DR. JOSE RIZAL MEMORIAL HO SPITAL

DR. JOSE RIZAL MEMORIAL HOSPITAL

CITIZEN’S CHARTER2019 (1ST Edition)

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DR. JOSE RIZAL MEMORIAL HOSPITAL

CITIZEN’S CHARTER2019 (1ST Edition)

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I. Mandate:Republic Act (RA) 8200: This is an Act approved on July 30, 1996 converting the Rizal Memorial District Hospital

in Dapitan City into a tertiary Hospital, under the full administrative and technicalsupervision of the Department of Health (DOH), which shall be known as the Dr. JoseRizal Memorial Hospital and appropriating funds therefore.

States that the said general hospital shall have the capabilities of a tertiary hospital,increasing its bed capacity to two hundred (200) beds.

Further states that the DOH shall formulate the necessary guidelines for its operation asa tertiary hospital and that the amount necessary to carry out the provisions of this Actshall be included in the General Appropriations Act of the year following its enactmentinto law and thereafter

DOH-Administrative Order No. 2015-0041 dated September 15, 2015 defined itsImplementing Rules and Regulations (IRR) with the following seven (7) implementingmechanisms involving the following areas:

Redirection and Expansion of Services Health Human Resource Assets and Liabilities Equipment Infrastructure Systems Development Quality Management

II. Vision:The Dr. Jose Rizal Memorial Hospital (DJRMH), an enabler in the attainment of Filipinos asamong the healthiest people in Southeast Asia by 2022, and by Asia by 2040.

III. Mission:As part of the Department of Health, the DJRMH shall lead in the hospital and communitybased development of people-centered, resilient, and equitable health system for its targetpopulation.

IV. Service Pledge:We, The members of the Management and Staff of Dr. Jose Rizal Memorial Hospital, dopledge and commit to deliver quality services as provided in our Citizen’s Charter.We commit to:1. UPHOLD our values of PROFESSIONALISM, RESPONSIVENESS, INTEGRITY,

COMPASSION, EXCELLENCE in dealing with our clients2. WEAR OUR IDENTIFICATION CARDS AND UNIFORMS with PRIDE & DIGNITY3. APPLY and IMPLEMENT consistently applicable Rules And Policies4. LISTEN and ACT Appropriately to our client’s feedback5. CONSCIOUSLY AIM for our client’s satisfaction

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LIST OF SERVICES

I. HOSPITAL OPERATIONS AND PATIENT SUPPORT SERVICEExternal Services

1 Issuance of Certificate of Employment 72 Issuance of Official Receipt and/or Clearance 93 Issuance of Service Record 104 Issuance of Statement of Account (SOA) 125 Processing of Receipt of Deliveries of Supplies/Equipment 136 Purchase of Bidding Documents 147 Releasing of Checks to External Creditors 158 Request of Data/Information under EO No. 2 179 Verification of PHIC Eligibility Status 18

Internal Services1 Issuance of Requested Supplies/Equipment 202 Leave of Absence Application 213 Leave of Absence Application – For Travel Abroad, Maternity

Leave and Leave of Absence for more than 30 days26

4 Liquidation f Cash Advance – Travel or Training 315 Production of Linen Supplies Based on Approved Job Order 326 Releasing of Checks to Internal Creditors 337 Request for Budget Obligation of Financial Transaction 348 Request for Corrective Maintenance (CM) 359 Request for Linen Supplies 36

II. NURSING SERVICEExternal Services

1 Availment of Animal Bite Services – Follow up Vaccination 392 Availment of Animal Bite Services – New Animal Bite Clients

(Category II & Category III bite exposure without PhilHealth41

3 Availment of Animal Bite Services – New Animal Bite Clients(Category III bite exposure) with PhilHealth

43

4 Availment of Medical and Surgical Supplies 445 Availment of Out-Patient Department Consultation 516 Availment of TB-DOTS Service – New TB DOTS Clients 527 Availment of TB-DOTS – Patient follow-up for Enrolled TB Clients 538 Availment of TB-DOTS Service – Patient follow-up for continuation

of treatment at the Hospital54

9 Availment of TB-DOTS Service – Patient follow-up for continuationof treatment at the RHU / CHO

55

10 Issuance of Patients Identification Card 5611 Issuance of Triage Pass 5712 Patient’s Registration at the Emergency Room 5913 Patient’s Triage at the Emergency Room 6014 Patient’s Post Triage Disposition at the Emergency Room 6215 Triaging and Admission of Suspect, Probable and Confirmed COVID-19 67

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Internal Services1 Discharge Process/Discharging a Patient from Clinical Areas 692 Issuance of Medical Supplies 71

III. MEDICAL AND ANCILLARY SERVICEExternal Services

1 Availment of Blood Units 742 Availment of In-Patient Registration 763 Availment of Laboratory Services for Out-Patients 774 Availment of Dental Services 815 Availment of Medical Assistance 826 Availment of Medico-Legal Examination at the Women

and Child Protection Unit84

7 Availment of MSS Classification/Re-Classification of Patient 868 Availment of Nutritional and Dietetics Service 879 Availment of Patient’s Data Correction 88

10 Availment of Patients Hospital Identification Card 8911 Availment of Philhealth Enrolment through Point

Of Service (POS)90

12 Availment of Services at Malasakit Center(Medical/Financial Assistance & Verification of PHIC Status

92

13 Availment of X-ray Services for Out-Patient 9414 Conduct of Procedure and Releasing of Result

for Out-Patient (X-Ray Special Procedure, Ultrasound and 2D Echo)97

15 Conduct of Procedure and Releasing of Resultfor Out-Patient (CT-Scan and Mammogram)

99

16 Issuance of Drugs and Medicines 10117 Issuance of Duplicated Copies of Health Records 10518 Issuance of Unregistered Death Certificate 10719 Issuance of Various Certificates and Completed

Insurance Forms109

20 Processing for Payment of Radiology Services– For Special Procedures

112

21 Processing of Unregistered Certificate of Live Birth 117

Internal Services1 Availment of Laboratory Services for In-Patient 1202 Availment of Imaging Services for COVID Related Patients

– For X-Ray Procedure and Ultrasound122

3 Availment of CT-Scan Procedure for COVID Related Patients– For CT Scan

124

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HOSPITAL OPERATION AND

PATIENT SUPPORT SERVICE

(HOPPS)

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External Services

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1. Issuance of Certificate of EmploymentThis certificate is issued to a requesting client relative to their services rendered as an employee of Dr.Jose Rizal Memorial HospitalOffice/Division: Human Resource Management SectionClassification: SimpleType of Transaction: G2G - Government to Government , G2C – Government to Client

Who May Avail: All Dr. Jose Rizal Memorial Hospital employees including those who arealready separated in the service

CHECKLIST OF REQUIREMENTS WHERE TO SECUREPrincipal:1. Official receipt2. Charge Slip

CashierHR Office

Authorized representative:1.Proof of Identification of the principal and authorized

representative2. Authorization letter3. Official receipt / Charge Slip

Any Government-issued IDs

Requesting party (principal)Cashier / HR Office

CLIENT STEPS AGENCY ACTIONFEES

TOBE

PAID

PROCESSINGTIME

PERSONRESPONSIBLE

1. Fills-out the logbookand secures theDocument RequestForm

1.1 Receives and fill up theDocument RequestForm

1.2 Presents the DocumentRequest Form andCharge Slip to the HRhead

1.3 Proceeds to theCashier’s office forpayment and pays thecorresponding amount

1.4 Proceeds to the officeof the Medical CenterChief for the approvalof the DocumentRequest Form

1.5 Returns to the HR officeand presents OfficialReceipt then submitsthe approvedDocument RequestForm

1. Entertains client’s request andadvise to fill-out the Logbookand provides DocumentRequest Form

1.1 Issues Charge Slip andadvice the client to proceed tothe HR head

1.2 Signs the Charge Slip andcountersigns the DocumentRequest Form

1.3 Issues official receipt

1.4 Approves the DocumentRequest Form

1.5 Receives the approvedDocument Request Form

1.5.1 Advices the client of thescheduled Date of release(Next working day afterrequest is done) of the

None

None

None

Php15.00

None

None

None

2 minutes

2 minutes

2 minutes

20 minutes

5 minutes

1 minute

2 minutes

AdministrativeAssistant II


AdministrativeOfficer V/ HRMO

Cashier’s officestaff

Medical CenterChief



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Certificate of Employment1.5.2 Verifies the employment

record of the client fromhis/her 201 File

1.5.3 Prepares and print theCertificate of Employment

1.5.4 Reviews and signs theCertificate of Employment

1.5.5 Signs the Certificate ofEmployment

None

None

None

None

5 minutes

2 day

5 minutes

5 minutes

AdministrativeOfficer IV



Medical CenterChief

2.1 Returns on thescheduled date

2.2 Signs the DocumentReleasing Logbook

2.1 Gives Document ReleasingLogbook

2.2 Releases the Certificate ofEmployment

None

None

1 minute

1 minute



TOTAL: Php15.00

2 days & 51minutes

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2. Issuance of Official Receipt and/or ClearanceThe Cashier is in charge with the collection of payment for hospital fees, sales from pharmacy andmedical/surgical supplies, professional fees of agency-credentialled physicians and billed throughcharge slips, statement of accounts, order slips and professional fee.Office/Division: Cash OperationsClassification: Simple

Type of Transaction: Government-to-Citizen (G2C), Government-to-Business (G2B),Government-to-Government (G2G)

Who May Avail: Patients or their representatives, employees, government agencies

CHECKLIST OF REQUIREMENTS WHERE TO SECUREAny of the following:Charge slip/ Order of Payment – 1 copy Cost center where service was renderedProfessional Fee Slip – 2 copies (1 original and 1photocopy)

Attending physician or his authorizedrepresentative

Statement of Account or Billing Statement – 3 copies Billing and Claims Section

CLIENT STEPS AGENCY ACTIONFEESTO BEPAID

PROCESSINGTIME

PERSONRESPONSIBLE

1. Gets queuing numberand waits for numberto be called

Note: Special priority forSenior Citizens, Pregnantwomen and PWDs.

1. Calls the number of thetransaction to beaccommodated

None 5 minutes CollectingOfficer

2. Approaches thewindow when calledand presents requireddocument

2. Receives document, suchas: charge slip / statementof account (SOA)/MSS Stamped SOA/Orderof Payment

None 5 minute CollectingOfficer

3.1 Gives cash/ checkspayment andpays correspondingamount.

3.2 Receives OfficialReceipt and/orclearance

3.1 Receives cash / checkfrom clients /creditors.

3.2 Issues Official Receipt/s(OR) and/or clearancethen gives instruction totheclient as needed

None

None

3 minutes

7 minutes

CollectingOfficer

CollectingOfficer

TOTAL None 20 minutes

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3. Issuance of Service RecordA service record is issued to clients relative to their services as an employee of the Dr. Jose RizalMemorial Hospital.Office/Division: Human Resource Management SectionClassification: ComplexType of Transaction: Government to GovernmentWho May Avail: All active human resource

CHECKLIST OF REQUIREMENTS WHERE TO SECUREPrincipal:1. Official receipt / Charge Slip Cashier / HR OfficeAuthorized representative:1.Proof of Identification of the principal and authorized

representative2. Authorization letter3. Official receipt / Charge Slip

Any Government-issued IDs

Requesting party (principal)Cashier / HR Office


TOBE

PAID

PROCESSINGTIME

PERSONRESPONSIBLE

1. Fills-out the logbook andsecures the DocumentRequest Form

1. Entertains client’s requestand advise to fill-out theLogbook and providesDocument Request Form

None 2 minutes AdministrativeAssistant II

2. Receives and fill up theDocument Request Form

2. Issues Charge Slip andadvice the client to proceedto the HR head


3. Present the DocumentRequest Form and ChargeSlip to the HR head

3. Signs the Charge Slip andcountersigns the DocumentRequest Form

None 2 minutes AdministrativeOfficer V/ HRMO

4. Proceeds to the Cashier’soffice for payment

4. Accepts payment and issuesofficial receipt

Php15.00

20 minutes Cashier’s officestaff

5. Proceeds to the office ofthe Medical Center Chieffor the approval of theDocument Request Form

5. Approves the DocumentRequest Form

None 5 minutes Medical CenterChief

6. Returns to the HR officeand presents OfficialReceipt and submits theapproved DocumentRequest Form

6.1 Receives the approvedDocument Request Form

6.2 Advices the client of thescheduledrelease of the ServiceRecord

6.3 Verifies the employmentrecord of the client fromhis/her 201 File

6.4 Prepares and print theService Record

None

None

None

None

1 minute

2 minutes

5 minutes

4 days





Administrative

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6.5 Reviews and signs theService Record

None 10 minutes Officer V/ HRMOMedical Center

Chief7.1 Returns on the scheduled

date

7.2 Signs the DocumentReleasing Logbook

7.1 Gives DocumentReleasing Logbook

7.2 Releases the ServiceRecord

None

None

1 minute

1 minute



TOTAL: Php15.00

4 days & 51minutes

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4. Issuance of Statement of Accounts (SOA)The Billing and Claims Unit is incharge for the issuance of Statement of Account (Billing Statement) forall patients managed in the hospital for purposes of use for discharge process and to avail externalfinancial assistance such as insurance companies, SSS, PCSO and others.Office/Division: Billing and ClaimsClassification: SimpleType of Transaction: G2C – Government to CitizenWho May Avail: All Patients

CHECKLIST OF REQUIREMENTS WHERE TO SECURENone None


TOBE

PAID

PROCESSINGTIME

PERSONRESPONSIBLE

1. Request for Billing andSOA

1.1 Receives request for Billingand SOA.

1.2 Generates and prints SOAto include PHIC benefitsand other related benefits/discounts as applicable

None

None

2 minutes

8 minutes

Billing andClaims Frontline

Staff

Billing andClaims Frontline

Staff

2. Receives SOA andsigns receipt thereto.

2. Releases the printed SOAand have theclient/authorizedrepresentative sign receiptthereto.

None 13 minutes Billing andClaims Frontline

Staff


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5. Processing of Receipt of deliveries of supplies/equipmentThe Materials Management Office has the sole authority to receive deliveries from all legitimatesuppliers. The MMO ensures that all deliveries are in accordance to the specifications stipulated in thePurchase Order. Any deliveries that are not in compliance to the specifications shall be rejected andshall be returned to the suppliers.

Office or Division: Materials Management SectionClassification: SimpleType of Transaction: G2C – Government to ClientWho may avail: Supplier

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Approved P.O./Sales Invoice /Delivery Receipt MMO / Supplier

CLIENT STEPS AGENCY ACTIONS FEES TOBE PAID

PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents documentaryrequirements ofsupplies/equipment fordelivery

1. Receives documentaryrequirements presented.Checks if delivery are inconformity with thespecifications stipulatedin the purchase order

None 1 hour MMO staff

2. Receives copy of receiptof supplies/equipmentdelivered

2. Signs when in order andgives a copy of thereceipt to the client

None 5 minutes End-Users/CSR


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6. Purchase of Bidding DocumentsThis process shows the process on how the suppliers/bidders can avail for the bidding documents.

Office/Division: Procurement

Classification: Simple

Type of Transaction: G2C – Government to Citizen

Who May Avail: Bidders / Suppliers

CHECKLIST OF REQUIREMENTS WHERE TO SECURE- Letter of Intent (LOI) - (1 copy)- Valid ID - (1 copy)

- Supplier

Official Receipt - (1 copy) - Cashier


PROCESSINGTIME

PERSONRESPONSIBLE

1.Signs in the Visitor’sLogbook

1. Gives the Visitor’s Logbook tothe Supplier/Bidder None 5 minutes

ProcurementStaff/BACSecretariat

2. Presents Letter of Intent(LOI) and Valid ID

2.1 Receives and reviews LOIand ID

1.1 Issues Charge Slip toSupplier/Bidder

1.2 Directs bidder/suppliers toCashier for payment

None

None

None

10 minutes

2 minutes

3 minutes




3. Presents charge slipand pays correspondingamount

3. Issues Official Receipt *Pleaserefer totablebelow

20 minutes Cashier

4. Presents Issued OfficialReceipt from theCashier

4. Receives Official Receipt andIssues bidding documents None 25 minutes



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7. Releasing of Checks to External CreditorsThe Cash Operations is tasked with the releasing of checks to external creditors through issuance ofprocessed and approved checks or through Authority to Debit Advice System. It ensures thatpayments are duly acknowledged by mentioned creditors through the issuance of valid official orcollection receipts whichever is appropriate, with the corresponding acknowledgment on the approveddisbursement or payroll vouchers and withholding tax certificates

Office or Division: Cash OperationsClassification: SimpleType of Transaction: Government-to-Citizen (G2C), Government-to-Business (G2B),

Government-to-Government (G2G)Who may avail: External creditors or suppliers

CHECKLIST OF REQUIREMENTS WHERE TO SECURE1. Valid identification card with signature of the claimant (1

ID)Company affiliation, Land TransportationOffice, or Professional RegulationCommission, GSIS, SSS, OSCA orOWWA, COMELEC

2. For company representative:a. Authorization letter using company stationary (1

original document)b. Photocopy of valid identification of authorizing

person with signature as shown in the identificationfor comparison purposes (1 copy)

Legitimate payee company

The authorizing person of the company

3. If representing a person: Special Power of Attorney (1original document)

Notary public

4. If representing a deceased payee: ExtrajudicialSettlement of Estate where name of representative ofthe claimant is included or Affidavit of Self-Adjudication(1 original document)

Lawyer or judicial court

5. Additional requirement for suppliers: Valid Official orCollection Receipt

Bureau of Internal Revenue authorizedprint

CLIENT STEPS AGENCY ACTIONSFEES

TOBE

PAID

PROCESSINGTIME

PERSONRESPONSIBLE

If not given permission to transact inside after assessment at designated area for COVID-19 triage area:Waits for the cashier’s staff to transact outside

If given permission to transact inside after assessment at designated area for COVID-19 triage area:Proceeds to Cashier’s Office

1. Presents requireddocuments

1.1 Verifies documents

1.2 If identification is appropriate,logs out documents to beissued out

None

None

3 minutes

2 minutes

DisbursingOfficer

DisbursingOfficer

2. Acknowledges thedisbursement documentsby affixing signature

2. Retrieves the check orAuthority to Debit Account

None 3 minutes DisbursingOfficer

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3. Issues Official orCollection Receipt andacknowledges BIR forms2306 and 2307

3. Issues the check or Authority toDebit Account


4. Returns the signeddisbursementdocuments

4. Inspects the documents forcompleteness and propriety ofacknowledgment



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8. Request for Data/Information under EO No. 2The Office of the Supervising Administrative Officer is in charged in receiving request for informationunder EO no. 2 which pertains to Freedom of Information (FOI). The service rendered is open to allFilipino Citizen that wants to access/asks for records/informationOffice/Division: Office of the Supervising Administrative Officer (SAO)Classification: Highly TechnicalType of Transaction: Government-to-Citizen (G2C)Who May Avail: Any Filipino Citizen

CHECKLIST OF REQUIREMENTS WHERE TO SECUREAny valid government-issued identification card – 1 copy Land Transportation Office, Professional

Regulation Commission, GSIS, SSS,OSCA, OWWA, COMELEC

FOI Request Form Office of the SAO


TOBE

PAID

PROCESSINGTIME

PERSONRESPONSIBLE

1. Fills up a request formand submits to the FOIReceiving Officer withthe copy of valid ID.

1. Receives, evaluates andclassifies the informationbeing requested and transmitit to the FOI Decision Makerfor proper assessment.

1.1 Checks if the agency holdsthe information requested, if itis already accessible, or if therequest is a repeat of anyprevious request. Forwardsrequest to the officialsinvolved to locate therequested information.

1.2 Retrieves all relevantinformation, checks if anyexemptions apply andrecommends appropriateresponse to the request.

1.3 Approves or denies therequest and notifies the FRO.

None

None

None

None

15 working days

(maybeextended with 5working days of

processingperiod as theneed arises)

FOI ReceivingOfficer (FRO)

FOI DecisionMaker (FDM)

ConcernedOfficial

FOI DecisionMaker (FDM)

2. Receives theinformation/ Recordson the desired format.

Receives notice ofdenial.

2. If approved, releasesInformation/ Records on thedesired format.

If denied, informs of denial.

None FOI ReceivingOfficer (FRO)

TOTAL None15 working days

( 20 working days if with 5working days extension)

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9. Verification of PHIC Eligibility StatusThe Billing and Claims Unit is incharge for the verification of the patient’s PHIC eligibility prior to patient’s availment of the PHIC Benefits/Package.

