AYJNISHD

Applicant Panel - Apply for Cochlear Implant Surgery
(Parents / Applicant Panel Registration & Login)

Hospital Panel
(Empanelled Hospitals & Surgeons)

Audiologist Panel
(Empanelled Activation & Mapping centres)

Habilitationists/Therapist Panel
(Empanelled ASLP, AVT’s & Special Educators(HI))

Check Application Status
(With Registration Number)

Check Application Status

Empanelled list

Reports

Cases scheduled / waitlisted for Cochlear Implant
Details of cases undergone Cochlear Implant Surgery (MIS Reports which are only for internal use are Password protected)

EXPRESSION OF INTEREST BY ASLPs/AVTs FOR PARTICIPATION IN COCHLEAR IMPLANTATION UNDER REVISED ADIP SCHEME (2014-15)

Audiologist Application Form for Empanelment

Application Details

Note : Please keep all required document’s soft copy with you before start to fill this form. Required documents are RCI Registration Certificate, Updated CV.

Name of Audiologist *

Gender*

Male Female

Date of Birth: *

RCI CRR Number *

RCI CRR Status *

Name of Center & Complete address *

Telephone Number

Mobile Number *

E-Mail Id *

Professional qualifications:

Qualification	University	Percentage/Grades	No. of Attempts

No. of years of experience in the field of Mapping for CI recipients: *

State Name*

Place

Date

Attachments

RCI registration certificate:*

Testimonials:

Updated CV: *

I, hereby declare that the above-stated information is true and I am willing to provide the services at the rate as per ADIP CI guidelines.

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Registered for CI

CI Surgery done

Hospitals Empanelled

Audiologists Registered

Habilitationists Registered

Updated:

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Ministry of Social Justice & Empowerment

AYJNISHD

Rehabilitation Council Of India

Jobs for Hearing Impaired

Cochlear Implant under ADIP Scheme of Government of India

Ali Yavar Jung National Institute of Speech and Hearing

Disabilities (Divyangjan), Mumbai

Registered for CI

CI Surgery done

Hospitals Empanelled

Audiologists Registered

Habilitationists Registered

Updated:

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Registered for CI

CI Surgery done

Hospitals Empanelled

Audiologists Registered

Habilitationists Registered

Updated: var currentTime = new Date() var month = currentTime.getMonth() + 1 var day = currentTime.getDate() var year = currentTime.getFullYear() document.write(month + "/" + day + "/" + year)

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