How to get the registration for small Nursing homes in India

By Dr. (Prof.) Mahesh Baldwa,

M.D, D.C.H, FIAP, MBA, LL.B, LL.M, PhD (law)

SENIOR PEDIATRICIAN & MEDICOLEGAL ADVISOR

Baldwa Hospital, Sumer Nagar, S.V. Road, Borivali (West) Mumbai 400 092

2. Dr Namita Padvi, MBBS, MD,DNB, PGDML, Fellowship in pediatric anesthesiology, Assistant Professor of Pediatric medical s at T.N. Pediatric medical College and Nair Hospital, Mumbai-400008

3. Dr Varsha Gupta, MBBS, MD, PGDML, Senior resident in department of pathology, Government medical college, kota, Rajasthan

Introduction

There is no provision of temporary registration of small Nursing homes in India. One can get the Permanent registration of small Nursing homes after filling the required form which one gets from local municipal office. In the municipal office medical official in charge and his department receives the duly filled form and after inspection of the nursing home issue   registration of small Nursing homes.

Minimum Standards for Private Hospitals/Nursing Homes

Up to 30 Bedded Unit Providing Medical / Surgical / Maternity Services

Preamble

This document contains information intended as model standards for planning a nursing home up to 30 beds in respect to functional program, human power, equipment, functional and space requirements. A few essential building services, engineering and environmental requirements have also been covered.

Definitions

A nursing home is envisaged as place where a patient is admitted for overnight medical and nursing care. It is common practice in most nursing homes to provide various disciplines under one roof. This document lists out minimum standards for nursing homes providing medical /surgical/maternity facilities.

Functional Programme for a Nursing Home

The basic minimum functions provided by a nursing home should include the following:

1. EMERGENCY FIRST AID: Emergency first aid is care provided initially to stabilize a victim’s condition and to minimize potential for further injury during transport to an appropriate service. At minimum each nursing home shall have provisions for emergency first aid treatment for staff as well as for persons who may be unaware of or unable to immediately reach services in other facilities. This is not only for minor incidents that may require minimal care but also for persons with severe injuries or in grave condition who must receive immediate first aid and assistance for transport to other facilities.

Emergency first aid includes facilities for incubation, venesection, thorough cleaning/dressing of wounds, ligations of bleeding vessels, insertion of intercostal drainage tube, application of Thomas Traction, starting of nasal O2, bladder catheterisation, stomach wash, establishing an intravenous line in case of patients in shock, controlling of convulsions, controlling of acute attacks of breathlessness, etc.

Emergency first aid services should be provided to all patients in need of them irrespective of their capacity to pay.

2. General Medicine : All nursing homes providing medical facilities should be able to provide Clinical diagnosis for infectious diseases, diabetes, hypertension, auto-immune disorders, endocrine disorders, neurological disorders, renal disorders, skin diseases, gastro-intestinal disorders, etc. Treatment and follow-up care for a majority of these conditions would also be possible by a physician.

Medical personnel manning such a facility should be able to take a decision regarding cases which require higher medical skills or which may eventually need transfer to a better equipped facility (intensive care, surgical facility, ventilators, hemodialysis machine, cardiac monitors, etc.) and accordingly transfer such patients at the earliest. In case a patient had been admitted in such a facility for more than 24 – 48 hours, it is expected that the patient will be transferred with a medical attendant *accompanying the patient and all medical records (including X-rays, investigation reports, clinical Advise s) will be made available to the next doctor who will be treating the patient. It is also expected that the doctor who had treated the patient initially will keep in touch with the institution to which the patient has been transferred in order to remain aware of the patient’s condition.

A nursing home which claims to provide Emergency Cardiology Services should possess intensive care facilities

3. General Surgery : A general surgical nursing home would be able to provide Elective General Surgery for the following : Benign and malignant soft tissue tumours, benign breast disease, carcinoma breast, thyroid surgery benign and malignant conditions of the gastrointestinal tract, benign anal conditions, inguinal hernia, hydrococle, varicose veins, testicular tumours, abscesses, vasectomy, splenectomy, etc.

4. Maternity Facilities : All nursing homes providing maternity facilities should provide basic obstetric facilities and neonatal facilities. All maternity homes should be able to carry out procedures like suction and evacuation, dilatation and curettage, Lower Segment Cesarean Section and Hysterectomy on an emergency basis. Blood transfusion facilities should be available within half to one hour. Also ultrasonography facilities should be available within half to one hour. The functional programme of the nursing home should mention nearest availability of neonatal intensive care facilities.

