NACO
Welcome to the Data Management System for Viral Load PT
I
Viral Load Facility / Laboratory Registration Form
     
1
Type of Facility:
 Please select a facility * Marked fields are mandatory
2
Name of Facility / VL Laboratory:
 Please select a Facility * Please refer this PDF file to find the respective ID (Lab ID will be the user ID for login)
3
VL Laboratory ID:
 *
4
National Identification Number (NIN):
 NIN to Health Facility of India (Optional)
5
Name of the linked Viral Load laboratory:
 Please select a Lab *
6
Name of your State Aids Control Society (SACS):
 Please select a SACS
7
Name of VL In-Charge:
 *
Mobile Number:
 Mobile number requiredInvalid formatIncorrect mobile numberIncorrect mobile number *
8
Official Email ID of VL Laboratory:
 Aa email ID is requiredInvalid email ID *
9
Name of Hospital / Institution:
 *
10
Name of Department / Division:
 *
11
Compete Postal Address:
 *
12
Name of the State:
 Please select a State
13
Name of District:
 *
PIN Code:
 A value is requiredInvalid formatInvalid PIN CodeInvalid PIN Code *
14
Name of Technical Officer (TO):
 *
Mobile Number:
 A value is requiredInvalid formatIncorrect mobile numberIncorrect mobile number *
15
Name of Laboratory Technician (LT):
 *
Mobile Number:
 A value is required.Invalid formatIncorrect mobile numberIncorrect mobile number *
16
Alternative Mobile / Land line Number:
 *
17
User ID:
 *
18
Preferred Password for future login:
 A value is required.Minimum no of characters not metExceeded maximum no of characters *(Minimum of 6 chars & Max 12 Chars)
19
Confirm Password:
 A value is required.The password don't match. *
   
 
Using other facilities login ID or password for registration / data submitting, editing or deleting shall be punishable as per the "IT Act"
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Please cross check all details before submitting