Escolar Documentos
Profissional Documentos
Cultura Documentos
Province: KALINGA
GENERAL INFORMATION
A. Classification
1. Service Capability
Service capability: Capability of a hospital/other health facility to render administrative, clinical, ancillary and
other services
General:
[ ] Level 1 Hospital
[ ] Level 2 Hospital
[ ] Level 3 Hospital (Teaching/ Training)
Specialty: (Specify)
[ ] Treats a particular disease (Specify):_______________
[ ] Treats a particular organ (Specify):________________
[ ] Treats a particular class of patients (Specify):________
[ X] Others (Specify): PRIMARY CARE FACILITY
WITH BEDS
Trauma Capability:
] Trauma Capable
[ ] Trauma Receiving
2. Nature of Ownership
Government:
[ ] National DOH Retained/ Renationalized
[ X ] Local (Specify):
[ X ] Province
[ ] City
[ ] District
[ ] Municipality
[ ] DND/ DOJ
[ ] State Universities and Colleges (SUCs)
[ ] Others (Specify):_________________
B. Quality Management
Private:
[ ] Single Proprietorship/Partnership/Corp.
[ ] Religious
[ ] Civic Organization
[ ] Foundation
[ ] Others (Specify):________________
Quality Management/ Quality Assurance Program: Organized set of activities designed to demonstrate on-going
assessment of important aspects of patient care and services
Department of Health
BUREAU OF HEALTH FACILITIES AND SERVICES
ANNEX E
A.O. No. 2012-0012
] International Accreditation
] PhilHealth Accreditation
[X ] Basic Participation
[ ] Advanced Participation
[ X ] PHA
C. Bed Capacity/Occupancy
1. Authorized Bed Capacity: 25 beds
Authorized bed: Approved number of beds issued by BHFS, the licensing agency of DOH.
II.
Bed Occupancy Rate: The percentage of inpatient beds occupied over a period of time. It is a measure of the
intensity of hospital resources utilized by in-patients.
Inpatient Service days: Unit of measure denoting the services received by one in-patient in one 24 hour period.
**Inpatient Service days (Bed days) = [(Inpatients remaining at midnight + Total admissions) Total
discharges/deaths) + (number of admissions and discharges on the same day)].
HOSPITAL OPERATIONS
A. Summary of Patients in the Hospital
For each category listed below, please report the total volume of services or procedures performed.
*Inpatient: A patient who stays in a health facility while under treatment.
*Bed day: Bed used for a continuous 24 hours by an inpatient.
Inpatient Care
Number
1,176
1,098
Department of Health
BUREAU OF HEALTH FACILITIES AND SERVICES
ANNEX E
A.O. No. 2012-0012
2,976
35
68
B. Discharges
Kindly accomplish the Type of Service and Total Discharges According to Specialty in the table below.
Type of Accomodation
Type
of
Service
No
of
Pts
Total
Length
of
Stay/
Total
No. of
Days
Stay
Non- Philhealth
Condition on Discharge
H
M
O
Philhealth
Total
Pay
O
W
W
A
R T
/
I
Total
Service
Charity
Pay
Member/
Dependent
60
Deaths
< 48
hrs
Service
Indigent
264
> 48
hrs
Total
Medicine
541
1455
217
217
Obstetrics
Gynecology
Pediatrics
Surgery:
Pedia
99
3
449
165
6
1184
0
0
0
36
3
36
0
Adult
Others,
Specify
TOTAL
1,0
96
80
2,818
1,018
158
80
158
0
0
Total
Newborn
-Pathologic
-Non-Patho
0
80
* R/I Recovered/Improved
H- Home Against Medical Advice
324
Total
Discharges
H A U
4
9
3
493
80
2
439
T- Transferred
A Absconded
U - Unimproved
D Died (died upon admission)
HOS-Stat Report Form
Revision:02
01/22/2014
Page 3 of 14
Department of Health
BUREAU OF HEALTH FACILITIES AND SERVICES
ANNEX E
A.O. No. 2012-0012
Average length of stay: Average number of days each inpatient stays in the hospital for each episode of care.