5. Pathology : The type and extent of laboratory facility to be available for a nursing home would depend on the functional programme of the nursing home. But provisions shall be made for the following minimum procedures to be performed on site or at a nearby facility.

Blood counts, urinalysis, blood glucose, blood urea and nitrogen, coagulation profile (bleeding time, clotting time, prothrombin time), Blood grouping, typing and cross-matching, serum electrolytes, serum amylase. Provision shall also be included for specimen collection and processing. A separate toilet facility should be provided for the pathology section.

6. RADIOLOGY : Equipment and space for the department would have to be planned according to the program functions. In the minimum following X-rays should be possible : X ray chest, abdomen, pelvis, femur and skull. For this an X-ray machine of 300MA capacity is needed. In nursing homes providing emergency surgical facilities and those with more than twenty beds, the X-ray machine should be installed within the nursing home premises. In smaller facilities, it should be possible to have access to such X-ray facilities within one hour. Standard precautions should be taken in the construction of the radiology room like constructing the walls with barium impregnated bricks. In radiation medicine facilities where procedures like DTPA scan are carried out, separate facilities should be provided for disposal of urine. In case radiotherapy, nuclear medicine facilities are to be provided, guidelines by local statutory bodies should be followed.

7. ECG : Portable ECG facilities should be available in all nursing homes round the clock.

8. HEALTH EDUCATION : All medical personnel in nursing homes should be aware of all the various national programmes for control of various diseases and should integrate with the same. For e.g., on detecting a care of leprosy, information regarding the same must be directed to Medical Officer in-charge of the local PHC/UHC where the survey, education and treatment centre of the National Leprosy Programme is situated. Nursing homes should maintain records of all such instances which may be checked by regulating bodies on a periodic basis. Special mention needs to be made regarding infectious and occupation related notifiable diseases.

9. AMBULANCE SERVICES : All nursing homes should have access to ambulance services within half an hour.

10. MEDICAL RECORDS :

Records for these also must be maintained as below as per the Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002.

Maintenance of medical records:

1. Every physician shall maintain the medical records pertaining to his/her indoor patients for a period of 3 years from the date of commencement of the treatment in a standard proforma laid down by the Medical Council of India and attached as Appendix 3.
2. If any request is made for medical records either by the patients / authorised attendant or legal authorities involved, the same may be duly acknowledged and documents shall be issued within the period of 72 hours.
3. A Registered medical practitioner shall maintain a Register of Medical Certificates giving full details of certificates issued. When issuing a medical certificate he / she shall always enter the identification marks of the patient and keep a copy of the certificate. He / She shall not omit to record the signature and/or thumbmark, address and at least one identification mark of the patient on the medical certificates or report. The medical certificate shall be prepared as in Appendix 2.
4. Efforts shall be made to computerize medical records for quick retrieval. 
5. Maintenance of medical records of all patients attending the nursing home is of utmost importance. The “OPD paper” of a patient attending the OPD should contain the doctor’s name and detailed clinical Advise s including patient’s name, age, occupation, chief complaints, onset/duration/progress of illness, past history, personal history, family history, detailed examination findings, provisional diagnosis and treatment advised. A separate prescription should be written out for the medication that has been advised. The OPD paper should be given to the patient along with X-rays and all investigation reports. Nursing homes may maintain a copy of the OPD paper. All indoor papers should be complete, i.e. clinical Advise s (as detailed above) should be written along with whatever treatment has been given during the admission and reports of investigation carried out. In case of operated patients detailed operation and anesthesia Advise s should be written. In case of deliveries, labour room Advise s should be complete. On discharge or on transfer a discharge summary should be given to the patient with all details clearly written down. Also all X-rays and investigation reports should be handed over to the patient. A separate register of all deaths occurring in the nursing home should be maintained. A separate register of all births occurring in the nursing home should be maintained. Duplicate copies must be maintained of all certificates issued by the nursing home. Notifiable disease register and whether local authorities have been informed of the same.

11. Dietary Facilities [optional] : All maternity homes and all nursing homes with more than 20 beds shall provide dietary facilities for indoor patients.

12. Others : Disciplines like Dentistry, Ophthalmology, ENT, Orthopedics etc. and diagnostic facilities like ultrasonography, C.T. scan, etc. if provided by a nursing home would require design, equipment, space as well as personnel over and above that specified in the document.

