ROLE AND RESPONSIBILITIES OF CHIEF MEDICAL OFFICER IN CHARGE
CLINICAL WORK
He will provide Primary Health Care/Comprehensive Health Care to the CGHS beneficiaries. He will ensure that emergency services are provided through the dispensaries 24hrs*365days.
He will implement all the National Programmes like Reproductive & Child Health Programme, Universal Immunization Programme, Vector Borne Diseases Control Programme, Revised National Tuberculosis Control Programme, National Leprosy Eradication Programme and National programme for Control of blindness.
FAMILY WELFARE PROGRAMME & M C.H.
He will be overall in charge of Family Welfare Programme.He will conduct and supervise the Family Welfare Programme to achieve the target successfully. H e will be responsible to promote the Family Welfare Program by educating the eligible couples and creating the community awareness about type of contraceptives available, sources of contraceptives and their availability, provision of MTP services and permanent method of contraception (vasectomy, tubectomy).
PREVENTIVE PROPHYLACTIC TREATMENTS
He will organize Preventive and Prophylactic treatment to the beneficiaries. The various immunization Programmes and antenatal Check-ups should be organized in the dispensary.
EVACUATION OF SERIOUS PATIENTS
He should ensure safe evacuation of serious patient by calling the ambulance from the hospital/any other arrangements depending upon the Seriousness of illness.
MINOR SURGICAL WORK
The facilities for minor surgical Work such as opening of abscess or stitching of wound should be available in the dispensary.
HEALTH EDUCATION
The Health Education Programme should be Organized in the dispensary. He will create awareness by educating the beneficiaries about personal hygiene, role of exercises, good food habits, use of O.R.S., breastfeeding and weaning foods, Immunization Schedules, safe sex and avoidance of AIDS etc.
He will adjust his own patient's load keeping in view his additional duties.
He will ensure as far as possible patients load is equally distributed among Medical Officers posted to this dispensary.
ADMINISTRATION
Chief Medical Officer In charge will take round daily to observe whether all staff is in their respective place of duty. He should also make surprise round in between to ensure smooth functioning of the dispensary. He will ensure that all staff is in position to start work at the scheduled time. He will maintain an attendance register for his staff, which he will place on his table and he will ensure that all, members of the staff note down the time of arrival and departure in the attendance register. He will countersign the attendance register daily which will be in his personal custody and which he will remove from his table half an hour after opening hour of the dispensary and at the time of closing of the dispensary. He will record absence or leave, late arrival etc. appropriately in red and take —suitable action and/or report defaulter to the competent authority.
CASUAL LEAVE COMPENSATORY OFF STATION LEAVE PERMISSION
He will maintain the Casual Leave record and grant Casual Leave and Compensatory off to all staff working in the dispensary other than him/her. He can also grant station leave permission. In exceptional cases he may consult Addl Director for advice.
RESIDENTIAL ADDRESS OF STAFF
The Chief Medical Officer In charge will maintain the record of residential addresses of all the staff members along with Telephone numbers if any.
He will be responsible for maintenance of discipline and order in the dispensary.
UNIFORM
The Chief Medical officer in charge should ensure that all staff wears the prescribed uniform while on duty.
PUNCTUALITY
He will ensure punctuality and deduct day Casual Leave from Casual Leave account for late coming, for each late attendance. But late attendance up to an hour on not more than two occasions in a month may be condoned by the Competent authority, if he is satisfied that it is due to unavoidable reasons. In case such a course 'does not ensure punctual attendance, suitable disciplinary action may be taken against the Govt Servant concerned in addition to deducting half a day's casual leave to his casual leave account for each occasion of such late attendance.
He will arrange a Group 'D' staff to take over the charge from the Chowkidar in the morning session and to hand over the charge to the Chowkidar in the evening session.
SAFAI WORK IN ABSENCE OF SAFAIWALA
The Chief Medical Officer in charge is authorized to appoint one Safaiwala on daily wages basis as and when required.
MAINTENANCE OF BUILDING
He has to keep good liaisons with the CPWD for the proper maintenance of building.
FINANCIAL MANAGEMENT
He will be responsible for disbursement of pay of dispensary according to the instructions.
IMPREST MONEY
Imprest money register will be maintained by the Chief Medical Officer In charge. He will send paid up vouchers duly certified to Zone for recoupment.
PREPARATION OF ACQUAINTANCE ROLL:
1. Separate Sheet should be used for each category of staff e.g. one sheet of staff Nurse, one sheet for L.D.C. , one sheet for Storekeeper etc. or as per the direction of D.D.Os.
