PROCESS REMITA RRR

Facility Name*

Registrstion Number *

Facility Type* Select Facility Type CHPS Compound Clinic Secondary Hospital Chemical Shop Maternity Home Polyelinic Tertiary Hospital Health Centre Pharmacy Ultrasound Scan

Other Facility Type*

Facility Ownnership* Select Facility Ownnership Type Government Mission Private Quasi_Government

Category Of Application* Select Application Category New Application Renewal Upgrade Re-accreditation

Registration Of Facility With Registrar General Department*

Registration of Facility With Health Regulatory Body*

Address*

Postal Code

L.G.A* Select L.G.A Lagos State Cross river State Edo State Delta State

Chief Executive Admininistrator Proprietor* i. Select Title Mr. Mrs. Miss Dr. Chief

Key Professional Staffs*

*