INVITATION OF EXPRESSION OF INTEREST (EOI) FOR CLINICAL ...

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INVITATION OF EXPRESSION OF INTEREST (EOI) FOR CLINICALINVESTIGATIONS

Applicants are advised to read the content of the document and all the termsand conditions carefully before filling and submitting the application.

Principal Chief Medical Officer, BLW, Varanasi invites Expression of interest(EOI)Reputed Private Diagnostic laboratories and imaging centres/ institutions(for Various pathological, imaging and special investigations), having distinctlegal existence and not merely general order investigation centres, for the purpose ofextending facility on bill payment basis for various investigations to RailwayBeneficiaries of BLW, Varanasi on 2014/ current CGHS/Allahabad rate.Empanelment will be done for Two Years. For detail please visitwww.blw.indianrailways.gov.in.

Application form and terms and conditions can also be downloaded from this website.

EOI is invited from

Reputed Diagnostic laboratories/institutions for routine and specialinvestigation in Haematology; Biochemistry including FT3 & FT4; Serologyincluding Heapatitis A and E IgG and IgM, Serum adenosine deaminase;Microbiology; Cytology & Histopathology (Biopsy, Surgical Specimen),Hormonal Assay; ELISA; Culture and Sensitivity of body fluids and otheradvanced investigations.

Reputed Imaging centres/ institutions for plain and special (contrast study)X-Rays/CT Scan(with facility of HRCT and Spiral CT), MRI, PET Scan, UltraSound, Colour Doppler, Echocardiography/Dental X-Ray/OPG/Mammography/Bone Densitometry, CT& US guided FNA& CoreBiopsy).

Reputed centres/ institutions special investigations viz. various endoscopiesincluding upper and lower GI endoscopies, ECG, EEG, audio metry, True CutBiopsy, ERCP,US Follicular Monitoring

Diagnostic Labs/Imaging Centres recognised by the CGHS shall be preferred.However centres which are not recognised by CGHS may also be considered if foundsuitable as per the laid down minimum qualifying criteria.

Signature of Proprietor or Authorised signatory

http://www.blw.indianrailways.gov.in/

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A. Terms and conditions for empanelment

To be submitted with application form duly accepted and each page dulysigned by the authorised signatory.

1-MANDATORY CONDITIONS:

a) Any conditional offer for empanelment will summarily be rejected.b) Applicants must give the name, address, telephone no. and fax no. of the centre

along with Name, Phone/ Mobile numbers of the proprietor/authorised signatoryand approximate distance in kilometres from BLW, Varanasi, through shortestmotor ableroute.

c) The rates applicable will be 2014/current CGHS/Allahabad rate at the time ofsubmission of application. It shall continue to hold good for two years ofempanelment and subsequently, if the period is extended beyond two years. Thecentres should be reputed and have at least two years of standing in the market.

d) The centres should submit a declaration in the form of an affidavit in Rs.100/- nonjudicial stamp paper that no major punitive action was taken or contemplatedagainst them by Railways/Central Govt./State Govt. and Defence organisationsand no investigation by Railways/Central Govt./State Govt. or any other statutoryinvestigating agency is contemplated or pending against the Diagnosticlab/Imaging centre and the centre has not been delisted/blacklisted by any Govt.Health authority. If any information is found incorrect, the empanelled centresmay be delisted from the empanelment list and be black listed.

e) Diagnostic Lab/Imaging centre should submit a copy of legal status, place ofregistration if any applicable and principal place of business.

f) As a proof of their establishment, the centres have to submit either recentelectricity bill or telephone bill of that centre.

g) Applicant centre must submit the list of available facilities in the centre.h) Applicant centre must submit the list of available tests in the centre along with

centre’s own rate comparing with the CGHS/Allahabad rate in tabulated form asper Annex –10 along with application form. If CGHS/Allahabad rate of a particulartest is not available, the space should be left blank (Rates of such test to bedecided as per clause “q” below).Non submission will make the applicationliable to be rejected.

i) All the logistics/consumables required for investigations/ procedures will beprovided by the empanelled centres it self and no assistance will be provided bythe Railways nor any demand shall be made to patient or his/ her attendants.

j) Used lab logistics/consumables or reuse of the disposable laboratory logistics/consumables by the diagnostic labs is not permissible under any circumstancesand if any incidence of this nature comes to the notice of Railway administration,the empanelment of that centre shall be cancelled without issuing a show causenotice and the centre will be black listed for a specified period of time which shallbe decided by Principal Chief Medical Officer, BLW, Varanasi.

k) There should be an arrangement of internal and external quality control. Propersupporting documents to be submitted.

l) In case of emergency and in rare circumstances, when there is no RailwayHospital Ambulance available, the empanelled imaging centres will provide suchvehicle to carry the patient to the centre for investigation and return him/her backto hospital. No extra charges will be paid to the centre for this purpose.