Office/Division: Billing and ClaimsClassification: SimpleType of Transaction: G2C – Government to CitizenWho May Avail: All Patients with PhilHealth

CHECKLIST OF REQUIREMENTS WHERE TO SECURE* Any of listed documentary requirements, as applicable:- Birth Certificate with Registry Number for undeclared

child - (1 copy)- Marriage Contract with Registry Number for undeclared

spouse - (1 copy)- MDR - (1 copy)- Notarized Affidavit of Guardianship if patient is a Minor

or the Member is absent - (1 copy)- CSF duly filled and signed if the member is employed -

(1 copy)- Valid ID(Government Issued I.D.) - (1 copy)

- Philippine Statistics Authority (PSA)- Philippine Statistics Authority (PSA)- PhilHealth Office- Public Attorneys’ Office

- Employer- BIR, Post Office, DFA, PSA, SSS,

GSIS,PAG-IBIG, LTO, COMELEC


TOBE

PAID

PROCESSINGTIME

PERSONRESPONSIBLE

1. Requests for PHICEligibility Status andpresents documentaryrequirements asnecessary

1. Asks client some key pointInformation and anydocumentary requirementsas necessary for searchingand verification of PHICEligibility Status in PHICPortal/eClaims


Staff

2. Receives PHICEligibility Status

2. Informs client’s PHICEligibility Status

if Not Eligible:Instructs clients to submitpertinentdocuments as applicable


Staff


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Internal Services

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1. Issuance of Requested Supplies/EquipmentThe Materials Management Office has the sole authority in the issuance of an approved Requisitionand Issuance Slip of supplies and equipment. The MMO ensures that the issuance are dulyacknowledged and received by the requesting end users.Office/Division: Materials Management Section


Type of Transaction: G2C

Who May Avail: End-users, CSR

CHECKLIST OF REQUIREMENTS WHERE TO SECUREApproved RIS End-users, CSR


TOBE

PAID

PROCESSINGTIME

PERSONRESPONSIBLE

1. Submits approvedRequisition andIssuance Slip (RIS)

1. Receives request None 5 minutes MMS staff

2. Waits for the requestedsupplies/equipment

2.1 Prepares requestedsupplies/equipment

2.2 Prepares PropertyAcknowledgment Receipt(PAR) for equipment andInventory Custodian Slip (ICS)for semiexpendable items

2.3 Issues requested supplies/equipment

None

None

None

1 hour

30 minutes

1 hour

MMS staff

MMS staff

MMS staff

3. Receives and signsrequested supplies/equipment

3. Signs the portion issued and letthe end users/CSR sign thereceived portion

None 5 minutes End-users/CSR

TOTAL: None 2 hours & 40minutes

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2. Leave of Absence ApplicationLeave of absence is generally defined as a right granted to officials and employees not to report forwork with or without pay as may be provided by law and as the rules prescribe in Rule XVI hereof.Leave application refers to the application of an employee to avail leave of absence.Office/Division: Human Resource Management SectionClassification: SimpleType of Transaction: Government to GovernmentWho May Avail: All employees holding plantilla position

CHECKLIST OF REQUIREMENTS WHERE TO SECUREPlease refer to Table of Requirements for the SpecificType of Leave Applied

Please refer to Table of Requirements forthe Specific Type of Leave Applied


TOBE

PAID

PROCESSINGTIME

PERSONRESPONSIBLE

1. Secures Application forLeave Form

1. Provides Application for LeaveForm


2. Submits the Applicationfor Leave Form with therequired documents forthe specific type ofleave applied and fill upthe Application forLeave Logbook

2. Receives the dulyaccomplishedApplication for Leave andvalidates the requireddocuments/ attachments

2.1. Verifies the Leave Balance(s)of the employee

If the employee has no leavebalance:2.1.a Informs the employee that

he/she may avail thedesired leave without paysubject for the approval ofthe head of the agency.

If the employee has leavebalance:2.1.b Made the necessary

computation and reflects inthe Leave Card

2.2 Entries the computation in theApplication for Leave Form

2.3 Forwards the Application forLeave Form to the HR Headfor certification of LeaveCredits balance

2.4 Certifies the Leave CreditBalance as reflected in theApplication for Leave

None

None

None

None

None

None

None

2 minutes

5 minutes

2 minutes

5 minutes

5 minutes

2 minutes

5 minutes








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2.5 Forwards the Application forLeave Form to the respectivedivision head

None 4 hours AdministrativeAssistant II

3. Claims the approved/disapproved leave andsign the releasedlogbook for leaveapplication foremployee’s copy

3. Releases the ApprovedLeaveApplication Form and givethe Released Logbook forEmployees copy

None 2 minutes In-charge of therespective

division concern

TOTAL: None 1 day, 4 hours& 30 minutes

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TYPE OFLEAVE CHECKLIST OF REQUIREMENTS WHERE TO SECURE

For VacationLeave:

CSC form No. 6 -Application for LeaveForm (2, Original Copy)

Human ResourceManagement Section(HRMS)

For one (1) month and above, additionalrequirements:

Hospital Clearance Form (4,Original Copy)


Additional Documentary Requirements(for Travel Abroad)

Travel Authority Form (1, Original Copy)

Letter of Intent approved by the Head ofthe Agency (1, Original Copy)


Requesting partyFor Sick Leave: CSC form No. 6 -Application for Leave

Form (2, Original Copy)

For infectious disease:Medical Certificate (Fit to Work statusupon returned to work, 1 photocopy)

Additional Documentary Requirements:For five (5) days above attached the ff:

Medical Certificate (1, OriginalCopy)

Medical Certificate (Fit to Workstatus upon returned to work, 1photocopy)


Issued by the AttendingPhysician


For one (1) month and above Medical Certificate (1,OriginalCopy) Medical Certificate (Fit to Work

status upon returned to work, 1photocopy)



TYPE OFLEAVE CHECKLIST OF REQUIREMENTS WHERE TO

SECUREFor MaternityLeave:

Medical Certificate (CSC Form 41, 3Original copies)


Sign by the AttendingPhysician

For MaternityLeave:For PaternityLeave:

Hospital Clearance (4, Original Copy) Human ResourceManagement Section(HRMS)

CSC form No. 6 -Application for LeaveForm

CSC form No. 6(Application for Leave

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(2, Original Copy) Form)

Marriage Contract (1, Photocopy) Local Civil Registrar

For PaternityLeave:For SoloParent Leave:

Birth certificate of the child (1, Photocopy)or Medical Certificate for Miscarriages (1,Photocopy)

Local Civil Registrar

CSC form No. 6 -Application for LeaveForm(2, Original Copy)


Solo Parent ID or Certificate from DSWD(1, photocopy)

Department of SocialWelfare andDevelopment (DSWD)

For SoloParent Leave:ForRehabilitationLeave: (forwounds and/orinjuriessustained whilein theperformance ofofficial duties.)



CSC form No. 6 -Application for LeaveForm(2, Original Copy)Medical Certificate (2, Original andPhotocopy)


ForRehabilitationLeave: (forwounds and/orinjuriessustained whilein theperformance ofofficial duties.)

For StudyLeaveApplication:

Approved Incident Report or PoliceReport (2, Original and Photocopy)

Agency or PhilippineNational Police

Approved Hospital Order / DepartmentOrder / Travel Order for Official Businessor Official Time(1, Original Copy)


Holds a permanent appointment Employees concerned


Holds a Degree that requires passing ofbar/board examination

Employees concerned

Field of study pursued must be relevant tothe agency’s mandate, or to the dutiesand responsibilities of the concernedofficial or employee, as determined by theagency head:School Certification (1, Original copy) towit:

For Bachelors Degree –Qualified for Board/BarExamination

Completion For Master’s

School attended

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DegreeCompletion For Doctoral DegreeWith at least two (2) years of continuousservice in DRMC:

Latest Service Record (1,Original copy)


Individual Performance Commitment andReview (IPCR) Form for the last 2 ratingperiod with at least Very SatisfactoryRating immediately preceding theapplication (1 Certified True Copy of eachrating period)

Employees concerned

Letter of Intent (1 Original copy) Employees concerned

No Pending administrative and / orcriminal case:Court Clearance (1 Original copy) City Trial CourtMust not have any current foreign or localscholarship grant:Certificate of No Current Foreign or LocalScholarship Grant (1 Original copy)


Clearance (4 Original copies) Human ResourceManagement Section(HRMS)

The employee must have fulfilled theservice obligation of any previoustraining/scholarship/study grantStudy Leave Agreement for the Serviceobligation

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3. Leave of Absence Application – For travel abroad, MaternityLeave and Leave of absence for more than 30 daysLeave of absence is generally defined as a right granted to officials and employees not to report forwork with or without pay as may be provided by law and as the rules prescribe in Rule XVI hereof.Leave application refers to the application of an employee to avail leave of absence.Office/Division: Human Resource Management SectionClassification: SimpleType ofTransaction:

Government to Government

Who May Avail: All employees holding plantilla positionCHECKLIST OF REQUIREMENTS WHERE TO SECURE

Please refer to Table of Requirements for the SpecificType of Leave Applied

Please refer to Table of Requirements forthe Specific Type of Leave Applied


TOBE

PAID

PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents clearance asan attachment for filingof leave application

1. Receives the clearance None 1 minute AdministrativeAssistant II

2. Secures Application forLeave Form

2. Provides Application for LeaveForm


3. Submits the Applicationfor Leave Form with therequired documents forthe specific type ofleave applied and fill upthe Application forLeave Logbook

3. Receives the dulyaccomplished Applicationfor Leave and validates therequired documents/attachments

3.1 Verifies the Leave Balance(s)of the employee

If the employee has no leavebalance:3.1.a Informs the employee that

he/she may avail thedesired leave without paysubject for the approval ofthe head of the agency.

(except for maternity leave)

If the employee has leavebalance:3.1.b Made the necessary

computation and reflects inthe Leave Card

3.2 Entries the computation in theApplication for Leave Form

3.3 Forwards the Application forLeave Form to the HR Head

None

None

None

None

None

None

2 minutes

5 minutes

2 minutes

5 minutes

5 minutes

2 minutes







27 | P a g e

for certification Leave Creditsbalance

3.4 Certifies the Leave CreditBalance as reflected in theApplication for Leave

3.5 Forwards the Application forLeave Form to the respectivedivision head forrecommending approval

3.6 Recommends approval of theApplication for leave andforwards to Head of theAgency for approval

3.7 Approves the Application forLeave

None

None

None

None

5 minutes

5 minutes

1 hour

1 day



Division Head

Head of Agency

4. Claims the approved/disapproved leave andsign the releasedlogbook for leaveapplication foremployee’s copy

4. Releases the ApprovedLeave Application Form andgive the Released Logbookfor Employees copy

None 2 minutes In-charge of therespective

division concern

TOTAL: 1 day, 1 hour &34 minutes

28 | P a g e

TYPE OFLEAVE CHECKLIST OF REQUIREMENTS WHERE TO SECURE

For VacationLeave:

CSC form No. 6 -Application for LeaveForm (2, Original Copy)


For one (1) month and above, additionalrequirements:



Additional Documentary Requirements(for Travel Abroad)

Travel Authority Form (1, Original Copy)

Letter of Intent approved by the Head ofthe Agency (1, Original Copy)


Requesting partyFor Sick Leave: CSC form No. 6 -Application for Leave

Form (2, Original Copy)

For infectious disease:Medical Certificate (Fit to Work statusupon returned to work, 1 photocopy)

Additional Documentary Requirements:For five (5) days above attached the ff:

Medical Certificate (1, OriginalCopy)

Medical Certificate (Fit to Workstatus upon returned to work, 1photocopy)




For one (1) month and above Medical Certificate (1,OriginalCopy) Medical Certificate (Fit to Work

status upon returned to work, 1photocopy)



TYPE OFLEAVE CHECKLIST OF REQUIREMENTS WHERE TO

SECUREFor MaternityLeave:

Medical Certificate (CSC Form 41, 3Original copies)


Sign by the AttendingPhysician

For MaternityLeave:For PaternityLeave:

Hospital Clearance (4, Original Copy) Human ResourceManagement Section(HRMS)

CSC form No. 6 -Application for LeaveForm

CSC form No. 6(Application for Leave

29 | P a g e

(2, Original Copy) Form)

Marriage Contract (1, Photocopy) Local Civil Registrar

For PaternityLeave:For SoloParent Leave:

Birth certificate of the child (1, Photocopy)or Medical Certificate for Miscarriages (1,Photocopy)

Local Civil Registrar



Solo Parent ID or Certificate from DSWD(1, photocopy)

Department of SocialWelfare andDevelopment (DSWD)

For SoloParent Leave:ForRehabilitationLeave: (forwounds and/orinjuriessustained whilein theperformance ofofficial duties.)



CSC form No. 6 -Application for LeaveForm(2, Original Copy)Medical Certificate (2, Original andPhotocopy)


ForRehabilitationLeave: (forwounds and/orinjuriessustained whilein theperformance ofofficial duties.)


Approved Incident Report or PoliceReport (2, Original and Photocopy)

Agency or PhilippineNational Police

Approved Hospital Order / DepartmentOrder / Travel Order for Official Businessor Official Time(1, Original Copy)


Holds a permanent appointment Employees concerned


Holds a Degree that requires passing ofbar/board examination

Employees concerned

Field of study pursued must be relevant tothe agency’s mandate, or to the dutiesand responsibilities of the concernedofficial or employee, as determined by theagency head:School Certification (1, Original copy) towit:

For Bachelors Degree –Qualified for Board/BarExamination

Completion For Master’s

School attended

30 | P a g e

DegreeCompletion For Doctoral DegreeWith at least two (2) years of continuousservice in DRMC:

Latest Service Record (1,Original copy)


Individual Performance Commitment andReview (IPCR) Form for the last 2 ratingperiod with at least Very SatisfactoryRating immediately preceding theapplication (1 Certified True Copy of eachrating period)

Employees concerned

Letter of Intent (1 Original copy) Employees concerned

No Pending administrative and / orcriminal case:Court Clearance (1 Original copy) City Trial CourtMust not have any current foreign or localscholarship grant:Certificate of No Current Foreign or LocalScholarship Grant (1 Original copy)


Clearance (4 Original copies) Human ResourceManagement Section(HRMS)

The employee must have fulfilled theservice obligation of any previoustraining/scholarship/study grantStudy Leave Agreement for the Serviceobligation

31 | P a g e

4. Liquidation of Cash Advance - Travel or TrainingThe Accounting Section is in-charged in the checking of the completeness of the supporting documents forliquidation of cash advances being submitted by the employees of the hospital. The Accounting Section is openfor official transactions from Monday to Friday (8:00AM to 5:00PM).Office/Division: AccountingClassification: SimpleType of Transaction: Government to GovernmentWho May Avail: All employees of DJRMH

CHECKLIST OF REQUIREMENTS WHERE TO SECURELiquidation ReportMandatory Supporting Documents: (3 copies each)a. Revised Itinerary of Travelb. Certificate of Travel Completedc. Paper/Electronic Receipt, boat or bus tickets, boarding pass,

terminal feesd. Certificate of Appearance/Attendancee. Post Activity Reportf. Travel Orderg. Letter of Invitation addressed to the agencyh. Revised or Supplemental office order or any proof supporting

the change of schedulei. Copy of the previously approved itinerary of travelj. Certificate of not requiring receipt, in case refund of excess of

cash advancek. Copy of Disbursement voucher upon cash advance

End-User


PROCESSINGTIME

PERSONRESPONSIBLE

1. Submits requireddocuments

1. Checks the completeness andaccuracy of the documents

If complete:1.1 The In-Charge signs the

approvalIf incomplete:1.2 Proceed to Step 2.

None 6 hours Accountant

2. Receives documents forcompliance and/orpayment of excess

2. Returns documents to theclient and issues Order ofPayment in case of excess ofcash advance

None 2 hours AccountingPersonnel/Accountant

3. Submits LiquidationReport with OfficialReceipt

3. Receives Liquidation Reportand signs it.

None 30 minutes Accountant

TOTAL None 1 day & 30minutes

32 | P a g e

5. Production of Linen Supplies Based On Approved Job OrderManufacturing of special requested linen supplies.Office/Division: Linen and Laundry Service (HOPSS-General Services)Classification: ComplexType ofTransaction:

Government-to-Government

Who May Avail: Nursing, Ancillary & HOPSS Service Supervisors and/or equivalentCHECKLIST OF REQUIREMENTS WHERE TO SECURE

Approved Job Request Form – 1 copy Engineering & Facilities ManagementSection-EFMS Engineer In charged/Housekeeper


TOBE

PAID

PROCESSINGTIME

PERSONRESPONSIBLE

1. Submits approved JobRequest Form

1.Receives approved JobRequest

None 5 minutes Linen & Laundrystaff

2. Waits for notice whento pick up the finisheditems

2.1 Fills out Job Order Logbook

2.2 Starts the manufacturingprocess

None

None

5 minutes

4 days

Linen & Laundrystaff

Linen & Laundrystaff

3. Receives notice fromLinen & Laundry

3. Informs the client for pick-up None 40 minutes Linen & Laundrystaff

4. Accepts Items andaffixes signature in theJob Request Form/Acceptance of Work &log book

4. Gives items and asks theclient to sign in the JobRequest Form/Acceptance ofWork & Logbook

None 5 minutes Linen & Laundrystaff

TOTAL: None 4 days & 55minutes

33 | P a g e

6. Releasing of Checks to Internal CreditorsThe Cashier is tasked with the releasing of checks to internal creditors through issuance of processedand approved checks or through Authority to Debit Advice System, while ensuring that payments areduly acknowledged by mentioned creditors with the corresponding acknowledgment on the approveddisbursement or payroll vouchers.

Office or Division: Cash OperationsClassification: SimpleType of Transaction: Government-to-Citizen (G2C), Government-to-Business (G2B),

Government-to-Government (G2G)Who may avail: Hospital personnel

CHECKLIST OF REQUIREMENTS WHERE TO SECUREValid identification card of the claimant (1 ID) Company affiliation, Land Transportation

Office, or Professional RegulationCommission, GSIS, SSS, OSCA orOWWA, COMELEC

If representing a person:

Special Power of Attorney. (1 original document)Notary public

If representing a deceased payee:

Extrajudicial Settlement of Estate where name ofrepresentative of the claimant is included or Affidavit ofSelf-Adjudication (1 original document)

Lawyer or judicial court

CLIENT STEPS AGENCY ACTIONSFEESTO BEPAID

PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents identifyingdocuments

1. Verifies documents

1.1 If identification isappropriate, log outdocuments to be issued out

None

None

3 minutes

2 minutes

DisbursingOfficer

DisbursingOfficer

2. Acknowledges thedisbursementdocuments by affixingsignature

2. Retrieves the check orAuthority to DebitAccount and Issues thecheck or Authority to DebitAccount


3. Returns the signeddisbursementdocuments

3. Inspects the documents forcompleteness and proprietyof acknowledgment



34 | P a g e

7. Request for Budget Obligation of Financial TransactionBudget Section is tasked to perform budget execution, monitoring and reporting of all obligatoryexpenses for the implementation of programs, activities and projects of DJRMH in accordance with theagency’s current year approved General Appropriation Act (GAA) and Approved Budgeted Revenue(Hospital Income/HI).

Office/Division: Budget


Type of Transaction: Obligation of Financial Transaction

Who May Avail: Different DJRMH Sections/Employees / External Clients

CHECKLIST OF REQUIREMENTS WHERE TO SECUREObligation Request Status (ObRS) / Budget Utilization RequestStatus (BURS)

End User

Supporting Documents (May vary upon the type of transaction) End user


TOBE

PAID

PROCESSINGTIME

PERSONRESPONSIBLE

1. Submits ObRS/BURSduly signed by theDivision Head withattached supportingdocuments toAccounting Section

1.1 Receives the ObRS/BURSand supporting documents

1.2 Checks the completenessand accuracy of thesupporting documents.

1.3 Processes for BudgetObligation

if found incomplete.Proceed to step 2

None

None

None

3 minutes

7 minutes

5 minutes

BudgetPersonnel

BudgetPersonnel

BudgetPersonnel

2. Receives ObRS/BURSwith incompletedocuments

2. Returns ObRS/BURS withincomplete documents toconcerned Section and informthe client of the deficiency.

None 15 minutes BudgetPersonnel


35 | P a g e

8. Request for Corrective Maintenance (CM)This process shows on how the Dr. Jose Rizal Memorial Hospital Employee can request for acorrective maintenance for their equipment. This covers from the time that the request is done up tothe acknowledgement of the work performed by signing the acceptance report.Office/Division: Engineering and Facilities Management Section (EFMS)Classification: SimpleType ofTransaction: Government-to-Government

Who May Avail: DJRMH Staff/Unit End-UserCHECKLIST OF REQUIREMENTS WHERE TO SECURE

Approved Job Request Form – 1 copy - EFMS OfficeSupplemental – 1 copyLetter Request – 1 copyPurchase Request – 1 copy- Requisition Issuance Slip (RIS) – 1 copy

- End-User

- MMO


TOBE

PAID

PROCESSINGTIME

PERSONRESPONSIBLE

1. Proceeds to EFMSJob Request Desk andfills out the JobRequest Form andsubmits to on dutystaff

1. Receives the filled out form,verify and checks its accuracyand completeness, anddetermines nature of thework.

1.1 Assigns to maintenance staffto do the job request

None

None

5 minutes

5 minutes

EFMS Staff onduty

Head ofEFMS/Authorized

Staff2. Assists the EFMS

maintenance staffduring the conduct ofassessment of the jobrequest and presentsneeded requirementsas necessary

2.1 Conducts visual inspectionimmediately after receipt ofassigned job request.

2.2 Request for materials ifnecessary and instructs tosecure documentaryrequirements as necessary

2.3 Performs the correctivemaintenance (CM)

None

None

None

2 hours

2 hours

For SimpleRepair/CM(2 hours)

For complexrepair/CM(3 days)

Assigned Staff

Assigned Staff

Assigned Staff

Assigned Staff

3. Acknowledges thework performed bysigning theAcceptanceReport after theconduct of correctivemaintenance

3. Asks the requestor to sign theAcceptance Report

None 5 minutes Assigned Staff

TOTAL:

For Simple:2 hours & 15

minutes

For Complex:3 days, 2 hours& 15 minutes

36 | P a g e

9. Request For Linen SuppliesRelease and replenishment of soiled linen for admitted patients.Office/Division: Linen and Laundry Service (HOPSS-General Services)Classification: SimpleType ofTransaction:

Government-to-Government

Who May Avail: Hospital Employees from Various WardsCHECKLIST OF REQUIREMENTS WHERE TO SECURE

Linen Issuance Slip From CSR/Nursing issued to patientsSoiled Linen Various Wards/CSR Linen room


TOBE

PAID

PROCESSINGTIME

PERSONRESPONSIBLE

1.1 Submits the issuedLinen Issuance Slip(LIS)

1.2 Returns soiled linen perLIS and signs thecollection logbook

1.1 Accepts Linen Issuance Slip(LIS)

1.2 Sorts, counts and checkssoiled linen and instructsclient to signs the collectionlogbook

None

None

5 minutes

15 minutes

Laundry Worker

Laundry Worker

2.1 Waits for the delivery ofclean linens

2.2 Receives delivery ofclean linens and signsthe clean linen logbook

2.1 Prepares linen for delivery

2.2 Delivers the processed cleanLinens and asks client to signthe clean linen logbook.

None

None

10 minutes

10 minutes

Laundry Worker

Laundry Worker


37 | P a g e

NURSING SERVICE

38 | P a g e

External Services

39 | P a g e

1. Availment of Animal Bite Services – Follow-up VaccinationTreatment protocols for Animal Bite treatment clients require follow-up vaccination. To promoteefficient services, the following steps must be followed:

Office/Division: Animal Bite Treatment Center (ABTC)Classification: SimpleType of Transaction: G2C – Government to CitizenWho May Avail: Animal Bite Clients for Follow-up Vaccination

CHECKLIST OF REQUIREMENTS WHERE TO SECURERabies Post-Exposure Prophylaxis Card ABTC

Order of Payment and/or Charge Slip ABTC

CLIENT STEPS AGENCY ACTION FEES TO BEPAID

PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents Rabies Post-Exposure ProphylaxisCard

1. Receives RabiesPost-ExposureProphylaxis Card

None 3 minutes ABTC Manager

For Free Vaccine:Proceeds to Step 5

2.a Receives prescriptionand proceeds toPharmacy then toCashier for payment

*If patient will avail formedical assistance

2.b Proceeds to MSS forAvailment of medicalassistance

2.a Issues prescriptionand instructs clientto proceed toPharmacy then tocashier for payment

2.b Processesavailment ofmedical_assistance

None

None

3 minutes

17 minutes

ABTC Manager

MSS

3. Presents order ofpayment and payscorresponding amountthen proceeds toPharmacy to get thevaccine

3.1 Issues OfficialReceipt

3.2 Dispenses Vaccine

*Please referto table below

None

20 minutes

3 minutes

Cashier

Pharmacy

4. Returns to ABTC andgives the vaccine

4. Receives the vaccine None 2 minutes ABTC Manager

5. Receives vaccination 5. Administers vaccineto client/patient None 5 minutes ABTC Manager

6. Receives furtherinstructions

6. Instructs client/patientfor follow-up dosesindicated in the card


TOTAL

*Please refer to tablebelow

*If patient will avail formedical assistanceAmount to be paid

depends on the discountgiven

For Non-FreeVaccine

39 minutes

For FreeVaccine:8 minutes

40 | P a g e

DEPARTMENT OF HEALTHDR. JOSE RIZAL MEMORIAL HOSPITAL

L A W A A N , D A P I T A N C I T YT E L E F A X : ( 0 6 5 ) 2 1 3 - 6 4 2 1

Website: www.djrmh.doh.gov.phEmail: [email protected]

PRICE LIST FOR ANIMAL BITE TREATMENT SERVICEMEDICAL SUPPLIES PRICEInsulin syringe (1cc) 3.103cc syringe 2.251cc syringe 2.20Alcohol pad 0.60Cotton balls 1.00Disposable needle (G26) 1.40

VACCINEActive rabies vaccine 1,220.70Passive rabies vaccine 1,180.40

41 | P a g e

2. Availment of Animal Bite Services - New Animal Bite Clients(Category II & Category III bite exposure without PhilHealth)Dr. Jose Rizal Memorial Hospital’s Animal Bite Treatment Center aims to deliver quality service amonganimal bite clients. Clients with category II and III bite exposures without PhilHealth can avail theABTC service by following these steps:Office/Division: Animal Bite Treatment Center (ABTC)Classification: SimpleType of Transaction: G2C – Government to Citizen

Who May Avail: New Animal Bite Clients (Category II & Category III bite exposure withoutPhilHealth)

CHECKLIST OF REQUIREMENTS WHERE TO SECURERabies Post-Exposure Prophylaxis Card ABTC


PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents self and waitsfor instructions.