Number
1.Acute Bronchitis
195
ICD-10 Code
(Individual)
J20.9
2.Acute Gastroenteritis
170
Ao9.9
3.Acute Gastritis
128
K29.1
125
N39.1
89
Jo3.9, Jo6.8
6.Influenza
88
J11.1
7.Hypertension
86
J10.1
67
J18.92
9.Bronchial Asthma
31
J45.90
10.Vertigo
20
R42
Department of Health
BUREAU OF HEALTH FACILITIES AND SERVICES
ANNEX E
A.O. No. 2012-0012
Cause of
Morbidity (Underlying)
Under
1
14
59
10 -14
F M
15 19
F M
20 24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
7
2
176
J20.9
7
7
8
2
8
2
3
6
140
A09.9
127
K29.1
124
N39.0
89
J03.9
4
9
5
7
88
J11.1
86
I10.1
70 &
over
Subtotal
1
0
4
6
3
4
5
4
2
5
3
3
9
2
9
F M
1. Acute Bronchitis
1
7
4 3
2
2
1
1 1 7 4 2 1
8 0
2 1
2 2
1 2 0
1 0 0
2 1 1
3 1
2. Acute
Gastroenteritis
3. Acute Gastritis
1
7
0
8 3 2 3 4 2
6 3
8 3
6 3 1
5 4 1
5 2 7
3 1
4
0 0
1 3 7 5 2 6
5 3
7 3
2 1 4
5 4 6
4. Urinary Tract
Infection
5.Acute
Tonsillitis/Acute
tonsillopharyngitis
6.Influenza
2 6
8 1
3 3
4 2 9
9 1 4
1 1
3
7 5 4 4 2 1
2
1 1 1 9 3 2
3 1 0
1 2
2 2
1 1 0
1 1 1
1 5 1
9
2 1 1
2
0 0 0
0 4
5 0
1 0
0 2 5
3 2 2
0 4 4
7.Hypertension
0 0
2 2 7 5 5 1
5
0 0 0 0 0 0
0 0
1 0
0 2 3
7 1 1
4 8 2
0
Total
ICD-10
CODE/
TABULAR
LIST
Department of Health
BUREAU OF HEALTH FACILITIES AND SERVICES
ANNEX E
A.O. No. 2012-0012
8.Community
Acquired Pneumonia
9.Bronchial Asthma
1
0
0
6 9
0 1 1 0 1 0
0 0
0 0
1 0 0
0 1 0
0 0
4 2 0 0 0 0
0 0
1 0
0 0 2
1 1 1
2 9 1
5
1 5 3
10.Vertigo
0 0
0 0 0 1 0 0
0 0
0 0
0 0 0
2 0 1
2 3 4
3
5
1
6
8
3
4
1
5
1
5
69
J18.92
31
J45.90
23
K42
Kindly accomplish the Ten Leading Causes of Morbidity/Diseases Disaggregated as to Age and Sex in the table below.
Department of Health
BUREAU OF HEALTH FACILITIES AND SERVICES
ANNEX E
A.O. No. 2012-0012
Number
ICD-10 Code
80
O80.9
80
O80.9
n/a
n/a
Number
1,448
2,154
1,911
1,691
645
n/a
141
54
54
Department of Health
BUREAU OF HEALTH FACILITIES AND SERVICES
ANNEX E
A.O. No. 2012-0012
Emergency visits
Number
1,275
674
601
11
Total number of medical imaging tests (all types including x-rays, ultrasound,
CT scans, etc.)
n/a
Total number of laboratory and diagnostic tests (all types, excluding medical
imaging)
4,577
Number
Number
168 (PCB 1)
10
C. Deaths
For each category of death listed below, please report the total number of deaths.
Types of deaths
Number
Total deaths
Department of Health
BUREAU OF HEALTH FACILITIES AND SERVICES
ANNEX E
A.O. No. 2012-0012
Number
ICD-10 Code
(Individual)
I64:I10.1
G96.1, J18.9
3.Cardiopulmonary Arrest secondary to Upper gastrointestinal bleeding secondary to Peptic Ulcer Disease
K92.2; K27.0
I27.9; G96.9
5.
6.
7.
8.
9.
10.
Department of Health
BUREAU OF HEALTH FACILITIES AND SERVICES
ANNEX E
A.O. No. 2012-0012
Kindly accomplish the Ten Leading Causes of Mortality/Deaths Disaggregated as to Age and Sex in the table below.
Cause of
Death (Underlying)
14
F M
59
10 -14
F M
15 19
F M
20 24
25-29
30-34
35-39
40-44
45-49
50-54
M F
55-59
1.
65-69
70 &
over
.Cardiopulmonary
Arrest secondary to
Hypertension, stage
2; to consider
Cardiovascular
Accident
2. Respiratory
60-64
I64:I10.
