A clinic in Kochi is usually three businesses sharing one building: an OP counter that fills up without anyone booking, a lab, and a pharmacy — with a single queue running through all of them. Kerala puts that building on a register: the Kerala Clinical Establishments (Registration and Regulation) Act, 2018 requires clinical establishments in the state, including laboratories and dental and AYUSH facilities, to register with their district registering authority.
The money side is split in a way that software written elsewhere tends to get wrong. Treatment is exempt from GST as health care services by a clinical establishment, while the pharmacy counter a few steps away is selling taxable goods and has to raise a proper tax invoice for them. Meanwhile patients pay by UPI at the desk, ask for the bill on WhatsApp, and speak Malayalam to reception and English to the doctor.
Cliniva runs in production at one 24-hour multi-department clinic in Kerala. That is one site, not a market. We are not going to describe ourselves as the clinic system Kochi runs on, because that is not true — what is true is that a demanding round-the-clock clinic uses it every day and we have the scars to show for it.
The Kerala Clinical Establishments (Registration and Regulation) Act, 2018 covers modern medicine, Ayurveda, homeopathy, Siddha, Unani, laboratories and dental facilities, and is administered through district registering authorities and a state council. No software registers you — but the records a registered establishment is expected to produce are exactly the records your system either keeps properly or does not.
Health care services by a clinical establishment are exempt under Notification No. 12/2017-Central Tax (Rate), with room charges above Rs 5,000 a day (excluding ICU, CCU and NICU) falling outside that exemption. Medicines and consumables sold across the pharmacy counter are taxable supplies. One patient, one afternoon, can generate an exempt line and a taxable line — and a billing engine that only understands one of them makes the other your problem at year end.
Cliniva's first production site is a 24-hour, multi-department clinic in Kerala, and the thing it needed on day one was not an appointment diary. It was a token queue with a casualty lane, per-doctor counts and a waiting-time estimate on a screen the waiting room can see. Systems designed around booked slots start from the wrong end of this building.
Malayalam is Kerala's official language and what the registration desk actually speaks. Case notes and prescriptions are written in English. Hindi turns up at the counter often enough that a receipt which can only print in one language is a real operational problem, not a nice-to-have.
UPI is India's dominant retail payment rail, and a clinic counter in Kochi runs on a QR code. But a clinic that never closes still takes cash on the night shift, across departments, on more than one till — which makes the boring question (does the declared cash match what the system expected, by counter and by shift?) the one that decides whether the accounts are trustworthy.
Walk-in OP tokens across multiple lanes including casualty, per-doctor queues and waiting-time estimates, shown on a waiting-room TV paired with a six-character code — with token confirmations going to the patient on WhatsApp.
Supplier GSTIN, HSN/SAC per line, CGST/SGST split and rupee rounding, with credit notes, fee waivers and immutable invoice snapshots — so the taxable pharmacy line and the exempt consultation sit on one patient record without being reconciled by hand.
Medicine master with batch and expiry, per-branch stock, purchase entry with CSV import, GST per line, partial dispensing and automatic stock decrement when the bill is raised.
Order, results, verify, release — with a hard gate so a report opens only once it is verified and paid. Reference ranges, test packages, referrer tracking and PDF reports are part of the module, not an integration.
A day book and a counter close that reconciles declared cash against expected, by department and by doctor. Branches share one patient database with per-branch stock, rosters and cash counters.
Everything above is a Cliniva capability, described on its own page in full detail — and the fastest way to find out whether it fits Kochi is to put your actual workflow in front of us.
The billing engine produces tax invoices built to CGST Rule 46 with HSN/SAC per line and a CGST/SGST split, alongside non-taxable service lines, on the same patient record. What it will not do is decide the tax treatment for you: whether a particular service in your clinic is exempt is a question for your auditor, and any vendor who answers it for you is guessing with your money.
No. The first production deployment is a 24-hour, multi-department clinic in Kerala, so shifts, per-shift counter closes, an overnight casualty lane and a cash office that reconciles by counter are in the product because that clinic needed them, not because a roadmap said so.
Four Avance builds for English, Malayalam, Hindi and Arabic, but coverage differs by product and by screen and we are not going to claim a blanket yes. Tell us which screens and which printed documents your staff and patients need in Malayalam and we will tell you exactly what is done today and what is not.
No, and be suspicious of anyone who says otherwise. Registration is a filing you make with your district registering authority. What software does is keep the patient, service and billing records straight enough that producing them is a five-minute job rather than a week.
Every regulation, rate and deadline on this page is the published position as of August 2026, linked so you can check it yourself. Rules move, so verify anything you are about to make a decision on — and none of this is tax or legal advice.
Facts last re-checked against these sources on 2026-08-31.
We would rather hear how the counter runs on a Tuesday than send you a brochure. If our software is the wrong answer for you, we will say so on the first call and point you somewhere better.