1. Receives client/patient andgives instructions.


2.a Receives charge slipand proceeds toPharmacy and CentralSupply Room (CSR)then to Cashier forpayment



2.a Issues charge slip andinstructs client to proceedto Pharmacy and CSR thento cashier for payment

2.b Processes availment ofmedical assistance

None

None

26 minutes

17 minutes

ABTC Manager/Pharmacy/

CSR

MSS

3. Presents chargeslip/order of paymentand pays correspondingamount

3. Issues official receipt *Pleaserefer totablebelow

20 minutes Cashier

4. Returns to ABTC andgives supplies andvaccines foradministration

4. Receives supplies andadministers vaccines

None 1 hour ABTC Manager

5. Receives Rabies Post-Exposure ProphylaxisCard and waits for furtherinstructions includingfollow-up schedules.

5. Provides Rabies Post-Exposure Prophylaxis Cardindicating the dates offollow up doses


TOTAL

* Please refer to tablebelow for applicable fees



1 hour & 54 minutes

*If patient will avail for medicalassistance

= 2 hours & 11 minutes

42 | P a g e


L A W A A N , D A P I T A N C I T YT E L E F A X : ( 0 6 5 ) 2 1 3 - 6 4 2 1

Website: www.djrmh.doh.gov.phEmail: [email protected]

PRICE LIST FOR ANIMAL BITE TREATMENT SERVICEMEDICAL SUPPLIES PRICEInsulin syringe (1cc) 3.103cc syringe 2.251cc syringe 2.20Alcohol pad 0.60Cotton balls 1.00Disposable needle (G26) 1.40

VACCINEActive rabies vaccine 1,220.70Passive rabies vaccine 1,180.40

43 | P a g e

3. Availment of Animal Bite Services - New Animal Bite Clients(Category III bite exposure) with PhilHealthLocated in the Out Patient Department is the PhilHealth Accredited Animal Bite Treatment Center ofthe Dr. Jose Rizal Memorial Hospital. The following steps must be followed for the availment of theAnimal Bite Package among clients with Category III bite exposure.Office/Division: Animal Bite Treatment Center (ABTC)Classification: SimpleType of Transaction: G2C – Government to CitizenWho May Avail: New Animal Bite Clients (Category III bite exposure) with PhilHealth

CHECKLIST OF REQUIREMENTS WHERE TO SECURERabies Post-Exposure Prophylaxis Card ABTCPHIC Note Billing and Claims


PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents self and waitsfor instructions.



2. Receives charge slip andproceeds to Billing andClaims to ask for PHICConfirmation Note then toPharmacy and CentralSupply Room(CSR) to getvaccines and supplies

1.1 Issues charge slip

1.2 Issues PHIC ConfirmationNote

1.3 Dispenses Vaccine

1.4 Dispenses Supplies

None 3 minutes

6 minutes

10 minutes

13 minutes

ABTC Manager

Billing & Claims

Pharmacy

CSR

2. Returns to ABTC,presents PHICConfirmation Note andendorses supplies andvaccines

3. Receives PHIC ConfirmationNote, supplies and administersvaccine

None 1 hour ABTC Manager

3. Receives Rabies Post-Exposure ProphylaxisCard and waits forfurther instructionsincluding follow-upschedules.

4. Provides Rabies Post-Exposure Prophylaxis Cardindicating the dates of followup doses


TOTAL

* Please refer to tablebelow for applicable fees



1 hour & 40minutes

44 | P a g e

4. Availment of Medical and Surgical SuppliesThe Central Supply Room under the supervision of the Nursing Service plays an essential role for theentire hospital service operation. It serves OPD- Patients and provides necessary supplies for theirtreatment at home or in other health facilities.

Office/Division: Central Supply RoomClassification: SimpleType of Transaction: G2C – Government to CitizenWho May Avail: Patients managed as Out-Patients

CHECKLIST OF REQUIREMENTS WHERE TO SECURECharge Slip - (1 copy) ER/OPDOfficial Receipt / MSS Stamped Charge Slip - (1 copy) Cashier/MSS


PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents charge slipand receivesinstruction/s if any.

1.1 Reviews charge slip/s andaffixes correspondingamount and providesinstruction if any

1.2 Directs to cashier forpayment

None

None

2 minutes

3 minutes

CSR Staff onDuty

CSR Staff onDuty

2.a Presents charge slipand pays correspondingamount



2.a Issues official receipt

2.b Processes Availment ofmedical assistance

Pleaserefer to

the tablebelow forapplicable

fees

None

20 minutes

17 minutes

Cashier staff onduty

MSS Staff onduty

3. Returns to CSR andpresents OfficialReceipt or MSSStamped charge slip

3. Receives Official Receipt orMSS Stamped Charge Slip

None 3 minutes CSR Staff onDuty

4. Checks dispensedsupplies and receivesinstructions if any

4. Dispenses supplies andgives

instructions if any


TOTAL

Please refer to the tablebelow for applicable fees



33 minutes


50 minutes

45 | P a g e

ITEM UNITRATE

Standard SeniorCitizen

Absorbent cotton, Sterile Small Pack ₱5.00 ₱4.00Big Pack ₱15.00 ₱12.00

Adhesive Plaster Roll ₱108.80 ₱87.04

Alcohol, 70% Isoprophyl, 500 ml Bot.Not for

SaleNot for

SaleAlcohol pad Piece ₱0.60 ₱0.48Anesthesia Face Mask #1 Infant Piece ₱361.40 ₱289.12

Pedia Small Piece ₱416.00 ₱332.80Pedia Large Piece ₱689.00 ₱551.20Adult-Small Piece ₱416.00 ₱332.80

Adult-Medium Piece ₱361.40 ₱289.12Adult-Large Piece ₱361.40 ₱289.12

Armsling Adult Piece ₱62.40 ₱49.92Pedia Piece ₱72.80 ₱58.24

Bag Vave Mask Adult Piece ₱1,904.50 ₱1,523.60Chidl/Pedia Piece ₱1,544.00 ₱1,235.20

Infant/Neonate Piece ₱1,935.00 ₱1,548.00BedPan Piece ₱81.90 ₱65.52Blood Administration Set Piece ₱117.00 ₱93.60Bone Wax, 2.5 Piece ₱603.20 ₱482.56BP rubber arm cuff Adult Piece ₱513.50 ₱410.80

with cloth Pedia Piece ₱676.00 ₱540.80Infant Piece ₱513.50 ₱410.80

Breathing Circuit/System Adult Piece ₱1,014.00 ₱811.20Pedia Piece ₱806.00 ₱644.80

Jackson Rees Piece ₱3,640.00 ₱2,912.00Cervical Collar Adult Piece ₱647.40 ₱517.92

Pedia Piece ₱570.00 ₱456.00Chest Tube Thoracostomy Bottle Piece ₱1,436.50 ₱1,149.20Closed wound Suction Drainage Sytem Piece ₱2,600.00 ₱2,080.00Colostomy Bag Adult, 24x15 cm Piece ₱42.25 ₱33.80

Pedia, 20x14 cm Piece ₱42.25 ₱33.80Condom Catheter Small Piece ₱22.75 ₱18.20

Medium Piece ₱32.15 ₱25.72

DEPARTMENT OF HEALTHDR. JOSE RIZAL MEMORIAL HOSPITALL A W A A N , D A P I T A N C I T YT E L E F A X : ( 0 6 5 ) 2 1 3 - 6 4 2 1Website: www.djrmh.doh.gov.phEmail: [email protected]

PRICE LIST OF MEDICAL AND SURGICAL SUPPLIESas of June 30, 2020

46 | P a g e

Large Piece ₱22.75 ₱18.20Cotton Applicator Stick Box ₱43.25 ₱34.60

Sterile Pack ₱5.00 ₱4.00CTG Recording Paper Pack ₱747.50 ₱598.00ECG Cream Tube ₱361.40 ₱289.12ECG Suction Cap Piece ₱650.00 ₱520.00ECG Tracing paper 50mmX30m Roll ₱52.00 ₱41.60ECG Tracing paper 80mmX20m Roll ₱83.00 ₱66.40

Welch Allyn Roll ₱715.00 ₱572.00Elastic Bandage 2"X5yards Roll ₱23.80 ₱19.04

4"X5yards Roll ₱29.25 ₱23.406"X5yards Roll ₱36.40 ₱29.12

Electrocautery grounding pad Piece ₱676.00 ₱540.80Electrocautery pencil with tip Piece ₱624.00 ₱499.20Endotracheal tube 2 Piece ₱57.20 ₱45.76

2.5 Piece ₱32.50 ₱26.003 Piece ₱40.30 ₱32.24

3.5 Piece ₱42.10 ₱33.684 Piece ₱42.10 ₱33.68

4.5 Piece ₱35.10 ₱28.085 Piece ₱53.30 ₱42.64

5.5 Piece ₱63.03 ₱50.426 Piece ₱49.40 ₱39.52

6.5 Piece ₱44.20 ₱35.367 Piece ₱98.80 ₱79.04

7.5 Piece ₱44.20 ₱35.368 Piece ₱42.90 ₱34.32

Epidural set G18 Piece ₱1,040.00 ₱832.00

Face Mask Respirator N95 PieceNot forSale

Not forSale

Respirator KN95 PieceNot forSale

Not forSale

with eye Shield Piece ₱273.00 ₱218.40earloop Piece ₱1.25 ₱1.00

Feeding Tube Fr. 5 Piece ₱7.45 ₱5.96Fr. 8 Piece ₱14.95 ₱11.96

Fr. 10 Piece ₱10.40 ₱8.32Fr. 12 Piece ₱15.40 ₱12.32Fr. 14 Piece ₱22.95 ₱18.36Fr. 16 Piece ₱12.35 ₱9.88Fr. 18 Piece ₱34.45 ₱27.56

Foley Balloon Catheter, Fr. 8 Piece ₱33.80 ₱27.042-way Fr. 10 Piece ₱32.85 ₱26.28

Fr. 12 Piece ₱32.45 ₱25.96Fr. 14 Piece ₱30.42 ₱24.34Fr. 16 Piece ₱37.05 ₱29.64Fr. 18 Piece ₱37.05 ₱29.64

47 | P a g e

Foley Ballon Catheter, 3-way Fr. 18 Piece ₱143.00 ₱114.40Fr. 22 Piece ₱143.00 ₱114.40

Foley Ballon Catheter, 3-way Fr. 24 Piece ₱143.00 ₱114.40Gloves Examination Small Pair ₱3.25 ₱2.60

Medium Pair ₱3.10 ₱2.48Large Pair ₱3.25 ₱2.60

Elbow Length 6 Pair ₱145.50 ₱116.407 Pair ₱145.50 ₱116.40

7.5 Pair ₱145.50 ₱116.40Surgical 6 Pair ₱21.00 ₱16.80

6.5 Pair ₱21.00 ₱16.807 Pair ₱21.00 ₱16.80

7.5 Pair ₱21.00 ₱16.808 Pair ₱21.00 ₱16.80

Heparin lock Piece ₱11.05 ₱8.84Hot water bag Piece ₱97.50 ₱78.00Hydrogen peroxide Bot ₱32.50 ₱26.00Hypoallergenic Plaster Roll ₱27.00 ₱21.60Ice Bag Piece ₱125.30 ₱100.24ID Wrist Band Adult/ White Piece ₱3.85 ₱3.08

Child/ Pink Piece ₱3.85 ₱3.08Child/ Blue Piece ₱3.85 ₱3.08

Infusion Set Macroset Piece ₱17.65 ₱14.12Macroset, Needleless Piece ₱182.00 ₱145.60

Microset Piece ₱14.30 ₱11.44Microset, Needleless Piece ₱182.00 ₱145.60

WithBurette/Soluset Piece ₱115.70 ₱92.56

Intubation Stylet Fr. 8 Piece ₱409.50 ₱327.60Fr. 12 Piece ₱520.00 ₱416.00Fr. 14 Piece ₱520.00 ₱416.00

IV Cannula G. 16 Piece ₱15.70 ₱12.56G. 18 Piece ₱15.34 ₱12.27G. 20 Piece ₱15.30 ₱12.24G. 22 Piece ₱15.30 ₱12.24G. 24 Piece ₱18.30 ₱14.64G. 26 Piece ₱24.70 ₱19.76

IV Dressing Piece ₱3.00 ₱2.40IV Extension Set Piece ₱195.00 ₱156.00IV Starter Kit Piece ₱100.60 ₱80.48IV Wrist Splint Adult Piece ₱67.60 ₱54.08

Pedia Piece ₱55.90 ₱44.72Infant/Neonate Piece ₱39.00 ₱31.20

Kelly Pad Piece ₱520.00 ₱416.00Kidney Basin Piece ₱14.95 ₱11.96Lubricating Jelly Tube ₱156.00 ₱124.80Nebulizing kit Piece ₱39.65 ₱31.72

48 | P a g e

Nebulizing kit with Mask Adult Piece ₱49.40 ₱39.52Pedia Piece ₱50.40 ₱40.32

Needle G 18 Piece ₱1.45 ₱1.16G 19 Piece ₱1.45 ₱1.16G 21 Piece ₱1.40 ₱1.12G 22 Piece ₱1.40 ₱1.12G 23 Piece ₱1.40 ₱1.12G 26 Piece ₱1.40 ₱1.12

Oral Airway #0, 60mm, Black Piece ₱27.30 ₱21.84#1, 70mm,

White Piece ₱32.50 ₱26.00#2, 80mm,

Green Piece ₱32.50 ₱26.00

#3, 90mm,Yellow Piece ₱43.90 ₱35.12

#4, 100mm, Red Piece ₱41.60 ₱33.28#5, 110mm,

Blue Piece ₱41.60 ₱33.28

Oxygen Face Mask Adult Piece ₱50.70 ₱40.56Pedia Piece ₱43.45 ₱34.76

Neonate/Infant Piece ₱67.60 ₱54.08with Reservoir,

Adult Piece ₱84.50 ₱67.60

Oxygen Nasal Cannula Adult Piece ₱19.50 ₱15.60Pedia Piece ₱19.50 ₱15.60Infant Piece ₱21.45 ₱17.16

Penrose drainage tube 1/4 inches Piece ₱18.20 ₱14.561/2 inches Piece ₱20.80 ₱16.64

1 inches Piece ₱29.50 ₱23.60Pill Crusher Piece ₱195.00 ₱156.00Pill Cutter Piece ₱387.00 ₱309.60Plaster of Paris 4 inches Piece ₱91.00 ₱72.80

6 inches Piece ₱130.00 ₱104.00Polypropylene mesh Piece ₱2,340.00 ₱1,872.00Povidone Iodine per cc cc ₱0.25 ₱0.20

40 cc in cup* cup ₱20.00 ₱16.00Scub Brush Piece ₱65.00 ₱52.00Skin Stapler Piece ₱247.00 ₱197.60Specimen Cup Stool Piece ₱7.20 ₱5.76

Urine/Sputum Piece ₱5.85 ₱4.68Spinal needle G. 23 Piece ₱102.95 ₱82.36

G. 25 Piece ₱68.25 ₱54.60Stockinette Roll ₱3,250.00 ₱2,600.00Suction Catheter Fr. 5 Piece ₱9.00 ₱7.20

Fr. 8 Piece ₱9.35 ₱7.48Fr. 10 Piece ₱11.70 ₱9.36Fr. 12 Piece ₱9.00 ₱7.20Fr. 14 Piece ₱9.35 ₱7.48

49 | P a g e

Fr. 16 Piece ₱9.35 ₱7.48Fr. 18 Piece ₱8.20 ₱6.56

Suction Poole Drain Piece ₱156.00 ₱124.80Suction Bottle Piece ₱3,900.00 ₱3,120.00Surgical Blade #10 Piece ₱3.80 ₱3.04

#11 Piece ₱3.64 ₱2.91#15 Piece ₱4.30 ₱3.44#20 Piece ₱3.80 ₱3.04#21 Piece ₱3.35 ₱2.68#22 Piece ₱4.65 ₱3.72

Suture, Chromic O Cutting Piece ₱47.65 ₱38.12O Round Piece ₱48.75 ₱39.001 Cutting Piece ₱47.65 ₱38.121 Round Piece ₱33.55 ₱26.84

2/O Cutting Piece ₱34.65 ₱27.722/O Round Piece ₱34.65 ₱27.723/O Cutting Piece ₱34.65 ₱27.723/O Round Piece ₱33.55 ₱26.844/O Cutting Piece ₱46.00 ₱36.804/O Round Piece ₱37.90 ₱30.325/O Round Piece ₱48.75 ₱39.00

Novosyn 3/O Round Piece ₱353.50 ₱282.80Polypropylene Mono Piece ₱252.75 ₱202.20

O Round Piece ₱530.75 ₱424.602/O Cutting Piece ₱487.50 ₱390.002/O Round Piece ₱487.50 ₱390.003/O Cutting Piece ₱595.75 ₱476.603/O Round Piece ₱577.75 ₱462.204/O Cutting Piece ₱476.50 ₱381.204/O Round Piece ₱48.75 ₱39.00

4/O w/o Needle Piece ₱54.15 ₱43.325/O Cutting Piece ₱54.15 ₱43.32

Suture, Mersilk O Piece ₱147.40 ₱117.922/O Piece ₱183.00 ₱146.403/O Piece ₱183.00 ₱146.404/O Piece ₱162.25 ₱129.80

Vicryl O Round Piece ₱593.35 ₱474.681 Round Piece ₱484.60 ₱387.68

2/O Round Piece ₱497.90 ₱398.323/O Cutting Piece ₱314.15 ₱251.323/o Round Piece ₱303.30 ₱242.64

4/O Cutiing Piece ₱455.00 ₱364.00Syringe O.5 mL Insulin Piece ₱12.70 ₱10.16Syringe 1 mL Insulin Piece ₱3.10 ₱2.48

1 cc Piece ₱2.20 ₱1.763 cc Piece ₱2.25 ₱1.80

50 | P a g e

5 cc Piece ₱2.25 ₱1.8010 cc Piece ₱3.80 ₱3.0420 cc Piece ₱10.10 ₱8.0850 cc Piece ₱23.50 ₱18.80

Asepto Piece ₱39.00 ₱31.20Tongue Depressor, Non-sterile Box ₱58.50 ₱46.80

Sterile Piece ₱1.00 ₱0.80Tourniquet Piece ₱26.00 ₱20.80Ultrasound gel 250 grams Bot ₱84.50 ₱67.60Umbilical Cord Clamp Piece ₱5.80 ₱4.64Underpad Piece ₱14.50 ₱11.60Urinal Piece ₱46.80 ₱37.44Urine Bag Adult A Piece ₱19.50 ₱15.60Urine Collector Pedia Piece ₱5.10 ₱4.08Ventilator Tubing Adult Piece ₱1,014.00 ₱811.20

Ventilator TubingWith Water

Traps Piece ₱1,495.00 ₱1,196.00Ventilator Filter Piece ₱715.00 ₱572.00Wound Drain Jackson Pratt Piece ₱1,852.00 ₱1,481.60Wadding Sheet 4 inches Piece ₱43.00 ₱34.40

6 inches Piece ₱50.50 ₱40.403-Way StopCock Piece ₱53.50 ₱42.80Oxygen lbs ₱0.48 ₱0.38Pink Card Piece ₱20.00 ₱16.00Sterile DS Pack ₱30.00 ₱24.00

51 | P a g e

5. Availment of Out-Patient Department ConsultationThe Out-Patient Department Consultation caters only non-emergent medical/surgical health cases ofpatients.Office/Division: Outpatient Department (OPD)Classification: Simple


Who May Avail: OPD ClientsCHECKLIST OF REQUIREMENTS WHERE TO SECURE

OPD Registration Form (ORF) – 1 copy OPDHospital ID CardTagubilin Form – 1 copy (For Post-Admission Patient) Ward


TOBE

PAID

PROCESSINGTIME

PERSONRESPONSIBLE

If Old Client:1.a.1 Presents Hospital ID

then fills up ORF1.a.2 Submits ORF to

designated personnelIf New Client / Old Client

(Without ID):1.b.1 Secures Hospital ID

1.b.2 Returns to OPDRegistration andpresents Hospital ID

1.a.1 Requests client to presentHospital ID and instructs tofills out ORF

1.a.2 Receives ORF and verifiesdata in the computer

1.b.1 Instructs client to secureHospital ID

1.b.2 Verifies data in thecomputer

None

None

None

None

3 minutes

7 minutes

35 minutes

5 minutes

OPD Preregistration

Nurse

OPD Pre-registration

Nurse

OPD Pre-registration

Nurse/ MedicalRecords Staff

2. Presents self forassessment and vitalsigns checking andwaits name to becalled for consultation

2. Asks client for Tagubilin Form, ifapplicable and interviewspatient regarding their medicalcondition and checks vitalsigns then issues queuingnumber accordingly.

