PCPAccFrm E-4D1F1 Rev2014

Hospital:

East Avenue Medical Center

Admissions:

OPD Census

Case-load (case census per year) and results of care

Month/Year:

January 2015

ICD 10

1 Rheumatic Heart Disease

2 Hypertension
3 Hypertensive Cardiovascular Disease
4 Ischemic Heart Disease
5 Congestive Heart Failure
6 Essentially Normal
7 Aortic Aneurysm
8 Pulmonary Hypertension
### Valvular Heart Disease
### Venous Insufficiency
### Cardiomyopathy

I09.9
I10.9
I11.9
I25.9
I50.0
Z10.0

TOTAL

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

# of Cases

8
116
57
53
93
25
1
1
5
1
16
376

Enter the place

of census i.e.
Ward, ICU, ER,
or OPD

Enter Total IM
Admisssions
(Patient person
count) for the
Month

1,341

Total IM Admissions:

CARDIOLOGY

Enter the Month

and Year

Enter Name of
Hospital

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
IM cases)
than 1 ff-up
than 1 ff-up/# of
Cases)

0.60%
8.65%
4.25%
3.95%
6.94%
1.86%
0.07%
0.07%
0.37%
0.07%
1.19%
28.04%

0
5
5
4
7
1
0
0
0
0
2
24

0.00%
4.31%
8.77%
7.55%
7.53%
4.00%
0.00%
0.00%
0.00%
0.00%
12.50%
6.38%

Type
Primary
Type the
here
the IC
Diagnosis
here.
code of the
Prim
need
more space
diagnosis
(rows), just inse
before the row o
to maintain the
Manually count
th
calculation
form

number of death p
disease entity fro
your monthly cens
and enter here.

Page 1 of 47

PCPAccFrm E-4D1F1 Rev2014

INFECTIOUS DISEASES

ICD 10

1 Dengue Fever
2 Syphilis
3 Measles
4 Tuberculosis
5 Soft Tissue Infection
6 Leptospirosis
7 Candidiasis
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

A90
A53.0
B05.9

113
1
1
1

TOTAL
We attest to the truthfulness of the above documentation:
Chairman, Dept. of Medicine

# of Cases

119

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
IM cases)
than 1 ff-up
than 1 ff-up/# of
Cases)

0.22%
0.00%
0.00%
8.43%
0.07%
0.07%
0.07%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
8.87%

5
0
0
1

0.00%
#DIV/0!
#DIV/0!
4.42%
0.00%
0.00%
100.00%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
5.04%
Page 2 of 47

PCPAccFrm E-4D1F1 Rev2014

PULMONARY MEDICINE

ICD 10

1 Upper Respiratory Tract Infection

2 Community Acquired Pneumonia
3 Chronic Obstructive Pulmonary Disease
4 Bronchial Asthma
5 Pleural Effusion
6 Allergic Cough
7 Acute Tonsillopharyngitis
8 Pumlonary Fibrosis
9
10
11
12
13
14
15
16
17
18
19

J06.9
J18.9
J44.9
J45.99
J90
R05

TOTAL

GASTROENTEROLOGY

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

# of Cases

52
87
25
32
10
2
20
1

229

ICD 10

# of Cases

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
IM cases)
than 1 ff-up
than 1 ff-up/# of
Cases)

3.88%
6.49%
1.86%
2.39%
0.75%
0.15%
1.49%
0.07%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
17.08%

1
5
2
3
1
0
2
0

1.92%
5.75%
8.00%
9.38%
10.00%
0.00%
10.00%
0.00%

14

6.11%

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
IM cases)
than 1 ff-up
than 1 ff-up/# of
Cases)

Page 3 of 47

PCPAccFrm E-4D1F1 Rev2014

1 Acute Gastroenteritis
### Hepatis B
### Acute Viral Hepatitis

A09.9
B18.1

B19.9

Gastroesophageal Reflux Disease

K21.9

1 Gastrointestinal Bleeding
### Peptic Ulcer without Hemorrhage
### Dyspepsia

K25.0
K29.00
K30.9

Functional Constipation

K59.0

Hemorrhoids

K64.9

Cirrhosis of the Liver

K74.6

Liver Disease

K76.9

Gallbladder and Biliary Tract Diseases

K81.8

Pancreatic Diseases

K85

Hepatitis A

TOTAL

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

7
13
3
26
16
59
15
9
4
29
9
5
2
1

198

0.52%
0.97%
0.22%
1.94%
1.19%
4.40%
1.12%
0.67%
0.30%
2.16%
0.67%
0.37%
0.15%
0.07%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
14.77%