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m) In case, more than one centres empanelled, patient will be given an option tochoose their preferred centre for investigation.

n) In case CGHS rate/ Allahabad for a particular investigation is not available, rateof any other local government hospital (IMS/BHU/ Varanasi) or AIIMS/ N Delhiwhichever is lower shall be applicable. In case no government rate is availablethen reasonable rates as per mutual agreement between Railway and the centreshall be payable.

o) Application for empanelment in the official pad of the lab/centres along with self-attested and notary-attested copies of all the required/ relevant documents,registration certificate of the centre (if any applicable)PAN/TAN/TIN/ GSTN/NABLAccreditation certificate if any/CGHS empanelment proof if any, relevant ISOcertificate(if any applicable),other qualification and experience certificates andcredentials, should be submitted in the office of Principal Chief Medical Officer,BLW, Varanasi, on or before the prescribed last date and time, in a sealedenvelope with a superscription of “Empanelment of Diagnostic laboratories” or“Empanelment of imaging centres for USG, CT or MRI etc” or “Empanelment ofimaging centres for Special Investigations” for Central Hospital, BLW, Varanasi..

p) In case signing/ executing the empanelment bid application, all documentswhatsoever and agreement/bond and signing and receiving of all legaldocuments/ letter regarding empanelment bid, is to be done by an authorisednominated person other than the proprietor/s of the Diagnostic lab/Imagingcentre, OR in case of partnership firm/centre, by one of the partners, a specialpower of attorney as per Annexure 6 in a non-judicial stamp paper of Rs.100/- isto be submitted along with the application.

q) Applicant centres must submit a Certificate of undertakings per Annex 5 on Rs.100/-non judicial stamp paper.

r) Applicant centres must submit a partnership deed (if any applicable) as perAnnex 7in a non-judicial stamp paper of Rs. 100/-.

s) Applicant centres must submit notary certified audited balance sheet of last twoyears as a proof of their standing in the market as well as their financial status.

t) The office of Principal Chief Medical Officer, BLW, Varanasi will not take anyresponsibility for any loss or delay by post or other reason whatsoever.

u) Any other terms and conditions as introduced from time to time shall be bindingupon the empanelling/empanelled centres.

v) Railway administration/Principal Chief Medical Officer, BLW, Varanasi reservesthe right to terminate the empanelment any time without assigning any reason tothe centre.

w) Incomplete application or application without required documents and fee will notbe considered and will liable to be rejected.

x) For any dispute, the decision of Principal Chief Medical Officer, BLW, Varanasiwill be final and shall be binding upon the empanelling/empanelled centres.

y) Payment will be made on submission of bills on monthly basis through FA&CAO,BLW, Varanasi by electronic fund transfer and centres will have to furnish theirbank details, complete in all respect as required for EFT and for this the centreswill have to give their mandate in the required Performa as per Annexure 3.

z) Railway shall not be responsible for any delay in the payment of bills whatsoever,in case there is paucity/non availability of funds, not will be liable to pay interestthereof.


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aa)Lab/imaging centres must submit an affidavit in a non-judicial stamp of Rs. 100/-regarding giving uninterrupted services in case of breakdown /failure of themachine being used for conducting the test/ investigation as per Annexure 8

bb)Empanelment will be done for Two Years with periodic assessment ofperformance. Extension beyond 2 years will be considered on performance basison same rates and conditions for six months or till the finalisation of the nextempanelment procedure whichever is earlier.

cc) Empanelled Centres shall entertain requisition forms for investigation only up tofive days from date of signature of consultant.

dd)Opportunity to accept counter offer of lowest rate shall be provided to allparticipating centres/ institutions.

ee)For PET scan, ceiling of maximum amount per scan is limited to NABL/ NonNABL rate specified by CGHS for Allahabad.

ff) For rest of the investigations, ceiling of maximum amount per investigation is Rs15,000/-.

gg)The centre must have a distinct legal existence and not merely general orderinvestigation/ collection centres. The centre must certify for performing more than90% of investigations/ tests/ procedures in their own centre referred from CentralHospital, BLW.

2- DESIRABLE CONCITIONS& GENERAL INSTRUCTIONS

A- General Desirable conditions

a) It is emphasized that the applicant must read all the terms and conditions ofthe empanelment. Application, terms and conditions and eligibility criteria andall documents, certificates credentials and list of available tests with centre’sown rate comparing with 2014/current CGHS/Allahabad rate etc. must besigned at the end of each page by the proprietor or authorised official on behalfof the centre. Non-compliance will make the application liable to be turneddown.

b) Suo-moto correspondence in post tender stage will not be entertained andaccepted

c) No post tender correspondence will be done with the applicants unless it isconsidered imminent and absolutely necessary by the medical committee andthat too with the approval of Principal Chief Medical Officer, BLW, Varanasi, forfinalisation of the empanelment.

d) Centres should be located in the municipal limits of Varanasi.e) Applicant should submit a copy of the certificate or memo, if any, of

Railways/Central Govt/State Govt. or Defence organisation health authority,recognising the centre and taking/taken services from them with a comment onthe performance of the centre.

f) All the documents and/or credentials submitted should be self as well as notaryattested.


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B- Specific desirable conditions (Eligibility criteria)

a- Eligibility criteria for Diagnostic laboratories

I. Diagnostic lab centres should have facility routine and special investigation inHaematology; Biochemistry including FT3 & FT4; Serology including HepatitisA and E IgG and IgM, Serum adenosine deaminase; Microbiology; Cytology &Histopathology (Biopsy, Surgical Specimen), Hormonal Assay; ELISA; Cultureand Sensitivity of body fluids and other advanced investigations

II. Lab having a Qualified Pathologist with PG Degree from a recognisedinstitution with minimum 3 years post degree experience for conduction ofinvestigation under his/her supervision, its interpretation and signing the report,would be preferred however a qualified pathologist with PG diploma from arecognised institution with 5 years of post diploma experience for conduction ofinvestigation under his/her supervision, its interpretation and signing the reportmay also be considered for the same. Self-attested copy of detailed qualifications with experience must be submittedalong with the application.

