Office No 5, Bhosale House Apts, Karve Road, Pune- 411004.
07620400100

For job inquiries use jobs@sperohealthcare.in

Registration Form(Doctor)



1.Post Applied*

Upload Your Photo

2. Total Years of Experience

Years*
Months


3. Relevant Experience

Years*
Months

4.Educational Qualification*



(A) Applicant Information

5.Date of Birth*

6.Gender Group

Male                               Female

7.Marital Status

Married                               Single

(B) Applicant Contact Information

8. Permanent Address

District*
Tehsil
City/ Village*
Locality
Landmark
Pin Code*


9. Residential Address*  Same as above

District*
Tehsil
City/ Village*
Locality
Landmark
Pin Code*


10. Contact Details(Mobile Number*)

11.Personal Email ID*

(C) Applicant Document,Work Experience & Skill Set Information

12.Official Email ID


13. Do you have Passport?

 No Yes Applied For

14. If yes

Number
Date Of Issue
Date Of Expiry


15. Registration No

16. Current organization


17. Workplace address

18. Current work Schedule

From
To


19. Names of the hospitals you are affiliated with

Sr No Hospital Name City Name Location
1
2
3

20. Bank A/c Details

Sr No Area of Information Details
1 Account Holder Name
2 Name of the bank
3 A/C Number
4 Branch Name
5 IFSC Code

Note:Please check and fill the Annexure enclosed with form, for more details read guidelines or for help contact reception



Annexure-1

Skill Set Chart (√) on skill levels- Write skills from list of Spero home health services list for


Sr No Physician Assistant Services – Medical Practitioner Yes No
1 Routine General check-up & Physical    
2 examinations (Preventive Check-up)

 

 
3 Traditional home visits (Common Ailments)    
4 On-going treatment of medical conditions    
5 Physician review/consultation for authorization of    
6 medical care, nursing care, pharmacy, diagnostics    
7 and referral to physical therapy and specialized    
8 rehabilitation services    
9 Post-Surgical care    
10 Ambulation    
11 BSL on Glucometer    
12 Bladder Wash    
13 Bladder Wash (In Situ Cathetor)    
14 Bilateral Stitch Removal    
15 Catheter removal/insertion/care    
16 Colostomy Care    
17 Counselling    
18 Central line (Advance IV)care and removal    
19 Cast - monitoring and removal    
20 Condom Cathetor    
21 Dressing: Small    
22 Dressing: Medium    
23 Dressing: Large    
24 Doctor Visit with Glucometer    
25 Doctor Visit with ECG Machine    
26 Glove Drain Catherization    
27 ICD care and assessment    
28 Insulin injectable    
29 ICD Dressing    
30 IV infusion care and therapy    
31 Injections (IV, IM, SC)    
32 Manual Evacuation of Feaces    
33 Nebulization therapy    
34 Need based Medical Transportation    
35 Ongoing-Preventive Care    
36 Oxygenation therapy    
37 Oxygen therapy    
38 Positioning advice    
39 PEG care    
40 Pain management    
41 Routine ECG monitoring    
42 RT removal/insertion/care    
43 Routine diet management    
44 Stoma care    
45 Sore care advice    
46 Suture/Stapler removal    
47 Tracheobronchial Suctioning    
48 Services we offer    
49 Traction    
50 Tube feedings    
51 Tracheostomy removal & replacement    
52 Unilateral TKR Stitch Removal    
53 V-P Shunt care    
54 Vitals monitoring (Pulse, BP, SPO2, RR etc)    
55 Ventilator support (C-PAP/Bi-PAP)    
56 Wound care management & Skin care    
 I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I undertake to inform you of any changes therein, immediately. In case any of the above information is found to be false or untrue or misleading or misrepresenting, I am aware that I may be held liable for it. I hereby authorize sharing of the information furnished on this form with the Spero Healthcare Innovations Pvt. Ltd.