GREEN - Non priorityYELLOW – Urgent, PWD/ Senior

Citizen/Pregnant WomenBLUE – Follow-Up on scheduled

time

None 20 minutes Triage Nurse

3. Presents self forPhysical Consult

3. Provides Clinical Consultation NONE 20 minutes OPD Physician

4. Receives instruction forDiagnostics examination,medications and follow-up check-up

4. Carries out doctor’s order None 15 minutes ConsultationRoom Nurse /

Cashier

TOTAL: None

If Old Client -(1 hour & 5 minutes)

If New Client1 hour and 20 minutes

if Old Client (Without ID):1hour & 35 minutes

52 | P a g e

6. Availment of TB-DOTS Service – New TB DOTS ClientsThe Dr. Jose Rizal Memorial Hospital TB DOTS clinic caters services to patients who are suspected ofTuberculosis. It aims to provide basic information and initial assessment to probable TB patients.

Office/Division: TB-DOTS Clinic



Who May Avail: New TB DOTS Clients

CHECKLIST OF REQUIREMENTS WHERE TO SECURENONE NONE


TOBE

PAID

PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents self and fillsup attended patient listlogbook and waitsname to be called forconsultation


None 30 minutes TB-DOTS Nurse

2. Presents self forPhysician Consult

2. Provides Clinical Consultation None 10 minutes Physician

3. Receives instruction bythe TB-DOTS Nurse

3. Provides instructionspertaining to laboratory anddiagnostics then advise to follow-up per physician’s schedule given


TOTAL: None 43 minutes

53 | P a g e

7. Availment of TB-DOTS Service – Patient follow-up forEnrolled TB ClientsThe Dr. Jose Rizal Memorial Hospital TB-DOTS clinic as a DOH Certified facility can give availableAnti-TB medication to enrolled patients as well as provide follow up check up. It aims to provide care topatient undergoing treatment.




Who May Avail: Enrolled TB Clients

CHECKLIST OF REQUIREMENTS WHERE TO SECURENTP ID Card TB-DOTS Clinic


TOBE

PAID

PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents NTP ID Cardand waits forinstructions

1. Receives NTP ID Card andgives instructions


2. Receives Anti-TBmedication andinstructions for follow-up schedule

2. Gives Anti-TB medication andinstructs for follow-upschedule.



54 | P a g e

8. Availment of TB-DOTS Service – Patient follow-up forcontinuation of treatment at the HospitalThe Dr. Jose Rizal Memorial Hospital TB-DOTS clinic as an accredited Philhealth facility can avail TBDOTS Package from patients who are philhealth beneficiary. Furthermore, non-member patients canstill avail of the free services of TB medications and consultation.




Who May Avail: TB-DOTS Client – Diagnose as TB Patient wants to be treated at thehospital

CHECKLIST OF REQUIREMENTS WHERE TO SECUREPHIC Note Billing/Claims Section


TOBE

PAID

PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents self and fills upattended patient listlogbook and waitsname to be called forconsultation


None

30 minutes TB-DOTS Nurse



3.a For client/patient withPhilHealth:Proceeds to PhilhealthSection and asks forPHIC note

3.b For client/patient w/oPhilHealth:Proceeds to Step 5

3.a For client/patient withPhilHealth:Instructs patients to go thePhilHealth Section

3.b For client/patient w/oPhilHealth:Proceeds to Step 5


4. Returns to TB-DOTSClinic then presentsPHIC Note

4. Receives PHIC Note and enrollpatient as TB Client


5. Receives NTP ID Cardand instructions forfollow-up schedule

5. Issues NTP ID Card then givesinstructions for follow-upschedule


TOTAL: None

w/ PHIC1 hour and16 minutes

w/o PHIC43 minutes

55 | P a g e

9. Availment of TB-DOTS Service – Patient follow-up forcontinuation of treatment at the RHU/CHO

As part of the Universal Health Care, the Dr. Jose Rizal Memorial Hospital TB DOTS partners withother health care facilities to strengthen the service delivery network. It aims to give patients the rightto choose their treatment partner for better treatment outcome.




Who May Avail: TB-DOTS Client – Diagnose as TB Patient wants to be treated at RuralHealth Unit/City Health Office

CHECKLIST OF REQUIREMENTS WHERE TO SECURENONE NONE


TOBE

PAID

PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents self and fillsup attended patient listlogbook and waitsname to be called forconsultation





3. Receives NTP ReferralForm and furtherinstructions

3. Prepares and Issues NTPReferral Form then gives furtherinstructions.



56 | P a g e

10. Issuance of Patients Identification CardThe Outpatient Department is in charged in the Issuance of Patient’s Identification Card for OutpatientClients. Hospital ID card issued with the patient’s hospital number serves as his/ her permanentrecord in this health facility.Office/Division: Outpatient Department (OPD)



Who May Avail: New OPD Clients / Old OPD Clients without/lost Hospital ID

CHECKLIST OF REQUIREMENTS WHERE TO SECUREOPD Registration Form (ORF) - (1 copy)Charge Slip - (1 copy)Hospital ID - (1 copy)

OPD

Stamped ‘Paid’ charge slip - (1 copy) Cashier


PROCESSING TIME

PERSONRESPONSIBL

E1. Fills out ORF 1. Instructs client to completely

fill up the ORFNone 10 minutes OPD Pre

registrationNurse

For New Client:2.a Receives Hospital ID

For Old Client(Without ID)2.b.1 Submits ORF and

Receives charge slipthen proceed tocashier for payment

2.b.2 Returns to OPD,presents charge slipstamped as paid andreceives Hospital ID

2.a Receives filled up ORFencodes data intocomputer and IssuesHospital ID.

2.b.1 Receives filled up ORFand verifies data in thecomputer. Issues chargeslip and instructs client toproceed to cashier forpayment

2.b.2 Receives charge slip andIssues Hospital ID

None

Php 30.00

None

10 minutes

20 minutes

5 minutes

Medical RecordsStaff

Medical RecordsStaff / Cashier

Medical RecordsStaff

TOTAL Php 30.00

For New Client-

20 minutes

For Old Client-35 minutes

57 | P a g e

11. Issuance of Triage PassThe new normal due to the COVID-19 pandemic stresses observation of Infection Prevention andControl protocols as well as contact traceability. The following steps must be followed to facilitatedelivery of goods/entry of persons inside health facility during this pandemic.Office/Division: Operational Center (OPCEN)Classification: SimpleType of Transaction: Government-to-CitizenWho May Avail: All watcher’s and visitors

CHECKLIST OF REQUIREMENTS WHERE TO SECUREWatcher’s Pass, if applicable Admitting SectionIf Deliveries of goods from areas with positive case ofCOVID-19 (outside the Province), if applicableProof of Identification/Proof of Employment/Good’sPass/Delivery Receipt

Supplier


TOBE

PAID

PROCESSINGTIME

PERSONRESPONSIBLE

1. Wears appropriate PPEprior to entering thehospital premises.

1. Provides advice on donningappropriate PPE prior toentering hospital premises.

None 2 minutes Security Guardon Duty

1.1 Performs hand wash/alcohol rub/foot bath

disinfection andpresents watcher’spass.

2.2 Submits self forassessment in todesignated TriageArea (located athospital gate) andprovides informationas requested.

If Deliveries of goodsfrom areas withpositive case ofCOVID-19

2.3 Presents any proof oftransaction

2.4 Allows hospital staff todisinfect the vehicleand receives advice toproceed to the DropOff Point

2.1 Directs client/s to handwash/alcohol rub/foot bathdisinfection and receiveswatcher’s pass

2.2 Assesses client for any of thefollowing :

a. Travel history to areas withpositive case of COVID 19.

b. Contact to person with positiveCOVID-19.

c. Signs and Symptoms.d. Body temperature.

2.3 Request for any proof oftransaction

2.4 Disinfects vehicle and providesadvice regarding Drop OffPoint.

None

None

None

None

5 minutes

5 minutes

5 minutes

15 minutes

Security Guardon Duty

DesignatedTriage Nurse on

Duty

DesignatedTriage Nurse on

Duty/ NursingAttendant

58 | P a g e

3. Registers in the TriageLogbook and receivestriage pass and otherinstructions.

*Note:Only one watcher/visitor can go

inside the hospitalpremises.

3. Registers client in the TriageLogbook and issues TriagePass and other instructions asnecessary.

None 5 minutes DesignatedTriage Nurse on

Duty/ NursingAttendant


59 | P a g e

12. Patient’s Registration at the Emergency RoomPatient registration at the Emergency Room is necessary for documentation purposes. The servicecaters all patients for registration. In order for the client/patient to be registered, the following steps areto be followed:Office/Division: Emergency DepartmentClassification: SimpleType ofTransaction: Government-to-Citizen

Who May Avail: All patients for registrationCHECKLIST OF REQUIREMENTS WHERE TO SECURE

Hospital ID Admitting Section


TOBE

PAID

PROCESSINGTIME

PERSONRESPONSIBLE

1. Proceeds to TriageArea for registration

(Note: Attendance to patient’smedical needs shall begiven utmost priority and thefollowing steps may bewithheld temporarily for anobviously emergency case)

For Old Patient

1.a Presents Hospital IDand providesinformationfor registrationthrough IHOMIS

For Old Patient withLost ID and for NewPatient

1.b. Watcher or significantother secures hospitalID as instructed

1. Receives patient and requestsfor Hospital ID

1.a Receives hospital ID for patientverification and registrationthrough IHOMIS

1.b.1 Instructs Client/s orSignificant other to securehospital ID at the AdmittingSection

1.b.2 Issues Hospital ID

None

None

None

None

1 minute

2 minutes

2 minutes

37 minutes

Nurse on Duty

Nurse on Duty

Nurse on Duty

Admitting Section2. Presents secured

hospital ID2. Receives hospital ID for patientverification and registration throughIHOMIS

None 2 minutes Nurse on Duty

TOTAL None

Old Patient:5 minutes

Old Patient with Lost ID:42 minutes

New Patient:24 minutes

60 | P a g e

13. Patient’s Triage at the Emergency RoomPatient triaging using the three (3) point triage scale category is done to ensure efficient services at theEmergency Room.Office/Division: Emergency DepartmentClassification: SimpleType of Transaction: Government-to-CitizenWho May Avail: All patients for triage

CHECKLIST OF REQUIREMENTS WHERE TO SECUREReferral form, if applicable Referring unit/hospital


TOBE

PAID

PROCESSINGTIME

PERSONRESPONSIBLE

1. Proceeds to TriageArea for assessmentand submission ofrelated documents

(Note: Attendance to patient’smedical needs shall begiven utmost priority and thefollowing steps may bewithheld temporarily for anobviously emergency case)

1. Receives patient and patient’srelated documents such asreferral form if available

None 2 minutes Triage Nurse onDuty

2. Provides requesteddata for properassessment and

recording

FOR EMERGENTCASE/S

2.a Receives informationregarding prioritizationof care in theEmergency Room. Maybe directed todesignated area in theEmergency Roomimmediately upon entryas necessary.

FOR URGENT CASE/S

2.b Receives informationregarding prioritizationof care in theEmergency Room.

FOR NON-URGENTCASE/S

2.c Receives informationregardingprioritization of carein the Emergency

2. Does initial client assessmentand data recording in the ERform

.

2.a Gives advice that their casehas 1st priority in the provision ofclinical management. Maytransfer client directly todesignated area in theEmergency Room.

2.b Gives advice that their casehas 2nd priority in the provisionof clinical management.

2.c Gives advice that their casehas 3rd priority in the provisionof clinical management.

None

None

None

None

5 minutes

15 minutes

2 hours

3 hours and 40minutes

Nurse on Duty

Nurse on Duty

Nurse on Duty

Nurse on Duty

61 | P a g e

Room.

3. Transfers toEmergency Room forPost-triage assessmentand disposition.

3. Transports to designated area inthe emergency room for Post-

triage assessment and disposition

None 2 minutes Nurse on DutyNursing

Attendant

TOTAL None

For Emergent Case24 minutes

For Urgent Case2 hours & 9 minutes

For Non-Urgent Case3 hours & 49 minutes

62 | P a g e

14. Patient’s post triage disposition at the Emergency RoomProper patient disposition (admission, referral or discharge) at the ER ensures efficient services, betterhealth outcomes and satisfied clients.Office/Division: Emergency DepartmentClassification: SimpleType ofTransaction: Government-to-Citizen

Who May Avail: All patients directed to ERCHECKLIST OF REQUIREMENTS WHERE TO SECURE

Emergency Room Form Triage SectionAdmission and Discharge Record Admitting SectionPrescription Attending MD/ NurseDiagnostic Request Attending MD/NurseOfficial Receipt/ MSS Stamped Charge Slip Cashier/ Medical Social ServiceReferral form, if applicable Referring unit/hospital


PROCESSINGTIME

PERSONRESPONSIBLE

1. Receives posttriage advice

1. Receives patient withER Form stating posttriage assessment

None 2 minutes Nurse on Duty

Patients for Admission2.a.1 Patient or

Significant othersigns consent forClinicalManagementand/orAdmission

2.a.2 Significant otherproceeds toAdmittingSection withAdmission Slipthen, secure andsign theAdmission andDischarge form.

2.a.3 Returns to theEmergencyRoom with thesecuredAdmission andDischarge formfrom thedesignated staffof the AdmittingSection.

2.a.1 Gives Order ofAdmission andprovides necessarymanagement at theEmergency Room

2.a.2 Provides AdmissionSlip and directssignificant other tothe AdmittingSection forissuance ofAdmission andDischarge form

2.a.3 Receives Admissionand DischargeForm from thedesignated staff ofthe AdmittingSection

None

None

None

30 minutes

2 minutes

10 minutes

Physician onDuty

Nurse on Duty

Nurse on Duty

Nurse on Duty

63 | P a g e

2.a.4 Takes themedical suppliesin the CentralSupply Roomand Medicines inthe HospitalPharmacy.

2.a.5 Patient waits forward/roomtransfer

2.a.6 Patient transfersfrom ER toward/room

2.a.4 Provides ChargeSlip and instructs toproceed to CentralSupply Room to getthe medicalsupplies used then,to HospitalPharmacy tosecure drugs andmedicines.

2.a.5 Endorses patient forward/room transfer

2.a.6 Transports toward/room transfer

None

None

None

10 minutes

10 minutes

10 minutes

Nurse on Duty

NursingAttendant

Nurse on Duty

Nurse on DutyNursing

AttendantPatients for Referral(Patients for referral in otherhospitals in Dipolog Cityrequiring ambulanceconduction withaccompanying nurse trainedin EMT)2.b.1 Patient or

Significant othersigns consent forClinicalManagementand/or Referral

2.b.2 Receives chargeslips

2.b.3 Receives otherinstructions forsettlement ofcharges

*If patient will availfor medicalassistance:2.b.4 Proceeds to

Medical SocialService formedicalassistance

2.b.5 Proceeds toCashier andpayscorrespondingamount

*If patient will availfor Malasakitassistance:2.b.6 Presents official

2.b.1 Gives necessarymanagement at theEmergency Roomand/or Order ofReferral

2.b.2 Prepares chargeslips forER/procedures/services/suppliesused.

2.b.3 Gives Instructionsfor settlement ofcharges.

2.b.4 Processesavailment ofdiscounts.

2.b.5 Issues OfficialReceipt

None

None

None

None

Depends on thecharge

slip/SOA/discountsavailed

30 minutes

2 minutes

2 minutes

17 minutes

20 minutes

Physician onDuty/

Nurse on Duty

Nurse on Duty

Nurse on Duty

Nurse on Duty

Cashier

64 | P a g e

receipt and/orproof of medicalassistance

2.b.7 Waits oncepatient is readyto transfer tohigher institutionand/or hospital ofchoice.

2.b.8 Conducts patientto referralhospital

2.b.6 Checks officialreceipt/s and/orproof of medicalassistance (ExcessWaived per AO 137Series of2002,Patila Pay,Poor/Indigent ,C/OMedical AssistanceProgram (MAP )

2.b.7 Stabilize patient andcoordinates to thereceiving healthfacility

2.b.8 Arranges for patienttransport

None

None

None

30 minutes

30 minutes

15 minutes

Malasakit CenterOn duty

Physician onDuty

Nurse on duty

AmbulanceNurse on Duty/

Driver on DutyPatients to be discharged from the ER2.c.1 Patient or

Significant othersigns consent forClinicalManagementand/or applicableforms forDischarge.

2.c.2 Receives chargeslips.

2.c.3 Receives otherinstructions forsettlement ofcharges

2.c.4 Proceeds toBilling Sectionthen to Cashierfor issuance ofofficial receipt forpayment ofcharges.

*if patient will availfor medicalassistance2.c.5 Proceeds to

Medical SocialService and/or

2.c.1 Provides necessarymanagement at theEmergency Roomand givesDischarge Order

2.c.2 Prepares chargeslips for ERservices/suppliesused.

2.c.3 Gives instructionsfor settlement ofcharges and directsclient to go to billingand cashier

2.c.4.1 Billing Section –(for status post suturedpatients): Issues SOA2.c.4.2 Cashier: IssuesOfficial Receipt

2.c.5 Processesavailment of

None

None

None

None

Depends onSOA/Charge Slipsor any equivalent

None

3 hours

2 minutes

2 minutes

23 minutes

20 minutes

17 minutes

Physician onDuty

Nurse on Duty

Nurse on Duty

Nurse on Duty

Billing/ClaimsStaff

Cashier Staff

MSS Staff

65 | P a g e

Malasakit Centerfor medicalassistance.

*if patient will availfor Malasakit assistance2.c.6 Presents official

receipts and/orproofs of medicalassistance andreplenishedmedical suppliesand medicinesused.

2.c.7 Receives dischargeinstructions.

medical assistance.

2.c.6 Checks officialreceipt/s and/orproof of medicalassistance andreplenishment ofmedical suppliesand medicinesused. assistance(Excess Waivedper AO 137 Seriesof 2002,Patila Pay,Poor/Indigent ,C/OMedical AssistanceProgram (MAP )

2.c.7 Gives dischargeinstructions.

None

None

30 minutes

3 minutes

Malasakitstaff/MSS Staff

Physician onDuty/

Nurse on DutyDischarge Against Medical Advice (DAMA)2.d.1 Patient or

Significant othersigns consent forClinicalManagement

2.d.2 Signs consent forthe Release fromResponsibilityform.

( Note: for minorpatients the patient nextof kin will sign theconsent )

2.d.3 Patient’ssignificant otherswill remove allthe contraptions.

2.d.4 Receives chargeslips.

2.d.5 Receives otherinstructions forsettlement ofcharges

2.d.6 Proceeds toBilling Sectionthen to Cashierfor issuance ofofficial receipt forpayment of

2.d.1 Provides necessarymanagement at theEmergency Room

2.d.2 Explained thepossible consequencesand secures consent forthe release ofresponsibility.

2.d.3 Instructs thesignificant other toremove all thecontraptions.

2.d.4 Prepares chargeslips for ERservices/supplies used.

2.d.5 Gives Instructionsfor settlement of chargesand directs client to go tobilling and cashier

2.d.6.1 Billing Section –(for status post suturedpatients): Issues SOA2.d.6.2 Cashier: Issues

None

None

None

None

None

None

Depends onSOA/Charge Slipsor any equivalent

1 hour

3 minutes

5 minutes

2 minutes

2 minutes

23 minutes

20 minutes

Resident on DutyNurse on Duty

Resident on DutyNurse on Duty

Resident on Duty

Nurse on Duty

Nurse on Duty

Billing/ClaimsStaff

Cashier Staff

66 | P a g e

charges.

*if patient will avail formedical assistance/Malasakit assistance:2.d.7 Proceeds to

Medical SocialService and/orMalasakit Centerfor medicalassistance.

2.d.8 Presents officialreceipts and/orproofs of medicalassistance andreplenishedmedical suppliesand medicinesused.

2.d.9 Receivesdischargeinstructions.

Official Receipt

2.d.7 Processesavailment of medicalassistance

2.d.8 Checks officialreceipt/s and/or proof ofmedical assistance andreplenishment of medicalsupplies and medicinesused. assistance (ExcessWaived per AO 137Series of 2002,Patila Pay,Poor/Indigent ,C/OMedical AssistanceProgram (MAP )

2.d.9 Gives dischargeinstructions.

None

None

None

17 minutes

30 minutes

3 minutes

Nurse on Duty

Malasakit Centeron Duty

Nurse on Duty

TOTAL

Depends onSOA/Charge Slipsor any equivalentand availment of

medicalassistance

Patients for Admission1 hour & 14 minutes

Patients for referral1 hour and 43 minutes

Patients to be discharge3 hours and 52 minutes

DAMA1 hour and 58 minutes

*if client will avail medicalassistance

Patients for referral2 hours and 30 minutes

Patients to be discharge4 hours and 39 minutes

DAMA2 hours and 45 minutes

67 | P a g e

15. Triaging and Admission of Suspect, Probable andConfirmed COVID-19Proper referral and coordination for triaging and admission of suspect, probable and confirmedCOVID-19 clients is important to facilitate appropriate care to clients and minimize contamination andcross transmission among patients and caregivers.Office/Division: Emergency DepartmentClassification: SimpleType of Transaction: Government-to-Citizen

Who May Avail: All patients for admission of suspect, probable and confirmed case ofCovid-19

CHECKLIST OF REQUIREMENTS WHERE TO SECUREReferral form, if applicable Referring unit/hospital


TOBE

PAID

PROCESSINGTIME

PERSONRESPONSIBLE

1. Notifies the health carefacility in advance priortransport and givesinformation related topresent healthcondition.

*Arrival at the facility dependson the distance where thereferral came from.

