society/trust. Whether they are in same buildings. 8. Whether College and Hospital building are in same premises Yes/No If no, distance between College and Hospital in km. 9 Whether the College and Hospital building have ever been shifted to some other place since Yes/No If yes, then how many times it has changed the place and whether all the necessary formalities/permission had taken place 61 to 100 (5 Acres) (Please furnish a copy of relevant documents duly certified) 10. Whether the management/society of college (in case of private College) has ever changed since Yes/No If yes, whether all the necessary formalities/permission had taken place (Please furnish a copy of relevant documents duly certified) I. INFORMATION OF ADMITTED STUDENTS SECTION B INFORMATION OF THE COLLEGE Year of Admission No. of Students admitted UG Course PG Course Manage Govt. ment quota quota Govt. quota Manage ment quota Students admitted by order of AYUSH Dept. (GOI)/Court order. Name and date of last admitted student II. INFORMATION OF PASSED OUT STUDENTS Academic Year No. of students appeared in exam UG Course Final Year No. of students passed out No. of students appeared in exam PG Course Final Year No. of students passed out Visitation Proforma Unani

4 III. AREA OF COLLEGE S.No (1) Particulars (2) As per Minimum Standard Requirement (Unani) (Sq.mtr.) Built up area (in sq.mt.) Up to 60 students intake Available Area 61 to 100 students intake (3) (4) Total constructed area of college 2,000 4,000 building (1) Administrative Section (2) Lecture Halls. 400 (5 class room x 80) 800 (5 class room x 160) (3) Seminar or Conference or Examination Hall (4) Library (5) Teaching Departments: Total 1200 sq.mt. and break up may be as follows: Total 2400 sq.mt. and break up may be as follows: (i) Deptt. of Kulliyat (ii) Deptt. of Tashreeh ul Badan (iii) Deptt. of Munafe-ul-Aza (iv) Deptt. of Ilmul Advia (v) Deptt. of Saidla (vi) Department of Tahaffuzi wa Samaji Tib (vii) Deptt. of Mahiyatul Amraz (viii) Department of Moalajat; (ix) Department of Ilaj bit Tadbeer; (x) Department of Jarahat (xi) Department Amraze Ain, Uzn, Anf wa Halaq wa Asnan (xii) Department of Niswan wa Qabalat (xiii) Department of Amraze Atfal (xiv) Department of Amraze Jild wa Tazeeniyat IV. DETAILS OF COLLEGE DEPARTMENTS Availabl e Area S. No. Department 1. Kulliyat 2. Tashreehul badan 3. Munafeul Aza 4. Ilmul Advia 5. Ilmul Saidla 6. Mahiyatul Amraz No. of Dept. Library Books No. of Charts Museum No. of Models /Specimen No. of Lectures / Practicals / Clinicals carried out in the Academic Year UG PG Theory Practical / Clinical Theory Practic al / Clinica l Seminar Visitation Proforma Unani

5 7. Tahaffuzi wa Samaji Tib 8. Moalajat 9. Niswan wa Qabalat 10. Ilmul Atfal 11. Jarahat Ain-Uzn.-Anf- 12. Halaq wa Asnan Amraze Jild wa 13. Tazeeniyat 14. Ilaj bit Tadbeer V. DETAILS OF VARIOUS SECTIONS A. DISSECTION HALL S.No. Details Available 1. Number of cadavers available at the time of visitation 2. Number of cadavers dissected in the year Proper Ventilation Yes/No 4. Embalming Room with Storage tank/freezer Yes/No B. CENTRAL LIBRARY S.No. Details Available 1. Number of books (i) Unani (ii) Modern (iii) Medical Journals (iv) Others (Ayurveda / Siddha, etc.) (v) Total 2500 for new college 5000 (Before 2 nd & 3rd Batch) 7500 (Before 4th Batch) (5 Year or More existing College) 2. Number of seats available in reading room (At least 50 seats for 60 Intake 80 seats for 100 Intake) 3. Number of computers with internet facility VI. INFORMATION OF TEACHING STAFF S.N o. Department Intake Capacity for UG Number of Teachers required Prof. Asso Assista ciate nt Prof. Prof. (1) Kulliyat 60 1 or Additional for PG 1 or 1 1 Deptt. (2) Tashreehul 60 1 or 1 1 badan Additional for PG 1 or 1 1 Deptt. (3) Munafeul Aza 60 1 or Additional for PG 1 or 1 1 Deptt. (4) Ilmul Advia 60 1 or Additional for PG Deptt. 1 or 1 1 No. of Existing Teachers Prof. Associa te Prof. Assista nt Prof. Total Visitation Proforma Unani

6 (5) Ilmul Saidla 60 1 or Additional for PG Deptt. 1 or 1 1 (6) Mahiyatul 60 1 or 1 1 Amraz Additional for PG 1 or 1 1 Deptt. (7) Tahaffuzi-wa 60 1 or 1 2 Samaji Tib Additional for PG 1 or 1 1 Deptt. (8) Moalajat 60 1 or Additional for PG 1 or 1 1 Deptt. (9) Niswan wa 60 1 or 1 1 Qabalat Additional for PG Deptt. 1 or 1 1 (10) Ilmul Atfal 60 1 or Additional for PG 1 or 1 1 Deptt. 11) Jarahat 60 1 or Additional for PG 1 or 1 1 Deptt. 12) Ain-Uzn-Anf or 1 1 Halaq wa Asnan Additional for PG 1 or 1 1 Deptt. 13) Amraze Jild wa 60 1 or 1 1 Tazeeniyat Additional for PG 1 or 1 1 Deptt. 14) Ilaj bit tadbeer 60 1 or Additional for PG Deptt. 1 or 1 1 TOTAL Note:- Tibbe Qanooni wa Ilmul Samoom is merged in deptt. of Tahafuzi wa Samji Tib. VII. DETAILS OF TECHNICAL & OTHER STAFF OF A UNANI COLLEGE S.No. Department Post Requirement Available (1) (2) (3) (4) 1. Library Librarian/Assistant Librarian 1 Library Attendant or Peon College Office Clerical staff for administrative 4 accounts services 3. Kulliyat Attendant 1 4. Tashreehul Badan Laboratory Technician 1 Museum Keeper 1 5. Munafeul Aza Laboratory Technician 1 Museum Keeper 1 6. Ilmul Advia Laboratory Technician 1 Museum Keeper 1 7. Saidla Dawasaz/Pharmacy Attendant 1 8. Mahiyatul Amraz Laboratory Technician 2 9. Niswan wa Qabalat Visitation Proforma Unani