III. Diagnostic lab should have full time qualified and experienced DMLT labtechnician for conducting the tests. Self-attested qualification and experience certificate should be submitted alongwith the application.

b- Eligibility criteria for Imaging centres

1-Criteria for MRI centre

I. MRI machine with good resolution will be preferred.(Enclose a scanned copyof supporting document).

II. Must have a Qualified Radiologist with PG degree from a recognised institutionwith minimum 3 years’ experience or a qualified radiologist with PG diplomafrom a recognised institution with minimum 5 years’ experience for conductionof test under his/her supervision, its interpretation and signing the report. Self-attested copy of detailed qualifications with experience must be submittedalong with the application.

III. Must have a full time technician/radiographer holding degree/diploma from arecognised institution. Self-attested copy of qualification must be submittedalong with the application.

IV. Must have MRI compatible equipment along with anaesthetist coverage forresuscitation of patients –like Boyle’s apparatus, suction machine, emergencydrugs to combat any allergic reaction due to contrast media or acutedeterioration of the patient due to existing illness, provision for sterilisedinstruments, disposable logistics, and washed clean linen.

V. Provision for changing roomVI. Female staff for attending female patients.

VII. Availability of waiting area.


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2-Criteria for CT scan centre:

I. Whole body CT Scan machine with good resolution will be preferred(enclose ascanned copy of supporting document)

II. Centres having facility of HRCT and Spiral CT will be preferred.III. Must have a qualified radiologist with PG degree from a recognised institution

with minimum 3 years’ experience or a qualified radiologist with PG diplomafrom a recognised institution with minimum 5 yrs experience for conduction oftest under his/her supervision, it’s interpretation and signing the report.Self-attested copy of detailed qualifications with experience to be submitted alongwith the application.

IV. Must have a qualified radiographer holding a degree/ diploma from arecognised institution. Self-attested copy of qualifications to be submitted alongwith the application.

V. Provision of radiation protective devices like screen, lead apron, thyroid andgonadal protective shields.

VI. Equipment for resuscitation of patients –like Boyle’s apparatus, suctionmachine, emergency drugs to combat any allergic reaction due to contrastmedia or acute deterioration of the patient due to existing illness, provision forsterilised instruments, disposable logistics, and washed clean linen. Coverageby an anaesthetist during procedures involving contrast media

VII. Provision for changing room.VIII. Availability of waiting area separate from radiation area.

IX. Female staff for attending female patients.X. AERB approval wherever applicable. Submit supportive document.XI. Provision of radiation monitoring of all technical staff and doctor through

DRP/BARC.

3-Criteria for Mammography centre:

I. Standard quality mammography machine with low radiation and biopsyattachment (enclose a scanned copy of supporting document)

II. Must have a qualified radiologist with PG degree from a recognised institutionwith minimum 3 yrs experience or a qualified radiologist with PG diploma froma recognised institution with minimum 5 yrs experience for conduction of testunder his/her supervision, its interpretation and signing the report. Self-attestedcopy of detailed qualifications with experience to be submitted along with theapplication.

III. Must have a qualified radiographer preferably holding a degree/ diploma froma recognised institution. Self-attested copy of qualification to be submittedalong with the application.

IV. Provision of radiation protective devices like screen, lead apron, thyroid andgonadal protective shields.

V. Equipment for resuscitation of patients –like Boyle’s apparatus, suctionmachines, emergency drugs to combat any allergic reaction due to contrastmedia or acute deterioration of the patient due to existing illness, provision forsterilised instruments, disposable logistics, and washed clean linen andcoverage by an anaesthetist during procedures involving contrast media.

VI. Provision for changing room.


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VII. Availability of waiting area separate from radiation area.VIII. Female staff for attending the patients.

IX. AERB approval wherever applicable. Submit supportive document.X. Provision of radiation monitoring of all technical staff and doctor through

DRP/BARC.

4-Criteria for Ultrasound/ Colour Doppler centre

I. It should be of high resolution ultrasound standard and of updated technology.Equipment having convex sector and should have minimum three probes withprovision/ facility of trans-vaginal/Trans-rectal probes.

II. Machine should be permanently housed in the diagnostic centre.III. Must be registered under PCPNDT Act and its status of implementation (enclose

a scanned copy of supporting document).IV. Must have a qualified radiologist with PG degree from a recognised institution

with minimum 3 years’ experience or a qualified radiologist with PG diploma froma recognised institution with minimum 5 yrs experience for conduction of test, itsinterpretation and signing the report. Self-attested copy of detailed qualificationswith experience to be submitted along with the application.

V. Equipment for resuscitation of patients along with coverage of an anaesthetist forpatients undergoing interventional procedures like FNAC, drainage of abscess&collection etc. or to attend in acute deterioration of the patient due to existingillness. Provision for sterilised instruments, disposable logistics, and washedclean linen

VI. Provision for changing room.VII. Availability of waiting area.VIII. Female staff for attending the female patients.

5-Criteria for X-Ray Centre/ Dental X-Ray/ OPG Centre

I. Good resolution X-Ray machine, Portable X-Ray machine, Dental X-Raymachine and OPG will be preferred.(Enclose a scanned copy of supportingdocument).

II. Must have a qualified radiologist with PG degree from a recognised institutionwith minimum 3 yrs experience or a qualified radiologist with PG diploma from arecognised institution with minimum 5 yrs experience for conduction of test underhis/her supervision, its interpretation and signing the report. Self-attested copy ofdetailed qualifications with experience to be submitted along with the application.

