Schedule – 1

Schedule – 1
(Related to Sub-section (2) of Section 3)
Application to be submitted for listing the name of a Doctor or
Health Worker
To,
The Director General / The Chief
Department of Health / District Health Office
Subject :– The name to be listed.
I have submitted this application pursuant to the Sub-section (2) of Section 3 of
Safe Abortion Service Processes, 2060, to include my name in the roster that
has been maintained for the purpose of providing the safe abortion services,
mentioning the following details.
Details
1. Name and Address of the applicant :–
2. Name of the professional council where his/her name has been
registered :–
3. Registration number of the professional council and date of
registration :–
4. Educational Qualification :–
(a)
(b)
(c)
5. Training :–
(a)
(b)
(c)
6. I shall follow the provisions and professional code of conduct that has
been mentioned in section on Homicide of National code (Muluki Ain)
and in these processes, while providing the safe abortion service.
7. I shall provide the service through the enlisted health institution
pursuant to the safe Abortion Service Processes, 2060.
Applicants;-
Signature :-
Date :- Name :-