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Format for listing empaneled providers for uploading in State/UT website
State Haryana/Panipat
Year 2016-17
Empanelment List for (Prepare separate list for
Minilap, Lap and Vasectomy and indicate the same)
SNo.
Name
of
District
Name of
Empanelled
Sterilization
Provider
Qualification
(MBBS/MS-
Gynae/DGO/DNB/MS-
Surgery/Other Specialty Designation
Type of
Facility
Posted
(PHC/CHC/
SDH/DH)
Postal address
of facility
where
empaneled
provider is
posted Contact
number
1 Panipat Dr. Shashi M.S Gynae M.O DH ` 9416077819
2 Dr. Suman M.S Gynae M.O DH
9896077704
3 Dr. Lipika M.S Gynae M.O DH
9466688482
4 Dr. Mani M.S Gynae M.O DH
8221056742
5 Dr. Sanjiv
Gupta M.S Plastic Surgery MO DH
9467361588
6
Dr. Vijay
Malik M.S Gen. Surgery SMO DH
9996996184
7
Dr. Sanjeev
Goel M.S Gen Surgery SMO DH
946131888
8 Dr. Ajay
Kapoor M.S Plastic Surgery SMO DH
941633304
Line Listing Of Sterilization Trained/Empaneled Providers S
.No
Na
me
of
Dis
tric
t
Na
me
of
tra
ined
/ E
mp
an
elle
d
pro
vid
er
Qu
ali
fica
tio
n
Pla
ce
of
Post
ing
(N
am
e of
Fa
cili
ty a
nd
Lev
el)
Co
nta
ct
Nu
mb
er
Trained/
Empaneled for Services provided in last one year
Rem
ark
s
Min
ila
p
La
pa
rosc
op
ic S
teri
liza
tion
NS
V
Nu
mb
er o
f M
inil
ap
per
form
ed
If n
ot
per
form
ed s
urg
ery
,
ple
ase
qu
ote
th
e re
aso
n
for
no
n-p
erfo
rma
nce
Nu
mb
er o
f L
ap
aro
sco
pic
Ste
rili
zati
on
per
form
ed
If n
ot
per
form
ed s
urg
ery
,
ple
ase
qu
ote
th
e re
aso
n
for
no
n-p
erfo
rma
nce
Nu
mb
er o
f N
SV
per
form
ed
If n
ot
per
form
ed s
urg
ery
,
ple
ase
qu
ote
th
e re
aso
n
for
no
n-p
erfo
rma
nce
P
an
ip
at
Dr.
Shas
hi
M
.
O DH
9
41
60
77
81
9 Y
es No
N
o
108
No No No No No
Dr.
Sum
an
M
.
O
DH 9
89
60
77
70
4
Ye
s No N
o
70
No No No No No
Dr.
Lipi
ka
M
.
O
DH 9
46
66
88
48
2
Ye
s
No N
o
123
No No No No No
Dr.
Man
i
M
.
O
DH 8
22
10
56
74
2
Ye
s
No N
o
123
No No No No No
Dr.
Sanj
iv
Gupt
a
M
O
DH 9
46
73
61
58
8
Ye
s
No Ye
s
39
No No No No No
Dr.
Vija
y
Mali
k
S
M
O
DH 99
96
99
61
84
Ye
s
No Ye
s
396
No No No No No
Dr.
Sanj
eev
Goel
S
M
O
DH 94
61
31
88
8 Ye
s
No Ye
s
12
No No No No No
Dr.
Ajay
Kap
oor
S
M
O
DH 9
41
63
33
04 Ye
s
No Ye
s
80
No No No No No
Format for listing SQAC/SISC/DQAC and DISC members in State/UT website
State/District Haryana/Panipat
Year 2016-17
Type of Committee (DQAC )
SNo. Name of
Member
Designation in the
Committee
(Chairperson/Vice
Chairperson/
Convener/Member
Secretary/
Member)
Designation in the state
(Secretary/MD/Director/
Joint Director/Deputy
Director/Empaneled
Gynaecologist/Surgeon
etc) Member Since
(Month/year) Address Contact
number
1
Dr. Inderjeet
Singh Dhankhar C.M.O.
15.12.2014 C.M.O. Panipat 7027826976
2
Dr. Sudhir
Batra Dy. C.M.O.