13. Universal biosafety guidelines shall be followed by all nursing homes to protect personnel employed from occupation related diseases.

Registration with pollution control board of the state for Bio-Medical waste generation is a must. Also contract with bio-medical waste transporter separately.

Human Power Requirements

Qualifications

Physician: M.D. degree from a university or equivalent from a local recognized body OR diploma from Diplomate of National Board or equivalent from a local recognized body. The degree needs to be registered with state medical council.

Surgeon: M.S. degree from a university OR Diploma from Diplomate of National Board or equivalent from a local recognized body. The degree needs to be registered with state medical council.

Obstetrician and Gynecologist: M.D. degree from a university or equivalent from a local recognised body or diploma from Diplomate of National Board. The degree needs to be registered with state medical council.

Anesthetist: M.D. degree from a university or university or equivalent from a local recognized body OR diploma from Diplomate of National Board. The degree needs to be registered with state medical council.

Neonatologist/Pediatrician: M.D. degree in Paediatrics from university or equivalent from a local recognised body or diploma from Diplomate of National Board. The degree needs to be registered with state medical council.

Duty Medical Officer: MBBS, BAMS should have completed one year of internship. The degree needs to be registered with state medical council. Responsibility regarding clinical decisions, procedures etc. is that of the consultant and not the DMO.

Availability of Personnel: As soon as a patient arrives at a nursing home, (in emergencies) he or she should immediately be seen by a Duty Medical Officer. A consultant should see the patient within half an hour.

A nursing home providing MEDICAL facilities should have a physician available on call round the clock.

A nursing home providing SURGICAL facilities should have a surgeon and anesthetist available on call. In case Emergency Surgical Facilities are also provided then a surgeon and anesthetist should be available on call round the clock.

A nursing home providing MATERNITY facilities should have an Obstetrician and Gynecologist, an anesthetist, a surgeon and a neonatologist available on call round the clock.

A nursing home may need an administrator to look after every day running of the nursing home. In nursing homes where consultants are resident, the requirement for D.M.O could be accordingly scaled down.

Minimum requirement of personnel:

Duty Medical Officer

• One duty medical officer for every 20 indoor beds or part thereof in every 8 hour shift.

• Two duty medical officers to function as O.T. assistants during routine O.T. hours (8 hrs) and one each for the next two shifts in those facilities providing emergency surgical care and obstetric care (nurses could be trained to perform this function).

• One duty medical officer for the labour ward in every eight hour shift. (Optional This function may be performed by the O.T. assistant or a trained nurse)

Nursing staff :

• One nurse for every 10 beds if on same floor on every eight hour shift and if on different floors then in same proportion on different floors. Here one nurse undergoing training may be posted along with a qualified nurse.

• Two qualified operation theatre nurses for routine surgery. For nursing homes offering maternity facilities and emergency surgical facilities two more operation theatre nurses will be required on shifts. (In practice the number of nurses posted specifically for this area would depend on the patient load there.)

• Four qualified nurses for labour room. One nurse should work in each eight hour shift. They may also function as O.T nurses when required.

• One nurse should be kept available for emergency patients on every eight hour shift.

• During regular OPD hours one more nurse should be kept available for OPD block.

Nursing aids:

• One ayahbai or one ward boy for every 8 beds for every eight hour shift.

• One ayahbai for obstetrics and gynaecology OPD.

• One ward boy for surgical and medical OPD.

• One ayahbai for labour room.

• One ayahbai or ward boy for O.T. suite

• One sweeper per eight beds for wards in every 8 hour shift.

• One sweeper for operation theatre and Labour ward.

Ayahbai/ward boy/sweeper need to undergo training in nursing care skills like measuring of urine output, assisting in inserting an I.V. line, transferring patients from trolleys to beds, etc.

Paramedical staff:

In case a contractual arrangement is being availed of for these functions, then these personnel may be appointed accordingly

• One Pathology technician (optional)

• One Radiology technician (optional)

• One ambulance driver (optional)

Availability of paramedical staff should be adequate to satisfy basic functions as specified in the functional program.

