ADM – R - 54
Date:
Dear Dr.
Sub: Invitation to join LifeSpring Hospital as an empanelled Consultant.
Greetings from LIFESPRING HOSPITALS!
LifeSpring Hospitals (P) Ltd. Is a chain of high-quality and affordable hospitals focused on women’s and
children’s health. Our goal is to provide lower-income clients in India access to maternal and child
healthcare services, through our network of small hospitals (20-25 beds). We are dedicated to providing
modern medical facilities with the age-old concept of care and attention to everyone.
We would like to invite you to join our hospital as Empanelled Consultant ………………. (Mention
specialty).
We would request you to kindly complete the attached application form along with copies of certificates of
professional qualifications and hand over to the hospital administrator of LifeSpring Hospitals.
In case you are interested in knowing more about our hospital, we would request you to kindly get in
touch with undersigned.
We look forward to having you as our consultant for our Hospital.
Thanking you,
Yours Sincerely,
For LIFESPRING HOSPITALS
Name:
Designation:
Enclosed
i)
Application Form.
ii)
Term sheet
iii)
Terms and condition
ADM – R - 55
LifeSpring Hospitals_____________
A. Consultant Empanelment-Application Form
1.1. Consultant TypeAnesthetist
Pediatrician
Gynecologist
General Surgeon
Physician
Others (Specify)
1.2. Personal and Professional detailsNAME
ADDRESS
CONTACT NO.
E-Mail ID
Pan Nos
QUALIFICATION DETAILS
Year of passing
College
University
& registration No
MBBS
Post Graduation 1
Post Graduation 2
1.3. Hospital Affiliations (Kindly provide the list of hospitals/clinics with whom you are associated)
Name of the Institution
Association type
For 1.2 please enclose photocopies of the following:
1. MBBS certificate copy.
2. Medical council of India registration certificate
3. Post graduation certificate copy
Date-_______________ Place-_______________ Signature of the Consultant-____________________
ADM – R – 56
LifeSpring Hospitals_________________
1. Consultant Empanelment- Term Sheet
1. 1. Charges*
1.1.1. Inpatient-Surgical
Sl
1
2
3
4
5
Procedure
>30minutes Simple
>1 hours Minor
>2hours Moderate
>3hours Major
>4hours Special
Charges in Rs.(All inclusive)
Semi Private
Private
General ward
Note-Please include TDS in your charges; Please see overleaf- for the terms and conditions; List of surgeries Package and non package.
1.1.2. Inpatient-Observation
1
Visit/Day (Normal)
2
Visit/day (Emergency)
Note-Please include TDS in your charges; Please see overleaf- for the terms and conditions; List of surgeries Package and non package.
1.1.3.Out patient visit
Sl
1
Particulars
General
2
Emergency
Total Fee
Consultant Share
LifeSpring Share
Note-Please include TDS in your charges; Please see overleaf- for the terms and condition
1.1.4 For Pediatrician Only*
Normal Delivery :
LSCS :
1.1.5. For Anesthetist Only*
Major Surgery :
Minor Surgery:
For 1.4 and 1.5 please refer to the scope of work printed overleaf in terms and condition.
1.2. Days and Timings
Days
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Emergency
Time
1.3. Declaration-I hereby declare that all information provided by me are true to the best of my
knowledge, and in sound mind I have gone through the terms and condition printed overleaf and
would abide by the same. I would herby like to offer my services to LifeSpring Hospital_______________Date-_________Place-_____________Signature of the Consultant-____________.
Date-_______________ Place-_______________ Signature of the Administrator-__________________
Note : HOSPITAL WILL REIMBURSE CONSULTANT WITH LOCAL TRAVEL EXPENDITURE ON
SUBMISSION OF CONVEYANCE STATEMENT AT MONTHLY BASIS.
1.4 For Official Use Only
Verified by
Administrator
Signature and date
Credentials Authorized by
Medical Director
Signature and date
1.5 Validity- _____________
months/year from the date of
authorization of the term
sheet.
1.6 Acknowledgement signature along with
date of the consultant
Copy to
Manager CRM (Original)
Hospital (filed by
Administrator)
Empanelled Consultant
* Refer to terms and
condition printed overleaf
Terms and condition for empanelment
1. Any form of payment from patient will be collected by LifeSpring Hospital (LSH) directly; doctors/consultant are requested not
to collect any payment from the patient.