7 10. Ilmul Atfal 11. Tahaffuzi wa Samaji tib 12. Moalajat 13. Jarahat Attendant Amraze Ain, uzn, Anf wa Halaq 15. Ilaj bit Tadbeer 16. Amraze Jild wa Tazeeniyat 17. Herbal Garden Gardener 1 Multipurpose worker 2 VIII. ADDITIONAL REQUIREMENT :- 1. College Council Available/Not Available I. No. of Members II. Name of Members (Attach List) III. Yearly No. of Meetings 2. College website as per MSR Mentioned/Not Mentioned IX. SALARY INFORMATION S.No. Pay Scale + Grade pay of teachers Tick whichever applicable Remarks 1. Mode of payment through Bank Yes/No (If no please mention reason thereof) 2. GPF & CPF is deducted from the salary Yes/No (If no please mention reason thereof) 3. Teachers promotion policy as per norms of CCIM Yes/No (If no please mention reason thereof) 4. Existing pay scale of teaching staff State Govt./UGC/others 5. Pay Scale + Grade pay Pay Scale + Grade pay of Professor Pay Scale + Grade pay of Reader/Associate Professor Pay Scale + Grade pay of Lecturer /Assistant Professor SECTION C DETAILS OF THE HOSPITAL I. REQUIREMENT OF AN ATTACHED HOSPITAL OF A UNANI COLLEGE S.No Particulars Built up area (in sq.mt.) Available Area Up to 60 students intake 61 to 100 students intake I. Total constructed area of hospital building 2, II. Hospital Administration Block: Superintendent room 2. Deputy Superintendent room 3. Medical officer s ( for 2 Resident Medical Officer/Resident Surgical Officer) 4. Matron room 5. Assistant Matron room (for 2) Visitation Proforma Unani

8 6. Reception and Registration III. Out-Patient Departments (OPD) Moalajat OPD with wash basin 2. Jarahat including Ain, Uzn, Anaf, Halaq wa Asnan OPD with wash basin and Examination Room 3. Qabalat wa Amraze Niswan OPD with toilet and Examination Room 4. Amraze Atfal OPD with wash room 5. Amraze Jild wa Tazeeniyat OPD with wash basin 6. Tahaffuzi wa Samaji Tib OPD with wash basin 7. Dressing and First Aid Room 8. Dispensary 9. Waiting Space for patients 10. Store 11. Male and Female Toilet for patients IV. In-Patient Department(IPD) Moalajat including Ilaj bit Tadbeer Male Ward with attached toilet and bath room 2. Moalajat including Ilaj bit Tadbeer Female Ward with attached toilet and bath room 3. Jarahat including Ain, Uzn, Anaf, Halaq wa Asnan Male Ward with attached toilet and bath room 4. Jarahat including Ain, Uzn, Anaf, Halaq wa Asnan Female Ward with attached toilet and bath room 5. Niswan wa Qabalat Ward with attached toilet and bath room 6. Amraze Atfal Ward with attached toilet and bath room 7. Doctors duty room one for each department with attached toilet- bath 8. Nursing staff duty rooms, one in each ward with attached toilet-bath 9. Store room for linen, etc. V. Operation Theatres Block Major Operation Theatre 2. Minor Operation Theatre 3. Labour Room with attached toilet and bath room 4. Neonatal care room 5. Central Sterilization or autoclave unit 6. Scrub room 7. Two Recovery room 8. Doctors duty room with attached toilet and bath room 9. Interns or house officer or resident doctors room with attached toilet and bath room. 10. Nursing staff room with attached toilet and bath room VI. Ilaj bit Tadbeer Block: Hammam 2. Dalak 3. Riyazat 4. Fasad 5. Kai, 6. Alq, Hajamatetc 7. Ilaj bil Tadbeer therapist Physicians Room Visitation Proforma Unani

9 8. Ilaj bil Tadbeer Store room 9. Physiotherapy room VII. Central Laboratory: Well equipped and spacious area with separate sections for Pathology, Biochemistry and Microbiology. Attached toilet shall be there for collection of urine samples. Other latest diagnostic facilities such as ECG also shall be provided. VIII. Radiology or Sonography section Radiology chamber with X-ray room, Dark room, film drying room, store room, USG room, patients waiting and dressing room, reception or registration or report room IX. Hospital Kitchen and Canteen: X. Store room TOTAL 2,000 3,500 II) STAFF REQUIRED FOR HOSPITAL S.No. Post Requirement Available (1) (2) (3) 1. Hospital Superintendent Deputy Medical Superintendent Consultants Teachers of clinical departments 4. Resident Medical Officers/ 05 (01in Moalajat, 02 in Niswan wa Resident Surgical Qabalat, 01 in Jarahat and 1 in Officer/Medical Officers (RMO/RSO/MO) Amraze Atfal ) 5. Matron/Nursing Superintendent 1 6. Staff nurses for In Patient 01 for every 20 beds Deptt. 7. Ward Boy or Ayah 1 for every 10 beds. 8. Pharmacists 2 9. Dresser Store Keeper Office Staff (for registration, 2 record maintenance, data entry etc.) 12. Dark-room Attendant Operation Theater Attendant 1 Modern Medical Staff 14. Medical Specialist 1 part time/on contract 15. Surgical Specialist 1part time/on contract 16. Obstetrician and Gynecologist 1 part time/on contract 17. Pathologist 1 part time/on contract 18. Anesthesiologist 1 part time/on contract 19. Ophthalmologist 1 part time/on contract 20. Pediatrician 1 part time/on contract 21. Radiologist 1 part time/on contract 22. Dentist 1part time/on contract 23. Physiotherapist 1 part time/on contract 24. X-Ray Technician/ 1 Radiographer Visitation Proforma Unani