For suspect, probableand confirmed covid-192.1 Proceeds to identified

COVID-19 IsolationUnit

2.2 Submits self for initialassessment

2.3 Signs consent forAdmission

2.4 Provides requesteddata for Input tohis/her Admission andDischarge Form.

2.5 Submits self forassessment forappropriate medicalnursing care

1.1 Verifies referral and determinesappropriateness of admissionwithin the capability of theinstitution for its management.

1.2 Prepares the room/s forpatient’s accommodation andnecessary medical supplies andmedical equipment to be used.

2.1 Directs client/s to identifiedCOVID-19 Isolation Unit.

2.2 Performs patient’s initialassessment on the following :

a. Travel history to areas withpositive case of COVID-19.

b. Contact to person with positiveCOVID-19.

c. Present signs and symptomsd. Check the referrale. Check the body temperature.

2.3 Secures consent for admission

2.4 Asks to provide demographicdata for his/her Admission andDischarge Form

2.5 Does patient assessment forappropriate medical nursingcare

2.6 Transports patient to assignedroom.

None

None

None

None

None

None

None

None

20 minutes

10 minutes

5 minutes

15 minutes

5 minutes

10 minutes

3 minutes

5 minutes

Nurse on Duty/Resident on Duty

Nurse on Duty/Resident on Duty

Nurse on Duty

Resident onDuty/

IM on duty/ISO Nurse on

duty

ISO Nurse

ISO Nurse

ISO Nurse/ISO Physician

NursingAttendant

TOTAL None 1 hour and 13 minutes

68 | P a g e

Internal Services

69 | P a g e

1. Discharge Process/Discharging a Patient from Clinical AreasThis service involves processing of patient’s discharge from the time of order until the time the patientis cleared and released from the clinical area of the institution.Office/Division: Nursing Service – Clinical AreasClassification: SimpleType of Transaction: G2C – Government to Client

Who May Avail: PatientPatient’s Representative: Relative or Legal Guardian

CHECKLIST OF REQUIREMENTS WHERE TO SECUREDischarge order from physician Nurse’s station (written on patient’s health

record)Statement of Account Billing and Claims OfficeClearance Slip Cash Operations Office


PROCESSINGTIME

PERSONRESPONSIBLE

1. Acknowledges Noticeof Discharge

1.1. Writes discharge order

1.2. Notifies costs centers andcarries-out discharge order

1.3 Completes and clearshospitalcharges and Notifies wardstations for discharge

None

None

None

15 minutes

50 minutes

1 hour

Physician

Nurse

Cost Centers(Central Supply

Room,Pharmacy,Laboratory,

Radiology,Billing/Claims)

2.a Acquires SOA fromthe Billing and ClaimsOffice

[Situation Specific]If client needs further

financial assistance:Proceed to Step 2.1

2.b Proceeds toMSW/MalasakitCenter forassistance/classification/discount

2.a.1 Receives and verifiescompleteness of alldocuments

2.a.2 Prints the Statement ofAccount (SOA)

2.b Processes medicalassistance/ classification/discount referrals

None

None

23 minutes

47 minutes

Billing andClaims Staff

MSW Staff

3.1 Proceeds to the CashOperations Office tosettle bills

3.2 Receives copy ofpaid SOA, OfficialReceipt (OR) andClearanceSlip

3.1 Receives the payment andSOA with indicated amount tobe paid

3.2 Issues the OR andClearance Slip to the client

Based onSOA

None

15 minutes

5 minutes

Cashier Staff

Cashier Staff

70 | P a g e

4. Presents the ClearanceSlip to the Linen Roomof the Central SupplyRoom (CSR) forclearance from linens

4. Signs the clearance slip afterall linens issued to the patientare properly accounted

None 5 minutes Linens in Charge

5. Presents theClearance Slip to theNurse’s Stationwhere the patient isadmitted and receivethe Tagubilin

5.1 Discusses all informationwritten in the Tagubilin andsigns the Clearance Slip

5.2 Ushers the patient to thehospital exit

None

None

10 minutes

5 minutes

Nurse

NursingAttendant

6. Presents ClearanceSlip to the guard andexits the hospital

5. Signs and collects ClearanceSlip and performs finalinspection of patient’sbelongings.

None 5 minutes Guard

TOTAL:

Basedon SOA

*DiscountsAvailed

3 hours and 13minutes

(for clientsneeding further

financialassistance)= 4 hours

71 | P a g e

2. Issuance of Medical SuppliesThe Central Supply Room provides the medical and surgical supplies necessary for the treatment ofthe hospital clients in the best, most efficient and timely manner. The CSR ensures the availability ofmedical and surgical supplies for hospital consumption.Office or Division: Central Supply Room; Nursing ServiceClassification: SimpleType of Transaction: G2G - Government-to-GovernmentWho may avail: Nurses, Nursing Attendant/Administrative Aide

CHECKLIST OF REQUIREMENTS WHERE TO SECUREPrescription for Medical Supplies Prescribing Doctor or NurseLogbook CSR Office


PROCESSINGTIME

PERSONRESPONSIBLE

1. Inputs charges topatient’s account throughiHOMIS

1. Reviews iHOMIS andchecks the availability ofrequested supplies

None 5 minutes Nurses /Nursing

Attendant /CSR Staff

2. Waits for notification 2.1 Prepares the availablerequested supplies

2.2 Clicks “ISSUE” to patients’IHOMIS account.

2.3 Notifies requestor to pickup prescribed medicalsupplies

None

None

None

10 minutes

5 minutes

5 minutes

CSR Staff onDuty

CSR Staff onDuty

CSR Staff onDuty

3. Receives requesteditems andacknowledges receiptthrough logbook

3. Dispenses items torequesting party andinforms requesting staff toacknowledgereceipt through logbook.



72 | P a g e

MEDICAL AND ANCILLARY SERVICE

73 | P a g e

External Services

74 | P a g e

1. Availment of Blood UnitsThe service involves storage and releasing of blood units, compatibility testing & antibody screening,testing for transfusion transmissible infection and releasing of blood units to outpatients who avail thisservice.Office/Division: Laboratory Section/ Blood StationClassification: Simple

Type of Transaction: G2C-Government to Citizen; G2B-Government to Business; G2G-Government to Government

Who May Avail: OPD/Walk-in Patients that needs blood unitsCHECKLIST OF REQUIREMENTS WHERE TO SECURE

Blood Request Form – 1 copyCharge Slip – 1 copy

Requesting PhysicianLaboratory Section

CLIENT STEPS AGENCY ACTION FEES TOBE PAID

PROCESSINGTIME

PERSONRESPONSIBLE

1.1 Presents bloodrequest form

1.2 Waits for the adviceon blood unitavailability

1.3 Secures a containerwith ice pack for thetransportation ofblood unit(s)

1.1 Receives and assesses therequest form

1.2 Checks for the availability ofblood unit requested

1.3 Instructs client to providetransport container and icepacks.

None

None

None

5 minutes

15 minutes

10 minutes

Laboratory Staff

Med Tech onduty

Med Tech onduty

2. Receives charge slipand proceeds tocashier for payment

2. Issues charge slip and directsto cashier for payment ofblood screening fee of theblood unit(s).

None 2 minutes Laboratory staff

3. Presents charge slipand payscorrespondingamount

3. Issues official receipt Refer tofees for

thespecific

procedure

20 minutes Cashier

4. Presents Stampedpaid charge slip withOR Number andwaits while the bloodunit(s) is prepared

4. Receives Charge Slip andinstructs client to wait whileblood unit is being packed fortransport.

None 30 minutes Laboratory staffDuty

5. Gets the donor’sscreening resulttogether with thepacked blood unit

5. Hands-over the donor’sscreening result separatelyfrom the packed blood unit(s)

None 5 minutes Med Tech onDuty

TOTAL

Refer tofees for

thespecific

procedure

1 hour and 27 minutes

75 | P a g e


LAW AAN, DAPITAN CITYTELEFAX: (065) 213 -6421Website: www.djrmh.doh.gov.ph

Email: [email protected] for Blood Units

as of June 30, 2020



Email: [email protected] for Blood Unitsas of June 30, 2020

SERVICES

RATE

SERVICES

RATEPHILHEALTH/ PAY/

OPD/ SERVICEWARD/

PRIVATE WARD

PHILHEALTH/ PAY/ OPD/SERVICE WARD/PRIVATE WARD

Blood Donor Screening 1,500.00 Blood Bag (250 ml) 114.00Blood Screening: WholeBlood 1,800.00 Blood Bag (450 ml) 138.50

76 | P a g e

2. Availment of In-Patient RegistrationThe Admitting Section is responsible in collecting in patient’s demographic data, patient’s registration,and printing of Admission and Discharge Record for every Admission.

Office/Division: Admitting SectionClassification: SimpleType of Transaction: G2C – Government to CitizenWho May Avail: For Admission Clients

CHECKLIST OF REQUIREMENTS WHERE TO SECUREAdmission Slip Emergency Room (ER)* Any of the following requirements listed: Any Valid ID (Government Issued ID) - (1 copy) BIR, Post Office, DFA, PSA, SSS, GSIS,

PAG-IBIG, LTO, COMELEC


PROCESSINGTIME

PERSONRESPONSIBLE

1.1 Presents AdmissionSlip

1.2 Provides any valid IDfor PHIC InitialAssessmentand receivesinformation on PHICcompliancerequirements

1.1 Receives filled-outadmission slip andinstructs to provideany valid document

1.2 Performs initial PHICassessment of patientand give informationto comply anyrequirements neededas indicated in thesystem Portal/eClaims).

None

None

15 minutes

30 minutes

Admitting Staff

Admitting Staff

2. Affixes signature on thedata furnished portion ofthe Admission andDischarge Record

2. Prints Admission andDischarge Record thenforwards to EmergencyRoom

None 5 minutes Admitting Staff


77 | P a g e

3. Availment of Laboratory Services for Out-PatientsLaboratory services are sought to assist the clinical management of patients. Various procedureswithin the scope of its license as a secondary laboratory can be availed by Outpatients

Office/Division: Laboratory SectionClassification: Simple

Type of Transaction: Government to Citizen; Government to Business; Government toGovernment

Who May Avail: Out-Patients / Walk-In PatientsCHECKLIST OF REQUIREMENTS WHERE TO SECURE

Completely filled up laboratory request Requesting Agency / OPDOfficial Receipt/ Stamped Paid or MSS StampedCharge Slip or its equivalent / Claim Slip

Cashier/MSSLaboratory Section


PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents Laboratoryrequest/s and receivesinstruction/s for theprocedure

1. Reviews submittedLaboratoryrequest/s andprovidesinstructions for theprocedure

None 10 minutes Laboratory Staff

2.a Receives charge slipand proceeds to cashierfor payment



2.a Issues charge slipand directs tocashier forpayment ofcharges

2.b ProcessesAvailment ofmedicalAssistance

None

None

2 minutes

17 minutes

Laboratory staff

MSS Staff

3. Presents charge slip forpayment and payscorresponding amount

3. Issues officialreceipt

Refer tofees for

thespecific

procedure

20 minutes Cashier

4.1 Presents Stamped paidcharge slip with ORNumber / MSS StampedCharge Slip together

4.1 Receives stampedpaid charge slip withOR number / MSSStamped charge slip


SECONDARY Hospital-based Laboratory Availability of Services (Monday to Friday):

8AM to 5PM

ROUTINE TESTS INCLUDES: Complete Blood Count (with Platelet) Urinalysis Fecalysis/ Stool Exam Blood Typing

Routine BloodChemistry FBS/RBS BUN Creatinine Lipid Profile BUA SGPT SGOT

SPECIAL TESTSINCLUDE: Gram Staining KOH HIV Testing HbsAg

78 | P a g e

with the laboratoryrequest/s

4.2 Presents self for sampleextraction and/or givessample

4.3 Receives claim slip andwaits for the result

then receiveslaboratory request/s

4.2 Verifies the clients’information thenproceeds toextraction and/orreceive specimen

4.3 Provides claim slipfor the claiming ofresults

4.4 Processes andanalyzes specimenaccording to theprocedurerequested

None

None

None

10 minutes

2 minutes

Routine:within 4 hoursupon receiving

of samples

Routine BloodChemistry: 8hours uponreceiving of

samples

MedicalTechnologist/Laboratory

Staff

Laboratory Staff

Laboratory Staff

5. Presents claim slipand signs ReleasingLogbook upon claimingthe Laboratory Results

5. Gets and verifiesclaim slip andreleases laboratoryresults


TOTAL

(check scheduleof fee, compute

accordingly)*If patient will

avail formedical

assistanceDepends on the

assistanceavailed

Routine:4 hours and 49 minutes


= 5 hours and 3 minutes

Routine Blood Chemistry:8 hours and 49 minutes


= 9 hours and 3 minutes

79 | P a g e



Email: [email protected] for Blood Units

as of June 30, 2020



Email: [email protected] for Blood Unitsas of June 30, 2020

SERVICES

RATE

SERVICES

RATEPHILHEALTH/ PAY/

OPD/ SERVICEWARD/

PRIVATE WARD

PHILHEALTH/ PAY/ OPD/SERVICE WARD/PRIVATE WARD

10% Formalin 163.00 10% Formalin 900ml 146.70

10% Formalin 90ml 14.67 10% Formalin 1000ml 136.0010% Formalin 100ml 16.30 AFB Stain 60.0010% Formalin 150ml 24.45 Albumin 100.0010% Formalin 200ml 32.60 Alkaline Phosphatase 350.0010% Formalin 250ml 40.75 Anti- HBs Determination 165.0010% Formalin 300ml 48.90 ASO 100.0010% Formalin 350ml 57.05 Blood Bag 250 ml 114.00

10% Formalin 400ml 65.20 Blood Bag 450 ml-Laboratory 138.50

10% Formalin 500ml 81.50 Blood Donor Screening 1,500.00

10% Formalin 600ml 97.80 Blood Smear for MalariaParasites (BSMP) 50.00

10% Formalin 700ml 114.10 Blood Typing with Rh 90.0010% Formalin 800ml 130.40 BUA 95.00BUN 140.00 FBS 95.00CBC 150.00 Fecalysis only 30.00

CBC with Platelet 210.00 Fecalysis with OccultBlood 130.00

Cholesterol 95.00 Gram Stain 50.00Clotting Time/ Bleeding Time(CTBT) 70.00 H. Pylori Detemination 295.00

Creatinine 135.00 Hba 1C 792.00Crossmatching 70.00 HBsAg 185.00CRP 85.00 HCV 330.00Dengue AntibodyDetermination 550.00 HDL/ LDL 135.00

Dengue NS1 300.00 Hematocrit 45.00Differential Count 40.00 Hemoglobin 45.00ESR 135.00 HIV 165.00KOH Preparation 35.00 Salmonella 600.00Lipid Profile (Package) 550.00 SGOT (AST) 125.00Occult Blood only 100.00 SGPT (ALT) 115.50

80 | P a g e

Oral Glucose Tolerance Test50 g 375.00 Sodium (Na+) 275.00

Oral Glucose Tolerance Test75 g 460.00 Total Bilirubin

(Total Direct & Indirect) 250.00

Platelet Count only 115.00 Total Protein 85.00Potassium (K+) 275.00 Triglyceride 245.00Pregnancy Test 80.00 Triple Bag 552.00Prothrombin Time 450.00 Troponin I 500.00RBC Count 30.00 Troponin T 1,004.00RBS/ Strips (Wet Method) 95.00 Urinalysis (Manual) 50.00Reticulocyte 150.00 Urinalysis (Automated) 150.00

81 | P a g e

4. Availment of Dental ServicesThis process starts with presenting the OPD Form until receiving of dental procedures and instructionsfor oral care.

Office/Division: Dental ServiceClassification: SimpleType of Transaction: G2C – Government to CitizenWho May Avail: Out-Patient Clients

CHECKLIST OF REQUIREMENTS WHERE TO SECUREOut Patient Department (OPD) Form OPD TriageStamped-Paid Charge SlipMedical Social Service (MSS) Stamped Charge Slip

CashierMSS


PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents OPD Form 1. Receives OPD Form forinitial examination

None 10 minutes Dentist/Dental Aide

2.a Receives prescriptionand charge slip thenproceeds to cashierfor payment.



2.a Issues prescription &charge slip and instructsclient to go to cashier forpayment

2.b Processes Availment ofmedical assistance

None

None

5 minutes

17 minutes

Dentist

MSS Staff

3. Presents charge slipand/or prescriptionand payscorrespondingamount

3. Issues Official Receipt. Php300.00

20 minutes Cashier

4. Returns to Dental Clinicand presentsstamped “Paid”charge slip with ORNumber/MSSStamped charge Slip

4. Initiates DentalProcedures

None 1 hour Dentist/Dental Aide

5. Receives instruction fororal care

5. Gives final oral careinstruction

None 5 minutes Dentist

TOTAL

Php 300.00



1 hour & 40 minutes


1 hour & 57 minutes

82 | P a g e

5. Availment of Medical AssistanceProvision of Medical Assistance to the poor or indigent patients, or those with chronic/catastrophicillnesses seeking medical services in the hospital.

Office/Division: Medical Social Service (MSS)Classification: SimpleType of Transaction: G2C – Government to CitizenWho May Avail: All patients

CHECKLIST OF REQUIREMENTS WHERE TO SECUREAny of listed requirements as applicable- Charge Slip - (1 copy)- Statement of Account - (1 copy)- Order of Payment Slip - (1 copy)- Medical Certificate/Medical Abstract

- Radiology/Laboratory/CSR/ER- Billing & Claims- Pharmacy- Health Information Management Office

Medical Social Service Card MSSAny of listed requirements, as applicable- Certificate of Indigency - (1 copy)- 4P’s ID (1 copy)- Sponsored MDR/PBEF - (1 copy)- Senior Citizen ID - (1 copy)- PWD ID - (1 copy)

- BHW ID - (1 copy)- Barangay Official ID - (1 copy)

- Barangay/DSWD- DSWD- PHIC- Office of Senior Citizen’s Affairs- City/Municipal Social Welfare and

Development Office- Rural Health Unit / DOH Regional Office- DILG


PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents chargeslip/SOA/Order ofPayment Slip &Medical SocialService Card and anydocumentaryrequirements, asapplicable.

1. Updates patient’s record &receives any documentaryrequirements (as applicable)then checks chargeslip/Order of PaymentSlip/statement of accountand determines amount formedical assistance to beprovided to client, or possiblecost sharing.

None 8 minutes Social worker onDuty

2. AcknowledgesMedical Assistanceavailed or signslogbook of QuantifiedFree Services(QFS)

2. Indicates amount assistedand/or amount to be paid inthe charge slips/Order ofpayment slip or SOA.

None 6 minutes Social Worker onduty

For OPD clients withcounterpart payment:3.a Proceeds to cashierfor payment before goingto the cost centers for theservices needed.

For OPD clients withoutcounterpart or FullMAIP assistance:3.b Proceeds to the cost

3.a Instructs client to proceed tothe Cashier for paymentbefore proceedingto the cost centers for theservices needed.

3.b Instructs client to proceed to

*Amountto be paidmay vary

dependingon

discountgiven

3 minutes

3 minutes

Social Worker onduty

Social Worker onduty

83 | P a g e

centers for the servicesneeded.For ER and In patients:3.c Proceeds to thecashier for paymentand/or clearance.

the cost center to avail theservices needed.

3.c Instructs client to proceed tothe cashier for payment and/orclearance that is needed to bepresented to the ward nurse orER nurse for their finaldischarge.

None


dependingon

discountgiven

3 minutesSocial Worker on

duty

TOTAL:


dependingon

discountgiven

17 minutes

84 | P a g e

6. Availment of Medico-Legal Examination at the Women andChild Protection UnitWCPU Is a unit that serves a holding and processing area to victims/survivors of violence againstwomen and their children (VAWC) and child abuse. It is a composed of multidisciplinary teammembers that provides comprehensive medical and psychosocial services to women and childrensurvivors of violence.Office or Division: Women and Children Protection UnitClassification: SimpleType of Transaction: Government-to-ClientWho may avail: Victims/survivors of VAWCCHECKLIST OF REQUIREMENTS WHERE TO SECURE- Referral letter

- Police request

- Government agencies such as but notlimited to, DSWD, PNP, NBI, etc. orNGOs/Pos.

- Philippine National PoliceNote : Walk in clients need not present requirements.


PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents referralletter/police request,if available.

1. Assesses referral letter asto what kind of service/sis/are requested or needed

None 10 minutes EmergencyRoom (ER)Triage staff

2. AccomplishesPatient DataInformation at the ERTriage forregistration

2.1 Verifies personalinformation submitted andprints patients’ record.

2.2 Informs physician andforwards patient to WCPU.

None 15 minutes ER Triage staff

3.1 Gives consent/assent for medicalexamination.

3.2 Submits for interviewand examination

3.3 Submits for MedicalExamination,evidence gatheringand documentation

3.1 Secures informed consent,assent and/or otherapplicable consent forinterview and examination.

3.2 Conducts intake interviewassessment.

3.3 Conducts medicalexamination, takesappropriate documentationand orders necessarytests, procedures and/orprescribe medicine,including referralto other agency orsections, as necessary.

None

None

None

5 minutes

1 hour

45 minutes

DesignatedNurse/ Resident

in-charge

Social Workeron-duty andAttendingPhysician

AttendingPhysician

4. Proceeds to costcenters for theperformance oftest/procedure or getprescribedmedicines, asordered by

4. Carries out request,facilitates performance ofnecessary tests/procedure or medicines.

*(Cost varydepending on

thetest/proceduresor medicines)

9 hours Designatednurse on duty

85 | P a g e

physician.