2. Charges (inpatient surgical procedure)as mentioned includes consultation charges till discharge of patient.
3. Medical equipment or accessories required for a procedure apart from those available at LSH may be included for Charges
(Inpatient surgical procedure).
4. Tax deduction at source (TDS) will be deducted before making payment to the consultant.
5. Any additional manpower required for any procedure will be provided by LSH. Consultant who is not empanelled with LSH will
not be entertained to perform/operate/consult patient.
6. Every consultant is expected to comply with the medical record management system of the hospital.
7. For Anesthetists and Pediatricians each doctors/consultant will be paid a fixed amount per patient for his /her services. This
will be decided at the time of empanelment of the doctors/consultant based on a discussion between the doctors/consultant and
LSH. Scope of Work for
1. Pediatrician-(for attending Normal ad LSCS) Attending Emergency call at the time of delivery or LSCS; Follow up of the baby till
discharge.
2. Anesthetist-(for major and minor procedure) Pre-Anesthetic Check Up; Attendance during procedure; Follow up.
8. The consultant shall indemnify LSH against the foregoing liabilities and any other liability that LSH may in law incur due to
medical negligence by consultant and the aforesaid obligation to indemnify LSH shall services the final payment and settlement here
under. In the event such liability exceeds the final payment, LSH would be reimbursed by the consultant and in default of payment
LSH would be entitled to take recourse to proceedings as provided by law.
9. The parties hereto agree and declare that if any disputes or differences shall arise touching or concerning these presents or the
interpretation thereof the parties hereto agree to resolve such disputes and differences by mutual negotiation and failing settlement
by mutual negotiation the disputes and differences shall be referred to arbitration by a sole arbitration to be appointed by
M/s.LifeSpring Hospitals Pvt. Limited. The arbitration shall take place in Hyderabad and all arbitration shall be held in accordance
with the Indian arbitration shall be held in accordance with the Indian Arbitration Act, 1996. The courts located in Hyderabad shall
have exclusive jurisdiction for all matters relating to any disputes or difference between the parties. Any award made by the
Arbitrator shall be final and binding up006Fn the parties hereto and it may be enforced by the parties hereto in the High court of
Hyderabad by making the same the rule of the said Honorable court.
List of Procedures
GENERAL SURGERY:- SIMPLE: Nail removal (single), Inj epidural, Removal of foreign body, Corn excision, Tumour or abscess - L.A, Would dressing
in O.T,
Aspiration- pleural, abdominal hydrocele, or superficial abscess, Removeal of F.B
EYE, ENT ,SUBCUTANEOUS, Sigmodoscopy, Scar excision
[minor],
Perianal Haemotoma –Evacuation, External piles excision, Piles –Injection, Piles Banding, Superficial Bursa excision, Corn or wart excision under G.A, Ranula
MINOR: Tumour or cyst removal (small) – LA, I&D abscess, I&Dsuper ficial abscess under G.A, Breast abscess, Perianal & Anal
Excision, Lords Procedure, CRYO
procedures for piles, Sigmoidoscopy under G.A, Removal of polyp rectum, Wiring for prolapse Rectum, Tumour of Cyst excision--under G.A, Ganglion Excision, Minor skin
grafting, Tumour biopsy, Biopsy -Breast ,Renal,Liver,Prostate or Testicular, Circumcision, Vasectomy, Ingrowing Toe nail under G.A, Debridement(Minor), Keloid Excision, Scar
excision (medium), Deep Abscess under G.A, Ischio-Rectal Abscss, Fissurectomy/Sphincteromy, Pilinopidal Fistula, Supra pubic Cystostomy, Cockets perforators ligation.
MODERATE: Fistuiectomy/Except Pelvirectal, Haemorrhoidectomy, Breast Lumpectomy, Fibro Adenoma Breast, Excision Biopsy of Cyst Mass Breast, Excision -EnmasLymph Nodes, Skin grafting(medium), Syndactylism(single), Trendelenberg Procedure with or without stripping, stripping of vericose vein with or without trendenberg,
Tremdelenverg with or without multiple ligations, R.G.P, P.C.N, Herniotomy, Anopiasty, Gastrostomy, Debroidment (medium), Keloid excision (large), Simple Mastectomy, Block
dissection Inguial Glands, RamstedtsOperation, Palotoplasty, Debroidment (major Burns>40%), Contracture release with S.S.G., Appendictomy Mc Burney/Paramedian.