10 Staff for Ilaj bit tadbeer Therapy Section for Out-patient Department (OPD) and In-Patient Department (IPD) 25 Ilaj bit tadbeer Specialists Teachers of Ilaj bit tadbeer department. 26 House Officer or Clinical 1 Registrar or Senior Resident (Unani) 27 Ilaj bit tadbeer Nurse 1 (in addition to the nurses indicated at S.No.6). 28 Ilaj bit tadbeer Assistant 1 Male and 1 female 29 Messieurs 1 Male and 1 female Staff of Operation Theatre 30 Jarahat Specialists Teachers of Ilmul Jarahat department 31 Operation Theatre Attendant 1 32 Dresser 1 33 Nurses 01; these will be in addition to the nurses indicated at S.No.6. Labour Room 34 Qabalat wa Amraze Niswan Specialists 35 Midwife 1 Clinical Laboratory 36 Laboratory Technicians 2 37 Peon or Attendant 2 Teaching Pharmacy and Quality Testing Laboratory Teachers of Qabalat wa Amraze Niswan department 38 Pharmacy Incharge (Teachers of 1 Ilmul Advia/Saidla deptt.) 39 Peon or Attendant 1 40 Workers 2 41 Analytical Chemist (Part Time) 1 (Lab Technician provided under non-teaching staff in the Deptt) 42 Pharmacognosist (Part Time) 1 (Lab Technician provided under non-teaching staff in the Deptt) III) NUMBER OF PATIENTS ATTENDED OPD (Jan. to Dec. 2012) S.No. Month Moalajat (Medicine) Jarahat including Ain, Uzn, Anaf, Halaq wa Asnan (Surgery including Eye, ENT and Dental) Qabalat wa Amraz-e- Niswan (OBG) Amraze Atfal (Pediatrics ) Amraze Jild wa Tazeeniyat (Skin and Cosmeticol ogy) 1. January 2. February 3. March 4. April 5. May 6. June 7. July 8. August 9. September 10. October 11. November 12. December Total Grand total Note:- 1. Patients of Medical Camp conducted outside the campus should not be included. Tahaffuzi wa Samaji Tib (Community Medicine) Visitation Proforma Unani

11 IV) DETAILS OF BED DISTRIBUTION S.No. In Patient Departments Distribution Number of existing beds 1. Moalajat including Ilaj bit Tadbeer and 50% beds Amraz-e- Jild wa Tazeeniyat 2. Jarahat including Ain, Uzn, Anaf wa Halaq 25% beds 3. Qabalat wa Amraze Niswan wa Atfal 25% beds Total no. of beds V) DETAILS OF IPD PATIENTS (1 st Jan to 31 Dec. 2012) Remark visitor of S.No. Month 1. January 2. February 3. March 4. April 5. May 6. June 7. July 8. August 9. September 10. October 11. November 12. December Total Grand total Moalajat including Ilaj bit Tadbeer and Amraz-e- Jild wa Tazeeniyat Jarahat including Ain, Uzn, Anaf wa Halaq Qabalat wa Amraze Niswan Amraze Atfal VI) DETAILS OF TOTAL BED DAYS OCCUPIED (1 st Jan to 31 Dec. 2012) Total number of bed days occupied from Jan. to Dec S.No. Month Moalajat including Ilaj bit tadbeer and Amraz-e- Jild wa Tazeeniyat Jarahat including Ain, Uzn, Anaf wa Halaq Qabalat wa Amraze Niswan Amraze Atfal 1. Jan. 2. Feb. 3. March. 4. April 5. May 6. June 7. July 8. August 9. Sept. 10. Oct. 11. Nov. 12. Dec. Total Grand total Note:- To calculate total number of bed days occupied of the months please calculate the date wise total number of patients, remained on bed at midnight. Visitation Proforma Unani

12 VII) INFORMATION ABOUT VARIOUS SECTIONS IN THE HOSPITAL Name of Section LABOUR ROOM- Details of available facilities, equipments, instruments (Details be furnished as per annexure--xii) Number of Deliveries performed during the year 2012 OPERATION THEATRE Details of available equipments, instruments and other facilities in Operation theatre Total number of operations done during the year 2012 AMBULANCE Available/Not Available Pathology Laboratory Total number of investigation done in the year 2012 X-Ray Total number of X-rays done in the year 2012 ECG Total number of ECG done in the year 2012 USG Total number of USG done in the year 2012 VIII. CENTRAL LABORATORY Remarks IX) S. No. Total No. of Investigation done in the year Total no. of Hematological Tests. 2. Total no. of Bio-Chemistry Tests. 3. Total no. of Serology Tests. 4. Total no. of Microbiology Tests. INFORMATION OF ILAJ BIT TADBEER DEPARTMENT S.No. Name of the Instrument Number of Instruments Available 1. Apparatus needed for Hajamat (Cupping Set) Venesection 2. Dal k Table 3. Riyazat 4. Taleeq (Aquarium for leeches) 5. Fasd (Venesection Set) 6. Hamam 7. Others X) DETAILS OF TADABEER (1 st Jan to 31 Dec. 2012) S.No. TADABEER CARRIED From OPD From IPD Total OUT 1. Fasad 2. Hajamat 3. Dal k 4. Riyazat 5. Taleeq 6. Hamam Others Grand Total XI) DETAILS OF MEDICAL CAMPS CONDUCTED BY COLLEGE IN THE YEAR 2012 S.No. Nature of the camp Date Place General/Specific Disease Number of Patients Note:- * If required additional sheet be attached in the prescribed format. Visitation Proforma Unani