15.12.2014 Dy. C.M.O. Panipat 9812233320
3 Dr. Shashi Lata Gyaneologist
15.12.2014 G.H.Panipat 9416077819
4 Dr. Vijay Malik S.M.O.
15.12.2014 G.H.Panipat 9996996184
5 Dr. Kavita M.O.
15.12.2014 G.H.Panipat 9416389742
6 Sarla P.O.
15.12.2014 W.C.D. Panipat 9896386599
7 Anil Lathwal Advocate
15.12.2014 Panipat 9813084006
8 Kailasho L.H.V.
15.12.2014 O/o C.M.O. Panipat 9050207810
Annual /Biannual Report Format
State
Report Type: (Annual /Biannual)
Reporting period
I. Family Planning performance
Services Q1 Q2 Q3 Q4 Total
Interval Minilap 659 300 359 541 1859
Laparoscopy 0 0 0 0 0
PPS 21 9 13 16 59
Female Sterilization 680 309 372 557 1918
Male sterilization 29 12 21 22 84
IUCD 1491 1344 1352 1450 5637
PPIUCD 2498 3149 2066 1885 9598
PPIUCD Acceptance
(Out of total public
health institutional
deliveries)
2927 4221 3888 3270 14306
ASHA Scheme Performance:
Services Q1 Q2 Q3 Q4 Total
HDC (percentage
distribution of
condoms, OCP and
ECP)
110 111 123 127 127
ESB Schemes (To be
filled by states where
scheme is implemented)
207 207 209 189 189
PTK Utilization
Status of Functionality of QAC
Number of meetings held 1
Frequency of meetings held(Quarterly/half yearly): Yearly
Minutes of the meeting prepared (Yes/No) Yes
Number of deaths ,complication and failure reported – Failure Reported
Number of Enquiries conducted for each category
Remedial steps taken
Status of FPIS Claims
S.N
o
STA
TE
FRESH/NEW CLAIMS
SUBMITTED IN 2016-17
( April 2016 to March 2017)
OUTSTANDING CLAIMS
from previous years (before
April 2016)
CLAIMS PAID IN 2016-17 CLAIMS REJECTED
(2016-17) OUTSTANDING CLAIMS TILL 31st MARCH 2017
Co
mp
licat
ion
De
ath
Failu
re
Co
mp
licat
ion
De
ath
Failu
re
Complication Death Failure
COMPLICATION DEATH FAILURE
No
. of
Fre
sh/n
ew
C
om
plic
atio
n C
laim
s su
bm
itte
d in
20
16
-17
pai
d
Tota
l Am
ou
nt
No
. of
ou
tsta
nd
ing
Co
mp
licat
ion
Cla
ims
fro
m p
revi
ou
s ye
ars
pai
d in
20
16
-17
Tota
l Am
ou
nt
No
. of
Fre
sh/n
ew
de
ath
Cla
ims
sub
mit
ted
in 2
01
6-1
7 p
aid
Tota
l Am
ou
nt
No
. of
ou
tsta
nd
ing
de
ath
Cla
ims
fro
m
pre
vio
us
year
s p
aid
in 2
01
6-1
7
Tota
l Am
ou
nt
No
. of
Fre
sh/n
ew
fai
lure
Cla
ims
sub
mit
ted
in 2
01
6-1
7 p
aid
Tota
l Am
ou
nt
No
. of
ou
tsta
nd
ing
fai
lure
Cla
ims
fro
m
pre
vio
us
year
s p
aid
in 2
01
6-1
7
Tota
l Am
ou
nt
Co
mp
licat
ion
Am
ou
nt
De
ath
Am
ou
nt
Failu
re
Am
ou
nt
No
. of
co
mp
licat
ion
Cla
ims
(su
bm
itte
d in
year
20
16
-17
) n
ot
pai
d
Am
ou
nt
No
of
old
pe
nd
ing
co
mp
licat
ion
cla
ims
fro
m p
revi
ou
s ye
ars
no
t p
aid
Am
ou
nt
No
. of
de
ath
Cla
ims
(su
bm
itte
d in
ye
ar
20
16
-17
) n
ot
pa
id
Am
ou
nt
No
of
old
pe
nd
ing
de
ath
cla
ims
fro
m
pre
vio
us
year
s n
ot
pai
d
Am
ou
nt
No
. of
fai
lure
Cla
ims
(su
bm
itte
d in
ye
ar
20
16
-17
) n
ot
pa
id
Am
ou
nt
No
of
old
pe
nd
ing
fai
lure
cla
ims
fro
m
pre
vio
us
year
s n
ot
pai
d
Am
ou
nt
1 0 0 4 0 0 3 0 0 0 0 0 0 0 0 0
120000 3
90000 0 0 0
00 0 0 0 0 00
3
90000 0 0
Specify reasons for claim rejection (Death/complication/failure)
Status of Death Audit
Name of State Number of Death
reported
Number of death audits
conducted
Number of deaths
attributed to sterilization
Reason of death Action taken
Haryana 0 0 0 0 0