SFRD National Care Alliance - Tertiary Care Hospital Partnership Onboarding Form

Section A: Institutional Identity & Contact Information

Welcome. Saba Foundation for Rare Diseases (SFRD) invites your institution to become a pillar of our National Care Alliance. Your hospital's expertise in managing complex conditions is vital. This strategic partnership is designed to co-create a leading center for rare disease care by combining your clinical excellence with SFRD's specialized knowledge, patient network, and support systems.

Full Legal Name of Hospital *

Type of Institution *

Date of Inception *

Official Website URL *

Social Media Handles *

Headquarters Address *

Nodal Officer for SFRD Partnership *

Nodal Officer's Designation *

Official Contact Email *

Official Contact Phone *

Unique Hospital Identifier

Section B: Legal, Structural & Accreditations

This information helps us understand your hospital's governance and quality standards.

Tax Exemption Status

12A 80G FCRA Not Applicable

Accreditations *

NABH NABL JCI ISO Certified Other

Upload Key Documents *

Please upload PDF copies of your By-laws, MoA, and AoA.

Key Office Bearers

Geographical Presence *

If you have multiple branches, please list the cities/states.

Section C: Operational Capacity & Expertise

Help us understand the scale and scope of your clinical services. This is crucial for matching patients to the right level of care.

Total Bed Capacity *

Number of Full-Time Staff *

List of Medical Specialities *

Advanced Equipment & Facilities *

Future Plans / Expansions

Section D: The SFRD Partnership: Building a Centre of Care

Our partnership is centered on a mutual commitment: SFRD provides the knowledge and patient pipeline to help you build a rare disease vertical, and you provide the expert care that these patients need.

1. Capacity Building Agreement: "Yes, our institution agrees to partner with SFRD on a capacity-building program. We will facilitate the training of our clinicians, paramedics, and staff through SFRD-led workshops, CMEs, and knowledge-sharing sessions." * 2. Priority Care Commitment: "We agree to establish a protocol to treat all SFRD-referred patients on a priority basis, aiming to reduce waiting times for consultations and admissions." *

3. Concessional Services Commitment: "We agree to offer a special, preferential discounted rate card for both out-patient and in-patient services for all SFRD-referred patients." *

Please upload the proposed rate card or specify the discount percentage.

4. Digital Integration: "We agree to assign a nodal officer to coordinate with the SFRD Network, manage digital referrals, and provide updates on patient status to ensure a seamless care continuum." *

How else can we collaborate?

Please select other ways you would be interested in contributing:

Joint Diagnostic & Health Camps: Co-hosting camps for undiagnosed patients. Research & Clinical Trials: Collaborating as a site for future rare disease research and clinical trials. Policy Advocacy: Joining SFRD in advocating for better healthcare policies for rare diseases. Patient Education: Co-creating and disseminating educational materials for patients and the broader medical community.

Section E: Consent & Formal Agreement

This agreement formalizes our strategic partnership. Please have an authorized representative of your institution complete this section.

I confirm that I am an authorized representative of the hospital named in this form. * I understand that this partnership is voluntary and collaborative. We can choose to end our association at any time by providing 60 days' written notice. * I consent to SFRD securely storing our hospital's information and listing our institution (Name, Logo, Website, Key Specialities) in its public directory of trusted Care Partners. * Patient Data Confidentiality: We agree to handle all patient data received through the SFRD Network with the strictest confidentiality, in compliance with all national data privacy, medical information, and hospital regulations. * By checking this box, I confirm that all the information provided is accurate to the best of my knowledge and our hospital agrees to the terms of this partnership. *

Full Name of Authorized Representative *

Designation *

Date

Digital Signature *