13 SECTION - D OTHER ALLIED INFRASTRUCTURE REQUIREMENTS OF A UNANI COLLEGE I) DETAILS OF HOSTEL Hostel Boys Girls Area (sq.mtr. / sq. ft.) Own / Rented No. of Rooms Capacity Mess (Available/Not Available) Warden (Available/Not Available) II) HERBAL GARDEN S.No. Particulars upto to 100 sq.mtr. sq.mtr. 1. Area Total number of Medicinal plants 3. Total number of species Irrigation facility available/not available - - Available III) SPORTS AND GAMES FACILITY Sports and Games Facility available / not available IV) TRANSPORT FACILITY Transport facility available/not available V) DETAILS OF TEACHING PHARMACY 1. Quality Testing Laboratory Available/Not Available 1. Number of medicine prepared in VI) DETAILS OF PREPARED MEDICINES IN THE YEAR 2012 S. No. Name of Prepared Medicine Quantity of Prepared Medicine Note- If required additional sheet be attached in the prescribed format. Visitation Proforma Unani

14 VII) PROGRESS MADE BY THE INSTITUTION IN LAST TWO YEARS ON SALIENT POINTS S.No. Important Information of College 1. Construction of college & hospital building Progress made by college 2. Appointment of Teaching staff 3. Appointment of non-teaching staff 4. Appointment of Paramedical and other Hospital staff 5. Expansion of Various Departments of College 6. Expansion of Herbal Garden, Plantation of New Plants 7. Development of Pharmacy 8. Progress in Hospital OPD 9. Progress in Hospital IPD 10. Progress of Ilaj Bit Tadbeer Department 11. Any national/international/state level seminars, ROTP,CME etc. 12. Publication by college and teaching staff 13. Research activities if any 14. Awards won by teaching staffs and students Visitation Proforma Unani

15 I s/o Shri Principal, (name of the College) solemnly writing that if any information provided by me in proforma and Annexure found false. I shall be held responsible in the matter. I shall have no objection if any legal action is taken by the CCIM against me. Dated Signature of Principal Place: Name with Stamp I am, s/o Shri Secretary/President (name of the Society) solemnly state that, looking after the management of the college & hospital. The information provided by the Principal in the proforma and Annexures are true. If any information provided by the Principal found false the undersigned has no objection for any legal action initiated by the CCIM against the Principal and me. Dated: Signature of Secretary/President Place: Name with Stamp Note:-Not applicable for Govt. Colleges Visitation Proforma Unani

16 LIST OF ANNEXURES TO BE SUBMITTED BY COLLEGE S.No. Annexure Number Name of the Annexure 1. Annexure-I Details of students admitted in Under Graduate course for the year Annexure-II Details of students admitted in Post Graduate course for the year Annexure-IIA Details of Post Graduate students allotted to individual guide for the Annexure-III Proforma to furnish the details of Teaching Staff 5. Annexure-IV Notarized Affidavit to be filled up by newly appointed teachers after last visitation (For 13C IMCC Act) in the given format. 6. Annexure-V Declaration form for newly appointed teachers before visitation 7. Annexure-VI Proforma to furnish the details of Non Teaching Staff 8. Annexure-VII Proforma to furnish the details of Hospital Staff 9. Annexure VIII Details of Drug distribution in OPD & IPD (Jan. to Dec. 2012) 10. Annexure IX Department Wise Details Of OPD Patients 11. Annexure X Details of the Indoor Patients of the Hospital 12. Annexure XI Details of Equipment & Instruments for various sections of College A) Dissection Hall B) Physiology Laboratory C) Ilmul Saidla Laboratory (Teaching) D) Pharmocognosy Laboratory E) Mahiyatul Amraz Laboratory (Pathology) 13. Annexure XII Details of Equipment & Instruments for various sections of Hospital A) Out Patient Department B) Labour Room C) Operation Theatre Visitation Proforma Unani

17 ANNEXURE-I DETAILS OF UNDER GRADUATE STUDENTS ADMITTED IN THE YEAR S. No Name of Student Father s Name Date of Birth Fee Receipt number and date Residential address Govt./ Management Quota % of PCB in 10+2 Category (Gen./SC/ ST/ OBC/ others ) ANNEXURE-II DETAILS OF POST GRADUATE STUDENTS ADMITTED IN THE YEAR S.No. NAME OF PG SUBJECT Permitted Seats by GOI / Court order no.dated.. 1. Kulliyat 2. Moalajat 3. Ilmul Advia 4. Ilmus Saidla 5. Tahaffuzi wa Samaji Tib 6. Amraze Niswan 7. Ilmul Jarahat 8. Mahiyatul Amraz 9. Ilaj Bit Tadbeer 10. Amraze Jild o Tazeeniyat 11. Tashreehul Badan 12. Munafeul Aza 13. Amraze Uzn, Anf, Halaque wa Asnan 14. Ilmul Atfal Grant Total ANNEXURE-II A Number of Admitted Students DETAILS OF POST GRADUATE STUDENTS ALLOTTED TO INDIVIDUAL GUIDE FOR THE YEAR S. No. Name of guide with designation Department Number of Students allotted Total Number of Students Visitation Proforma Unani

18 Sur Name First Name Middle name Father's Name Date of Birth UG Qualification (University & year) PG Qualification with subject (University & year) Duration (d/m/y) Designation Name of the college Department (Subject) Nature of present appointment (regular/ contractual/ deputation/ part time/ adhoc) Local Residential Address Permanent Address Name of State Board & Registration Number Salary Account Number, Name of Bank & Branch Telephone Number & Mobile Number of Teacher Note- If requiannexure-iii PROFORMA TO FURNISH THE DETAILS OF TEACHING STAFF S. No. Name of the Teacher Date wise details of Experience in chronological order (1 st appointment to till date) Photograph of Teacher (Attested by the Principal) Signature of Teacher ( At the time of visitation) Note: Please attach the certified copies of UG, PG & Registration Certificates experience certificates, Form No. 16 and original affidavit of newly appointed teachers after the last visitation. Inspectors will verify the teachers based on declaration forms submitted to the council. If in case of any newly appointed additional teachers before visitation, declaration forms can be submitted to inspectors for verification. If any teaching staff promoted after submitting declaration form may submit a new declaration along with necessary documents and duly verify with the inspectors. Visitation Proforma Unani