5. Returns to WCPU forplanning &counseling, andwaits for furtherinstruction.

5.1 Explains disposition andgive further instructions.

5.2 Makes medico-legalcertificate.

5.3 Initiates plan of action andprovides counseling.

None

None

None

3 minutes

2 hours

15 minutes

Attendingphysician

Attendingphysician

Social Workeron-duty

6. Receives advicewhere to proceed toclaim medico-legalcertificate.

6.1 Advices patient/accompanyingadult to proceed toHIM/Medical Record toclaim the Medico-legalCertificate.

6.2 Endorses patient healthrecord to HIM.

None

None

2 minutes

10 minutes



TOTAL

*(Cost varydepending on

thetest/proceduresor medicines)

1 day, 5 hoursand 45

minutes

86 | P a g e

7. Availment of MSS Classification/Re-Classification of PatientPatient social classification is a type of categorization of patients who seek consultation or admissionin the hospital on the basis of their economic status or paying capacity and poverty threshold level.There are three social classifications namely; full pay, partial pay and the poor and indigent.Office/Division: Medical Social Service (MSS)Classification: SimpleType of Transaction: G2C – Government to CitizenWho May Avail: Walk IN or Referred Patients (In- Patients, ER clients, OPD)

CHECKLIST OF REQUIREMENTS WHERE TO SECUREMedical Social Service Card MSS Section


PROCESSINGTIME

PERSONRESPONSIBLE

For NEW Clients:1.a Fills out necessary

information and submitsfor interview andassessment . andpresents ID as necessaryfor identificationpurposes

For OLD Clients:1.b Presents Medical Social

Service Card

1.a Interviews and assessesclient’s socio-economic statusor the financial capability andcoping capacity of the client.

1.b Receives Medical SocialService Card and updatesrecord

None

None

20 minutes

5 minutes

Social Workeron Duty

Social Workeron duty

2. Receives assessment andMedical Social ServiceCard.

2. Provides assessment, issuesMedical Social Service Cardfor new clients, re-issue orrevalidates Medical SocialService Card for old clients

None 3 minutes Social Workeron Duty

3. Asks information relativetohospitalization/consultation issues/ concerns andor difficulty.

3. Provides information on thescope of services andlimitations and explainsnecessary requirements andprovides necessaryintervention to client’spresenting problem.

None 10 minutes Social Workeron Duty

TOTAL: NoneNew Client : 33 minutes

Old Client : 18 minutes

87 | P a g e

8. Availment of Nutritional and Dietetics ServiceThe Nutrition and Dietetics Section is responsible in the provision of optimal nutrition care throughquality food service. Client starts from presenting the required documents until receiving of dietaryinstruction.

Office/Division: Nutritional and Dietetics ServiceClassification: SimpleType of Transaction: G2C – Government to CitizenWho May Avail: Out-Patient Clients

CHECKLIST OF REQUIREMENTS WHERE TO SECUREIntra-Agency Referral Sheet OPDLaboratory Result/s OPDPrescription Form OPD


PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents requireddocuments

1. Receives requireddocuments

None 2 minutes Dietitian onDuty

2. Receives dietaryinstruction

2. Prepares necessaryinstructional materials andprovides dietary instructionregarding prescribed diet

None 15 minutes Dietitian onDuty


88 | P a g e

9. Availment of Patient’s Data CorrectionChanges and corrections for In-Patient’s registered data is done in Admitting Section. This is to ensurethat the patient’s information on his/her hospital record is correct based on the valid documentreceived in this office.

Office/Division: Admitting SectionClassification: SimpleType of Transaction: G2C – Government to CitizenWho May Avail: In-Patients

CHECKLIST OF REQUIREMENTS WHERE TO SECURE* Any of the following requirements listed: Any Valid ID (Government Issued ID) - (1 copy)

Birth Certificate - (1 copy) Marriage Contract - (1 copy) Baptismal Certificate - (1 copy) Company ID - (1 copy)

BIR, Post Office, DFA, PSA, SSS, GSIS,PAG-IBIG, LTO, COMELEC

PSA PSA Church Employer


PROCESSINGTIME

PERSONRESPONSIBLE

1. Informs theAdmitting Staff forany corrections onthe patients’ data.

1. Retrieves the patient’s datafrom the IHOMIS, verifieswith the filled-outadmission slip instructs thepatient/watcher to provideany valid document tosupport the changes


2. Providesphotocopy of anyvalid documentneeded to supportthe changes.

2. Receives the ValidDocument / ID and correctsthe patient’s data.



89 | P a g e

10. Availment of Patients Hospital Identification CardThe Admitting Section is in charged for the Issuance of Patient’s Identification Card for patientsmanaged at the Emergency Room. Hospital ID card issued with the patient’s hospital number servesas his/her permanent record in this health facility.

Office/Division: Admitting SectionClassification: SimpleType of Transaction: G2C – Government to Citizen

Who May Avail: Patients managed at the Emergency Room (New Patient and Old Patient withlost Hospital ID)

CHECKLIST OF REQUIREMENTS WHERE TO SECUREStamped Paid Charge slip with OR Number - (1 originalcopy)Charge Slip – (1 original copy)

CashierAdmitting


PROCESSINGTIME

PERSONRESPONSIBLE

1. Provides patient’s data 1. Checks in the computer ifthe patient has existinghospital record


2. Receives charge slipand proceeds to cashierfor payment

2.a (if old Client w/o ID) :Issues charge slip and directsto cashier for payment ofcharges2.b (if New Patient): CreatesPatient’s Master Record andgenerates hospital recordnumber then proceeds to Step5

None

None

3 minutes

10 minutes

Admitting Staff

Admitting Staff

3. Presents charge slipand payscorresponding amount

3. Issues official receipt Php30.00

20 minutes Cashier

4. Returns to admittingsection and presentsstamped paid chargeslip with OR number

4. Receives stamped paidcharge slip withOR number


5. Receives Patient’sidentification Card

5. Issues Patient’sIdentification Card


TOTAL Php30.00

New Client -21 minutes

Old Client w/o ID37 minutes

90 | P a g e

11. Availment of Philhealth Enrolment through Point Of Service(POS)

Point of Service (POS) refers to the program to cover all Filipinos (The unregistered and inactivemembers) under the National Health Insurance Program, through the General Appropriations Act forthe current year.

Office/Division: Medical Social Service (MSS)



Who May Avail: Admitted clients/patients

CHECKLIST OF REQUIREMENTS WHERE TO SECURE* Any of listed documentary requirements (asapplicable)- Birth Certificate - (1 copy)- Affidavit of guardianship of the legal guardian

in the absence of their parents - (1 copy)

- Philippine Statistics Authority (PSA)- Public Attorney’s Office


PROCESSINGTIME

PERSONRESPONSIBL

E1. Asks information

how to access PHICenrolment.

1.1 Secures neededdocumentaryrequirements asneeded.

1. Provides informationand instructs watcheror patient to securecomplete requirementsincluding timelines for itscompletion.

None

None

5 minutes

2 days

Social Worker onDuty

2. Presentsdocumentaryrequirements andaccomplishesPhilhealthMembershipRegistration Form(PMRF).

2.1 Waits to be enrolledat Philhealth POSSystem

2.2.a Proceeds to theBilling and Claims tosubmit documents.

2.2.b Proceeds to

2. Checks completeness ofrequired documents andprovides PhilhealthMembershipRegistration Form(PMRF)

2.1 Enrolls patient toPhilhealth POS System,and issues note asproof of PHIC enrolment

For Financially Incapable:2.2.a Instructs watcher/

patient to submitdocuments to Billing &Claims for propertagging.

For Financially Capable:

None

None

None

10 minutes

10 minutes

2 minutes




91 | P a g e

Philhealth LocalHealth InsuranceOffice, Dipolog Cityto pay the AnnualPHIC Premium thenreturns to submits toBilling and Claimsthe proof ofpayment.

2.2.b Instructs client to payAnnual Premium at

the PHIC-LHIO,Dipolog City for PHICmembership andinstruct patient to submitproof of payment atBilling & Claims.

None 3 hours Social Worker onDuty

TOTAL: None

FinanciallyIncapable:

2 days and 27minutes

FinanciallyCapable:

2 days, 3 hoursand 25 minutes

92 | P a g e

12. Availment of Services at Malasakit Center (Medical/FinancialAssistance & Verification of PHIC Status

Malasakit Center serves as a one-stop shop, where the different participating agencies receive andprocess request for medical and financial assistance for indigent and financially incapacitatedpatients.Office/Division: Malasakit CenterClassification: SimpleType of Transaction: G2C – Government to CitizenWho May Avail: All patients

CHECKLIST OF REQUIREMENTS WHERE TO SECUREA. For Medical Assistance: DOH-MSW

Any of listed requirements as applicable ( as proof ofthe needed medical services)- Charge Slip - (1 copy)- Statement of Account - (1 copy)- Order of Payment Slip - (1 copy)

- Radiology/Laboratory/CSR/ER- Billing & Claims- Pharmacy

Medical Social Service Card MSSAny of listed requirements, as applicable ( as proof ofindigency/underpriviledge sector)- Certificate of Indigency - (1 copy)- 4P’s ID (1 copy)- Sponsored MDR/PBEF - (1 copy)- Senior Citizen ID - (1 copy)- PWD ID - (1 copy)

- BHW ID - (1 copy)

- Barangay Official ID - (1 copy)

- Barangay/DSWD- DSWD- PHIC- Office of Senior Citizen’s Affairs- City/Municipal Social Welfare and

Development Office- Rural Health Unit / DOH Regional

Office- DILG

For Financial (Burial, Transportation, etc.) Assistance:DSWD

1. Certificate of Indigency - (1 copy)2. Medical Certificate/Medical Abstract

3. Proof of needed assistance such as, deathcertificate, request of test/procedure,etc.

4. Social case summary report/social case study

BarangayHealth Information Mgt System at thehospitalHospital/CHO or MHO

Municipality Social Welfare Office ormedical social worker

For PHIC status inquiry/problems, PHIC dataupdating,etc.Any of the following:-PHIC ID with PIN or MDR- Birth Certificate or correct data of member esp.name & birthdate

PHIC LHIOPSA, Local Civil Registar


TOBE

PAID

PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents documentaryrequirements for the

1. Provides information ofservices and requirements

None 3 minutes Designatedstaff at the

93 | P a g e

services needed and endorses client to thepartner agency by providingpriority number.

informationcounter

2. Accomplishesnecessary forms andwaits for the number tobe called

2. Advises client to proceed tothe waiting area and waits forthe number to be calledand/or displayed on thescreen.

None 3 minutes Designatedstaff at theinformation

counter

3. Proceeds to thedesignated counter ofthe partner agencywhen called andpresents queuingnumber.

3. Receives queuing number.Receives review andvalidates documentspresented.

None 5 minutes MSW/PHICCares/DSWDSocial Worker

4. Provides accurate andcomplete informationas needed, and signsnecessary documents

4. Interviews client, assessesneeds and providesnecessary assistance.


5. Proceeds to the cashierfor payment, ifapplicable, or to theappropriate servicecenters they needed asadvised by the partneragency or socialworker.

5. Advises client where toproceed.



94 | P a g e

13. Availment of X-ray Services for Out-PatientThe Out-Patient X-ray services provides best quality radiographic images and accurate fast diagnosticreading using the state of the art high end X-ray machines ensuring utmost safety and quality serviceto our clients. This service takes in from the presentation of x-ray request form until the result isrelease.

Office/Division: Radiology and Imaging Section


Type of Transaction: Government-to-Citizen

Who May Avail: All Out-Patients

CHECKLIST OF REQUIREMENTS WHERE TO SECUREX-ray Request Form – 1 copy (original) Prescribing Doctor

Charge Slip Radiology Clerk

Official Receipt – 1 copy (original) Cashier Section

MSS Approval/ Acknowledgment (if applicable) Medical Social Worker

Claim slip Radiology Clerk

If by an Authorized Representative1 Valid ID photocopy of the authorized representative Any Government issued ID1 Valid ID photocopy of the patient Any Government issued ID

Authorization Letter from the patient Patient


PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents x-ray requestform

1.1 Receives patient’s x-rayrequest form

1.2 Checks for completenessof data and verifies the lastmenstrual period (if

female client).

None

None

2 minutes

2 minutes

Radiologic clerk

Radiologic clerk

2.a Receives charge slipand proceeds tocashier for payment



2.a Issues order of paymentand directs to cashier forpayment of charges

2.b Processes availment ofmedical assistance

None

None

3 minutes

17 minutes

Radiologic clerk

MSS Staff

3. Presents charge slipand pays correspondingamount

3. Issues official receipt. Pleaserefer to

approvedscheduleof fees

20 minutes Cashier Staff

95 | P a g e

4. Returns to Radiologyand presents OfficialReceipt / Stampedpaid charge slip withOR Number / MSSStamped Charge Slip

4. Receives Official Receipt /Stamped paid charge slipwith OR number / MSSStamped charge slip

None 2 minutes Radiologic clerk

5.1 Waits until name iscalled and submits selffor x-ray procedure

5.2 Acknowledgesschedule of x-rayresult

5.1 Calls patient for x-rayprocedure and performsthe requested x-rayprocedure

5.2 Informs the patient whento return for the officialresult. Issues claim slipand instructs to bring theofficial receipt or claimstub upon claiming theresult.

5.3 Sends images to PACSand assigns to theRadiologists forinterpretation ofRadiologist

None

None

None

32 minutes

5 minutes

5 minutes

RadiologicTechnologist

Radiologic clerk


6.1 Returns to releasingcounter on thescheduled release ofresult and submitsclaim slip.

6.2 Signs the releasinglogbook

6.1 Releases x-ray result tothe patient.

6.2Let the patient sign thereleasing logbook.

None

None

3 days

2 minutes

Radiologic clerk

Radiologic clerk

TOTAL

(checkschedule of

fee,compute

accordingly)

3 days, 2hours and 28

minutes

96 | P a g e

SERVICES RATEA. RADIOLOGIC PROCEDURE

CHEST X-RAY 200.00A. ADULT PA/AP VIEW 200.00

LATERAL VIEW 300.00B. PEDIA PAL/APL VIEW 200.00

PA/AP VIEWSKULL X-RAY

A. ADULT/PEDIA APL VIEW 400.00EXTREMITIES X-RAY

A. ADULT APL VIEW 350.00B. PEDIA APL VIEW 300.00

THIGH X-RAYA. ADULT APL VIEW 400.00B. PEDIA APL VIEW 300.00

ABDOME X-RAYADULT/PEDIA FLAT PLATE VIEW 200.00UPRIGHT VIEW 200.00

THORACOLUMBAR SPINE X-RAYAP VIEW 200.00LATERAL VIEW 200.00

LUMBOSACRAL X-RAYAP VIEW 200.00LATERAL VIEW 200.00

PELVIC X-RAYAP VIEW 200.00

B. MAMMOGRAM 1,500.00

D. C-ARM WITH OUT PRINTOUT

WITH PRINTOUT

1. LESS THAN 30 MINUTES 700.00 800.0030 MINUTES TO 1 HOUR 1,000.00 1,500.00FOR EVERY HOUR BEYOND, AN ADDITIONALOF: 500.00 700.00

97 | P a g e

14. Conduct of Procedure and Releasing of Result for Out-Patient (X-ray Special Procedure, Ultrasound and 2D Echo)

Radiology services for Out-Patient provides best quality radiographic images and accurate diagnosticreading using the state of the art high end imaging machines ensuring utmost safety and qualityservice to our clients. This service only includes the following special procedures: 1) X-ray SpecialProcedure 2) Ultrasound 3) 2D Echo

Office/Division: Radiology and Imaging Section - OPD

Classification: Complex


Who May Avail: Patients (Out-patient and Walk-In patients)

CHECKLIST OF REQUIREMENTS WHERE TO SECURERequest for procedure DoctorCharge Slip Radiology ClerkOfficial Receipt for paid procedure CashierMSS Approval/ Acknowledgment (if applicable) Medical Social WorkerContrast Media History and Assessment Form Radiology nursePertinent Clearances, if needed Requesting doctorComplete materials for procedure PharmacyBowel Preparation Instruction Form, if needed Radiology clerkClaim Slip Radiology Clerk


TOBE

PAID

PROCESSINGTIME

PERSONRESPONSIBLE

1. Returns on thescheduled date of theprocedure and submitsrequirements.

For Ultrasound & 2DEcho:

Proceed to step 2

For procedures withcontrast:

1.1 Patient goes to OPD forskin testing

1.2 Returns to RadiologySection

1. Receives request and stampedcharge slip and instructs patientto proceed to designated waitingarea.

1.1.Instructs patient to go to OPDfor skin testing of contrastmedia and gives furtherinstruction

1.2.Prepares patient materials forthe procedure

None

None

None

2 minutes

30 minutes

15 minutes

Radiology clerk

RadiologicTechnologist/OPD Nurse

RadiologicNurse

2.a Waits until name iscalled and submits selffor the procedure.

For Ultrasound & 2DEcho:

Proceed to step 3

2.a.1 Calls patient’s name, checkscompliance to pre-proceduraland material requirements,prepares materials and instructspatient on what to do.

2.a.2 Conducts procedure.

None

None

10 minutes

X-Ray SpecialProcedure:30 minutes

Ultrasound:30 minutes

RadiologicTechnologist/

2D EchoTechnologist


98 | P a g e


2.b Receives post-procedural instructionsand receives claim slip

2.b Observes patient for postcontrast reaction and providespost procedural instructions

None

2D Echo:60 minutes

1 hour Radiologynurse

3. Receives claim slip 3.Issues claim slip and instructs tobring the official receipt or claimslip upon claiming the result onspecified date

None 2 minutes Radiology clerk

4.1 Returns to releasingcounter on thescheduled release ofresult and submits claimslip.


4.1 Releases x-ray specialprocedure/ct scan result to thepatient.

4.2 Let the patient sign thereleasing Logbook.

None

None

X-Ray SpecialProcedure:

3 daysUltrasound:Simple case:

1 hourComplicated

case:1 day

2D Echo:5 days

2 minutes

Radiology clerk

Radiology clerk

TOTAL None

X-Ray Special Procedure:3 days, 3 hours & 5 minutes

Ultrasound:Simple case:

1 hr & 49 minutes

Complicated case:1 day & 49 minutes

2D Echo:5 days & 49 minutes

99 | P a g e

15. Conduct of Procedure and Releasing of Result for Out-Patient (CT-Scan and Mammogram)

Radiology services for Out-Patient provides best quality radiographic images and accurate diagnosticreading using the state of the art high end imaging machines ensuring utmost safety and qualityservice to our clients. This service only includes the following special procedures: 1) CT-Scan 2)Mammogram

Office/Division: Radiology and Imaging Section - OPD

Classification: Complex


Who May Avail: Patients (Out-patient and Walk-In patients)

CHECKLIST OF REQUIREMENTS WHERE TO SECURERequest for procedure DoctorCharge Slip Radiology ClerkOfficial Receipt for paid procedure CashierMSS Approval/ Acknowledgment (if applicable) Medical Social WorkerContrast Media History and Assessment Form Radiology nursePertinent Clearances, if needed Requesting doctorComplete materials for procedure PharmacyBowel Preparation Instruction Form, if needed Radiology clerkClaim Slip Radiology Clerk


TOBE

PAID

PROCESSINGTIME

PERSONRESPONSIBLE

1. Returns on thescheduled date of theprocedure and submitsrequirements.

For Plain procedure &Mammogram:

Proceed to step 2


1.1 Patient goes to OPD forskin testing

1.2 Returns to RadiologySection

1. Receives request and stampedcharge slip and instructs patientto proceed to designated waitingarea.

1.1.Instructs patient to go to OPDfor skin testing of contrastmedia and gives furtherinstruction

1.2.Prepares patient materials fortheprocedure

None

None

None

2 minutes

30 minutes

15 minutes

Radiology clerk

RadiologicTechnologist/OPD NurseRadiologic

Nurse

2. Waits until name iscalled and submits selffor the procedure.


Proceed to step 3

2. Calls patient name, checkscompliance to pre-proceduraland material requirements,prepares materials and instructspatient on what to do.

