REQUEST FORM  (valid only in  India)
VATIM™ Aid
To Growing & Charitable
   Diagnostic Centres
   Pathology Laboratories

Step 1: Review your centres eligibility

Remember: Only completed requests will be reviewed. Please feel free to provide additional documents.
 
Step 2: Answer all questions on this form
Step 3: Mail additional supporting documents: It may take 2-3 weeks to receive feedback from the committee on charity requests.
To,
VATIM™ AID Committee
Visual Access Health Systems (P) Ltd.
1st floor, Hill view apts,
Near Kishore Industrial Estate,
Majiwada, Thane (West). 400 601

Thank you for your interest in the VATIM™ AID Scheme   (VATIM ™ AID)

CONTACT INFORMATION
Centre / Hospital Name :
Charity Comm Regn. No :
Contact Person  :
Email id : Tel. No.
Designation    :
Address :
City : Pin :
Phone : Fax :
Website :

BACKGROUND & HISTORY
  Please write a short description about your centre giving your objectives / mandate.
                                                               

How old is your Institution?

years

What are the services provided by the Institution?
                                                               

Please provide a list of your Board of Directors / Trustees / Proprietors
                                                               
 

Who are your beneficiaries? If concessional and charitable services are provided, please provide the basis of providing concession / charity and the percentage of patients benefiting from this.

                                                               

How many patients have benefited from your Centre in the last two years

This year:

 Last year:

Of these, how much were poor patients:

This year:

 Last year:
 
IT USAGE  
  Have you deployed any IT systems within the centre?
If Yes, since when?
  Which of the following areas are computerized? Please tick.
Front desk
Processing Area
Lab Equipment Interfaces
Reporting
Dispatch
Back Office
MIS Reports
Others      
  Could you please enlist the present deployment of computer systems and printers at various functional areas?
 
  What benefits do you hope to get by adopting IT Systems?
                                                               
 
CONTRIBUTION & USAGE  
What is the type of charity that you are requesting?
VATIM™ LIS Solutions
Pre-owned Computer Systems
By which date, do you intend to deploy the system?

 
The VATIM ™ AID Committee
 

 The VATIM ™ AID Committee consists of VAHSPL directors, a panel of eminent and concerned citizens and representatives of   NGO’s. Their mandate is to support growing and charitable diagnostic centres and pathology laboratories spread across the remote corners of the country, who desire to harness Information Technology to provide efficient and affordable medical services to the weaker sections of the community.
 
 

ELIGIBILITY
 

 Organizations requesting support from the VATIM™ AID Committee must:
 • Be a registered charity, non-profit organization with a charity commissioner number.
 • Have individuals represented by a registered charitable organization
 • Offer services to the community at large and not restrict them to the members of the organization
 
VATIM PROGRAM STRUCTURE
 

Approval Process: The VATIM™ AID Committee reviews applications submitted by organizations requesting for VATIM™ LIS  Solutions.
It is expected that all submissions will be subject to eligibility, committee approval and resource availability.
Charities will be notified of their request status.
Request for Charity: Please submit your form completely with all supporting documents
REMEMBER:
 

Requests containing false or misleading information will be rejected
Forms containing erroneous information may not be reviewed and may be rejected
Allow a minimum of three weeks for review and decision
Please submit your request with an appropriate lead-time for our review.
 


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