1
G96.1,
J18.9
3. Cardiopulmonary
Arrest secondary to
Upper gastrointestinal bleeding
secondary to Peptic
Ulcer Disease
Arrest secondary to
Central Nervous
System Infection
Total
Failure;
Community
Acquired
Pneumonia
4. Cardiopulmonary
Subtotal
ICD-10
CODE/
TABULAR
LIST
K92.2;
K27.0
I27.9;
G96.9
Department of Health
BUREAU OF HEALTH FACILITIES AND SERVICES
ANNEX E
A.O. No. 2012-0012
5.
6.
7.
8.
9.
10.
Department of Health
BUREAU OF HEALTH FACILITIES AND SERVICES
ANNEX E
A.O. No. 2012-0012
2. Minor Operation refers to surgical procedures requiring only local anesthesia/ no OR needed, example suturing.
10 Leading Major Operations (excluding Caesarian
Sections)
Number
ICD-10 Code
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Department of Health
BUREAU OF HEALTH FACILITIES AND SERVICES
ANNEX E
A.O. No. 2012-0012
Number
ICD-10 Code
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
III.
Profession/ Position/
Designation
Number
of
permanent
staff
A. Medical
1. Consultants
(indicate One-Peso
consultant)
1.1. Internal Medicine
a. Generalist
b. Cardiologist
c. Endocrinologist
d. GastroEnterologist
e. Pulmonologist
f. Nephrologist
g. Neurologist
h. Others (Specify)
1.2. Obstetrics/
Gynecology (and
subspecialty)
1.3. Pediatrics (and
subspecialty)
1.4. Surgery (and
subspecialty)
1.5. Anesthesiologist
Number of
contractual
staff
Number
of
volunteer
staff
Number of
permanent
staff
Number of
contractual
staff
Active
Rotating or
Visiting/
Affiliate
(For Private
Facilities)
Outsourced
Number
of
volunteer
staff
Department of Health
BUREAU OF HEALTH FACILITIES AND SERVICES
ANNEX E
A.O. No. 2012-0012
1.6. Radiologist
1.7. Pathologist
2. Post-Graduate
Fellows
(Indicate specialty/
subspecialty)
3. Residents
3.1. Internal Medicine
3.2. ObstetrictsGynecology
3.3. Pediatrics
3.4. Surgery
3.5. Others (Specify)
B.
1.
2.
3.
4.
5.
6.
7.
Allied Medical
Nurses
Midwives
Nursing Aides
Nutritionist
Physical Therapist
Pharmacists
Medical
Technologist
8. Dentist
C. Non-Medical
1. Social Workers
2. Medical Records
Officer/ Hospital
Health
Information
Officer with
formal training in
medical records
management
3. Laboratory
Technicians
4. X-Ray Technicians
5. Administrative
Officer
6. Accounting/
Finance Officer
7. General Support
Staff
7
1
5
1
0
1
1
1
0
1
0
1
1
0
14
Department of Health
BUREAU OF HEALTH FACILITIES AND SERVICES
ANNEX E
A.O. No. 2012-0012
(maintenance,
janitorial,
secretarial)
indicate if
outsourced
IV.
EXPENSES
Report all money spent by the facility on each category.
Expenses
Amount in
Pesos
n/a
Total amount spent on medicines funded by the Government of the Philippines (from
any level of government, including the central, provincial and municipal
governments)
809,500
Total amount spent on medical supplies (i.e. syringe, gauze, etc.; exclude
pharmaceuticals)
1,000,000
50,000
Total amount spent on non-medical services (For example: security, food service,
laundry, waste management)
356,000
30,000
20,000
1,185,000.00
V.
REVENUES
Department of Health
BUREAU OF HEALTH FACILITIES AND SERVICES
ANNEX E
A.O. No. 2012-0012
Please report the total revenue this facility collected last year. This includes all monetary resources
acquired by this facility from all sources, and for all purposes.
Revenues
Total amount of money received from the Department of Health
Amount in
Pesos
n/a
None
Total amount of money received from donor agencies (for example JICA, USAID,
and others)
None
None
3,636,431.00
313,994.00
None
Total amount of money received from other sources (PDAF, PCSO, etc.)
none
TOTAL Revenue
P 3,950,425.00
Report Prepared by
Designation/Section/Department
:MILAGROS D. PASTOR
:Chief Nurse
Date: _______
__________________________________________________________________________________________________________
PREPARED BY:
STANDARDS DEVELOPMENT DIVISION (SDD)
BUREAU OF HEALTH FACILITIES AND SERVICES (BHFS)
DEPARTMENT OF HEALTH (DOH)
APPROVED BY:
ATTY. NICOLAS B. LUTERO III, CESO III
ASSISTANT SECRETARY
DOH