MAJOR: Herniorrhaphy -Inguinal Femoral or umblikal, Undescended Inguinal Testis, Sub-Hyoid Bursa, Caecostomy/Colostomy(closure &Revision)/Cholecystostomy, Pelvi
Rectal Fistularepair, Soft tissue flap cover to Bone, Skin graft (major), Thyroid Cyst, Thyroglossal Cyst and fistula, Total mastectomy with pectoral node biopsy, Hemi
Thyroidectomy/subtotal thyroidectomy, Total paratidectomy, Submadibular Sialectomy, Sympathectomy-Cervical/Lumbar, Branchial fistula, Cervical rib, Above knee ambutation,
Below knee ambutation, Amputation Forearm/Arm lavel, Hiatus Hernia, vagetomyGJ/Pyloroplasty, Partial Gastrectomy, Partial Gastrectomy, Cholecytectomy, Cholecytectomy
with or without Spincterctomy, Intestinal Obstruction, Resection Anastamosis of small bowel, Perforations in G.I.Tract, Splenectomy, Laprotomy, Embolectomy, Conginatal Cleft
palate /lip repair, Radical Mastectomy, Hemicolectomy right or coiectomy, Sigmoid/Transverse /Partial Colectomy, Conservative Superficial Parotidectomy, Fundoplication
SPECIAL: Achalasia cardia, Anastamotic Ulcer, Mesh repair for incisonal/recurrent hernia, Femoro poplitieal bypass, Adrenelectomy(unilateral), Parathyroid excision,
Pharyngoplasty, Gastrectomy, Total radical gastrectomy, Total colectomy, A.P.Resection, Pancreatic surgery, Oesophagectomy, Aortofemoral bypass, Femoro poplitieal
bypass, Proctocolectomy with Iiecostomy, Embolectomy-Femoral/Poplitial/Brachial, Hepatic lobecetomy, Lobectomy/Pneumonectomy, Radical gastrectomy with splenectomy
and block desection, Radical Oesophagectomy with block desection, Porcto-colectomy ileo -anal anastamosis, A-V Fistulla major, Bypass to upper limb arteries, carotid
endarterectomy, Femoro poplitieal bypass, Femoro-Distal bypass, Aortic anurysm, Retroperitoneal tumour excission with node dissection, Pulmonary metastetectomy,
Mediastinal dissection with oesophagectomy. Other Surgical procedure:- Excision of Haemorrhoids; Hydrocele; Appendicectomy; Inguinal Hernia Repair; Incisional Hernia
Repair; Gall Bladder Removal; Intestinal Obstruction / Perforation; Fistulectomy; Fisturectomy; Tonsillectomy; Prostatectomy.
ORTHOPEADICS--- SIMPLE: Cortisone Inj. For periarthritis, Intra articular Inj.., Corn Excision under L.A.
MINOR: Skeletal Traction-LA, Foreign body removal-superficial-LA, Ingrowing toe nail excision-LA, Minor implant removal[screw/K wire/ext.fixator]-sedation/LA, Bone/or soft
tissue biopsy-LA, Closed reduction of dislocation-Ivsedation [pethidine/diazepam/midazolam], Miscellaneous procedurfes local anaesthesia(procedure on fingers/toes, Ganglion
Excision, Superficial Bursa excision, Wound suturing under G.A, Corn/Wart Excision under G.A, Minor skin grafting, Ingrowing Toe Nail, Amputation of Toe/Finger-GA, Bone
biopsy-GA, Trigger finger release-Local, Superfical abscess drainage-GA, Iiizarov appratus/external fixator readjustment-GA, Wound debridement-minor, Open reduction of
minor bones hand feet, Skull traction for cervical spine injury, Foreign body removal -deep-GA. MODERATE:Diagostic Arthroscopic, Syndactylism(single), Trigger finger - G.A.,
Bursa Caleaneum spur, Synovial Biopsy, Phemister bone grafting, CarpalTunnel Syndrome Release, Dequervain's disease release, Tennis elbow/Plantar fascitis release, Deep
Abscess drainage - spinal cord abscess/hip/knee/elbow/Brodie's abscess, Ilizarov apparatus removal - G.A., Wound debridement – Major, Open reduction & fixation - minor
bones hand/feet - G.A./SPINAL, Tendom/Nerve repair (single), Removal tension band wring, Tibial femoral nail, Removal/single forearm plate removal, Arthrodesis of digits,
Keller's excision arthroplasty toes(Hallux rigidus/joint arthritis), Sequestrectomy - forearm/small bones, Open reduction ofMCP joint dislocation(KAPLAN'S), Closed reduction of
