HEALTH FACILITY SCOPE OF SERVICES
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1 Kindly fill the herein form specifying the scope of services (inpatient and outpatient) provided by your institution and the present medical professionals level. Health Authority Abu Dhabi Facility Licensing & Inspection Department P.O.Box: 5674 Abu Dhabi Tel: (2) Fax: (2) SECTION 1 GENERAL INFORMATION Office Use Only: Reference. N. Zone: Date Received: Institution Name Location Hospital Director Medical Director Street: City: Name: Name: Sector: Tel: SECTION 2 FACILITY DESCRIPTION General Hospital Specialized Hospital Rehabilitation Geriatric & Elderly Other: Hospital Capacity Beds Outpatient Services Operating Room O.T. Consultation Rooms: Recovery Room Beds Treatment Rooms: Delivery Room Rooms Specialized Clinics: Beds Allocation Wards Critical Care Units Geriatric Beds Burns Unit Beds Gynaecology Beds CCU Beds Medicine Beds CICU Beds Obstetric Antenatal Beds ICU Beds Obstetric Postnatal Beds NICU Beds Paediatric Beds PICU Beds Psychiatry Beds StepDown Unit Beds Surgery Beds Isolation Unit/Rooms Beds Accident Emergency Triage [Cubicles] Fast Track [Rooms] Isolation Rooms Observation [Beds] Resuscitation [Beds] Treatment Rooms
2 SECTION 3 VOCATION Specialties/ Subspecialties Anaesthesia General Cardiac Obstetric Internal Medicine Allergy Cardiology Noninvasive Cardiology Dermatology Family Medicine Geriatric Maternal and Foetal Medicine Medical Oncology Gynaecologic Oncology Haematology Oncology General Paediatric Cardiac Surgery Cardiology Noninvasive Cardiology HaematologyOncology Endocrinology & Metabolism Cardiac Surgery Valve Repair Aortic Surgery Arrhythmias Surgery Minimally Invasive & Robotic Surgery General Surgery Abdomen Surgery Endocrine Surgery Colon & Rectal Surgery Maxillofacial Cosmetic Reconstructive Neurosurgery Epilepsy Surgery Stereotactic Biopsy Trauma Vascular Neurosurgery Neurodegenerative Disorders Chiropractic Medicine Folk Medicine Herbal Medicine Gastroenterology & Hepatology Endocrinology & Metabolism Haematology Infection Disease Intensive Care Obstetric and Gynaecology Reproductive Medicine Oncology Surgical Oncology UroOncology Bone Marrow Transplant Paediatric Gastroenterology & Hepatology Neonatology Nephrology Neurology Neurosurgery Surgery Ophthalmology General Ophthalmology Corneal Refractive Orbital Reconstruction Glaucoma Retina LASIK Ocuplastic Squint Congenital Glaucoma Cataract Phacoemulsification Orthopaedic General Orthopaedic Arthroplasty Arthroscopy Spine Surgery Foot Surgery Hand Surgery Hip Replacement Limb lengthening Sports Medicine Alternative Medicine Homeopathic Medicine Osteopathic Traditional Chinese Medicine Neurology Nephrology Pulmonology Rheumatology Other: Sexual & Reproductive Health Radiation Therapy Other: Ophthalmology Orthopaedic Paediatric Surgery Psychiatry Pulmonology Urology Otolaryngology General ENT Head & Neck Surgery Rhinology Snoring Endoscopy Skull Base Cochlear Implantation Middle Ear Surgery Plastic Surgery Cosmetic Reconstruction Vascular & Endovascular Urology General Urology EndoUrology Urodynamics Urogynecology Reconstructive Urology Thoracic Surgery Traditional Medicine Tropical Medicine Ozone Therapy
3 General Dentistry Endodontics Orthodontics Dental Oral Surgery/ Surgical Dentistry Pediatric Dentistry Periodontology Clinical Support Services Prosthodontics Restorative Dentistry Other: Specialized Clinics Ambulatory Care Services Rehabilitation Services Allergy Clinic Andrology Breast Cancer Screening Cervical Cancer Screening Obesity Clinic Dietetic Diabetes Immunisation Wound s Clinic Others: Dialysis ESWL Day Surgery Women s Health InVitro Fertilization (IVF) Home Care Services Others: Speech Therapy Neurorehabilitation Physiotherapy Occupational Therapy Ergo therapy