III. Must have a qualified radiographer holding a degree/ diploma in radiography froma recognised institution. Self-attested copy of qualifications to be submitted alongwith the application.

IV. Provision of Radiation protective devices like screen, lead apron, thyroid andgonadal protective shields.

V. Equipment for resuscitation of patients –like Boyle’s apparatus, suction machine,emergency drugs along with coverage of an anaesthetist to combat any allergicreaction to contrast media or an acute deterioration of the patient due to existingillness, with provision for sterilised instruments, disposable logistics, and washedclean linen for procedure like HSG,MCU,RGU.

VI. Provision for changing room.


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VII. Availability of waiting area separate from radiation area.VIII. Female staff for attending female patients.

IX. AERB approval. Submit supportive document.X. Provision of radiation monitoring of all technical staff and doctor through

DRP/BARC.

6-Criteria for Bone Densitometry Centre

I. Bone densitometry equipment ultrasound/x-ray based with colour printer(enclose a scanned copy of supporting documents).

II. Must have a qualified radiologist with PG degree from a recognised institutionwith minimum 3 yrs experience or a qualified radiologist with PG diploma from arecognised institution with minimum 5 yrs experience for conduction of test underhis/her supervision, it’s interpretation and signing the report. Self attested copy ofdetailed qualifications with experience to be submitted along with the application.

III. Coverage by an anaesthetist during procedures involving contrast media.IV. Must have a qualified radiographer holding a degree/ diploma from a recognised

institution. Self attested copy of qualifications to be submitted along with theapplication.

V. Provision of Radiation protective devices like screen, lead apron, thyroid andgonadal protective shields.

VI. Equipment for resuscitation of patients –like Boyle’s apparatus, suctionmachines, emergency drugs to combat any allergic reaction due to contrastmedia or acute deterioration of the patient due to existing illness, provision forsterilised instruments, disposable logistics, and washed clean linen.

VII. Provision for changing room.VIII. Availability of waiting area separate from radiation area

IX. Female staff for attending female patients.X. AERB approval, if any. Submit supportive documents.XI. Provision of radiation monitoring of all technical staff and doctor through

DRP/BARC.


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INSTRUCTIONS TO APPLICANTS

1. Application form comprises of following Annexures–

S.No. ANNEXURE

DOCUMENT DETAIL

1. Annex.1 Application form with list of enclosures

2. Annex.2 Eligibility criteria for Diagnostic Lab/Imaging Centres

3. Annex.3 Mandate form for EFT

4. Annex.4 Affidavit, regarding – that no investigation by CentralGovt./State Govt. or any other statutory investigatingagency is contemplated or pending against the Diagnosticlab/imaging centre and/or the Lab/imaging centre is notconvicted /under conviction in a court of Law and/or theLab/imaging centre is not delisted by any Govt. Healthauthority ,in a RS. 100/- non judicial stamp paper.

5. Annex.5 Certificate of undertaking in a non-judicial stamp paper ofRs. 100/-

6. Annex.6 Special power of attorney, to sign all the documents ofempanelment, in a non-judicial stamp paper of Rs. 100/-

7. Annex.7 Partnership deed in a non-judicial stamp paper of Rs.100/-

8. Annex.8 Format of requisition form

9. Annex.9 Affidavit regarding- consent for giving uninterrupted servicesin case of breakdown /failure of the machine being used forconducting the test/investigation in a non-judicial stamppaper of Rs.100/-

10.

Annex.10 List of available tests in the centre along with centre’s ownrate comparing with the CGHS /Chandigarh rate intabulated form

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Annex.11 HQ approved list of Diagnostic lab/imaging investigations forHealth units

2. Application form can be downloaded from the website atwww.blw.indianrailways.gov.in.

3. Applicants should fill all the columns of the application legiblein BLOCK lettersin English.

4. Application is to be submitted in sealed cover with a superscription of“Empanelment of Diagnostic laboratories” or “Empanelment of ImagingCentres” or “Empanelment of Centres for Special Investigations” for CentralHospital, BLW, Varanasi. All the pages of application, terms and conditions,annexures, credentials, certificates and list of available tests etc. and allrelevant documents must be signed by the proprietor/authorised person. Non-compliance will make the application liable for rejection.



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5. All the pages of application, terms and conditions, annexure and all relevantdocuments, certificates, credentials and list of available tests must be seriallynumbered

6. Applicants must prepare and submit a list of all annexure and all credentials,certificates and other documents etc. along with the application and indicatethe serial number against each as per Annexure 1.

7. As far as all the information should be given in the application. If a particularfacility is not available it should be entered as “Not Available”. It should not bementioned as “Not Applicable”.

8. Application is liable to be rejected if the eligibility criteria are not fulfilled.9. Diagnostic lab/Imaging centres must submit the centres’ own rate along with

both non-NABL and NABL CGHS rates (if applicable) for allprocedures/services available with them as per Annexure 9.

10.The signatory must mention as whether he/she is the sole proprietor orauthorised agent/person. In case of partners hip firm, partnership deed as perAnnexure 7 on Rs. 100/- non judicial stamp paper duly attested by the notaryshould be furnished. Similarly in case of authorisation, special power ofattorney as per Annexure 6 on Rs. 100/- non judicial stamp paper should befurnished.

11.Diagnostic lab/Imaging centres must agree to accept and abide by the termsand conditions spelt out in the bid document.