19 ANNEXURE-IV NOTARISED AFFIDAVIT TO BE FILLED UP BY TEACHER IN THE GIVEN FORMAT Pass Port Size Photograph (To be attested by Principal) S. Information of Teacher No. 1. Name of the Teacher (Sur Name- First Name- Middle Name) 2. Change of Name (if Applicable after marriage) 3. Date of Birth ( dd / mm / yyyy ) ( xx/xx/xxxx) 4. UG Qualification (University & year) Year Name of the University 5. PG Qualification with subject (University & Subject year) of completion Year Name of the University 6. Ph.D (if applicable) Subject Year Name of the University 7. Post wise details of Experience in chronological order (* Date, Month and Year wise experience should be mentioned) Duration (dd/mm/yyyy) to (dd/mm/yyyy) To be filled up by Teacher Department (Subject) Designation Name of the college 8. Present working Department (Subject) 9. Present Designation 10. Nature of present appointment (regular/contractual/deputation/part time/ adhoc) 11. Name of present working college 12. Permanent Residential Address 13. Local Residential Address 14. State Board/ Council Registration detail Registration Number Name of State Board 15. Bank detail Salary Account Number Name and Branch of Bank 16. Contact Number Mobile Number Residence Number Permanent Residence Number ID I hereby solemnly affirm that the above information is correct as per my record and knowledge. I further affirm that if any information given in this affidavit is found to be incorrect/ false, I shall be liable to be blacklisted or debarred from service and to face any disciplinary action. Date: Signature of Deponent/ Teacher I hereby solemnly affirm that the above information is correct as per my record and knowledge. I further affirm that if any information given in this affidavit is found to be incorrect/ false, I have no objection for any disciplinary action against the concerned teacher and myself. Date: Signature of Principal with Stamp Visitation Proforma Unani

20 ANNEXURE - V DECLARATION FORM FOR NEWLY APPOINTED TEACHERS BEFORE VISITATIONS Visitation Proforma Unani

21 ANNEXURE-VI PROFORMA TO FURNISH THE DETAILS OF NON TEACHING STAFF S.No. Name of Employee Father s Name Qualification Date of Appointment Nature of Appointment (regular/ contractual/ Part time) Designation Name of working department Pay Scale ANNEXURE-VII S.No. PROFORMA TO FURNISH THE DETAILS OF HOSPITAL STAFF (Including Part Time Modern Medical Staff) Father s Qualification Date of Designation Pay Scale Name Appointment Name of Employee Nature of appointment (regular/ contractual/ Part time) Name of working department S.No. Name and Quantity of Drugs obtained from own Pharmacy ANNEXURE-VIII DETAILS OF DRUG DISTRIBUTION IN OPD & IPD (JAN. to DEC. 2012) Name and Quantity of Drugs Name and Quantity of utilized Drugs along with balance purchased from market Note:-*If required additional sheet be attached in the prescribed format. Unani Drugs Modern Drugs Unani Drugs Modern Drugs Utilized Balance Utilized Balance Visitation Proforma Unani

22 ANNEXURE-IX DEPARTMENT WISE DETAILS OF OPD PATIENTS OPD SECTIONS MOALAJAT INCLUDING ILAJ BIL TADBEER JARAHAT INCLUDING AIN, UZN, ANF WA HALAQ QABALAT O AMRAZE NISWAN BEFORE 15 DAYS OF VISITATION TOTAL NUMBER OF PATIENTS ATTENDED OPD PREVIOUS DAY OF VISITATION DAY OF VISITATION AMRAZE ATFAL OTHERS Visitation Proforma Unani

23 A. TOTAL NUMBER OF BEDS AVAILABLE ON THE DAY OF VISITATION B. TOTAL NUMBER OF IPD PATIENTS ON THE DAY OF VISITATION ANNEXURE X DETAILS OF THE INDOOR PATIENTS OF THE HOSPITAL C. DEPARTMENT WISE DETAILS OF IPD PATIENTS AVAILABLE ON THE DAY OF VISITATION:- S.No. OPD Registration Number IPD Registration Number Name of Patients Age Sex M/F Bed Number Diagnosis Date of Admission Name of treating Doctor Visitation Proforma Unani

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28 ANNEXURE - XI DETAILS OF EQUIPMENT AND INSTRUMENTS REQUIRED FOR VARIOUS SECTIONS A) DISSECTION HALL S.No. Name of Instrument Number of Instruments and Equipments available 1 Bone Cutters of various types and sizes 2 Forceps of various types 3 Chisels 4 dissecting scissors of various types and sizes 5 Tagging 6 Knifes of various types 7 Needles of various types 8 Dissection tables (full size) 9 Dissection table ( half size) 10 Laboratory trays 11 Glass jars with cover for specimen 12 Embalming machine 13 Rocking pump/foot sprayer 14 Disinfecting machine 15 Buckets 16 Formaldehyde solution 17 Carbolic acid 18 Sodium acetate 19 Potassium acetate 20 Disinfecting solution 21 Glycerin 22 Dummy cadaver and models of body parts 23 Whole body skeleton, bones, dissected/preserved body organs etc b) PHYSIOLOGY (Munafeul Aza) LABORATORY S.No Essential Equipment and Instruments Number of Instruments and Equipments available 1. Microscopes with oil immersion 2. Westergren s pipette for ESR 3. Haematocrit Tube 4. Sahli s Haemoglobinometer 5. Haemocytometer 6. Sphygmomanometer 7. Stethoscopes 8. Clinical Thermometer 9. Knee Hammer 10. Tuning forks 11. Electrocardiograph 12. Stop watches 13. Water Distillation still 14. Thermometers, balances, Microslides, 15. Cover slips, glassware 16. Centrifuge with speed control 17. Colorimeter (photoelectric) 18. ph meter Electric 19. ph comparator with disc Visitation Proforma Unani