2. Name of dispensary in block letters.
3. Stamp of the dispensary at the top with date in each sheet.
4. Each sheet should have serial number and initial of Medical Officer in charge.
Checking of Chemist Bill
CMO I/C should examine the chemist bill and forward to the concerned authority within the stipulated time. He should ensure that Local Chemist should write the different rates uniformly on the indent forms i.e. He should write ones under ones, tens under tens, hundreds under hundreds etc. Bills should be checked thoroughly. Rates have been already checked while receiving the indents so more attention can be given to calculations horizontally as well as vertically. Where the packing size is different than the usual 10 more attention is to be given in horizontal calculations. Costly medicines are also to be checked. Here we can apply ABC analysis and HML analysis. Find out the 10% items where 70 % of budget is consumed and pay more attention to those items rates and calculations. Out of others (hml analysis) take the costly items and check thoroughly. From the rest, the random items may be checked. Items like loprin which has very less value, in single /double figures; putting single digit in front is very easy not to get noticed. Take steps to prevent that. Ask the chemist to put 0 under hundreds. Tens as the case may be. Always recheck from the dispensary copy. Keep all the L P vouchers month wise and if possible get it bounded.
IMPORTANT CIRCULAR FILE (GUARD FILE)
He will maintain the guard file and all important circulars should be filed serially with page mark and keep the file in his personal custody.
DAILY DIARY
He will maintain a daily diary and record all the important incidents occurring in the dispensary.
AUTHORITY BOOKS AND CHIT BOOKS:
The Chief Medical Officer In charge will keep an account of Authority Books and Chit Books and issue the Chit Books to the Medical Officers as per proforma lay down.
CONDEMNATION AND WEEDING OUT OF OLD RECORDS
The Chief Medical Officer in charge will undertake the condemnation and weeding out of old records.
ACCOUNTING OF STORES
He will scrutinize and countersign- the expenditure of drugs from the stock ledgers of medicines issued by the store-keeper to various units of the dispensary as per demand register. He will countersign all the entries in receipt column of medicines as per vouchers of indents.
He will be responsible for overall consumption of issue of drugs etc. He will be at par with the Specialist regarding issue of Specialist items listed in CGHS formulary. To do the surprise checks of store, dispensing counter.
PROCUREMENT OF MEDICINES FROM LOCAL CHEMISTS THROUGH LOCAL PURCHASE INDENT / BY HAND AUTHORITY
Medicines available should not be indented. Prescriptions should be signed and stamped by the specialist if out of CGHS formulary drugs are prescribed. If the prescriptions is signed by the registrar/ junior or senior resident than it should be signed and stamped by the specialist if out of CGHS formulary drugs are prescribed.
Only valid prescriptions are to be indented, if time barred fresh opinion of specialist is essential. The prescriptions of recognized hospitals are only to be entertained.
Prescriptions and local purchase indents must be legible.
Advertised and food products, cosmetics, ayurvedic drugs prescribed by allopathic physician, inadmissible items declared and imported drugs should not be indented.
H O D items of formulary must be prescribed or countersigned by consultants only. Quantity indented must not be more than the quantity prescribed and the strength of each item must be indicated.
The index card of the beneficiary should be invariably being checked from the record. Date and the quantity indented and supplied should be written legibly in the prescription.
A photocopy of prescription required in case of- cost more than Rs 1000/- per medicine. These photocopies of prescriptions should be paged, numbered, indexed and got properly bound month wise. Medicines should be supplied in full by the local chemist. Write clearly and legibly and in capital letters and mention the strength of medicine.
To bring transparency in the system give code to each medicine. Code should also be different in case of same medicine but different strength. Avoid overwriting and all cuttings should be verified by cmo i/c. Quantity of indented/ supplied medicines to be written in words also. Mention the name of "prescribing doctor" along with hospital in the relevant column.
Medicines not supplied to be indicated as not available. Substitute medicines should not be received. Substitute means medicines of different company/ strength.
The pharmacist should also sign along with his name.
The indent should be entered in register with the following columns
No. And date of indent
No. Of items indented.
No. Of items received
No. Of pages sent
Remarks
Local chemist should indicate batch no/ company name/ mfg. Date/ exp. Date, mrp, local tax and the quantity in the prescribed columns while supplying to the dispensary. Mrp and local tax should be shown separately.
Local chemist should not supply the inadmissible items. Pharmacist receiving the medicines should also ensure it.
While receiving the indent, pharmacist should check the batch no, expiry date, mrp and strength of the medicines. Medicines should be kept separately day wise for one week.
