Mandatory documents required for Entry Level Accreditation for Hospital - PowerPoint PPT Presentation

View by Category
About This Presentation

Mandatory documents required for Entry Level Accreditation for Hospital


This presentation has been prepared by Global Manager Group, to give knowledge of mandatory and most commonly used documents that are required for Pre Accreditation Entry Level for Hospital - NABH Certification. For further information about Pre Accreditation Entry Level documentation requirements visit @ – PowerPoint PPT presentation

Number of Views:134


Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Mandatory documents required for Entry Level Accreditation for Hospital

  • Pre Accreditation Entry Level for Hospital

By Global Manager Group
What is Pre Accreditation Entry Level for
  • The National Accreditation Board of Hospital and
    Healthcare provider has launched new entry level
    standards for hospital accreditation. The
    standard developed for hospitals who have
    facilities of above 50 beds for patients and wish
    to start the quality certification process.
Documentation for Pre Accreditation Entry Level
for Hospital
  • When hospitals are going for Pre Accreditation
    Entry Level - NABH Certification, there are
    specific NABH documentation requirements that
    need to be fulfill which provides better control
    over implemented system. List of such
    requirements for better system as per Pre
    Accreditation Entry Level are as below
  • Hospital Manual
  • Department Manual
  • System Procedures
  • Standard Operating Procedures
  • Forms Templates
  • Audit Checklist
Hospital Manual
Pre Accreditation Entry Level standard based
Hospital Manual covers details on how system is
implemented. It also covers the introduction,
scope of service, hospital policy, vision and
mission, applicable laws and regulations, quality
policy and organization structure.
Department Manual
  • The different departmentwise manual is given in
    this department manual as listed below.
  • Central Sterility Supply Department (CSSD) manual
  • Emergency Preparedness
  • Infection Control
  • Medical Record
  • Human Resource Management
System Procedures
  • System Procedures help the organization to make
    the best system and quick process improvements.
    All procedures are divided in 08 system
    procedures as listed below.
  • Procedure for control of nonconforming services
  • Procedure for management review
  • Procedure for document and data control
  • Procedure for corrective and preventive action
  • Procedure for control of quality records
  • Procedure for internal audit
  • Procedure for control of monitoring and measuring
  • Procedure for training
Standard Operating Procedures
Standard Operating Procedures document covers a
guideline to establish system as per NABH pre
entry level standards requirements. covering
access, Assessment and Continuity Care (AAC),
Care of Patient (COP), Continuous Quality
Improvement (CQI), management of medicine and
patient rights and education department
Forms Templates
The templates covered sample blank forms that
required to maintain records as well as establish
control and make system in the Hospital. The
samples given are a guide for the user to follow.
The hospitals are free to change the same to suit
their own requirements.
Audit Checklist
NABH Audit Checklist covers audit questions to be
used for hospital system auditing for objectively
evaluate the adherence of system by functional
heads to establish processes. It also includes
audit questions as a quick reference for all
related work areas of the hospital
Pre Accreditation Entry Level Documentation Kit
Global Manager Group provides Pre Accreditation
Entry Level for Hospital Documentation Kit that
having sample documents required for NABH
Certification. It contains all documents that
covers all such requirements standard. The
Hospital manual to NABH audit checklist are
provided in editable format that serves as the
primary source of documentation.
Global Manager Group
Global Manager Group is the first company that
introduces Online Consultancy by offering
International System Certification Documentation
and Auditor Training Packages available on
Email us