29 20. Refrigerator 21. Newton s colour wheel In a batch 22. Spirometer 23. Tonometer 24. Hydrometer 25. Viscometer 26. Osmometer 27. Stalagmometer 28. Sterilizer C) DETAILS OF EQUIPMENT AND INSTRUMENTS REQUIRED FOR SAIDLA LABORATORY (TEACHING PHARMACY LAB) S.No. Essential Equipment and Instruments Number of Instruments and Equipments available 1. Pestle and Mortara. Small b. Medium c. Porcelain d. Iron 2. Heating Devicea. Gas Stove b. Electric stove c. Hot plate d. Chulla (Charcoal) 3. Vesselsa. Frying Pan b. Steel Vessel c. Spatula d. Ladles & Spoons e. Knife f. Plates g. Tongs 4. Measuring Equipments Different Size (Glass) 5. Big Vessels & Containersa. Brass b. Copper c. Steel etc. 6. Balance (Different Capacities) a. Physical b. Chemical 7. Pounding Apparatus 8. Sieves (Assorted Nos. & Size) 9. Wet Grinder 10. Mixi 11. Juice Extractor 12. Putas (Different kind) 13. Pyrometer 14. Thermo meter 15. Pressure Cooker 16. Crucibles 17. Refrigerator Visitation Proforma Unani

30 18. Jars (Porcelain) Fermentation Purpose 19. Distillation Apparatus including traditional methods such as Qara Ambiq, Nal Bhabka etc. 20. Enamel Trays 21. Spirit Lamp 22. Microscope 23. Earthen Vessels-Pots 24. Almirahs & Racks for storage D) DETAILS OF EQUIPMENT AND INSTRUMENTS REQUIRED FOR PHARMACOGNOSY LABORATORY S.No. Essential Equipment and Instruments 1. Field magnifier 2. Compound microscope 3. Dissecting Microscope 4. Microscope 5. Slides box with cover slips, 6. Blotting/filter papers 7. Electronic balance 8. Dissection Box 9. Enamel Trays 10. Reagentsa. Chloroform b. Alcohol. c. HCL d. Sulphuric acid e. Sodium, potassium hydroxide f. Benedict solution g. Sodium nitrate h. Potassium nitrate i. Citric acid j. Iodine k. Ethyl Alcohol l. Potassium Iodide m. Xylol/pure xylene (slide preparation) Number of Instruments and Equipments available E) DETAILS OF EQUIPMENTS & INSTRUMENTS REQUIRED FOR MAHIYATUL AMRAZ LABORATORY (PATHOLOGY LABORATORY) S.No. Essential Instruments and Equipments Number of Instruments and Equipments available 1. Binocular microscope 2. X-ray view box 3. Sterile disposable lancer/needle 4. Sahli s Square tube 5. Hb pipette 6. Dropper 7. Glass rod 8. WBC Pipette 9. Improved Neubauer chamber 10. Cover slip 11. Red cell pipette 12. Cleaned slides 13. Incubator Visitation Proforma Unani

31 14. Wintrobe s tube 15. Pasteur s pipette 16. Centrifuge Graduatee machine 17. Westregrens pipette 18. Rubber teat 19. Westergrens s stand 20. Litmus paper 21. ph indicator paper strips 22. Urinometer 23. Multi stix 24. Bunsen burner 25. Test tube 26. Test tube holder 27. Filter paper 28. Steel almirah 29. Steel rack 30. Glass Jars with lid of different sizes 31. Glass view rack 32. Magnifying lens 33. Autoclave 34. Water bath 35. Separating funnels of various sizes 36. Stop watch 37. Ultraviolet lamp 38. Monocular microscope with oil emersion lens20(e) 39. Capillary Tubes 40. Hot air oven 41. Microscope with oil immersion 42. Refrigetors 43. Sterile vessels/bottle to collect samples 44. BP Apparatus 45. Stethocope 46. Thermometer 47. Tongue depressor 48. Torch 49. Knee hammer 50. Measuring Tape 51. ENT examination set 52. Reflectors(Mirrors) 53. Weighing machine 54. Tuning Forks 55. Nasal speculum 56. Laryngoscope 57. Catheters 58. Probes 59. Disposable Gloves 60. Physical balance 61. Syringe needle destroyer 62. HBs Ag kit 63. HIV kit - Tridot (method by T Mitra) 64. CT and BT kit 65. Cell counter (haemoautoanalyser) 66. Renal profile, LET kit, Lipid profile, Blood Sugar kit Visitation Proforma Unani

32 ANNEXURE XII A) DETAILS OF EQUIPMENT AND INSTRUMENTS REQUIRED FOR OUT PATIENT DEPARTMENT S. No. Name of OPD Equipment, Instrument, Furniture etc required as per norms of CCIM 1. Moalajat X-Ray View Box BP Apparatus Stethoscope Examination Table Thermometer Tongue depressor Cotton balls Torch Measuring tape Weight and height measuring stand Knee Hammer Washbasin 2. Jarahat Hand washing facility Drainage facility Minor OT. Instruments for anorectal examination Examination Table BP Apparatus Thermometer Surgical Blades Cotton Balls Gauze pieces X-ray viewing Box Stethoscope Cheetle s forceps Torch 3. Ain-Uzn-Anf-Halaq wa Asnan Tuning forks Ophthalmoscope/fundoscope Auroscope Examination Table X-Ray Viewing Box BP Apparatus Stethoscope Thermometer ENT kit Torch Bull s lamp 4. Qabalatwa Amraze Niswan Weighting machine Sim s speculum Thermometer Cusco s speculum Examination Table Lamp stand Torch X-Ray Viewing Box Visitation Proforma Unani