3
1
0
1
2
6
3
0
0
4
0
1
1
0

42.86%
7.69%
0.00%
3.85%
12.50%
10.17%
20.00%
0.00%
0.00%
13.79%
0.00%
20.00%
50.00%
0.00%

22

11.11%

Page 4 of 47

PCPAccFrm E-4D1F1 Rev2014

NEPHROLOGY

ICD 10

1 Urinary Tract Infection

2 Urolithiasis
3 Acute Pyelonephritis
4 Chronic Kidney Disease
5 Nephrotic Syndrome
6 Nephritic Syndrome
7 Uremia
8 Acute Cystitis
9 Electrolyte Imbalance
10
11
12
13
14
15
16
17
18
19
20
21

N39.0
N10
N18.8
N04.9
N00.0
N19
N30.0

TOTAL

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

# of Cases

82
16
3
40
2
5
1
11
1

161

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
IM cases)
than 1 ff-up
than 1 ff-up/# of
Cases)

6.11%
1.19%
0.22%
2.98%
0.15%
0.37%
0.07%
0.82%
0.07%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
12.01%

7
2
0
4
1
0
1
2
0

17

8.54%
12.50%
0.00%
10.00%
50.00%
0.00%
100.00%
18.18%
0.00%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
10.56%

Page 5 of 47

PCPAccFrm E-4D1F1 Rev2014

ENDOCRINOLOGY

ICD 10

### Hyperthyroidism
1 Diabetes Mellitus
2 Hypothyroidism
### DM Foot

E05.9
E11.9
E89.0

Non Toxic Giuter

### Toxic Goiter

TOTAL

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

# of Cases

38
178
8
19
14
6

263

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
IM cases)
than 1 ff-up
than 1 ff-up/# of
Cases)

2.83%
13.27%
0.60%
1.42%
1.04%
0.45%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
19.61%

4
11
0
0
3
0

10.53%
6.18%
0.00%
0.00%
21.43%
0.00%

18

6.84%

Page 6 of 47

PCPAccFrm E-4D1F1 Rev2014

HEMATOLOGY

ICD 10

1 Anemia secondary to Blood Loss

2 Anemia secondary to Chronic Disease
3 Anemia, Nutritional
4 Aplastic Anemia
5 B thalassemia

D62

TOTAL
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
We attest to the truthfulness of the above documentation:
Chairman, Dept. of Medicine

# of Cases

4
1
5
1
1
538

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
IM cases)
than 1 ff-up
than 1 ff-up/# of
Cases)

0.30%
0.07%
0.37%
0.07%
0.07%
40.12%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

1
0
0
0
1
38

25.00%
0.00%
0.00%
0.00%
100.00%
7.06%

Page 7 of 47

PCPAccFrm E-4D1F1 Rev2014

NEUROLOGY

ICD 10

1 Bell's Palsy
2 Benign Paroxysmal Positional Vertigo
3 Headache
4 Cerebrovascular Accident, Hemorrhagic
5 Cerebrovascular Accident, Infarct
6 Seizure Disorder
7 Spinal Cord Compression
8 Parkinson's Disease
9 Anxiety Disorder
10 Cerebral Palsy

G51.0
H81.1
G44.0
I61.9
I63.9
R56.8
G95.2
G20
F41.1
TOTAL

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

# of Cases

5
15
14
12
67
11
2
5
6
1
138

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
IM cases)
than 1 ff-up
than 1 ff-up/# of
Cases)

0.37%
1.12%
1.04%
0.89%
5.00%
0.82%
0.15%
0.37%
0.45%
0.07%
10.29%

1
1
0
1
5
0
0
0
0
0
8

20.00%
6.67%
0.00%
8.33%
7.46%
0.00%
0.00%
0.00%
0.00%
0.00%
5.80%

Page 8 of 47

PCPAccFrm E-4D1F1 Rev2014

ONCOLOGY

ICD 10

1 Tumors of the Gastrointestinal |Tract

2 Breast Mass
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

2
1

TOTAL
We attest to the truthfulness of the above documentation:
Chairman, Dept. of Medicine

# of Cases

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
IM cases)
than 1 ff-up
than 1 ff-up/# of
Cases)

