NACO
Welcome to the Data Management System for CD4 PT
I
CD4 Laboratory / Facility Registration Form
Non-registered Public Sector CD4 laboratories are requested contact ICMR-NARI for ‘CD4 Laboratory ID’ for completing the registration
1
CD4 Laboratory ID:
*
<-- Kindly contact ICMR-NARI for UID
2
Type of Facility:
Please select a facility * Marked fields are mandatory
3
Name of CD4 Laboratory / Facility:
*
4
National Identification Number (NIN):
NIN to Health Facility of India (Optional)
5
Name of your State AIDS Control Society (SACS):
Please select a SACS *
6
Name of CD4 Lab-In-Charge:
*
Mobile Number:
Mobile number requiredInvalid formatIncorrect mobile numberIncorrect mobile number *
7
Official Email ID of CD4 Laboratory:
Aa email ID is requiredInvalid email ID *
8
Department / Division:
*
9
Complete Name of Hospital / Institution:
*
10
Compete Postal Address:
*
11
Street:
*
City:
*
12
Name of District:
*
PIN Code:
A value is requiredInvalid formatInvalid PIN CodeInvalid PIN Code *
13
Name of the State:
Please select a State
14
No of Equipment in your CD4 Lab:
*A value is required.Invalid format.
Cyflow
FACSCalibur
FACSCount
FACSPresto
Pima
Other:
15
Platform used for PT Program:
Please select a Platform*
16
No of LT/s working in the CD4 Lab:
*A value is required.Invalid format.
17
LT/s supported by:
Please select an option*
18
Name of Laboratory Technician (LT):
*
Mobile Number:
A value is requiredInvalid formatIncorrect mobile numberIncorrect mobile number *
19
Alternative Mobile / Land line Number:
*
20
User ID:
*
21
Preferred Password for future login:
A value is required.No of characters not metNo of characters not met *(Minimum of 6 chars & Max 12 Chars)
22
Confirm Password:
A value is required.The password don't match. *
   
 
Using other facilities login ID or password for registration / data submitting, editing or deleting shall be punishable as per the "IT Act"
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