NOMINATIONS FOR SELECTION OF BEST STAFF NURSE

For conduction deliveries in PHCs

Sl.
No.

Name of the Staff

Nurse with address

Population of PHC

Highest No. of
Deliveries conducted
by the staff Nurse in
PHC during the year
2011-12 from PHC area

Deliveries conducted for

10,000 population

1
2

NOMINATIONS FOR SELECTION OF BEST MPHAs (F)

Name of the
MPHA (F)
with
Address

Population

No.

Sl.

Total
Deliveries
in Sub
Center
area

Inst.
deliveries
Promoted
(2011-12)

% of Inst.
Deliveries

Full
Immunization
performance
(2011-12)

Sterilization
cases
promoted
(2011-12)

Sterilizations
per 1000
population

1
2

NOMINATIONS FOR SELECTION OF BEST MPHAs (M)

Name of the MPHA (M)
with Address

Population

No.

Sl.

No. of Vasectomies
promoted during the year
2011-12

No of Blood Smears
Collected / No. of
positives

1
2

NOMINATION FOR BEST MEDICAL OFFICER

Sl.
No.

Name of
the
Medical
Officer
with
address

Populatio
n

Total
Deliverie
s

No. of
Institutiona
l Deliveries
conducted
during the
year
2011-12

% of Inst.
Deliverie
s

Sterilizations
done during
the year
2011-12 From
PHC area
only (Inst.
Performance)

No.of
Sterilizations
per 10,000
population

% of Full
immunization
done during the
year 2011-12

1
2

NOMINATION FOR BEST MPHS (F)

Sl.
No.

Name of
the
MPHS
(F) with
address

Populatio
n

Total
Deliverie
s

No. of
Institutiona
l Deliveries
conducted
during the
year
2011-12

% of Inst.
Deliverie
s

Sterilizations
done during
the year
2011-12 From
PHC area
only (Inst.
Performance)

No.of
Sterilizations
per 10,000
population

% of Full
immunization
done during the
year 2011-12

1
2

NOMINATION FOR BEST MPHS (M)

Sl.
No.

Name of
the
MPHS
(M) with
address

Populatio
n

Sterilizations
done during
the year
2011-12 From
PHC area
only (Sector
Performance)

No.of
Sterilizations
per 10,000
population

% of Full
immunizatio
n done
during the
year 2011-12

No of Blood
Smears
Collected

No. of
positives

1
2

NOMINATION FOR BEST CHO/MPHEO

Sl.
No.

Name of the
CHO/MPHEO
with address

Total
Deliverie
s

No. of
Institutiona
l Deliveries
conducted
during the
year
2011-12

Sterilizations
done during
the year
2011-12
From PHC
area only
(Inst.
Performanc

% of Full
immunizatio
n done
during the
year 2011-12

Involvement
in Health
Programmes
(Personal
appraisal)

Reporting
System
(Personal
appraisal)

Management
of Institution
area
(Personal
appraisal)

No.

Name of the
LAB
TECHNICIAN
with address

Covered
Populatio
n

1
2

NOMINATION FOR BEST LAB TECHNICIAN

Sl.

RNTCP

NVBDCP

OTHER LAB TESTS

No. of
Sputums
Examined

No. of
found
positives

No. of
Blood
Smears
Examined

No. of
Smears
detected
Positives

No. of Urine
Tests
Conducted

No. of HB Tests
Conducted

NOMINATION FOR BEST PHARMACIST

Sl.
No.

Name of the
Pharmacist with

Population

Stock
registers

Store
Maintenance

Maintenance
of Disease

Maintenan
ce of VLF

IDSP
Reports

address

Maintenance
(personal
appraisal)

(personal
appraisal )

wise
Classificatio
n Register

(personal
appraisal)

(personal
appraisal)

87

NOMINATION FOR BEST L D COMPUTER

Name of the L D
COMPUTER with
address

No. of Births Verified

No. of Deaths Verified

No.

Sl.

NOMINATION FOR BEST ASHA

Sl.
No

Name of the ASHA with full

address

No. of
Sterilizations
promoted

No. of
Institution
deliveries
promoted

No. of infants
promoted for
Full
Immunization

1
2

SIGNATURE OF THE MEDICAL OFFICER

NOMINATION FOR BEST HEALTH EDUCATOR

Sl.

Name of the CHNC

Name of the
HEALTH
EDUCATOR with
address

No. of Group
Discussions
attended

No. of
Demonstration
Sessions
attended

No. of
Mass
Meetings
Attended

Total No. of IEC and BCC

activities
attended/conducted

No.

1
1

SIGNATURE OF THE SPHO