Engineering staff [optional]

• One plumber (To be available on call throughout the day)

• One electrician

• One qualified consultant engineer

Administrative and Ancillary staff [optional]

• Receptionist 2 (on shifts)

• Cashier 1(optional in NHs with low patient turnover this function may be performed by any of the other staff)

• Storekeeper 1

• Stenographers 1 (in NHs with more than 20 beds for maintenance of records)

• Security staff 4 (one per shift)

Minimal Functional and Space Requirements

To facilitate planning and framing of the structural grid a usable space planning module of 14 sq.m based on basic space unit of 3.5 sq.m has been stipulated in order to rationalise the requirements for various facilities in the hospital. This space planning module is derived by assuming a planning grid of 1.6 m. Six such grid units i.e. 3.2 x 4.8 m will lead to a carpet area of about 14 sq.m after deducting the space taken by walls. All floor space requirements recommended for various facilities in respective table of the various sections of general hospital are based on above basic space unit. Fractional variation in floor spaces in actual planning may be ignored. Area requirement for the nursing home is to be derived from carpet area of various functions and services as outlined in the following tables by applying conversion factor (40%) for circulation space. This circulation space will include corridors.

Space requirements have been divided into following categories:-

• – Entrance Zone

• – Ambulatory Zone

• – Diagnostic Zone

• – Intermediate Zone

• – Critical Zone

• – Service Zone

Entrance Zone

1. Entrance hall with Enquiry counter with cash counter and records area

(to maintain few OPD records) 28 sq.m

2. Pharmacy 17.5sq.m

Ambulatory Zone

1. Medical clinic (consultation and examination room) 17.5 sq.m, Waiting area 21 sq.m

2. Surgical clinic (consultation and examination room) 17.5 sq.m, Waiting area 21 sq. m.

3. Casualty and emergency care (optional) 17.5 sq.m

4. Treatment and dressing 21 sq.m

5. Injection room (optional) 17.5 sq.m

6. Communication system

An efficient communication system within the nursing home is necessary. An intercom system would be the best. If not possible softly ringing alarm bells with lighting up system should be installed connecting wards, nursery units, operation theatre, delivery room, labour room to the nursing stations.

7.  Fire-fighting system

Efficient fire fighting systems should be installed in every nursing home.

8. Ventilation requirements for areas affecting patient care in nursing homes

The following table covers ventilation for comfort as well as for aspesis and odour control in areas if acute care hospitals that directly affect patient care.

Compulsory documents and licences:

1. Developer/Builders ownership or lease agreement for premises. If doctor is the owner of the land and constructed building then no such agreement required.
2. Stamp Duty payment and registration with registrar of sub assurances of hospital premises
3. Change of user in case if residential premises being used for Nursing Home from municipal authority.
4. separate water connection from local authority for Nursing Home
5. separate drainage sanction from local authority for Nursing Home
6. separate entrance sanction from local authority for Nursing Home
7. NOC from Developer/Builder for opening of a Nursing Home
8. NOC of housing co-operative Society for opening of a Nursing Home if part of housing society
9. Nursing Home Registration, renewed every year
10. Doctor’s qualification and medical council registration Certificate, renewed every five years
11. Nurse’s qualification and Nursing council registration Certificate, renewed every five years
12. Shop and establishment registration renewed every year or three years
13. Bio medical waste registration with pollution board (PCB) and biomedical transporter
14. spirit licence
15. licence from fire authorities to store oxygen cylinders
16. licence for narcotic drugs like morpheme etc
17. Ambulance licence, in case of ambulance
18. Lift licence, in case of lift
19. Registration for TPA, as on 30 TPA’s are working
20. MTP registration of a. place, b. doctor, monthly report to CMO
21. PNDT registration for a. USG machine, b. place and c. doctor, Form F and report submission to CMO
22. Registration with sales tax authority for Profession tax for a. doctor b. staff members with salary more than Rs. 5000/=Pm
23. Drug licence if medical store is in nursing home.
24. pollution board NOC for genset
25. Blood Bank registration with FDA and State Blood Transfusion And Certification Committee
26. in case of x-ray machine, CT scan & whole body radioisotope study, a licence for radiation safety
27. Electrical installation safety licence
28.  birth and death registration information
29. acute  flaccid paralysis information
30. infectious disease information
31. accident, burns, septic abortion, OT table death and tetanus and like to be information to police

Optional for doctor’s safety:

32. Medical indemnity policy for doctor
33. Hospital error and omission policy
34. ISO 9001:2000 accreditation
35. insurance of hospital premises and equipment