33 BP Apparatus Stethoscope Measuring tape Washbasin 5. Amraze Atfal Scale Weighing machine Torch View Box Thermometer BP Apparatus Stethoscope Examination Table 6. Ilaj bit Tadbeer As per Moalajat Massage table, Glass tank for Leeches, Cupping sets, Venesection set etc. B) LABOUR ROOM S.No. Essential Equipment and Instruments 1. Shadowless Lamp 2. Suction Machine (Neonatal) 3. Oxygen Cylinder and Mask 4. Foetal Toco Cardiograph 5. Radient Warner 6. Phototherapy Unit 7. Weighing Machine (Paediatric) 8. Patient trolley 9. Anaesthesia trolley 10. Infantometer 11. Vacuum extractor 12. Foetal Doppler 13. Low cavity forceps 14. Steriliser 15. Machintosh rubber sheet 16. Catguts and Thread 17. Speculum Sim s -Cuscos 18. Instruments for labour and Episiotomy (Scissors, forceps, needle holders etc.) 19. Baby tray 20. Draw Sheets 21. Plastic Aprons 22. HIV kit for emergency patients 23. Plain and Hole towels 24. Gloves 25. Nebuliser 26. Foetoscope 27. Auto Clave 28. Drums 29. Instrumental Trolley 30. OT tables and head Up and head low facility 31. Double dome Shadowless lamp 32. Pulse Oxymeter 33. Oxygen Cylinder Visitation Proforma Unani

34 S.No. Essential Equipment and Instruments 34. Resuscitation kit 35. Boyle s apparatus 36. Electro Cautery 37. MTP Suction Machine 38. Anaesthesia Kit 39. Blunt and Sharp Curettes 40. Dilators set (Hegar s, Hawkins) 41. Anterior Vaginal Wall retractor 42. Uterine sound 43. Volsellum 44. MTP Suction Curette 45. Needles 46. Needle holders 47. Sponge holding forceps 48. Towel Clips 49. Retractors abdominal (Doyne s etc.) 50. Green armytage forceps 51. Uterus holding forceps 52. Kocher s forceps 53. Artery forceps (Long, short, Mosquito) 54. Scissors- different sizes 55. Forceps obstetrics 56. Tongue depressor 57. Endotracheal tubes 58. B.P. apparatus 59. HSG Cannula 60. Cord Cutting appliances 61. I.U.C.D. removing hook 62. Bladder Sound C) OPERATION THEATRE S. No. Essential Equipment and Instruments I JARAHAT 1. Spot light (Shadowless ceiling fitted) 2. Needle holding Forceps (big-medium-small) 3. Aprons 4. Specimens Jar 5. Dressing drums of Assorted size 6. Drum stand 7. IV Stand 8. X-ray View Box (double) 9. Surgeon s gown 10. Mask and caps 11. Gauze, cotton and Bandage 12. Gloves of different size 13. Cheetles Forceps 14. Towel Clips 15. Mosquito forceps 16. Scissors straight (Tailor) 17. Scissors curved of different sizes 18. Stitch removal Scissors 19. Dissection forceps 20. Sinus forceps 21. Probes Assorted size Visitation Proforma Unani

35 22. Pointed scissors 23. Gastric and Intestinal clamps (occlusive and crushing) 24. Abdominal Retractors 25. Tissue Forceps 26. Bob Kock s Forceps 27. Kocher s forceps 28. Urethral Dilators 29. Rubber catheters of Assorted size 30. Metal Catheters 31. Corrugated Rubber drain 32. Suturing Needle (straight/curved) of Assorted size 33. Surgical Thread 34. Sponge holding forceps 35. Right Angle cholecystectomy Forceps 36. Stone holding forceps 37. Proctoscope with or without illuminator 38. Bougies (Megars) 39. Allies Forceps small 40. Allies Forceps Big 41. Pile holding forceps 42. Artery Forceps small 43. Artery Forceps big 44. Artery Forceps Medium 45. Sigmoidoscope Rigid/flexible 46. Barron Pile s Gun 47. Laryngoscope Pediatric/Adult 48. Boyles Apparatus 49. Multiparameter Monitor 50. Ambu Bag 51. Suction machine Electrical/Manual 52. Generator (Minimum 30 KV) 53. Emergency light 54. Fire Extinguisher 55. Skin grafting knife with handle 56. Surgical blades of different size 57. BP Handle of different size 58. Vertical BP Instrument 59. Self Retaining Retractor 60. Bone Drill Machine 61. Bone cutter 62. Giggly Saw 63. Scoop 64. Periosteum elevator 65. Maggler Forceps 66. E.T. Tubes of different sizes 67. High Pressure Autoclave 68. Fumigator 69. Refrigerator 70. Nitrous Oxide Cylinder 71. Exhaust Fan 72. X.ray view box 73. Auto linen Washing Machine 74. Hydrolic Operation Table 75. Shadow less lamp ceiling 76. Anaesthesia Trolley/Boyle s Apparatus 77. Instrument Trolley 78. Endotracheal Tube 79. Ambu Bag Visitation Proforma Unani

