Heath Facility Registry (HFR) Data Collection Form for Hospitals and Clinics

The form is divided into several sections, including SIGNATURE DOMAIN, SERVICE DOMAIN, and HUMAN RESOURCES. The SIGNATURE DOMAIN section requires facilities to provide identifying information, including a National Facility Unique Identifier, State Unique Identifier, and Corporate Affairs Commission Registration Number. Facilities must also provide their registered name, alternate facility name, date of commencement of operation, and location details, including state, local government area, and ward. The SERVICE DOMAIN section focuses on the types of services offered by the facility. Facilities can select from a range of service types, including outpatient and inpatient services. They must also indicate the services rendered, such as medical, surgical, and dental services. Additionally, facilities can specify the types of specialized services they offer, such as cardiology, gastroenterology, and neurology. The HUMAN RESOURCES section requires facilities to provide information about their staff, including the number of medical doctors, dentists, dental technicians, pharmacists, and other healthcare professionals. Facilities must also indicate the number of nurses, midwives, community health officers, and other support staff. Facilities must also provide information about their operational status, registration status, and license status. They must indicate whether they are provisionally registered, pending registration, or fully registered. Facilities must also specify their license status, including whether they are licensed, not licensed, or have a cancelled license. The form also includes a section for facilities to provide information about their physical location, including their postal address, GPS coordinates, and phone number. Facilities can also specify their days and hours of operation, as well as their website and email address. The form is designed to be completed by healthcare facilities and is used to gather information about their services, staff, and operational status. The data collected through this form can be used to improve healthcare services, monitor facility performance, and inform policy decisions. The form is supported by the United States Agency for International Development (USAID) under the terms of the MEASURE Evaluation cooperative agreement AID-OAA-L-14-00004. The views expressed in the form are not necessarily those of USAID or the United States government.