However as required a Hospital has to one point of time has to undergo challenges from any of the below Laws of the land to remain on safe practice side of LAW;

Following Laws are related to governing the commissioning of nursing home / hospital are helpful if nursing home owner know about them for smooth running of their hospitals:-

1. Society Registration Act 1960
2. Companies Act 1956
3. Urban land Act 1976
4. National building code 2005
5. Building permit from municipality
6. Delhi Fire Service Act, 2007
7. Delhi Fire Prevention and Fire Safety Act, 1986
8. Fire safety rules 1987
9. Electricity Rules 1956
10. Delhi electricity regulatory commission (Grant of consent for captive power plants) Regulations 2002
11. Delhi Lift Act 1942
12. Bombay Lifts Act,1939
13. Delhi Nursing Home Registration Act 1953
14. Bombay Nursing Homes Registration (Amendment) Act, 2005
15. Bombay Nursing Homes Registration (Extension and Amendment) Act, 1959
16. Bombay Nursing Homes Registration Act,1949
17. Radiation protection certificate for radiology dept from BARC
18. Atomic energy regulatory body approval for radiology / nuclear medicine services under the Atomic Energy Act 1962
19. Atomic energy (safe disposal of radioactive waste) Rules 1987
20. Indian Telegraph Act 1885.
21. Clinical Establishments Bill, 2010
22. Building and other construction workers (regulation of employment and conditions of service) act, 1996 (27 of 1996).
23. The Registration Act, 1908
24. The National Capital Territory Of Delhi Laws (Special Provisions) Second Bill, 2007
25. Government Buildings Act, 1899
26. Karnataka Medical Registration (Amendment) Act, 2003
27. Karnataka Private Nursing Homes (Regulation) Act, 1976
28. Red Cross Society (Allocation of Property) Act, 1936
29. St. John Ambulance Association (India) Transfer of Funds Act, 1956

Following Laws governing the qualifications / practice and conduct of professionals of nursing home / hospital are helpful if nursing home owner know about them for smooth running of their hospitals:-

30. Indian medical council Act 1956
31. Indian medical council (professional conduct, etiquette and ethics) Regulations,2002.
32. Indian Medical Degrees Act
33. Registration of Medical Practitioners with State Medical Councils
34. Indian Nursing Council Act 1947
35. Delhi Nursing Council Act 1997
36. The ICN Code of ethics for nurses
37. The Dentists Act 1948
38. The Dentists (code of ethics regulation) 1976
39. Dental council of India regulations 2006
40. AICTE rules of physiotherapy rules
41. All India council for Technical Education ACT, 1987
42. The Apprenticeship Act 1961
43. Rehabilitation Council of India Act, 1992
44. Rehabilitation Council of India (Amendment) Act, 2000
45. Kerala Anatomy Act, 1957
46. Kerala Co-operative Hospital Complex and the Academy of Medical Sciences (Taking over the Management) Act, 1997
47. Kerala Professional Colleges or Institutions (Prohibition of Capitation Fee, Regulation of Admission, Fixation of Non-exploitative Fee and Other Measures to Ensure Equity and Excellence in Professional Education) Amendment Act, 2007
48. Karnataka Anatomy Act, 1957

Law governing storage / sale of drugs and safe medication of nursing home / hospital are helpful if nursing home owner know about them for smooth running of their hospitals:-:-

49. Drugs and cosmetic Act 1940
50. Drug and cosmetic Act amendment 1982,
51. The drug and cosmetics rules 1945, Amendment 2005
52. The drugs control Act 1950
53. Pharmacy Act 1948
54. License for possession and use of Rectified / denatured spirit
55. Narcotics and psychotropic substances Act 1985
56. Central excise Act 1944 ( for permit to use and store sprit )
57. Retail drug licence
58. VAT Act
59. Central sales Tax Act 1956
60. Sales of good Act 1930
61. Adulteration of drugs (IPC S. 274)
62. Sales of adulterated drugs ( IPC S. 275 )
63. Sales of drug as different drug or preparation (IPC S. 276)
64. Negligent conduct with regard to poisonous substances (IPC S. 284)
65. Blood bank regulations under Drugs and cosmetic (2nd amendment) rules, 1999.
66. Homoeopathy Central Council (Amendment) Act, 2002
67. Homoeopathy Central Council Act, 1973, Law governing Biomedical Research
68. Breeding of and Experiments on Animals (Control and Supervision) Amendment Rules, 2005.
69. Reconstitution of Committee for the Purpose of Control and Supervision of Experiments on Animals (CPCSEA).

