Application for the Establishment of a Medical Institution in Hainan Province

Prepared by Hainan Provincial Health Commission

I. Instructions

1. This application form can be downloaded from the websites of Hainan Provincial Government Service Center or Hainan Provincial Health Commission.

Websites: http://www.hizw.gov.cn; http://www.wst.hainan.gov.cn

2. Please read the relevant regulations and application acceptance provisions carefully before filling out this form.

3. Establishing entity (individual): Fill in the superior competent entity or investor of the medical institution to be established.

4. Address: Fill in the legal address of the establishing entity (individual) and the individual shall fill in the home address.

5. Category: Fill in the corresponding category according to Article 3 of the Implementation Rules for the Regulation on the Administration of Medical Institutions.

6. Name: Fill in the name of the medical institution being applied for.

7. Site selection: Fill in the detailed address of the medical institution to be established (for applications to establish an Internet hospital, fill in the address of the physical medical institution on which the Internet hospital relies).

8. Ownership form: Select one of the following forms to fill in (only one can be filled in)

a. Owned by the whole people      b. Collectively owned      c. Privately owned

d. Chinese-foreign joint venture (cooperative)      e. Other

9. Business nature: Fill in whether the medical institution is a not-for-profit institution founded by the government, not-for-profit institution not founded by the government or for-profit institution.

10. Sickbeds (dental chairs): Fill in the number of sickbeds, dental chairs and observation beds to be established.

11. Service recipient: (Only one can be filled in)

a. Social      b. Internal

12. Diagnosis and treatment items: Fill in all the primary and secondary items being applied for.

13. The content of this application form shall be complete, clear and free of alterations. Fill in “None” in any blank spaces.

14. The content of this application form and all application materials must be printed.

15. This application shall be submitted to the Approval of Hainan Provincial Health Commission of Hainan Provincial Government Service Center after being filled out by the applicant.

II. Appendix 1 Site Selection Materials Shall Include:

1. Selection basis;

2. Environment and public facilities in the selected area;

3. Relationship between the site and nearby childcare institutions, primary and secondary schools and food production and operation entities; and

4. Site space and construction space.

III. Housing Rental Agreement, Property Certificate or Land Certificate

IV. One Copy of the Application Form and Application Materials