fracture/dislocation, Amputation of hand/foot(wrist/ankle level), Open reduction fracture patella, Dupuytren's Cantracture, Disar ticulationElbow/Knee Joint, Syme's Amputation,
Plantar fibromatosis, Plantar fibromatosis, Club foot(C.T.E.V.) - one stage Turco/Cinncinnati release, Implant removal (plates&screws both bones foream/leg), Primary tendon
repair(multiple)/Tendon&Nerve repair, Osteomyelites of long bones -- curettage&sinus excision(except femur), Darrach's procedure (Excion lower end ulna), Tenotomy/Tendon
lentheming/release – unilateral, Fixatiuon of only medial malleolus, Syndactism(multiple), Excision of bony exostosis, Open acromioplasty, Hallux Valgus Correction - McBrides
operation/Osteotomy, Sterno mastoid tumor Excision, Excision Head of Radious MAJOR: Tendon transfers (for poliomyelitis/cerebral plasty), Tenotomy /Tendon
lengthening/release – bilateral, Tenotomy /Tendon lengthening/release – bilateral, Open surgery for habitual/reccurentdislocation of knee, Osteomyelitis of long bones(femur),
Cervical/Lumbar Sympathectomy, Secondary Repair of Nerve/Tendon, Surgery for acromioclavicular joint dislocation, Tendon transplantaion /Nerve Transplantation, Above &
Below knee amputation, French Osteotomy for malunited supracondylar humerous fractures, Open reduction &Int. fixation of radius /ulna or both, Arthroscopic surgery
(Menisectomy, Synovectomy etc…), Application of External Fixator, Open redcion elow/hip dislocation, Surgery for unicameral bone cyst/aneurysmal bone cyst, Amputation
Arm/Forearm Leval. Surgery for recurrent dislocation shoulder joint, Nailing ofFracture neck of femur, Applicating of UMEX/JES fixaor for resistnt club foot, High tibial
Osteotomy, Open reduction of intertrochanteric femur fractures, Internal fixation fractures with bone grafting. Corrective Osteotomy for malunited fractures
tibial/forearm/femur/genu/ valgum, Reconstruction of anteror cruciate ligament knee, Hemi arthoplasty of hip, Application of Umex/Jess fixator for resistant club foot,
Laminectomy&Discectom Arthroderis of knee/anklee/shoulder/hip, Open Reduction of Acetabular Fractures. SPECIAL: Fore Quarter/Hind Quarter Amputation, Anterior
Decompression with Bone Grafting for T.B., Application of Limp Lengthening Aparatus&Limb, Application of Ilizaror apparatous - Various appliations., Spondylolisthesis - Fusion
of spine/scoliosis Surgery., Total Knee Replacement, Spinal Instrumentation (Harrington Instrumentation), Total hip replacement.
OTHER GYNECOLOGY PROCEDURE - Diagnostic curettage; Fractional Curettage; D & C and cervical biopsy; Cervical polypectomy; Cervical Cauterization; Excision of
vaginal cyst / septum; Diagnostic Laparoscopy; Excision / Marsupialization Bartholins cyst; Diagnostic hysteroscopy; Hysteroscopic removal of IUCD; Hysteroscopic removal of
uterine septum; Gaping abdominal wound – secondary suturing; Colpotomy drainage / needing / EUA; Repair of postcoital tear / Perineal injury; Excision of urethral caruncle;
Salpingo-oophorectomy (causes other than ectopic rupture); Ovarian cystectomy; Oophorectomy; vaginoplasty; Simple vulvectomy; Repair of vesicovaginal fistula; Repair of
rectovaginal fistula; Manchester / Fothergill’s operation; Perineorthaphy; Colporrhapy; Operative laparoscopy – adhesiolsis, ovarian cystectomy, drilling; Operative laparoscopy
– hysterectomy, myomectomy, ectopic pregnancy; Transcervical endometrial resection (TCRE); Explorarory laparotomy; Salpingectomy – causes other than ectopic rupture;
Breast abscess (unilateral); Breast abscess (bilateral); Fibroadenoma (Breast); Cervical cerclage