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1
Facility details
2
Documents
3
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Application reference
*
Private access code
*
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1 · Facility details
Legal business name
*
Trading name
Facility type
*
Select facility type
Clinic
Hospital
Eye centre
Optical centre
Facility type
Business registration number
*
Tax identification number
*
Health facility licence
*
Licence issue date
*
Licence expiry (YYYY-MM-DD)
*
Physical address
*
Digital address
*
Region
*
Select region
Ahafo
Ashanti
Bono
Bono East
Central
Eastern
Greater Accra
North East
Northern
Oti
Savannah
Upper East
Upper West
Volta
Western
Western North
Region
District
*
Select district
District
Town
*
Landmark
Latitude
*
Longitude
*
Primary contact person
*
Telephone
*
Email
*
Website
Ownership type
*
Select ownership type
Public
Private
Faith based
Non-governmental organization
Ownership type
Settlement details
Expected monthly examinations
*
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