0.15%
0.07%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.22%

1
0

50.00%
0.00%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
33.33%
Page 9 of 47

PCPAccFrm E-4D1F1 Rev2014

DERMATOLOGY

ICD 10

1 Allergic Dermatitis
2 Allergic Rhinitis
### Hypersensitivity Reaction
### Urticaria
### Eczema
###
###
###
###
###
###
###
###
###
###
###
###
###
###
###
###
###
###

L23.9
J30.4
T78.4
T78.3

TOTAL

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

# of Cases

0
18
4
1
1

24

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
IM cases)
than 1 ff-up
than 1 ff-up/# of
Cases)

0.00%
1.34%
0.30%
1.00%
1.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
1.79%

0
0
0
0
0

#DIV/0!
0.00%
0.00%
0.00%
0.00%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
0.00%

Page 10 of 47

PCPAccFrm E-4D1F1 Rev2014

RHEUMATOLOGY

ICD 10

1 Rheumatoid Arthritis
2 Gout
3 Osteoarthritis
4 Toricollis
5 Cervical Spondylosis
1 Costochondritis
2 Hyperuricemia
3 Musculoskeletal Strain
4 Carpal Tunnel Syndrome
5 Scleroderma
6 Systemic Lupus Erythematosus
7 Takayasu Arteritis
8 Plantar Fascitiis
9 Vasculitis
10
11
12
13
14
15
16
17
18
19
20

M06.99
M10
M19.99
M43.62
M47
M94

5
12
40
2
1
23

R79.89
S43.7

TOTAL
We attest to the truthfulness of the above documentation:
Chairman, Dept. of Medicine

# of Cases

50
3
1
2
1
3
1

144

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
IM cases)
than 1 ff-up
than 1 ff-up/# of
Cases)

0.37%
0.89%
2.98%
0.15%
0.07%
1.72%
0.00%
3.73%
0.22%
0.07%
0.15%
0.07%
0.22%
0.07%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
10.74%

0
1
1
1
0
2

0.00%
8.33%
2.50%
50.00%
0.00%
8.70%

2
0
0
1
0
0
0

4.00%
0.00%
0.00%
50.00%
0.00%
0.00%
0.00%

5.56%
Page 11 of 47

PCPAccFrm E-4D1F1 Rev2014

ALLERGOLOGY & IMMUNOLOGY

1 Food Allergy
2 Hypersensitivity Reaction
3 Urticaria
4 Eczema
5 Allergic Cough
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

R05

TOTAL
We attest to the truthfulness of the above documentation:
Chairman, Dept. of Medicine

ICD 10

# of Cases

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
IM cases)
than 1 ff-up
than 1 ff-up/# of
Cases)

0.00%
0.00%
0.00%
0.00%
0.15%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.15%

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
0.00%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
0.00%
Page 12 of 47

PCPAccFrm E-4D1F1 Rev2014

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

Page 13 of 47

PCPAccFrm E-4D1F1 Rev2014

Hospital:

East Avenue Medical Center

Admissions:

OPD Census

Case-load (case census per year) and results of care

Month/Year:

FEBRUARY 2015
879

Total IM Admissions:

CARDIOLOGY

1 Essentially Normal
2 Hypertensive Cardiovascular Disease
3 Hypertension
4 Ischemic Heart Disease
5 Prehypertension
6 Stable Angina
7 Thoracic Aneurysm
8 Rheumatic Heart Disease
9 Venous Insufficiency
10 Mitral Valve Prolapse
11 Hypertensive Heart Disease
12 Congestive Heart Failure
13 Dilated Cardiomyopathy
We attest to the truthfulness of the above documentation:
Chairman, Dept. of Medicine

Enter Name of
Hospital

ICD 10

Z10.0
I11.9
I10.9
I25.9
120.9
I71.9
I09.9
I34.1
I11.9
I50.0
I42.0

# of Cases

Enter the
Month and
Year
Enter Total IM
Admisssions
(Patient person
count) for the
Month

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
IM cases)
than 1 ff-up
than 1 ff-up/# of
Cases)

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

Enter the place

of census i.e.
Ward, ICU, ER,
OPD

Manually coun
disease entity
your monthly c
and enter here

Manually count
number of deat
disease entity f
your monthly c
and enter here

Yellow boxes
automatically
computed from
entered in the
boxes. DO NOT
ANYTHING ON
YELLOW BOXE