2.1. Conducts procedure.

None

None

10 minutes

CT-Scan:30 mins

Mammogram:


2D EchoTechnologist


100 | P a g e


2.2. Receives post-procedural instructionsand receives claimslip

2.2. Observes patient for postcontrast reaction and providespost procedural instructions

None

30 mins

1 hour Radiologynurse

3. Receives claim slip 3.Issues claim slip and instructs tobring the official receipt or claimslip upon claiming the result onspecified date


4.1 Returns to releasingcounter on thescheduled release ofresult and submitsclaim slip.


4.1 Releases x-ray specialprocedure/ct scan result to thepatient.

4.2 Let the patient sign thereleasinglogbook.

None

one

CT Scan:10 days

Mammogram:7 days

2 minutes

Radiology clerk

Radiology clerk

TOTAL None


CT-Scan:10 days and 48 minutes

Mammogram:7 days & 48 minutes

For procedures with contrast:CT-Scan:

10 days and 2 hours and 31minutes

101 | P a g e

16. Issuance of Drugs and MedicinesThe Pharmacy Section dispenses drugs and medicines for hospital clients including out-patients. Anorder of payment form and a valid prescription is required in the availment of medicines.Office/Division: PharmacyClassification: SimpleType of Transaction: G2C – Government to CitizenWho May Avail: Outpatient

CHECKLIST OF REQUIREMENTS WHERE TO SECUREPrescription - (1 copy)Order of Payment / Charge Slip – (1 copy)

Emergency Room/Outpatient DepartmentPharmacy / OPD

Official Receipt /Stamped paid charge slip with OR Number /MSS Stamped Charge Slip Cashier / MSS


PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents Prescriptionand receivesinstructions

1.1 Receives unfilledprescription

1. Checks the completeness andcorrectness of the prescriptionand the medicines.

For unfilled prescription,1.1 Returns prescription if non-

available

None 3 minutes Pharmacist/Pharmacy Clerk

2.a Receives order ofpayment and proceedsto cashier for payment



2.a Issues order of payment anddirects to cashier for paymentof charges

2.b Processes Availment ofmedical Assistance

None

None

2 minutes

17 minutes

Pharmacist/Pharmacy Clerk

MSS

3. Presents order ofpayment and payscorresponding amount

3. Issues official receipt *pleaserefer totable

below forapplicable

fees

20 minutes Cashier

4.1 Presents OfficialReceipt / Stamped paidcharge slip with ORNumber / MSS StampedCharge Slip

4.2 Checks dispensedmedicine and receivesinstruction/s if any

4.1 Receives Official Receipt /Stamped paid charge slip withOR number / MSS Stampedcharge slip

4.2 Dispenses medicine/s andgives instruction/s if any

None

None

2 minutes

3 minutes



TOTAL

*pleaserefer totable

below forapplicable

fees

*Dependson the

discountgiven

30 minutes


= 47 minutes

102 | P a g e


LAWAAN, DAPITAN CITYTELEFAX: (065) 213-6421Website: www.djrmh.doh.gov.ph

Email: [email protected] of Drugs and Medicines

as of June 30, 2020

DEPARTMENT OF HEALTHDR. JOSE RIZAL MEMORIAL

HOSPITALLAWAAN, DAPITAN CITYTELEFAX: (065) 213-6421Website: www.djrmh.doh.gov.ph

Email: [email protected] of Drugs and Medicines

as of June 30, 2020

DRUGS AND MEDICINES DESCRIPTION UNITCOST DRUGS AND MEDICINES DESCRIPTION UNIT

COSTACETYLCYSTEINE 100 mg sachet 11.70 ATENOLOL 50MG TABLET 3.90

100 mg sachet 13.00 ATORVASTATIN 10MG TABLET 3.90

600 mg TABLET 32.50 ASCORBIC ACID 500MG TABLET 2.50

23.40 ASCORBIC ACID 250MG/5ML 50.70

ADENOSINE 3MG/ML, 2ML AMP 3,380.00 ASPIRIN 80MG TAB (in-patient only) 0.70

3mg/ml, 2ml vial 298.10 ATROPINE SULFATE 1MG/ML(ATROPAN) 9.85

ALLOPURINOL 300 mg TABLET 4.20 AZITHROMYCIN 500MG VIAL 381.45

AMLODIPINE 5MG TAB 0.55 500MG TABLET 19.75

0.50 14.00

AMIKACIN 50MG/ML, 2ML VIAL 29.70 200MG/5ML, 15ML 372.65

AMINO ACID + SORBITOL 500ML BOTTLE 592.80 BENZYLPENICILLIN 1,000,000 IU 6.75

AMINOPHYLLINE 25MG/10ML AMP 17.45 BIPHASIC ISOPHANE HUMANINSULIN 70/30 115.70

AMOXICILLIN 500 mg CAPSULE 1.80 BISACODYL 5MG TABLET 12.35

250MG/5ML 49.40 10MGSUPPOSITORY 24.45

AMPICILLIN 250MG VIAL 10.80 BIPERIDEN 2MG TABLET 6.15

500 mg VIAL 10.10 BUDESONIDE 250MCG/ML, 2ML 65.00

AMPICILLIN + SULBACTAM 750MG VIAL 27.15 BUDESONIDE+FORMOTEROL 160MCG + 4.5MCG 1,281.35

1.5G VIAL 60.95 BUTAMIRATE 50MG MR TABLET 20.80

ANTI-RABIES IMMUNOGLOBULIN 200 IU, 5ML VIAL 1,180.40 BUPIVACAINE 0.5% (Plain) 10ml 812.50

ANTI-RABIES VACCINE 1,220.70 BUTORPHANOL 2MG/ML, 1ML 552.50

CALCIUM GLUCONATE 10%, 10 ml VIAL 22.40 CHLORAMPHENICOL 1G VIAL 35.55

CARBOPROST 125mcg/0.5ml amp 292.50 CINNARIZINE 25MG TABLET 1.60

250mcg/ml, 1ml amp 403.00 CIPROFLOXACIN 500mg tablet 1.60

CARVEDILOL 6.25MG TABLET 1.45 CLARITHROMYCIN 500mg tablet 16.95

CEFAZOLIN 1G 21.00 250MG/5ML 218.40

CEFIXIME 200MG CAPSULE 10.00 CLINDAMYCIN 150MG/ML, 4MLAMP 130.00

CEFOXITIN 1G VIAL (in-patient only) 309.40 CLONIDINE 75MCG TAB 7.70

CEFOTAXIME 500MG VIAL 61.65 CLOPIDOGREL 75MG TABLET 1.35

CEFUROXIME 500MG TABLET 11.50 CLOXACILLIN 500MG capsule 4.20

750 mg VIAL 24.55 CLOZAPINE 100MG TABLET 9.75

250mg/5ml suspension 260.00 CO-AMOXICLAV 400MG/57MG PER5ML, 70ML 299.00

CEFTAZIDIME 1G VIAL 61.10 625MG TABLET 10.10

CEFTRIAXONE 1GM VIAL 21.35 D5 0.3 NaCl 500 ml 60.80

CETIRIZINE 10MG TABLET 0.50 D5 0.9 NaCL 1L 63.40

10mg/ml oral drops 85.25 D5 IMB 500ML 60.80

103 | P a g e

97.50 D5 LR 1 L BOTTLE 44.05

5mg/5ml, 60ml 79.30 500 ML 62.20 / 42.05

101.40 D5 NM 1 L 63.40

D5 NSS 1 L 63.40 ENALAPRIL 5MG TABLET 5.85

D5 WATER 250 ML 57.60 ENOXAPARIN 0.6 ML 344.20

500 ML 34.20 EPERISONE 50MG TABLET 15.60

D10 WATER 500ML 63.40 ERYTHROPOIETIN 4, 000 IU 325.00

D50 WATER 50 ML 49.40 FENTANYL 50 mcg/ml, 2 mlAMP 97.30

DIGOXIN 250 MCG TABLET 4.95 76.55

250MCG/ML, 2ML 147.50 FENOFIBRATE 200MG CAPSULE 34.80

DIAZEPAM 5 mg/ml, 2 ml AMPULE 107.60 160MG TABLET 36.40

DIPHENHYDRAMINE 50MG/ML, 1ML 39.10 FERROUS SULFATE 325MG TABLET 3.25

DIVALPROEX SODIUM 250MG TABLET 35.75 FLUTICASONE + SALMETEROL 125MCG+25MCG X120 ACTUATION 310.70

DEXAMETHASONE 4MG/ML, 2ML 21.20 250MCG+25MCG X120 ACTUATION 464.10

18.60 FLUPENTIXOL 20MG/ML, 1MLAMP 520.00

DOBUTAMINE 50 mg/ml, 5 ml AMPULE 325.00 FUROSEMIDE 10 mg/ml, 2mlAMPULE 9.20

DOMPERIDONE 1mg/ml, 60ml SYRUP 118.30 GABAPENTIN 300 mg CAPSULE 7.70

10 mg TABLET 1.95 GLICLAZIDE 60 mg TABLET 19.60

DOPAMINE 40 mg/ml, 5 ml AMPULE 50.50 14.30

61.65 80 mg TABLET 4.25

47.20 GENTAMICIN 40 mg/ml(80mg/2ml) AMP 5.45

HALOPERIDOL 5MG TABLET 4.20 IOHEXOL 300MG/ML, 50MLVIAL 1,417.00

5MG/ML, 1ML 585.00 350mg/ml, 50mlvial 1,882.40

HEPATITIS B IMMUNOGLOBULIN 0.5 ml VIAL 1,886.30 IOPRAMIDE 300MG/ML, 50ML 1,051.05HUMAN TETANUS

IMMUNOGLOBULIN 250 IU pre-filled syringe 845.00 370MG/ML, 50ML 1,716.00

HUMAN ALBUMIN 20%, 50ML 2,038.95 ISOXSUPRINE 5MG/ML AMP 365.30

HYDRALAZINE 20MG/ML, 1ML AMP 31.75 KETAMINE (YellowPrescription)

50 mg/ml, 10 mlVIAL (ETAMINE) 784.30

HYDROCORTISONE 100MG VIAL 23.65 KETOROLAC 30MG/ML , 1ML 19.75

250MG VIAL 67.40 LAMOTRIGINE 100MG TABLET 35.10

HYDROXYETHYL STARCH 500ML BOTTLE 479.70 18.20

HYOSCINE N-BUTYL BROMIDE 10MG TABLET 4.40 LACTULOSE 3.3G/5ML 247.00

20 MG/ML AMPULE 27.15 LEVETIRACETAM 500MG TABLET 17.55

IMATINIB MESILATE 100MG TABLET 104.00 LEVOFLOXACIN 50mg tab 6.50

ISOSORBIDE MONONITRATE 60 mg TABLET SR 7.80 5MG/ML, 100MLVIAL 132.40

30MG TABLET 9.75 LIDOCAINE 20MG/12.5 MCG,1.8ML CARPULE 51.35

IRBESARTAN 150MG TABLET 4.00 2% 50ML VIAL 61.75

5.00 LORATADINE 10MG TAB 2.15

300 MG TABLET 13.00 MAGNESIUM SULFATE250 mg/mL

AMPULE(replacement)

23.40

IRON SUCROSE 20MG/ML, 5MLAMPULE 148.60 MANNITOL 500ML BOTTLE 85.50

IODIXANOL 625MG/ML, 50ML 3,136.50 MEFENAMIC ACID 500MG CAPSULE 2.60

METHIMAZOLE 5MG TABLET 2.45 OXACILLIN 500MG VIAL 23.25

104 | P a g e

METFORMIN 500MG TABLET 0.60 OXYTOCIN 10 IU/ml AMPULE 9.40

METOCLOPRAMIDE 5MG/2ML AMP 4.00 PARACETAMOL 500MG TABLET 1.30

METRONIDAZOLE 500MG TABLET 3.70 1.95

5MG/ML, 100ML VIAL 16.75 125MG/5ML, 60ML 28.60MONOBASIC SODIUM ( fleet

enema) BOTTLE 281.45 250MG/5ML, 60ML 63.70

MONTELUKAST 5MG TABLET ( in patientonly) 10.40 100MG/ML, 15ML 65.00

(ORAL DROPS)

10MG TABLET 9.85 PLAIN NSS 1 L 41.85

MULTIVITAMINS 60ML SYRUP 58.50 50 ML BOTTLE 24.35

CAPSULE 5.20 PLAIN NSS IRRIGATION 1L BOTTLE 57.75

NALBUPHINE 10MG/ML, 1ML AMP 70.60 PLAIN LR 1 L 57.75

NALOXONE 400MCG/ML AMP 340.85 49.20

NEOSTIGMINE 0.5MG/ML, 1ML AMP 383.50 PHYTOMENADIONE 10MG/ML, 1MLAMP 39.00

NICARDIPINE 1MG/10ML (replacement) 361.95 POTASSIUM CHLORIDE 750 MG TABLET 14.30

NOREPINEPHRINE 10MG/10ML(replacement) 1,235.00 PIPERACILLIN + TAZOBACTAM 4.5G VIAL 152.75

OMEPRAZOLE 40MG CAPSULE 4.40 2.25GM VIAL 92.60

ONDANSETRON 2MG/ML, 4ML AMP(Replacement) 100.65 PROPOFOL 10MG/ML, 20ML

AMP 70.75

ORAL REHYDRATION SALT 20.5 grams SACHET 5.80 QUETIAPINE 100MG TABLET 58.50

QUETIAPINE 200MG TABLET 44.85 SUXAMETHONIUM 20MG/ML, 10MLVIAL 160.35

300MG TABLET 65.00 TAMOXIFEN 20 mg TABLET 9.10

RANITIDINE 25mg/ML, 2ML AMPULE 4.30 TETANUS TOXOID 0.5 ML 37.40RABIES IMMUNOGLOBIN

(HUMAN) 150 IU/ml, 2ml vial 4,420.00 TRAMADOL 50MG CAPSULE 5.75

RIFAXIMIN 200MG TABLET 82.15 50 mg/ml, 1 mlAMPULE 10.90

RISPERIDONE 2MG TABLET 4.35 TRANEXAMIC ACID 100 mg/ml, 5 mlAMPULE 17.15

3.70 VERAPAMIL 2.5MG/ML 1,115.75

SALBUTAMOL 2MG/5ML, 60ML SYRUP 52.00 VITAMIN B COMPLEX 100MG/5MG/50MCG TABLET 3.25

SALBUTAMOL + IPRATROPIUM 2.5MG + 500MCG per2.5ml 29.90 ZINC SULFATE 27.5MG/5ML

(ORAL DROPS) 49.40

SEVOFLURANE 250ML BOTTLE 6,485.95

SILVER SULFADIAZINE 500 grams 300.00 /1,157.00

SODIUM BICARBONATE 84MG/ML, 20 MLAMPULE 234.00

SODIUM VALPROATE + VALPROICACID 500MG TABLET 20.15

STERILE WATER FOR INJECTION 50 ML 22.05

105 | P a g e

17. Issuance of Duplicated Copies of Health RecordsThis service involves photocopying and releasing of health records like laboratory/diagnostic results,records of operations, medical abstract, discharge summary and issued certificates

Next of kin refers to the following: parents, children, and sibling/s.Office or Division: Health Information Management ServiceClassification: SimpleType of Transaction: G2C – Government to ClientWho may avail: Spouse and next of kin of the deceased or their Authorized Representative

PatientNext of kin/ Authorized RepresentativeCourts and Administrative bodies exercising quasi-judicial and/orinvestigative function

CHECKLIST OF REQUIREMENTS WHERE TO SECUREPrimary requirements for principal:1. Request Form2.One (1) photocopy valid ID, any of the following: government issued IDs such as GSIS, SSS,

Pag-ibig, Driver’s License, Passport, Voter’sIDs, PHIC ID, TIN, Postal)

Cedula Student ID Company ID

3.Official Receipt/Stamped Paid/MSS StampedCharge Slip or its equivalent4. Hospital card (inpatient)

HIMGSIS, SSS, PagIbig, LTO, DFA, LGU, BIR,PhilHealth, PHLPost, COMELEC, School andconcerned company of the requesting party

Cashier

Admitting SectionAuthorized Representative:1. Request Form2. One (1) photocopy of valid ID of the principaland authorized representative, any of the following: Government issued IDs such as GSIS, SSS,

Pag-ibig, Driver’s License, Passport, Voter’sIDs, PHIC ID, TIN, Postal)


3.Official Receipt/Stamped Paid/MSS StampedCharge Slip or its equivalent4. Authorization letter/Special Power of Attorney,Affidavit of guardianship (for minor with no next ofkin)


Cashier/MSS

Requesting party (patient/principal)


PROCESSINGTIME

PERSONRESPONSIBLE

1.1 Secures prioritynumber

1.2 Presents requirementsand Undertakesinterview

1.1Receives prioritynumber andreceives requestform

1.2 Evaluatesrequirements andinterviews the client

None

None

2 minutes

13 minutes

HIM Staff

HIM Staff

106 | P a g e

2. Receives charge slipand proceeds tocashier for payment

2.1 Issues charge slip anddirects to cashier forpayment of charges

2.2 Retrieves patient’schart

None

None

2 minutes

15 minutes

HIM Staff

HIM Staff

3. Presents charge slip andpays correspondingamount

3. Issues official receipt Php2.00/copy 20 minutes Cashier

4.1 Returns to HealthInformationManagement Officeand presents Stampedpaid chargeslip with OR Number /MSS Stamped ChargeSlip

4.2 Receives thephotocopied healthrecord/s

4.1 Receives stampedpaid charge slipwith OR number /

MSS Stamped chargeslip then photocopy the

requested healthrecord/s

4.2 Releases thephotocopiedhealth record/s

None

None

15 minutes

3 minutes

HIM Staff

HIM Staff

TOTAL Php 2.00/copy 1 hour and 10 minutes

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18. Issuance of Unregistered Death CertificateThis service involves processing and releasing of unregistered Death Certificate (for Inpatient &Emergency Room, except for Dead on Arrival). Further, this service is necessary for the registration ofDeath Certificate at the Local Civil Registry.

Next of kin refers to the following: parents, children, and sibling/s.Office or Division: Health Information Management ServiceClassification: SimpleType of Transaction: G2C – Government to ClientWho may avail: Spouse and next of kin of the deceased or their Authorized

RepresentativeCHECKLIST OF REQUIREMENTS WHERE TO SECURE

Primary requirements for principal:1. Request Form2.One (1) photocopy valid ID, any of the following: government issued IDs such as GSIS, SSS, Pag-

ibig, Driver’s License, Passport, Voter’s IDs, PHICID, TIN, Postal)


3. Official Receipt/Stamped Paid/MSS Stamped ChargeSlip or its equivalent4. Marriage Certificate (spouse) or Birth Certificate (next ofkin)5. Notarized Waiver Form6. Claim Stub

- HIM

- GSIS, SSS, PagIbig, LTO, DFA, LGU,BIR, PhilHealth, PHLPost,COMELEC, School and concernedcompany of the requesting party

- Cashier/MSS

- PSA

- HIM/PAO- HIM

Authorized Representative:1. Request Form2.Photocopy of one (1) valid ID of the principal andauthorized representative, any of the following: government issued IDs such as GSIS, SSS, Pag-



3.Official Receipt or MSS Note/Form or its equivalent4. Marriage Certificate (spouse) or Birth Certificate (nextof kin)5.Authorization letter /Special Power of Attorney6. Notarized Waiver Form7. Claim Stub

HIMGSIS, SSS, PagIbig, LTO, DFA, LGU,BIR, PhilHealth, PHLPost, COMELEC,School and concerned company of therequesting party

Cashier/MSSPSA

Next of kinHIM/PAOHIM


TOBE

PAID

PROCESSINGTIME

PERSONRESPONSIBLE

1.1 Secures priority numberand presents request

1.1 Receives priority numberand receives request

None 2 minutes HIM Staff

108 | P a g e

form


form

1.2 Evaluates requirementsand interviews the client

None 13 minutes HIM Staff

2. Receives charge slip andproceeds to cashier andpays correspondingamount

2.1 Issues charge slip anddirects to cashier for paymentof charges

2.2 Retrieves patient’s chart andvalidates the entries DeathCertificate Draft

None

None

2 minutes

15 minutes

HIM Staff

HIM Staff



20 minutes Cashier

4.1 Returns to HealthInformationManagement Office andpresents Stamped paidcharge slip with ORNumber / MSS StampedCharge Slip thenvalidates entries andreceives claim stub andinstruction/s if any

4.2 Presents Claim Stuband signs the releasinglogbook

4.3 Receives the unregisteredDeath Certificate

4.1 Receives stamped paidcharge slip with OR number /MSS Stamped charge slipthen prepares the BirthCertificate then gives claimstub and instruction/s if any

4.2 Receives claim stub andinstructs client to sign thelogbook

4.3 Releases the unregisteredDeath Certificate

None

None

None

2 days

2 minutes

3 minutes

HIM Staff

HIM Staff

HIM Staff

TOTAL Php50.00 2 days and 57 minutes

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19. Issuance of Various Certificates and Completed Insurance FormsThis service involves processing and releasing of Medical Certificate/Certificate of ConfinementCertificate/Medico-Legal Certifications, other Certificationsand Insurance Forms/Physician’s Statementthat will be issued for the patients in this hospital.

Next of kin refers to the following: spouse, parents, children, and sibling/s.Office or Division: Health Information Management ServiceClassification: SimpleType of Transaction: G2C – Government to Citizen and G2G – Government to GovernmentWho may avail: Patient

Next of kin/ Authorized RepresentativeCourts and Administrative bodies exercising quasi-judicial and/orinvestigative function

CHECKLIST OF REQUIREMENTS WHERE TO SECUREPrimary requirements for principal:1. Request Form2.One (1) photocopy valid ID, any of the following: government issued IDs such as GSIS, SSS,

Pag-ibig, Driver’s License, Passport, Voter’s IDs,PHIC ID, TIN, Postal)


3.Official Receipt/Stamped Paid/MSS StampedCharge Slip or its equivalent4. Hospital card (for inpatient)5. Court Order/ Police Request indicating the name ofthe authorized claimant(For Medico-Legal Certificates)6. Insurance form (for Insurance claims only)7. Claim Stub

HIM

GSIS, SSS, PagIbig, LTO, DFA, LGU, BIR,PhilHealth, PHLPost, COMELEC, School andconcerned company of the requesting party

Cashier

Admitting SectionClerk of Court/Presiding Judge, PNP, NBIand enforcement agencies

Insurance OfficeHIM

Authorized Representative:1. Request Form2. One (1) photocopy of valid ID of the principal andauthorized representative, any of the following: Government issued IDs such as GSIS, SSS,

Pag-ibig, Driver’s License, Passport, Voter’s IDs,PHIC ID, TIN, Postal)


3.Official Receipt/Stamped Paid/MSS StampedCharge Slip or its equivalent4. Court Order/ Police Request indicating the name ofthe authorized claimant(for Medico-Legal Certificates)5. Authorization letter/Special Power of Attorney,Affidavit of guardianship(for minor with no next of kin)6. Insurance form (for Insurance claims only)


Cashier/MSS

Clerk of Court, PNP, NBI and enforcementagencies

Requesting party (patient/principal)

110 | P a g e

7. Claim Stub Insurance OfficeHIM


PROCESSINGTIME

PERSONRESPONSIBLE

1.1 Secures prioritynumber and fillsout request form


1.1 Receives priority numberand provides RequestForm

1.2 Evaluates requirementsandinterviews the client

None

None

2 minutes

5 minutes

HIM Staff

HIM Staff


2.a.1 Issues charge slip anddirects to cashier forpayment of charges

2.a.2 Retrieves patient’s chart

None

None

2 minutes

8 minutes

HIM Staff

HIM Staff3. Presents charge slip

and payscorresponding amount

3. Issues official receiptA. Medical Certificates/Certificate of Confinement/

Other CertificationB. Medico-Legal Certificate

C. Completed InsuranceForms

Php 30.00

Php50.00

Php150.00

20 minutes Cashier

4.1 Returns to HealthInformationManagementOffice(based on theindicated schedule)and presentsStamped paid chargeslip with OR Number

4.2 Receives claim stuband instruction/s if any

4.1Receives stamped paidcharge slip with ORnumber and prepares theCertifications:

A. Medical Certificates/Certificate of Confinement

B. Medico-Legal Certificate/Other Certificates/Insurance Claims

4.2 Gives claim stub andinstruction/s if any

None

None

None

6 hours

2 days

2 minutes

HIM Staff

HIM Staff

HIM Staff

5.1 Presents Claim Stuband Signs the hospitalcopy of requestedcertificate

5.2 Receives therequested certificate

5.1 Receives claim stub andInstructs client to sign thehospital copy of therequested certificate

5.2 Releases therequestedcertificates

For MedicalCertificates/Certificate ofConfinement

*For request made at 8:00 AMto 11:00 AM: releasing willbe during 1:00 PM to 5:00PM

*For request made at 11:01 AMto 5:00 PM : releasing will beon the next working day perHospital Order No. 405 s.2018

None

None

2 minutes

2 minutes

HIM Staff

HIM Staff

111 | P a g e

TOTAL

MedicalCertificates/Certificate ofConfinement

OtherCertificationPhp 30.00

Medico-Legal

CertificatePhp50.00

CompletedInsurance

FormsPhp 150.00

For Medical Certificates/Certificateof Confinement

6 hours and 43 minutes

For Medico-Legal Certificate/OtherCertificates/Completed Insurance

Form2 days and 43 minutes

112 | P a g e

20. Processing for Payment of Radiology Services – ForSpecial Procedures

Radiology services for Out-Patient provides best quality radiographic images and accurate diagnosticreading using the state of the art high end imaging machines ensuring utmost safety and qualityservice to our clients. This service only includes the following special procedures: 1) X-ray SpecialProcedure 2) CT Scan 3) Ultrasound 4) 2D Echo 5)MammogramOffice/Division: Radiology and Imaging Section - OPDClassification: SimpleType of Transaction: Government-to-CitizenWho May Avail: Patients (Out-patient and Walk-In patients)

CHECKLIST OF REQUIREMENTS WHERE TO SECURERequest Form Requesting PhysicianCharge Slip Radiology ClerkOfficial Receipt for paid procedure CashierMSS Approval/ Acknowledgment (if applicable) Medical Social Worker


PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents properly filledup X-Ray/CT Scan/Ultrasound/2DEcho/Mammogramrequest form byattending physician.