36 80. Proctoscope with or without illumination 81. Revolving Stool 82. Gabriel Syringe 83. Stretcher with trolley 84. Mosquito forceps 85. Piles holding forceps 86. Needle holder 87. BP Apparatus 88. Suction Machine II AIN (EYE): Ophthalmic Equipments/Instruments for Operative Surgery 89. Operating Microscope with Coaxial Illumination and foot control 90. Bipolar Wet field cautery 91. Mini Halogen Light (table mouning) 92. Ophthalmic operation table with head rest 93. Sterilizing box /case with mats 94. Lens insertion forceps 95. Keratome 96. Barraquer wire speculum (adult/child/infant) 97. Desmarres lid retractors 98. Cat-paw lacrimal retractor 99. Mueller lacrimal sac retractor 100. Dastoor iris retractor 101. Castro Viejo caliper 102. Meyrhoefer Chalazion curette 103. Sinsky lens manipulating hook 104. IOL Manipulator 105. Foreign body spud 106. Lewis lens loop (vectis) 107. Cystotome and spoon 108. Mule Evisceration spoon 109. Wells Enucleation spoon 110. Iris repository (double-ended) 111. Tooks Corneal knife 112. Graefe Strabismus hook 113. Jameson muscle hook 114. Smith lens expressor 115. Wills cautery with copper ball-point 116. Barraquer blade braker and holder 117. LangsIacrimal sac dissector 118. Kelly Glaucoma punch 119. West Lacrimal Chiesel 120. Elevator (double ended) 121. Mallet 122. Nasal speculum adult/child 123. Pigtail Probe with Suture holes 124. Wilder punctum Dilator 125. Bowman lacrimal probes 126. Towel clamp 127. Hartman mosquito forceps 128. Colibri forceps 1*2 teech 129. Mc. Person corneal forceps with tying platform 130. Kelman Mc. Pherson angled forceps 131. Mc. Phersons tying forceps 132. Dressing forceps, serrated 133. Moorfieldconjuctival forceps 134. Fixation forceps 135. Beer cilea (epilation) forceps Visitation Proforma Unani

37 136. Arruga capsular forceps 137. SnellenEntropion clamp 138. Chalazion clamps 139. Chalazion clamps 140. Iris scissors 141. Westcott tenotomy scissors 142. Vannas straight scissors 143. De-Weckers iris scissors 144. Strabismus scissors 145. Enucleation scissors 146. Barraquer needle holder 147. Castroviejo micro needle holder 148. Silcok needle holder with sid lock 149. Air injection cannula 150. Healon aspirating cannula 151. AC was cannula 152. Lacrimal cannula 153. Hydrodialysis cannula 154. J-loop cannula (rt./it. With silicon tubing) 155. Simcoe direct I/A cannula with silicon tubing 156. Irrigating aspirating handle 157. Lens dialer 158. Superior Rectus forceps 159. Eye wash glasses 160. Swimming Goggles III ENT-Surgical/Operative procedural Instruments 161. Aural Syringe 162. Jobson s Aural Probe 163. Eustachian Catheter 164. Mastoid Retractor 165. Mastoid Gouge 166. Mallet 167. Mastoid Cell seeker with scoop 168. Nasal Foreign Body hook 169. Nasal packing forceps 170. Antral Trocar cannula 171. Antral Burr 172. Nasal Snare 173. Freer sseptal knife 174. Ballinger s swivel knife 175. Bayonet Shaped gouge 176. Walshman s forceps 177. Laryngeal forceps 178. Boyle-Davis mouth gag 179. Tongue plate with throat suction 180. Tonsil holding forceps 181. Tonsillar suction 182. Tonsillar Dissector 183. TonsillarSuare 184. Guillotine 185. Adenoid curette with cage 186. Peritonsillar abscess draining forceps 187. Fuller s Tracheostomy Tube 188. Steriliser box 189. Cheatel s Forceps 190. Other consumable articles like gloves, syringes, bandages etc ENT operating microscope and lens Visitation Proforma Unani

38 CENTRAL COUNCIL OF INDIAN MEDICINE, NEW DELHI Guidelines/Instructions for Colleges regarding Visitation 1. College may download the updated visitation proforma (Part I) from website of CCIM and may use it to expand the tables wherever necessary. Annexure III (MS-excel format) should be separately downloaded from CCIM website, duly filled & sent along with the visitation proforma. Hard copy of visitation proforma (Part I) is enclosed for ready reference. 2. Any change in the prescribed format will not be accepted by CCIM. 3. Read the proforma carefully before filling up. 4. College should keep ready three sets of Visitation proforma duly signed on each page by the Principal/ Dean/ Director along with all annexure for visitors. 5. A soft copy of the details of teaching staff as per Annexure-III should be submitted along with the visitation report. 6. New teacher appointed after visitation of the college will not be considered/counted in the faculty list of the concerned college. 7. Any data / documents submitted by the college after visitation will not be accepted by the central council. 8. College shall bear the whole responsibility of typographical errors in the OPD/IPD data and experience of teachers. In previous years, due to incomplete information and typographical errors in the visitation proforma, colleges have to face the Hearing. Therefore, college is advised to submit all the relevant information and fill the proforma in proper manner as per the given guidelines. (Note:- While furnishing details of various section please crosscheck various requirement from notified Minimum Standard Requirements of Unani 2013). 9. Page-wise Index of all annexure should be provided. 10. Attested copy of UG & PG Certificates, Experience Certificates, Joining report, Relieving letter and Affidavit (as per annexure-iv) of teachers should be attached. 11. Teachers of Govt. colleges/ constituent colleges of University should also submit the affidavit of newly appointed teachers after the last visitation. 12. If false affidavit/ false experience is submitted by any teacher or if teacher is found in duplicity, then legal action will be initiated by the central council against the concerned teacher and Principal of the college. 13. Copy of Form No. 16 issued for purpose of income tax should be submitted in respect of all the teaching staff. (Not admissible for Govt./ constituent colleges of University). 14. Financial information should be filled as per enclosed proforma. 15. College should make arrangement of videographer and photographer during visitation of CCIM team for preparing CD and group photographs with Teaching staff and nonteaching staff of College and Medical and Paramedical staff of Hospital with the visitors separately. The name of each staff member should be mentioned on the bottom of the photograph. It is to be noted that without CD & Photograph, the visitation report will not be accepted by CCIM. 16. If college has any queries/ doubt/ other information required regarding the visitation Proforma, you are requested to contact telephonically or send an to the central council on the given mail-id, ccimvisitation2012@gmail.com. 17. Local residential address of teacher should be of the same city in which he is working presently. ************* Visitation Proforma Unani