Law governing to management of patients of nursing home / hospital are helpful if nursing home owner know about them for smooth running of their hospitals:-:-

70. Drugs and Magic Remedies (objectionable) Advertisements Act 1954
71. PNDT Act 1994
72. Pre conception and prenatal diagnostic techniques (prohibition of sex selection) Rules, 1996.
73. MTP Act 1997
74. MTP Rules 1971
75. Transplantation of Human Organ Act 1994
76. Transplantation of human organ Rule 1995
77. Rules for insurance cover for the sterilization cases
78. Laws of contract section 13 (Consent)
79. Birth and death and Marriage Registration Act 1886
80. Delhi registration of Birth and Deaths act 1969
81. Indian Lunacy Act 1912
82. The Epidemic Disease Act 1897
83. Delhi Municipal corporation (Malaria and other mosquito Borne disease) Bye Law 1975
84. Lepers Act
85. Guardians and Wards Act 1890
86. National guidelines for clinical management of HIV / AIDS , NACO, Government Of India.
87. Manual for control of hospital associated infections: SOPs, NACO, Government of India
88. The Mental Health Act 1987
89. Ear Drums and Ear Bones (Authority for Use for Therapeutic Purposes) Act, 1982
90. Eyes (Authority for Use for Therapeutic Purposes) Act, 1982 Law governing medico legal aspects
91. Law of privileged communications
92. Indian Evidence act (disclosure of privileged / confidential patient related information before a court of law – under protest)
93. Law of Torts
94. Consumer Protection Act 1986
95. Protection of human rights Act
96. IPC S. 52
97. IPC S. 80
98. IPC S. 89
99. IPC S. 92
100. IPC S. 93
101. IPC S. 269

Law governing the safety of patients, public and staff within the hospital premises and environmental protection of nursing home / hospital are helpful if nursing home owner know about them for smooth running of their hospitals:-

102. Biomedical medical waste management handling rules 1998 (Amended on 2000)
103. Water ( prevention and control of pollution ) Act 1974
104. The Water (Prevention and Control of Pollution) Cess (Amendment) Act, 2003.
105. The Water (Prevention and Control of Pollution) Act, 1974, Amended 1988
106. The Water (Prevention and Control of Pollution) Cess Rules, 1978
107. The Water (Prevention and Control of Pollution) Rules, 1975
108. The Noise Pollution (Regulation and Control) (Amendment) Rules, 2010 [pdf].
109. The Noise Pollution (Regulation and Control) (Amendment) Rules, 2006.
110. The Noise Pollution (Regulation and Control) (Amendment) Rules,2006.
111. The Noise Pollution (Regulation and Control) (Amendment) Rules, 2002.
112. The Noise Pollution (Regulation and Control) (Amendment) Rules, 2000..
113. Business Rules, 1975 Amended 1976
114. Rules regarding the safe discharge of effluents in the public sewers / drains
115. DMC sanitation and public health Bye laws, 1959
116. Air (prevention and control of pollution) act 1981, Amended 1987
117. The Air (Prevention and Control of Pollution) (Union Territories) Rules, 1983
118. The Air (Prevention and Control of Pollution) Rules, 1982
119. Environment protection Act 1986
120. Environment protection Rule 1986
121. Environment protection Act 1996
122. Noise pollution control Rules 2000
123. IPC S. 269 (negligent act likely to spread infection or disease dangerous to life, unlawfully or negligently)
124. IPC S. 278 (making atmosphere noxious to health)

Law governing the safety of patients, public and staff within the hospital premises of nursing home / hospital are helpful if nursing home owner know about them for smooth running of their hospitals:-