The medicines, left undistributed, should be kept separately. After 15 days unclaimed medicines should be taken on charge and to be distributed to the first beneficiary came for the indent. A separate register should be maintained for above purpose. The pharmacist should verify the name and address of the beneficiary from the token card. Listed items should be taken on charge and separate register should be maintained for the purpose. No separate chit is required. Beneficiary should not be asked to get registered for the purpose. The pharmacist should submit the list of beneficiaries to the entry clerk at the end of the day. Weekly summery of listed drugs and if possible of out of formulary medicines should be made. This summery will be useful for taking the medicine under the formulary and for the provisioning at a later stage.
To avoid the misuse and to bring transparency in the system, all the medicines should be leveled as CGHS supply not for sale and all the sealed items should be handed over to the beneficiary after breaking the seal in front of him as per the store procedures. Medicines should be leveled in such a way that name batch number expiry date etc should always be visible clearly.
Re circulated medicines should not be accepted and matter should be brought to the notice of cmo i/c. The pharmacist should be polite and also explain the doses duration, frequency of medicines to be taken. And any adverse reactions expected to the beneficiary in their language.
BY HAND AUTHORITY
He will ensure that patients get the medicine of short durations for emergency treatment immediately on by hand authority. He will take all the precautions mentioned above in procuring medicines.
PENALTIES
In case of indent for specific brand of medicines, the same shall not be substituted. If any such case is noticed during subsequent scrutiny after or before the payment, then supplier will be penalized for Rs.1000 + cost of the specific brand of medicines for each such default.
The delivery of supplies in full will be made on the next working day by 8.30 a.m. or at the opening hours of unit/dispensary, whichever is later, at the premises of the dispensaries indenting the supplies or in case of emergency at the residence of the patients as directed by CMO I/c of the dispensary/unit. In the event of non-supply of indented medicines in time as aforesaid, Rs. 500/- will be deducted from the bill of the Chemists for each delay.
Forecasting
He will forecast and prepare the demand for the dispensary for the future year.
A time series is a sequence of observations which are ordered in time. Inherent in the collection of data taken over time is some form of random variation. There exist methods for reducing of canceling the effect due to random variation. Widely used techniques are "smoothing". These techniques, when properly applied, reveals more clearly the underlying trends. Moving averages rank among the most popular techniques for the preprocessing of time series. They are used to filter random "white noise" from the data, to make the time series smoother or even to emphasize certain informational components contained in the time series.
Brass Seal
He should ensure sealing of stores with brass seal and the brass seal should be in his personal custody.
BEST CLEAN DISPENSARY
For the best clean dispensary, the following activities were performed: Cleanliness of dispensary, Display of Posters, Keep up of Notice Board, Maintenance of store, F. W. activities, working in Hindi.
To save the staff from legal consequences under Law of Torts and to provide better facilities to beneficiaries, instructions were displayed prominently at the Notice Board outside the injection room, Doctors' room, local purchase counter, Dressing room, Medicine Counters under the guidance of CMO I/C.
PERMISSION FOR INVESTIGATIONS AND TREATMENT IN PRIVATE RECOGNIZED HOSPITALS
CMO i/c shall issue permission for Investigations / Treatments procedures as per the specific tests / treatment procedures as advised by CGHS / GOVERNMENT Specialist / CMO in a CGHS recognized Diagnostic Centre / Hospital of the choice of beneficiary in respect of pensioners / Ex-Mps, Freedom fighters, CGHS staff.
Such permission in respect of serving employees is granted by HOD.
GRIEVANCE COMMITTEE
The Chief Medical Officer In charge will form Grievance Committee in consultation with Area Welfare Officer and hold meetings regularly preferably on second Saturday to solve the problems of the dispensary. The committee will have two members of Resident Welfare Association, Pensioners respectively. The Committee will try to settle any complaint against the dispensary/Staff. The minutes of the meeting should be recorded and forwarded to the Zonal Headquarter/Addl Director (HQ).
Revalidation of Pensioner Card:
The Chief Medical Officer In charge is to revalidate the pensioner Card as and when required. It should be done both annually or bi-annually i.e. June and December.
RELIEVING DUTY OF MEDICAL OFFICERS
The Chief Medical Officer In charge will depute Medical Officers on relieving duty in turn.
MONTHLY REPORTS
Monthly reports are prepared. It includes the number of cards, beneficiaries, new patients, old patients, working days and average daily attendance. Monthly Hindi report is also prepared.
EMPLOYEES STRIKE OR LOCAL CHEMIST STRIKE
He will take all the measures so that the beneficiaries are not harassed during the employees strike or Local Chemist strike.
CPIO
He will act as CPIO for the dispensary under the RTI act.
Any other work assigned by the Additional Director.
Dr Marwah
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