1. Receives patient’s X-Ray/CTScan/Ultrasound/2D Echo/Mammogram request form


For x-ray specialprocedure & CT Scan

2.a.1 Submits self toInterview andEvaluation

2.a.2 Signs patient’sconsent, receivesschedule andpreparations

For Ultrasound, 2D Echo& Mammogram

2.b Receives schedule andinstruction on thepreparation of theprocedure

2.a.1 Confirms appropriateness ofdata of the requestedprocedure and reviews historyof patient. Creatinine check.

2.a.2 Secures patient’s consentand gives schedule andinstructs on the preparation ofthe procedure. Verifies the lastmenstrual period (if femaleclient).

2.b Confirms appropriateness ofdata, gives schedule andinstructs on the preparation ofthe procedure. Verifies the lastmenstrual period (for pelvic,TVS ultrasound &mammogram).

None

None

None

15 minutes

10 minutes

10 minutes

Radiologist



2D EchoTechnologist


3.a Issues charge slip and directsto cashier for payment ofcharges


113 | P a g e



3.b Processes Availment ofmedical Assistance

None 17 minutes MSS Staff


4. Issues Official Receipt Pleaserefer to

approvedscheduleof fees

20 minutes Cashier

5. Receives instruction onthe schedule of theprocedure

5. Instructs patient to come backon specified date of scheduleof the procedure

None 2 minutes Radiology clerk/Radiologic

Technologist

TOTAL

Pleaserefer to

approvedschedule of

fees

*If patientwill avail

formedical

assistanceAmount

paiddependson the

discountavailed

X-Ray Special Procedure &CT-Scan:52 minutes

Ultrasound, 2D Echo &Mammogram:

37 minutes


X-Ray Special Procedure &CT-Scan:


Ultrasound, 2D Echo &Mammogram:

54 minutes

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DEPARTMENT OF HEALTHDR. JOSE RIZAL MEMORIAL HOSPITALL A W A A N , D A P I T A N C I T YT E L E F A X : ( 0 6 5 ) 2 1 3 - 6 4 2 1Website: www.djrmh.doh.gov.phEmail: [email protected]

Pricelist of Special Procedures(Ultrasound, X-ray Special Procedures, 2D Echo,Mammogram, CT Scan)as of June 30, 2020

PROCEDURE PRICE2D Echo with Doppler 3,500.002D Echo Scan 2,500.00WHOLE ABDOMEN 1,400.00WHOLE ABDOMEN WITH PELVIC 1,500.00WHOLE ABDOMEN WITH PROSTATE 1,500.00UPPER ABDOMEN 1,000.00LOWER ABDOMEN 1,000.00KUB 1,000.00KUBP 1,200.00CHEST 900.00CHEST WITH MARKINGS 1,000.00NECK 1,000.00THYROID 900.00BREAST 900.00CRANIAL 800.00INGUINAL 800.00SCROTAL 900.00PROSTATE TRUS 900.00PROSTATE TAS 800.00SINGLE ORGAN 800.00SOFT TISSUE SUPERFICIAL 800.00DOPPLER UPPER EXTREMITY (SINGLE) 3,200.00DOPPLER UPPER EXTREMITY (BOTH) 6,000.00DOPPLER LOWER EXTREMITY (SINGLE) 3,200.00DOPPLER LOWER EXTREMITY (BOTH) 6,000.00DOPPLER CAROTID (SINGLE) 3,200.00DOPPLER CAROTID (BOTH) 6,000.00INTERVENTIONALUTZ GUIDED DRAINAGE 8,200.00UTZ GUIDED BIOPSY 8,200.00GYNEPELVIC TAS 800.00TRANSVIGANAL (TVS) 850.00PELVIC TRUS 950.00

115 | P a g e

TRANSVIGANAL (TVS) DOPPLER 1,000.00PELVIC TAS 3D 1,200.00HYSTEROSALPINGOSONOGRAPHY 5,000.00OBPELVIC TAS 900.00TRANSVAGINAL (TVS) 950.00TRANSVAGINAL (TVS) 3D 1,500.00PELVIC PBS 1,200.00BPS - DOPPLER FETAL/MATERIAL 2,200.00PELVIC CAS 2,000.00PELVIC AFI ONLY 500.00SINGLETON 3D 2,700.00SINGLETON 4D 3,200.00TWIN 3D 3,200.00TWIN 4D 3,700.00TWIN CAS 3,000.00TRIPLET 3D 3,700.00TRIPLET 4D 4,200.00DOPPLER TWIN 5,000.00Cranial plain 3,600.00Cranial w/ contrast excluding dye and kit 4,000.00Cranio-facial plain 4,300.00Cranio-facial plain w/ contrast excluding dye andkit

4,800.00

Facial plain 3,600.00Facial w/ contrast excluding dye and kit 4,000.00Whole abdomen 4,300.00Whole abdomen w/ contrast excluding dye and kit 4,800.00Upper abdomen plain 4,000.00Upper abdomen w/ contrast excluding dye and kit 4,200.00Lower abdomen 4,000.00Lower abdomen w/ contrast excluding dye and kit 4,000.00Triphasic liver scan 5,800.00Chest plain 5,800.00Chest w/ contrast excluding dye and kit 3,900.00Neck plain 4,400.00Neck w/ contrast excluding dye and kit 3,750.00Pelvis plain 4,300.00Pelvis w/ contrast excluding dye and kit 4,000.00Spine (cervical/thoracic/lumbar) 4,300.00Spine (cervical/thoracic/lumbar) w/ contrastexcluding dye and kit

4,500.00

Mastoids 3,900.00Nasopharynx 3,900.00Nasopharynx w/ contrast excluding dye and kit 4,400.00Paranasal sinuses plain 3,900.00Paranasal sinuses w/ contrast excluding dye andkit

4,500.00

116 | P a g e

Pituitary gland 4,300.00Pituitary gland w/ contrast excluding dye and kit 4,800.00Temporal bone 3,875.00Stonogram 4,300.00Joints 3,875.00Single organ 3,875.00Screening sinus 3,600.00Ct angiography 6,300.00Extremities plain 4,300.00Extremities w/ contrast excluding dye and kit 4,500.00Orbit 3,900.00Sella tursica plain 3,900.00Sella tursica w/ contrast excluding dye and kit 4,300.00

117 | P a g e

21. Processing of Unregistered Certificate of Live BirthThis service involves processing and/or issuance of unregistered Certificate of Live Birth. Further, thisservice is necessary for the registration of Certificate of Live Birth at the Local Civil Registry.Office or Division: Health Information Management ServiceClassification: SimpleType of Transaction: G2C – Government to Client

Who may avail: ParentsAuthorized Representative

CHECKLIST OF REQUIREMENTS WHERE TO SECUREPrimary requirements for principal:1. Pink Card and Request Form2.One (1) photocopy of valid ID, any of the following: government issued IDs such as GSIS, SSS, Pag-



3. Official Receipt/Stamped Paid/MSS Stamped ChargeSlip or its equivalent4. Marriage Certificate (for married) or Certificate of LiveBirth for mother (for unmarried/minor) Affidavit ofguardianship (for minor with no parents)5. Notarized Waiver Form (For personal submission ofCertificate of Live Birth to LCR)6. Claim Stub

HIM/Delivery Room

GSIS, SSS, PagIbig, LTO, DFA, LGU, BIR,PhilHealth, PHLPost, COMELEC, Schooland concerned company of the requestingparty

Cashier/MSS

PSA/Local Civil Registry/ DSWD

HIM/PAO

HIMAuthorized Representative:1. Pink card and Request Form2. One (1) photocopy of valid ID of the principal andauthorized representative, any of the following: government issued IDs such as GSIS, SSS, Pag-



3. Official Receipt/Stamped Paid/MSS Stamped ChargeSlip or its equivalent4. Marriage Certificate (for married) or Certificate of LiveBirth for mother (for unmarried/minor) Affidavit ofguardianship (for minor with no parents)5. Notarized Waiver Form (For personal submission ofCertificate of Live Birth to LCR)

6. Authorization letter/Special Power of Attorney, Affidavitof guardianship (for minor with no next of kin)7.Claim Stub

HIM/Delivery RoomGSIS, SSS, PagIbig, LTO, DFA, LGU, BIR,PhilHealth, PHLPost, COMELEC, Schooland concerned company of the requestingparty

Cashier/MSS

PSA/Local Civil Registry/DSWD

HIM/PAO

Parent (mother or father)

HIM


PROCESSINGTIME

PERSONRESPONSIBLE

118 | P a g e

1.1 Secures prioritynumber andrequest form.


1.1 Receives prioritynumber and requestform.

1.2 Evaluates requirementsand interviews the client

None

None

2 minutes

13 minutes

HIM Staff

HIM Staff

2. Receives charge slipand proceeds tocashier and payscorresponding amount

2.1 Issues charge slip anddirects to cashier forpayment of charges

2.2 Retrieves patient’s BirthCertificate (Draft)

None

None

2 minutes

8 minutes

HIM Staff

HIM Staff

3. Presents charge slip andpays for correspondingamount


20 minutes Cashier

For hospital submissionof Certificate of LiveBirth to LCR

4.a Returns to HealthInformationManagement Officeand presents Stampedpaid charge slip withOR Number / MSSStamped Charge Slip

4.a.1 Reviews thecorrectness of entriesat the birth certificatedraft and receivesinstruction/s if any

For personal submissionof Certificate of LiveBirth to LCR

4.b Returns to HealthInformationManagement Officeand presents Stampedpaid charge slip withOR Number / MSSStamped Charge Slipthen validates entriesand receives claim stuband instruction/s if any

4.b.1 Presents Claim Stuband receives theunregisteredCertificate of Live BirthCertificate

4.a Receives stamped paidcharge slip with OR number /MSS Stamped charge slipand prepares the BirthCertificate

4.a.1 Shows the draft forverification and givesinstruction/s if any

4.b Receives stamped paidcharge slip with OR number /MSS Stamped charge slipthen prepares the BirthCertificate then gives claimstub and instruction/s if any

4.b.1 Receives claim stub andReleases the unregisteredCertificate of Live BirthCertificate

None

None

None

None

20 minutes

5 minutes

2 days

3 minutes

HIM Staff

HIM Staff

HIM Staff

HIM Staff

TOTAL Php50.00

For hospital submission ofCertificate of Live Birth to LCR


For personal submission ofCertificate of Live Birth to LCR

2 days, 1 hour and 13 minutes

119 | P a g e

Internal Services

120 | P a g e

1. Availment of Laboratory Services for In-PatientLaboratory services are sought to assist the clinical management of patients. Various procedureswithin the scope of its license as a secondary laboratory can be availed by In-Patients

Office/Division: Laboratory SectionClassification: SimpleType of Transaction: G2C - Government-to-GovernmentWho May Avail: Nurse on Duty, Nursing Attendant

CHECKLIST OF REQUIREMENTS WHERE TO SECURECompletely Filled up Laboratory Request form – 1 copy WARD / ER


TOBE

PAID

PROCESSINGTIME

PERSONRESPONSIBLE

1. Inputs laboratoryrequest/s to patient’saccount throughiHOMIS

1.1Reviews iHOMIS/Patient’sLaboratory ExaminationMonitoring System andaccepts the request/s

1.2 Proceeds to area wherepatient is admitted

1.3 Extracts/Collects blood

None

None

None

5 minutes

15 minutes

15 minutes

MedicalTechnologist/

Laboratory staff

Phlebotomist

Phlebotomist2. Waits for test result to

be forwarded2. Goes back to the laboratory

and processes sample forexamination and clicksappropriate icons in theiHOMIS to reflect charges inpatient’s hospital bill.

None STATWithin 1 hour

upon receivingthe samples

Routine Tests2 hours

upon receivingthe samples

BloodChemistry:

5 hoursupon receiving

the samples

Med Tech onduty

3. Receives laboratoryresult thru iHOMIS orreceives lab resultsfrom the laboratorystaff

3. Inputs lab results thruiHOMIS or provides lab resultsto the corresponding ward

None 35 minutes Med Tech onduty

SECONDARY Hospital-based Laboratory Availability of Services (Monday to Friday):

8AM to 5PM

ROUTINE TESTS INCLUDES: Complete Blood Count (with Platelet) Urinalysis Fecalysis/ Stool Exam Blood Typing

Routine BloodChemistry FBS/RBS BUN Creatinine Lipid Profile BUA SGPT SGOT

SPECIAL TESTSINCLUDE: Gram Staining KOH HIV Testing HbsAg

121 | P a g e

TOTAL None

STAT2 hours and10 minutes

Routine Tests6 hours and10 minutes

Blood Chemistry3 hours and10 minutes

122 | P a g e

2. Availment of Imaging Services for COVID Related Patients –For X-ray Procedure and Ultrasound

This process shows on how to handle In-Patient clients that came from the Isolation Unit for COVID-19related cases. It takes in from the presentation of x-ray request until the result is release. It onlyincludes X-ray Procedure and Ultrasound.Office/Division: Radiology Department

Classification: SimpleType ofTransaction: Government-to-Citizen

Who May Avail: All In-Patients

CHECKLIST OF REQUIREMENTS WHERE TO SECUREX-ray/Ultrasound Request Form – 1 copy (original) Prescribing Doctor


TOBE

PAID

PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents properly filledout X-Ray/ Ultrasoundrequest form byattending physician

1.Receives patient’s X-Ray/ultrasound request form.

2.1 Checks for completeness ofdata and verifies the lastmenstrual period (if femaleclient).

For ULTRASOUND1.2.a Informs nurse in charge on

the schedule andpreparation

of the patient.For X-RAY1.2.b Proceed to step 2

1.3 Donning of PPE’s and coversultrasound machine/x-raycassette with disposableplastic bag

None

None

None

None

2 minutes

2 minutes

3 minutes

10 minutes





Radiologist

1. 2.1 Accompanies the client2. for x-ray/ultrasound3. procedure

2.2 Receives instructionregarding release ofresult

2.2 Performs the requestedX-Ray/Ultrasound procedure

2.3 Informs the client that theresult will be delivered by theradiology and imaging sectionstaff to the ward.

2.4 Disinfection of X-Ray/ultrasound machine anddoffing of PPE’s

2.5 Generates charges thruiHOMIS for the procedure.

None

None

None

None

30 minutes

2 minutes

30 minutes

2 minutes




Radiologic clerk

123 | P a g e

2.6 Sends radiology images to theassigned Radiologists forinterpretation.

None 5 minutes RadiologicTechnologist

3.1 Nurse in chargereceives the X-rayofficial result.

3.2 Signs the logbook

3.1 Releases results to the ward

3.2 Asks the Nurse in charge tosign in the releasing logbook.

None

None

10 minutes

2 minutes



TOTAL None

X-RAY:1 day, 2 hours &

3 minutes

ULTRASOUND:SIMPLE CASE:

3 hours & 3minutes

COMPLICATEDCASE:1 day,

2 hours &3 minutes

124 | P a g e

3. Availment of CT-Scan Procedure for COVID Related Patients– For CT ScanThis process shows on how to handle In-Patient clients for CT Scan that came from the Isolation Unitfor COVID-19 related cases. This service takes in from the presentation of x-ray request until the resultis release.Office/Division: Radiology Department

Classification: Highly TechnicalType ofTransaction: Government-to-Citizen

Who May Avail: All In-Patients

CHECKLIST OF REQUIREMENTS WHERE TO SECURECT Scan Request Form – 1 copy (original) Prescribing Doctor


TOBE

PAID

PROCESSINGTIME

PERSONRESPONSIBLE

1. Nursing staff bringsproperly filled up CTScan request form byattending physician

1. Receives patient’s CT Scanrequest form.

1.1Confirms appropriatenessof data of the requestedprocedure and reviewhistory of patient. Verifiesthe last menstrual period (iffemale client).

For CT Plain:1.2.a. Proceed to step 2

For CT with Contrast:1.2.b Secures patient’sconsent

and check creatinine.

1.3 Informs nurse in charge onthe schedule andpreparation of the patientand the materialrequirements use for theprocedure.

None

None

None

None

2 minutes

15 minutes

10 minutes

3 minutes

Radiology Clerk

Radiologist



2. Returns on thescheduled date of theprocedure andsubmits materialrequirements

2.Enters patient’s data in thePACS and donning of PPE’s

For CT Plain:2.1.a. Proceed to step 3For procedures withcontrast:

None

None

12 minutes

15 minutes


Radiology

125 | P a g e

2.1.b Prepares patientmaterials/IV line for theprocedure.

Nurse

3.1Submits self for CTScan procedure

3.2Receives instructionregarding release ofresult

3.1 Performs the requestedCT Scan procedure

3.2 Informs the patient thatthe result will bedelivered by the radiologyand imaging section staffto the ward.

3.3 Disinfection of CT Scanmachine and doffing ofPPE’s

3.4 Generates charges thruiHOMIS for theprocedure.

3.5 Sends images to PACSand Assigns it to theRadiologist (FCTMRI)out-sourced

None

None

None

None

None

30 minutes

2 minutes

60 minutes

2 minutes

5 minutes





Utility Staff

Radiologic clerk


4.1Nurse in chargereceives the CT Scanofficial result.

4.2 Signs the logbook

4.1 Releases the CT ScanResult to the ward.

4.2Asks the Nurse in charge tosign in the releasinglogbook.

None

None

10 days

2 minutes



TOTAL: None

CT ScanPlain:

10 days,2 hours & 33

minutes

CT Scan withContrast:10 days, 3

hours& 36 minutes

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FEEDBACK AND COMPLAINTS

FEEDBACK AND COMPLAINTS MECHANISMHow to send feedback Fill-up the client feedback/customer satisfaction form and drop it

at the designated drop box in the frontline offices.How feedbacks are processed Every Friday, the Integrity Management Committee

Chair/Authorized Representative opens the drop box andcomplies and records all feedback submitted.Feedback requiring answers are forwarded to the relevant officesand they are required to answer within three (3) days of thereceipt of the feedback.The answer of the office is then relayed to the citizen.For inquiries and follow-ups, clients may reach the followingcontact details:Telephone No. : (065) 213-6421Email: [email protected]

How to file a complaint Fill-up the client Complaint Form and drop it at the designateddrop box in the frontline offices.Complaints can also be filed via telephone or email. Make sure toprovide the following information:- Name of person being complained- Incident- EvidenceFor inquiries and follow-ups, clients may reach the followingcontact details:Telephone No. : (065) 213-6421Email: [email protected]

How complaints are processed The Integrity Management Committee Chair/AuthorizedRepresentative opens the complaints drop box on a daily basisand evaluates each complaint.Upon evaluation, Integrity Management CommitteeChair/Authorized Representative shall start the investigation andforward the complaint to the relevant office for their explanation.The Integrity Management Committee Chair/AuthorizedRepresentative will create report after the investigation and shallsubmit it to the Head of Agency for appropriate action.The Integrity Management Committee Chair/AuthorizedRepresentative will give the feedback to the client.For inquiries and follow-ups, clients may reach the followingcontact details:Telephone No. : (065) 213-6421Email: [email protected]

Contact Information of CCB, PCC,ARTA

CCB: [email protected]: 0908-8816565 / Tel#: 1-6565

Citizen’s Complaint Center: Hotline: 8888

ARTA: [email protected]: 1-ARTA (2782)

127 | P a g e

LIST OF OFFICES

Office Address Contact InformationOutpatient Department (OPD) Dr. Jose Rizal Memorial

Hospital, Main Building(065) 213-6222/(065) 213-

6421Emergency Room (E.R) Dr. Jose Rizal Memorial


6421Admitting Section Dr. Jose Rizal Memorial


6421Health and InformationManagement (HIM)

Dr. Jose Rizal MemorialHospital, Main Building

(065) 213-6222/(065) 213-6421

Laboratory DJRMH - Satellite PharmacyBuilding - Temporary

(065) 213-6222/(065) 213-6421

Radiology Dr. Jose Rizal MemorialHospital, Main Building

(065) 213-6222/(065) 213-6421

Central Supply Room (CSR) Dr. Jose Rizal MemorialHospital, Main Building

(065) 213-6222/(065) 213-6421

Pharmacy DJRMH OB-High Risk Building- Temporary

(065) 213-6222/(065) 213-6421

Medical Social Service Dr. Jose Rizal MemorialHospital, Main Building

(065) 213-6222/(065) 213-6421

Billing and Claims Dr. Jose Rizal MemorialHospital, Main Building

(065) 213-6222/(065) 213-6421

Cashier Dr. Jose Rizal MemorialHospital, Main Building

(065) 213-6222/(065) 213-6421

Animal Bite Center Dr. Jose Rizal MemorialHospital, Main Building

(065) 213-6222/(065) 213-6421

TB-DOTS Clinic Dr. Jose Rizal MemorialHospital, Main Building

(065) 213-6222/(065) 213-6421

Procurement DJRMH Procurement Office (065) 213-6421Materials and Management Office(MMO)

DJRMH - MMO (065) 213-6421