Prosthetics & Orthotics Psychotherapy Hydrotherapy Others: econsultation Services Oral Hygiene Dental Laboratory Optometry Inpatient Pharmacy Others Pulmonary Functions Laboratory Audiology Electrocardiography Stress Test ERG/EOG/VOP EEG/EMG/VEP Sleep Disturbances Lab. Epilepsy Unit Other: SECTION 4 MEDICAL LABORATORY Scope Services Moderate Complexity High Complexity Low Complexity Tests Anatomic Pathology Blood Bank Clinical Chemistry Cytogenetics Hematology Histocompatibility Immunology Microbiology Molecular Biology Phlebotomy Others, Satellite Limited Services Laboratory Full Service Laboratory Laboratory Medicine System
4 SECTION 5 MEDICAL DIAGNOSTIC IMAGING SERVICES RadioDiagnostic General Radiography ( ) Fluoroscopy ( ) Interventional Radiology ( ) Panoramic ( ) Mammography ( ) Nuclear Medicine SingleHead Camera ( ) DualHead Camera ( ) PET Scan ( ) PETCT Scan ( ) Bonedensitometry ( ) Ultrasound General ( ) Doppler ( ) Obstetric ( ) Cardiac ( ) CT Scan ( ) MRI ( Tesla) Open System Close System Cardiac Catheterization Lab. Single Plane ( ) Dual Plane ( ) SECTION 6 MEDICAL STAFFING Physicians Dentist Nursing Clinical Support Staff Physicians Allergy ( ) Alternative Medicine ( ) Anaesthesia ( ) Anatomic Pathology ( ) Audiological Medicine ( ) Cardiac Surgery ( ) Cardiology ( ) Cardiology (Noninvasive) ( ) Chiropractic Medicine ( ) Clinical Chemistry ( ) Clinical Immunology ( ) Clinical Pathology ( ) Dermatology ( ) Emergency Medicine ( ) Endocrinology ( ) Family Medicine Physician ( ) Folk Medicine ( ) Gastroenterology ( ) General Medicine ( ) General Surgery ( ) Geriatric ( ) Haematology ( ) Herbal Medicine ( ) Homeopathic Medicine Infection Diseases ( ) Intensive care ( ) Maxillofacial Surgery ( ) Medical Microbiology ( ) Neonatology ( ) Nephrology ( ) Neurology ( ) Neurosurgery ( ) Nuclear Medicine ( ) Obstetric & Gynaecology ( ) Oncology ( ) Ophthalmology ( ) Orthopaedic ( ) Osteopathic ( ) Otolaryngology ( ) Paediatric Medicine ( ) Paediatric Cardiology ( ) Paediatric Cardiac Surgery ( ) Paediatric Endocrinology ( ) Paediatric Gastroenterology ( ) Paediatric Nephrology ( ) Paediatric Neurology ( ) Paediatric Neurosurgery ( ) Paediatric Oncology ( ) Paediatric Ophthalmology ( ) Paediatric Orthopaedic ( ) Paediatric Surgery ( ) Paediatric Urology ( ) Plastic Surgery ( ) Psychiatry ( ) Radiology ( ) Respiratory ( ) Rheumatology ( ) Traditional Chinese Medicine ( ) Tropical Medicine ( ) Urology ( ) Vascular Surgery ( ) Other: ( )
5 Dentist General Practitioner ( ) Dental Public Health ( ) Endodontic ( ) Oral Medicine ( ) Oral & Maxillofacial Surgery ( ) Oral Surgery/ Surgical Dentistry ( ) Orthodontics ( ) Pediatric Dentistry ( ) Periodontology ( ) Prosthodontics ( ) Restorative Dentistry ( ) Other ( ) Nursing Registered Nurse ( ) Practical Nurse ( ) Dental Nurse ( ) Registered Midwife ( ) Practical Midwife ( ) Other ( ) Clinical Support Staff Anaesthesia Technician ( ) Audiologist ( ) Dental Technician ( ) Dental Assistant ( ) Dental Hygienist ( ) Dietician ( ) ECG Technician ( ) EEG Technician ( ) Emergency Medicine Technician ( ) Haematology Lab. Technologist ( ) Histopathology Lab. Technologist ( ) IVF Medical Technologist ( ) Medical Lab. Technologist ( ) Microbiology Lab. Technologist ( ) Molecular Biology Medical Laboratory Technologist ( ) Nuclear Medicine Technologist ( ) Occupational Therapist ( ) Optometrist ( ) Perfusionist ( ) Pharmacist ( ) Pharmacist (in charge) ( ) Pharmacy Technician ( ) Physiotherapist ( ) Physiotherapy Technician ( ) Podiatrist ( ) Psychologist ( ) Radiographer ( ) Radiology Technician ( ) Respiratory Therapist ( ) Speech Therapist ( ) Social Worker ( ) Note: ( ): specify the number available at your institution Stamp Hospital Director (Signature)
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