Empanelment application

Complete your
empanelment

This is the full application, completed after we have spoken and you have seen the operation. It takes about ten minutes with your documents to hand.

Only expressing interest for the first time? Use the ninety-second form instead — this one is for consultants already in conversation with us.

Application received.

We will verify your qualifications and council registration and come back to you within 3 working days. A countersigned copy of your agreement will follow by email. If anything is missing we will tell you exactly what, rather than asking you to start again.

01 Profile

02 Registration

03 Documents

04 Practice

05 Agreement

STEP 01

Your profile

This becomes your consultant profile. Patients see your name, qualifications, speciality and photograph — nothing else from this form.

Title

Full name *

Qualifications, as they should appear *

Years in practice

Primary speciality *

Super-speciality or special interest

A short professional biography

Mobile *

WhatsApp, if different

Email *

STEP 02

Registration and insurance

Council registration no. *

Council / state *

Year of registration

HPR ID, if you hold one

Current hospital or clinic attachment

City *

Indemnity insurer

Sum insured

Before you continue — many Indian indemnity policies are written around a named hospital and some predate telemedicine. Please confirm with your insurer, in writing, that your policy responds to teleconsultation and to care delivered at a patient's residence. We ask because it protects you, not us.

I have confirmed both with my insurer I am checking I would like help with this

STEP 03

Documents

PDF, JPG or PNG. Up to 10 MB each. You can photograph documents with your phone — a clear, flat, well-lit photo is fine.

Documents are used solely to verify your credentials for empanelment, and are stored under the Digital Personal Data Protection Act, 2023.

+ Medical degree certificates MBBS and all post-graduate qualifications. Multiple files accepted. Required + Council registration certificate From your State Medical Council or the NMC. Required + Current registration status Screenshot or printout from the council portal, dated within 90 days. Required + Identity and address proof Aadhaar, passport, driving licence or voter ID. Required + Professional indemnity policy schedule The schedule page showing sum insured and validity dates. Required + Recent photograph Passport style, plain background. Used on your consultant profile. Required + Curriculum vitae Brief is fine — two pages is plenty. + Bank details and PAN Cancelled cheque or bank letter, and PAN card. Required for payment and TDS.

No documents attached yet.

STEP 04

How you want to practise

Select the formats you are empanelling for. These are recorded in Schedule A of your agreement and can be changed later by email.

Online consultations on Diagnex CoreScheduled teleconsultation in slots you set OPD sessions at a Diagnex clinicIn-person consulting with full support Home consultation visitsAttending patients at home, coordinated by us Home dialysis supervisionClinical oversight of a defined cohort — nephrology Continuing care for my own patientsThey receive home care under my prescription Second opinion & case reviewStructured review, asynchronous where suitable Clinical advisoryProtocol, quality, training and incident review Academic engagementCME, clinical talks, staff training

Preferred mode

OnlineAt a Diagnex clinicAt the patient's homeFlexible

Indicative availability per week

Under 2 hours2–5 hours5–10 hoursMore than 10 hoursPrefer to discuss

Availability windows

Escalation response window

Covering practitioner, if nominated

STEP 05

The agreement

Below is the plain-English summary. The full Consultant Empanelment Agreement governs, and we would encourage you to take your own advice on it before accepting.

Full agreement (PDF) Plain-English summary (PDF)

What you keep

You practise as an independent practitioner. This is not employment.
Clinical decisions are yours alone — suitability, modality, prescription, referral. We do not direct or override your judgement.
No exclusivity. Your hospital work, private practice and any other platform are unaffected, and you need not tell us about them.
Your patients remain yours, during the engagement and after it ends.
You set your availability and can change it. No minute-level response targets, no penalties.
You may decline any patient or allocation, for any reason, with no effect on future allocation.

What we provide

Equipment, consumables, water treatment, vehicles, trained technicians and nurses, scheduling, logistics, billing, records and compliance — at no capital or running cost to you.
A structured session record within 24 hours, and a monthly trend summary for any continuing cohort.
An escalation protocol under which our staff follow a fixed trigger list and call you — they do not exercise clinical judgement.
A standing right for you to inspect us — water testing log, machine service history, staff certification file and incident register, at any time, on request.

Fees

A fixed fee or retainer for a defined clinical scope, agreed in writing before any patient is allocated. It is never linked to how many patients you refer or are allocated, or to tests, medicines or procedures you order. That structure protects you under the professional conduct regulations, and it is deliberate.

Insurance and liability

You hold your own professional indemnity and give us the schedule at empanelment and each renewal. We separately hold Medical Establishment Professional Indemnity covering our clinical staff and operations, including home and mobile settings. The indemnity runs both ways — each side answers for its own acts. We indemnify you for our staff, equipment failure, water quality, consumables, logistics and any failure to run the escalation protocol.

Records and data

Records are shared with you and the patient, and retained for the statutory period. They will not be used for marketing, research, publication, product development or the training of any software or model without written consent from both you and the patient.

Leaving

Either side may end the agreement on 30 days' written notice, without giving a reason. You may pause new allocations at any time while finishing care already started. If you leave, no patient's care is reduced — arranging alternative supervision is our obligation.

Note

This summary is for clarity and has no legal effect. Where it differs from the Consultant Empanelment Agreement, the Agreement prevails. Nothing here is legal advice.

Please scroll to the end of the summary before accepting.

I have read the Consultant Empanelment Agreement and this summary, and I accept the terms of the Agreement. I confirm that I hold valid, current registration with a State Medical Council or the National Medical Commission, and that no suspension, condition or disciplinary proceeding affects my practice. I confirm the information and documents provided are true and complete, and I will notify Diagnex within seven days of any change to my registration status. I consent to Diagnex (Carehorizon Health Private Limited) processing my personal data and documents for empanelment and credential verification, under the Digital Personal Data Protection Act, 2023. I may withdraw consent by writing to care@diagnexhealth.com. I consent to my name, qualifications, speciality and photograph appearing on my public consultant profile. (Optional — you can be empanelled without a public profile.)

Electronic signature

Type your full name *

Date *

Typing your name constitutes an electronic signature under the Information Technology Act, 2000. Diagnex will record the date, time and submission reference, and will return a countersigned copy by email. The Agreement takes effect only when countersigned by Diagnex — your submission alone does not bind either party.

Questions first? Call +91 XXXXX XXXXX Please complete the fields marked with an asterisk, attach the required documents, and accept the agreement.

What happens after you submit

We verify your qualifications and council registration — usually within 3 working days. If anything is missing we tell you exactly what, rather than asking you to start again. Once verified, you receive a countersigned agreement and we agree a first allocation: a small, defined cohort so both sides can assess how it works before it scales.

Complete yourempanelment