Award Category: Diagnostic Service Provider of the Year
1.
What is the ownership structure of your diagnostic centre?
 Government
 Partnership
 Co-operative
 Trust
 Corporate
 Proprietorship
 Armed Forces
 Others
Please Specify:
2.
What is the location of your diagnostic centre?
 Urban
 Semi-urban
 Rural
3.
Does your diagnostic centre have split location(s)?
 Yes
 No
If yes, provide the details about the diagnostic and imaging center located at different location (s)
Please Specify:
4.
Which of the following lab tests are provided by your diagnostic and imaging centre?
 Pathology Tests
 Biopsy
 Parental Tests (Genetic Tests)
 Prenatal Testing
 Sleep Studies
 Allergy Tests
 Pulmonary Function Test
 Audiometry
 Urodynamic Evaluation
 Others
Please Specify:

5.
Which all imaging facilities are provided by your diagnostic and imaging centre?
 CT Scan
 MRI
 X-ray facility
 Sonography
 ECG
 Ultrasound
 Mammography
 Endoscopy
 Other Imaging Facilities
Please Specify:
6.
Does your diagnostic and imaging centre provide options for claustrophobic or overweight patients?
 Yes
 No
If yes, please provide the details about such options.
Please Specify:
7.
If required, does your laboratory provide advanced imaging services or portable diagnostic and monitoring equipment at patient’s location?
 Yes
 No
If yes, please provide the details about such options.
Please Specify:
8.
What is the time-frame of delivering reports to patients for imaging tests performed at your diagnostic and imaging centre?
 < 6 hours
 6 hours to 12 hours
 13 hours to 24 hours
 > 24 hours

9.
Does your diagnostic and imaging centre provide radiologists for discussion with doctor, if required?
 Yes
 Only on extra payment
 No
10.
Does diagnostic and imaging centre have radiologists on-site, available for consultation?
 Yes
 No
11.
Does the diagnostic and imaging centre is in partnership with any hospital?
 Yes
 No
If yes, please provide the details of this partnership alliance with hospitals
Please Specify:
12.
What all measures are taken by your diagnostic and imaging centre to prevent patients or healthcare workers acquiring infections in the centre? (Maximum 200 words)
Please Specify:
13.
Is your diagnostic and imaging centre equipped with proper disease surveillance and reporting systems for safety of employees?
 Yes
 No
If yes, please provide details and proof for the same
Please Specify:

14.
Does your diagnostic and imaging centre provide compensation for treatment, if any centre staff acquires infection or disease during job activities?
 Yes
 No
If yes, provide proof for the same.
15.
Does your diagnostic and imaging centre hold NABL accreditation?
 Yes
 No
16.
Does your diagnostic and imaging centre hold any ISO certification for Quality
Management System?
 Yes
 No
If yes, please provide the details of the same and attach a copy of certificate as proof
Please Specify:
17.
Would you like to give any other relevant information apart from the above points in the questionnaire to be considered for “Diagnostic Service Provider of the Year
Award” by the jury? (Maximum 300 words)