12.Diagnostic lab/Imaging centres shall have to furnish an undertaking to acceptthe rates notified by CGHS/Allahabad or as mutually agreed with the PrincipalChief Medical Officer, BLW, Varanasi for those tests/ Investigations, govt ratesare not available.

13.The private diagnostic lab/imaging centres which are selected forempanelment will have to enter into an agreement with the competent authorityof Railway for providing services at the rates accepted.

14.Accepted CGHS/Allahabad rate shall continue to hold good for two years ofempanelment and subsequently if the period is extended beyond two yearsunless it is revised. The revised rated are to be submitted to Principal ChiefMedical Officer, BLW, Varanasi for approval.

15.Those centres whose application has been found in order must be prepared toextend all help to get their centres inspected by a nominated team of doctors.

16.The Diagnostic lab/ imaging centres shall all time, indemnify and keepindemnified Indian Railway against all actions, suits, claims and demandsbrought or made against it in respect of anything done or purported to be doneby the diagnostic lab/imaging centre in execution of or in connection with theservices under this agreement and against any loss or damage to IndianRailways in consequence to any action or suit being brought against the IndianRailways, along with(or otherwise), diagnostic lab/imaging centre is a party foranything done or purported to be done in the course of the execution of thisagreement. The diagnostic lab/imaging centres shall at all time abide by thejob safety measures and other statutory requirements prevalent in India andshall keep free and indemnify the Indian Railway from demand orresponsibilities arising from accidents or loss of life resulting from thenegligence or misconduct of the Diagnostic lab/imaging centres.

17.The Diagnostic lab/imaging centres shall pay all indemnities arising fromincidents without any extra cost to the Indian Railways and shall not hold theIndian Railways responsible or obligated. Indian Railway may at its discretionand shall always be entirely at the cost of the diagnostic laboratory/ imaging


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centres defend such suit, either jointly with diagnostic laboratory/ imagingcentre or singly in case the latter chooses not to defend the case.

18.Corrupt practice means the offering, giving, receiving or soliciting of anything ofvalue to influence the action of the public official.

19.Fraudulent practice means a misinterpretation of facts in order to influence thetender process or a execution of a contract to the detriment to Indian Railways,and includes collusive practice among bidding diagnostic labs/ imagingcentres’ authorised representatives/service providers (prior to or after bidsubmission) designed to establish bid prises at artificial non-competitive levelsand to deprive Railways of the benefits of the free and open competition.Railway will reject a proposal for award if it determines that centresrecommended for empanelment has engaged in corrupt or fraudulent practice.It will declare a firm ineligible, either indefinitely or for a stated period of time, tobe awarded a contract if it at any time determines that the bidding centres hasengaged in corrupt and fraudulent practices in competing for , or in executing acontract.

20. In case of any ambiguity in the interpretation of any clause of the empanelmentbid, the interpretation of Principal Chief Medical Officer, BLW, Varanasi shallbe final and binding on all parties.

21.Principal Chief Medical Officer, BLW, Varanasi reserve the right to accept orreject any application at any time without thereby incurring any liability to theaffected centres or any obligation to inform the affected centres of the groundfor his action.

22.Every application must be accompanied by all the copies of documents aslisted indifferent Annexure duly signed at the bottom of the page with termsand conditions.

23.Principal Chief Medical Officer, BLW, Varanasi reserve the right to inspect thecentres at any time to ascertain the compliance of the clauses of MOU.

24.The bills of the centres shall be reviewed periodically for any irregularitiesincluding overcharging and if found involved in any wrong doings, theconcerned centre will be removed from the Railway panel and black listed forempanelment for a specified period.

25.Exit from the panel: The rates fixed by the CGHS shall continue to hold goodunless revised by CGHS. In case the notified rates are not acceptable to theempanelled Diagnostic centre/imaging centre or for any other reason, thelab/centre wants to exit from the panel it can do so by at least three monthsprior notice.

26.Nothing under this empanelment shall be constructed as establishing orcreating the parties any relationship of Master and servant or principal andagent between Indian Railway and the centre. The centre shall not representor hold itself out as an agent of the Indian Railway.

27.The Indian Railway shall not be responsible in any way for any negligence ormisconduct of the diagnostic lab/imaging centre and its employees for anyaccident, injury or damage sustained or suffered by any beneficiaries or anythird party resulting from or by any operation conducted by and on behalf of thecentre or in the course of doing its work or perform their duties under thisagreement or otherwise.

28.The centres shall notify the government of any material or legal changes intheir status and shareholding or that of any guarantor of the centre in particularwhere such change would have an impact on the performance of obligationunder this agreement.


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29.The agreement can be modified or altered only on agreement signed by boththe parties.

30.The empanelled centres will receive a requisition for the test, duly filled andsigned by one railway doctor and countersigned by Principal Chief MedicalOfficer, BLW, Varanasi. Centre must ensure that the requisition is complete inall respect and countersigned by the Principal Chief Medical Officer, BLW,Varanasi before going for test. It has to perform only those tests mentioned inthe requisition. For any other test on the request of patient or by the centreitself, which is not mentioned in the requisition form, no payment will be made.

31.Last date and time for submission of application in the Office of Principal ChiefMedical Officer, BLW, Varanasi: / 03 /2021, PM.15.30

32.All application either to be dropped in a box kept for this purpose in the officeof Principal Chief Medical Officer, BLW, Varanasi.

33.All application so received will be opened in the presence of deputed official ofthe accounts branch and medical department of BLW, Varanasi. Arepresentative of applicants, if interested may make their presence whileopening of the applications.

