Panchayat Swasthya Mitra Application Form

Apply to join GramEClinic as a Panchayat Swasthya Mitra. Admin team will review your qualification, location readiness, centre infrastructure and operational suitability.

Personal Details

Applicant identity and contact information.

Full NamePhone NumberEmailQualification

Proposed PSM Centre Location

Location where applicant wants to operate GramEClinic PSM point.

State / UTDistrictBlock / Taluka / TahsilGram PanchayatVillageProposed Opening DateCentre Address

Centre Readiness

Basic infrastructure availability for PSM operations.

Electricity AvailableMobile/Internet Network AvailableSmartphone/Tablet Available

Certificate Requirement

ANM/GNM/B.Sc Nursing preferred. Other applicants may require GramEClinic Telemedicine Operation and Patient Facilitation Certificate.

Current selection: Certificate Not Required Initially

I confirm that the information submitted is correct. I understand that PSM role is patient facilitation only, and diagnosis/prescription will be done only by qualified registered doctors or official telemedicine systems.

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