Every licence an Indian hospital needs, and how often each one expires

In July 2025 the Maharashtra health department reported inspecting 23,354 private hospitals in two rounds. It found 5,134 in breach, issued compliance notices, re-inspected, and cancelled the registrations of 258 that had not fixed anything. The department said the audit would become annual.

Very little of what it recorded was clinical. The violation heads were infrastructure, staffing, hygiene, fire safety, biomedical waste, transparent billing and grievance redressal. That is a paperwork list.

Registration to operate at all

Which law applies depends entirely on your state. The Clinical Establishments Act 2010 now stands adopted in 19 States and UTs. Provisional registration runs to the last day of the twelfth month; permanent registration runs five years, with renewal to be sought six months before expiry.

The rest run their own statutes, and the Act's 2026 decriminalisation does not reach them. Karnataka uses the KPME Act 2007. Maharashtra still runs the Bombay Nursing Homes Registration Act 1949, with a replacement Bill introduced on 3 July 2026 and not yet passed. Tamil Nadu registers for five years with renewal 90 days before expiry and a fee capped at ₹5,000. West Bengal has its own 2017 Act. Delhi is the only UT outside the central Act, using the Nursing Homes Registration Act 1953, renewable every third year.

Registration fees are set by each state, not centrally. We are not publishing a fee table because no reliable state-by-state one exists.

The rest of the stack

• Biomedical waste authorisation — Form II to the State Pollution Control Board. For a bedded facility the validity is synchronised to your Consent to Operate, so the two renew together. Annual return in Form IV by 30 June. Records kept five years. Accidents reported in writing within 24 hours.
• Consent to Establish and Consent to Operate — Water Act 1974 and Air Act 1981, from the SPCB. A hospital with an incinerator is a Red category unit regardless of effluent volume.
• Fire NOC — a state subject, with no central statute. Maharashtra, as one worked example, requires a licensed-agency certificate twice a year, in January and July, and a fire and life safety audit every two years.
• AERB licence — mandatory for every diagnostic X-ray unit, through the eLORA portal. Formal RSO approval is mandatory for CT and interventional radiology. AERB's own guidance says only that the licence must be renewed before expiry and states no period; we could not verify one, so do not assume five years.
• PC-PNDT registration — anything with an ultrasound machine. Form A to apply, Form B certificate, five years, renewal 30 days before expiry, Form F records kept two years. ₹3,000 for a single centre, ₹4,000 combined, renewal at half.
• Pharmacy licence — Form 20 or 21. Worth reading Rule 63(1) closely: this is no longer a renewal but a perpetual licence contingent on a retention fee every five years. Checklists still saying "renew every five years" are out of date, and the practical effect is the same only if somebody pays on time.
• Blood bank — an entirely separate licence under Part X-B, Form 27-C to apply and Form 28-C issued, approved centrally on the state's recommendation, five years.
• Narcotics — Recognised Medical Institution status to stock morphine and other essential narcotic drugs. Three years, renewal 60 days before expiry, though the operative rules are state-notified and may vary.
• MTP approval — Form A to a District Level Committee, certificate in Form B. Separate from everything above.

Then the ones people forget: FSSAI for the hospital kitchen, lift licence, trade or health trade licence, professional tax, EPF and ESI registration, and THOTA registration if you retrieve or transplant.

What this means for your hospital

Build the register once. One row per licence: the instrument, the issuing authority, the certificate number, the expiry date, the renewal lead time, and a named person. Set the reminder at the renewal lead time, not the expiry date, because several of these require action months in advance.

Two things are worth checking this week specifically. Whether your biomedical waste authorisation and Consent to Operate are still in step, since they expire together and one lapsing takes the other with it. And whether anyone paid the pharmacy retention fee.