34.A medical team/committee of three doctors duly constituted by Principal ChiefMedical Officer, BLW, Varanasi will scrutinise applications and the documentssubmitted by the centres and will submit its report with recommendation toPrincipal Chief Medical Officer, BLW, Varanasi.Those centres whose application has been approved and accepted byPrincipal Chief Medical Officer BLW, Varanasi will be inspected by the medicalcommittee of three doctors, constituted as above or a different one. All centreswhich fulfil the pre laid qualifying criteria shall be empanelled with theconcurrence of Finance. The contract shall be governed by General Conditionsof Contract of Railways. The Terms and Conditions can be accessed atwebsitewww.blw.indianrailways.gov.in .

35.Empanelled/Diagnostic lab/Imaging centre shall notify one nodalofficer/executive for Railway beneficiaries, who can be contacted by Railwayadministration/beneficiary in case of any requirement.



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ANNEXURE-1APPLICATION DOCUMENT FOR EMPANELMENT OF DIAGNOSTIC

CENTRES/IMAGING CENTRES(TO BE SUBMITTED IN THE OFFICIAL LETTER HEAD OF THE APPLICANT)

To,Principal Chief Medical Officer,BLW, VaranasiI/we the undersigned submit the application for empanelment of our centre. Our details are as her underName of the Diagnostic Lab/Imaging centre requesting for empanelment

Name of the proprietor/s

Name of the authorised signatory

Address of the Diagnostic Lab./ Diagnostic Lab/Imaging Centre

Telephone No. and Fax No. Of Diagnostic Lab/Imaging centre

e-mail address/website address

Mobile No. of Proprietor/ Authorised signatory of Diagnostic Lab/Imaging centre

Approximate distance (through shortest route) of the Diagnostic Lab/Imaging centre from the hospital to which centre wants to give services.

Special power of attorney in case the empanelment bid application and all documents whatsoever is to be signedand issued/received by an authorised signatory other than the proprietor as per Annx.6 attached

YES/NOAttached at S. No.

Affidavit regarding no investigation by Central Govt./State Govt. or any other YES/NO


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statutory investigating agency is contemplated or pending against the Diagnostic lab/imaging centre or delisting by any Govt. Health authorityin a non judicial stamp paper of RS. 10/-(or appropriate amount) attached

Attached at S. No.

Recent Electricity /Phone bill as a proof of establishment of Diagnostic Lab/Imaging centre attached.


Mandate form for EFT along with a cancelled bank cheque by the proprietor or the authorised signatory of the Diagnostic Lab/ Imaging centre attached.


Copy of PAN in the name of centre or the proprietor attached.


Relevant ISO certificate/CGHS empanelment proof, NABL Accreditation certificate etc. of Diagnostic Lab/Imaging centre if any attached.

YES/NO/Not applicableAttached at S. No.

Available facilities in the Diagnostic Lab/Imaging centrelist attached.


Copy of certificate or memo of Health Authority of State Govt/ Central Govt/Defence organisation, if any, recognising the diagnostic/ imaging centre attached.

YES/NO/Not applicableAttached at S. No

List of the available test in the Diagnostic Lab/Imaging centre along with centre’s own rate comparing with the CGHS /Allahabad rate attached.

YES/NOAttached at S. No


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Certificate of under taking by the proprietor of the Diagnostic Lab/Imaging centre attached.


Notary attested copy of the partnership deed in the Diagnostic Lab/Imaging centre, if applicable attached.


Copy of audited balance sheet for the last two years (Main document only) ofthe Diagnostic Lab/Imaging centre as a proof of its standing in the market and financial capability attached.


Copy of legal status, place of registration if any and principal place of business of the Diagnostic Lab/Imaging centre attached.


Copy of the terms, conditions and instructions duly accepted and signed by the authorised signatory/ Proprietorof the Diagnostic Lab/Imaging attached.


Copy of the eligibility criteria duly signed by the authorised signatory/ Proprietor of the Diagnostic Lab/Imaging centre attached.


Affidavit for uninterrupted service attached


Supporting documents regarding arrangement of internal and external quality control attached


Name and mobile No. of the person trained and authorised in collection of samples.


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Name and mobile No. of the Nodal officer/ executive for Railway beneficiaries

Has attached duly signed Annexure 8 & 11


Has all the pages of application and alldocuments serially numbered

YES/NO

I, hereby declares that the above information submitted by me is correct and complete. If any information is found incorrect/incomplete, my centre may be rejected deleted from the list of the registered centres of office of Principal Chief Medical Officer, BLW, Varanasi.

Signature/ Name of the authorised signatory

Official position in the centreAddress, Mob/Phone, E-mail


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ANNEXURE-2

ELIGIBILITY CRITERIA FOR THE DIAGNOSTIC LABORATORIES/ IMAGINGCENTRES

(To be submitted in the official letter head of the centre concerned and copy of this annexure must be signed below and to be attached with the application form)

Name of the centre:To be given by -

Eligibility requirement Yes/No andDocumentattached atS.No.