125. No objection certificate from the chief fire officer
126. Periodic fitness certification for operation of lifts
127. Indian Boilers Act , 1923
128. Explosive Act 1884 (for diesel storage)
129. Petroleum Act + storage Rules 2002
130. Gas cylinder Rules, 2004
131. Rules for provision of safe drinking water
132. Rules for provision of uninterrupted power supply
133. Prevention of food adulteration Act 1954
134. The Radiation Surveillance Procedures for the Medical Application of Radiation 1989
135. Radiation Protection Rules 1971
136. AERB safety code no . AERB/SC/Med -2 ( REV -1) 2001
137. Insecticide Act 1968
138. Arms Act, 1950
139. IPC S. 336 (act endangering life and personal safety of others)
140. IPC S. 337 (causing hurt by act endangering life and personal safety of others)
141. IPC S. 338 (causing grievous hurt by act endangering the life and personal safety of others)
142. The Indian fatal accidents Act , 1955
143. The cigarettes and other Tobacco products (prohibition of advertisement and Regulation of trade and commerce, production, supply and distribution) Bill 2003
144. Prohibition of smoking in public places Rules 2008
145. The Indian fatal accidents Act 1855
146. The Tamil nadu Medicare service persons and Medicare service institutions (prevention of violence and damage or loss to property) Act 2008.
147. Vaccination Act, 1880
148. Vaccination (Repeal) Act, 2001
149. Disaster Management Act, 2005
150. Protection of Human Rights Act, 1993

Laws governing the employment of manpower in Hospital of nursing home  / hospital are helpful if nursing home owner know about them for smooth running of their hospitals:-

151. Child Labour Act
152. Citizenship Act 1955
153. Employees provident fund and misc provision Act 1952
154. ESI Act 1948
155. ESI (Central) Rules 1950
156. Employment exchange (compulsory notification of vacancies) Act 1959
157. Equal Remuneration Act 1976
158. Minimum Wedge Act 1948
159. Payment of Bonus Act 1965
160. Payment of Gratuity Act 1972
161. Payment of wages Act, 1963
162. PPF Act 1968
163. TDS Act
164. Maternity Benefit (Amendment) Act, 2008
165. Workmen’s Compensation Act, 1923
166. Workmen’s Compensation (Amendment) Act, 2009
167. Indian Trade Union Act 1926
168. Industrial Disputes Act, 1947
169. Shops and factories Act (for national holidays)
170. Negotiable instrument Act , 1881
171. Persons with Disabilities Act 1995
172. SC and ST Act 1989
173. Weekly Holidays Act, 1942
174. Official Secrets Act, 1923
175. Persons With Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995
176. Karnataka Prohibition of Violence against Medicare Service Personnel and Damage to Property in Medicare Service Institutions Act, 2009
177. Information Technology (Amendment) Act, 2008
178. Information Technology Act, 2000
Law governing to professional training and research
179. MCI rules for internship training
180. National board of examinations Rules for DNB training
181. NCI Rules for staring school / college of nursing
182. AICTE Rules fir training courses for technicians (Lab Tech, Radiographers, OT tech)
183. ICMR rules governing Medical Research.

Regulations governing the business aspects of hospital of nursing home / hospital are helpful if nursing home owner know about them for smooth running of their hospitals:-

184. Charitable and Religious Trust Act 1920
185. Contract Act, 1982
186. Income Tax ACT 1961
187. Customs Act 1962
188. Foreign Exchange Management Act 1999
189. Insurance Act 1938
190. Rules for display of Red Cross Insignia
191. Sales of Good Act 1930
192. Vehicle registration certificate
193. Wireless operation certificate from post and telegraphs
194. Cable television network ACT 1995
195. Gift Tax Act 1958
196. Copyright Act 1982
197. The Public Liability Insurance Act, 1991, Amended 1992
198. The Public Liability Insurance Rules, 1991, Amended 1993

Various licenses / certificate required with sanctioning authority of nursing home / hospital are helpful if nursing home owner know about them for smooth running of their hospitals:-

199. Incorporation of hospital as Company (Registrar of Companies)
200. Allotment of land ( State DI/SIDC/Infrastructure Corporation /SSIDC)
201. NOC and consent under Water and Air Pollution Control Acts State Pollution Control Board
202. Approval of construction activity and building plan (a. Town and country planning, b. Municipal and local authorities, c. Chief Inspector of Factories d. Pollution Control Board e. Electricity Board)
203. Sanction of Power (State Electricity Board)
204. Boiler Inspection Certificate (Chief Inspector of Boilers)
205. Registration under States Sales Tax Act, and Central and State Excise Act ( i. Sales Tax Department,  ii. Central and State Excise Depts.)
206. General permission of RBI under FEMA
207. Form FC-IL – COMPOSITE FORM FOR FOREIGN COLLABORATION
208. Land, Water, Electricity, Registrations (Ministry of Environment and Forests
209. Environmental Clearance (EC) Process in India

210. RTI Act