Medical, Health & Family Welfare Department, Government of Rajasthan

चिकित्सा, स्वास्थ्य एवं परिवार कल्याण विभाग Department of Medical, Health & Family Welfare

श्री भजनलाल शर्मा

माननीय मुख्यमंत्री

श्री गजेन्द्र सिंह

माननीय चि. एवं स्वा. मंत्री

RSMHA Registration Form Check Form Status

MENTAL HEALTH ESTABLISHMENT
Registration Form

Salutation

Full Name

DOB

Age

Select Gender

Mobile

License No

Authority

Date

Professional Experience in Psychiatry (Joining Date)

Total Experience

Present Address

Address Line 1

Address Line 2

City

District

State

Pin Code

Permanent Address

Same as Present Address

Address Line 1

Address Line 2

City

District

State

Pin Code

Proposed accommodations

Number of Rooms

Number of Beds

Facilities provided

Out-patient

Emergency services

In-patient

Occupational and recreational facilities

ECT facilities (n X-Ray facilities)

Psychological testing facilities

Investigation and laboratory facilities

Treatment facilities

Staff Pattern

Number of Doctors

Number of Nurses

Number of Attendees

Others

I hereby declare that the information provided above is true and correct to the best of my knowledge. I understand that any false information may lead to the rejection of my application.

Check Form Status

MENTAL HEALTH ESTABLISHMENTRegistration Form

Present Address

Permanent Address

Proposed accommodations

Staff Pattern

MENTAL HEALTH ESTABLISHMENT
Registration Form