Diagnostic Laboratory

Availability for routine investigation in Haematology, biochemistry, Microbiology, Cytology & Histopathology, Hormonal Assay, ELISA, Culture and sensitivity and other advanced investigations(For those Applicants applying for giving services to Health Units the criteria is as per Annexure 11)

Imaging centres

MRI-Availability of MRI machine minimum oneTesla or above(enclosea scanned copy of supporting document)CT SCAN-Availability of Whole body CT. Scan with scan cycle of less than one second or a good resolution CT Machine(Enclose a scanned copy of supporting document). Installation should be as per AERB guideline (enclose a scanned copy of supporting document)Is facility of HRCT and Spiral CT available?MAMMOGRAPHY-Availability of Standard quality Mammography machine with low radiation and biopsy attachment.(enclose a scanned copy of supporting document)ULTRA SOUND-Availability of high resolution ultrasound standard and of updatedtechnology. Equipment having convex sector and should have minimum three probes with provision / facility of trans vaginal /Trans rectal probes.

X-RAY-Availability of X-Ray machine should be of minimum 300MA with image intensifier TV system, Portable X-Ray machine should be minimum of 60 MA, Dental X-Ray machine should be of 6MA and OPG 4.5 TO 10 MA.(enclose a scanned copy of supporting document).Installation should be as per AERB guideline (enclose a scanned copy of supporting document) BONE DENSITOMETRY-Availability of Bone densitometry equipment ultrasound/x-ray based with colour printer (enclose a scanned copy of supporting document).Installation should be as per AERB guideline (enclose a scanned copy of supporting document)

Diagnostic Laboratory/All imaging centre

Availability of a qualified Pathologist/Radiologist with PG degree from a recognised institute with minimum 3 years post graduate experience / Or qualified Pathologist /Radiologist with PG diploma from a recognised institute with minimum 5 years post


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graduate experience(Attach qualification and experience certificates)

Diagnostic Laboratory/All imaging centre

Availability of full time qualified and experienced DMLT lab technician/Degree or diploma holder Radiographer for conducting the tests. (Attach Qualification and experience certificates.)

Diagnostic Laboratory

Availability of authorised trained person for collection of the samples.

All imaging centres

Availability of resuscitation equipments along with Anaesthetist coverage for resuscitation of patients –like Boyle’s apparatus, suction machines, emergency drugs to combat any allergic reaction due to contrast media or acute deterioration of the patient due to existing illness, provision for sterilised instruments,disposable logistics, and washed clean linen.

All imaging centres

Availability of provision for changing room.

All imaging centres

Availability of female staff for attending female patients

All imaging centres

Availability of waiting area.

X-Ray, Dental X-Ray, OPG, CT Scan, Mammography, Bone densitometry centre

Provision of radiation monitoring of all technical staff and doctor through DRP/BARC.

Provision of Radiation protective devices like screen, lead apron,thyroid and gonadal protective shields.

Ultrasound centre

Registration under PNDT Act and its status of implementation (enclose a scanned copy of supporting document).

I, hereby declares that the above information submitted by me is correct and complete. Ifany information is found incorrect/incomplete, my centre may be deregistered from the listof the registered centres of Northern Railway.

Signature/ Name of the proprietor /Authorised signatory

Official position in the centreAddress/ Mob/Phone No./ E-mail ID


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ANNEXURE -3

MANDATE FORM

EMPANELING CENTRE’S MANDATE FOR RECEIVING PAYMENT THROUGH E-PAYMENTName of the Diagnostic Lab/Imaging centre-

Name of the proprietor

Address of the Diagnostic Lab/Imaging centre

Account No. of the Diagnostic Lab/Imaging centre

Type of account (SB/Current)

Bank’s name

IFSC (Indian financial system code)

MICR code of the bank

Copy of the cancelled cheque for confirmation Of t correctness of the Ac. No. and IFSC

I, hereby declare that the particulars given above are correct and complete. If the transaction is delayed or not effected at all for reasons of incomplete information given by me as above, I would not hold Railway administration responsible.

Date: (Signature of the authorised signatory of the centre)Place:

Certified that the particulars as furnished above are correct as per our records.

Date: (Signature of the authorised official of the bank)


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ANNEXURE-4

AFFIDAVIT REGARDING UNDER NON- CONVICTION IN THE COURT OF LAW/DELISTING/UNDER INVESTIGATION CONTEMPLATED OR PENDING AGAINST

THE LAB/ CENTREIN A Rs.100/- NON JUDICIAL STAMP PAPER

Name of the centre-I hereby declare that 1-I am authorised to sign the affidavit on behalf of M/S--------------------------------------In my capacity as --------------------------------2- The applicant firm/centre M/S--------------------------------------------------------------------(and its officials) has not been convicted/has been convicted (Details of which areattached.) in the past.3-There is no investigation by Central Govt./State Govt. or any other statutoryinvestigating agency is contemplated or pending against the Diagnostic lab/imagingcentre.3- The applicant firm/centre M/S----------------- ----------------------------------------------------(and its officials ) has not been blacklisted ,debarred, delisted by any Railway/CentralGovt./State Govt./Defence organisation from participating in tenders/contracts on thedate of opening of the bid either in individual capacity of the proprietor or in anyfirm/centre in which the proprietor/s is/are partner.4-I understand that any concealment/wrong information in regards to above shallmake the contract, of M/S ---------------------------with Railway, liable for terminationunder General condition of contract of Indian Railway.5- That the financial condition status of the firm/ centre (Name and address of thecentre) is sound.Above information are true to my knowledge and belief and is based on facts.

Signature of Deponent/s(Proprietor/s or Authorised signatory)


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ANNEXURE-5

CERTIFICATE OF UNDERTAKING IN NON JUDICIAL STAMP PAPER OFRS.100/-

Name of the centre-1- It is certified that the particulars regarding establishment, physical facilities,

investigations, procedures and experience/ expertise of speciality are correct.2- The Diagnostic Lab/Imaging centre shall not charge higher than the CGHS/

Allahabad /Govt hospital (as and where applicable) rates or the rates chargedfrom non CGHS patients.

3- The rates have been provided against a facility/Procedure actually available atthe centre.

4- That if any information is found to be untrue, Diagnostic Lab/Imaging centre isliable for derecognition by the Railways. The centre will be liable to paycompensation for any physical injuries caused to Railway beneficiaries.

5- That the Diagnostic centre/imaging centre has the capability to submit bills andmedical records both in soft and hard format.

6- That the centre will not raise a question and ask for any interest in case thepayment is delayed due to any cause.

7- That the Diagnostic Lab/Imaging centre will pay damage to the beneficiaries ifany injury, loss of part or death occurs due to gross negligence or due to faultymedical reports.

8- That the centre has not been derecognised by CGHS or any railway, centralgovernment, state government or defence health authorities, after beingempanelled there.

9- That no investigation by central government/ state government or any statutoryinvesting agency is pending or contemplated against the DiagnosticLab/Imaging centre

10-That the Indian Railway shall not be held responsible in any way for anynegligence or misconduct of the diagnostic lab/imaging centre and itsemployees for any accident, injury or damage sustained or suffered by anybeneficiaries or any third party resulting from or by any operation conducted byand on behalf of the centre or in the course of doing its work or perform theirduties under this agreement or otherwise.

11-The centres shall notify the government of any material or legal changes intheir status and shareholding or that of any guarantor of the centre in particularwhere such change would have an impact on the performance of obligationunder this agreement.

12-The Diagnostic lab/ imaging centres shall all time, indemnify and keepindemnified Indian Railway against all actions, suits, claims and demandsbrought or made against it in respect of anything done or purported to be doneby the diagnostic lab/imaging centre in execution of or in connection with theservices under this agreement and against any loss or damage to IndianRailways in consequence to any action or suit being brought against the IndianRailways , along with (or otherwise) ,diagnostic lab/imaging centre is a partyfor anything done or purported to be done in the course of the execution of thisagreement .The diagnostic lab/imaging centres shall at all time abide by thejob safety measures and other statutory requirements prevalent in India andshall keep free and indemnify the Indian Railway from demand orresponsibilities arising from accidents or loss of life resulting from thenegligence or misconduct of the Diagnostic lab/imaging centres.


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13-The diagnostic lab/imaging centres shall pay all indemnities arising fromincidents without any extra cost to the Indian Railways and shall not hold theIndian Railways responsible or obligated. Indian Railway may at its discretionand shall always be entirely at the cost of the diagnostic laboratory/ imagingcentres defend such suit, either jointly with diagnostic laboratory/ imagingcentre or singly in case the latter chooses not to defend the case.

14-Agree for the terms and conditions/instructions in the application document.

Signature of Deponent/s (Proprietor/s or Authorised signatory)


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ANNEXURE-6

SPECIAL POWER OF ATTORNEY

Name of the centre-Know all men by these presents, I/we (Name and address of theproprietor/proprietors), do hereby, nominate/appoint /constitute Mr/Mrs(Name andaddress of the person other than proprietor/or one of the proprietors, in case ofpartnership firm, who is being nominated/authorised).As our special power of attorneyto deed with Railway Department and to do the following acts as under:

1. To sign all the documents regarding Diagnostic lab/Imaging centre /to file anyapplication /empanel bid and documents, whatsoever, on my/our behalf.2. To receive and sign all legal documents/ letters regarding empanelment bid on ourbehalf.3. To sign any agreement/bond regarding empanelment bid on our behalf.All acts whatsoever, deeds and things done by him shall be deemed to have beendone by me/us and this centre and shall be bound on the same act. I/ we have signedspecial power of attorney on date in the presence of (Two witness)

WITNESS (Name with address) Executants (Name, address and signature ofthe Proprietor/proprietors)

1. 1.

2. 2.

Holder of attorney-(Name, address andsignature of the person other thanproprietor/or one of the proprietor in case ofpartnership firm/centre, so nominated)

1.


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Annexure-7

Partnership deed in a non judicial stamp paper of Rs.100/-


Annexure -8

Affidavit in a non judicial stamp paper of Rs 100/-regarding givinguninterrupted services

I hereby declare that –1-I am authorised to sign the affidavit on behalf of M/S--------------------------------------In my capacity as ---------------------------------2-In case of breakdown /failure of the machine being used for conducting thetest/investigation with a remark that the required test/investigation will got done fromother reputed Diagnostic lab/Imaging centre in CGHS rate or the as fixed mutuallybetween the centre and the Principal Chief Medical Officer, BLW, Varanasi3-In case of failure to do so and if the same test/investigation is done by the hospitalfrom other non empanelled (When only one centre is empanelled) centre the entireamount of the charges will be levied from the prospective bills of the empanelledcentre.



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ANNEXURE 9

LIST OF AVAILABLE TESTS/ PROCEDURES ALONG WITH CENTRE’S OWNRATES ANDNON-NABL & NABL CGHS/ ALLAHABAD RATE

(Includingtests/ investigations/ procedures not listed in CGHS Rate List, without Sr No)

Name of the centre-SNo

Name oftests

Centre’sown rate

Sr. No. of CGHS Rate List

Non-NABL/ CGHS/ Allahabad Rate

NABL/ CGHS/Allahabad Rate

In-house availability of test/ investigation/ procedure (Yes or No)



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