Type the Prima

Diagnosis here
need more spa
(rows), just in
before
row
Page 14the
of 47
to maintain th
calculation for

Type here the I

code of the Prim
diagnosis

PCPAccFrm E-4D1F1
Rev2014
Type
the Prima
14 Acute Coronary Syndrome, STEMI
15 Acute Coronary Syndrome, NSTEMI
16 Atrial Fibrillation
17 Abdominal Aortic Aneurysm
18 Obesity
19 Orthostatic Hypotension
20 Subclavian Vein Thrombosis
21 Unstable Angina
22 Edema, Drug-induced
23
24
25

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

I48
I71.9
E66.9
I82.8
I20.0

TOTAL

INFECTIOUS DISEASES

1 Acute Tonsilopharyngitis
2 Carbuncle
3 Cellulitis
4 Dengue Fever
5 Syphilis
6 Measles
7 PostMeasles Leukoria
8 Leprosy
9 Bacterial Vaginosis
10 Gonococcal Urethritis
11 Viral Exanthem
12 Rheumatic Fever
13 Pinworm Infection
We attest to the truthfulness of the above documentation:
Chairman, Dept. of Medicine

ICD 10

J06.B
L03.9
A90
A53.0
B05.9
A30.9
A54.2
I00

# of Cases

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

Diagnosis here
need more spa
(rows), just in
before the row
to maintain th
calculation for

Type here the I

code of the Prim
diagnosis

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
IM cases)
than 1 ff-up
than 1 ff-up/# of
Cases)

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
Page 15 of 47

PCPAccFrm E-4D1F1 Rev2014

14 Sinusitis, Chronic
15
16
17
18
19
20
21
22
23
24
25
TOTAL

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

Page 16 of 47

PCPAccFrm E-4D1F1 Rev2014

PULMONARY MEDICINE

ICD 10

1 Allergic Cough
2 Bronchial Asthma
3 Bronchiectasis
4 Community Acquired Pneumonia
5 Chronic Obstructive Pulmonary Disease
6 Pleural Effusion
7 Pulmonary Tuberculosis
8 Upper Respiratory Tract Infection
9 Mass, Pulmonary
10 Pneumonia in the Immunocompromised
11 Lower Respiratory Tract Infection
12 Methamphetamine Inhalation
13
14
15
16
17
18
19
20
21
22
23
24
25

R05
J45.99
J47
J18.9
J44.9
J90
A16.2
J06.9
R91
J18.93

TOTAL

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

# of Cases

5
8
1
50
10
10
42
16
2
1
1
1

147

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
IM cases)
than 1 ff-up
than 1 ff-up/# of
Cases)

0.57%
0.91%
0.11%
5.69%
1.14%
1.14%
4.78%
1.82%
0.23%
0.11%
0.11%
0.11%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
16.72%

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
0.00%
Page 17 of 47

PCPAccFrm E-4D1F1 Rev2014

GASTROENTEROLOGY

1 Cholelithiasis
2 Gastroesophageal Reflux
3 Acute Gastritis
4 Acute Gastroenteritis
5 Hepatitis B Infection
6 Colonic New Growth
7 Acid Peptic Disease
8 Chronic Liver Disease
9 Peptic Ulcer Disease
10 Dyspepsia
11 Hepatitis A Infection
12 Bleeding Peptic Ulcer Disease
13 Hemmorhoids
14 Cholecystitis
15 Appendicitis
16 Viral Hepatitis
17 Cirrhosis
18 Abdominal Mass
19 Amoebic Abscess
20 Ascites
21 Cholecystolithiasis
22 Choledocholithiasis
23 Constipation, Functional
24 Crohn's Disease
25 Erosive Gastropathy
26 Esophageal Mass
27 Gastric Ulcer
We attest to the truthfulness of the above documentation:
Chairman, Dept. of Medicine

ICD 10

K80.2
K21.9
K29.1
A09
B16.9
D48.9
K31.9
K76.9
K27.9
K30.9
B15.9
K27.4
I84.9
K81.9
K37
B19.9
K74.6
R19.0
A06.4
R18
K80.2
K59.0
K50.0
K29.1
K25.0

# of Cases

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
IM cases)
than 1 ff-up
than 1 ff-up/# of
Cases)

0.00%
0.00%
0.00%
0.00%
0.11%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
100.00%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
Page 18 of 47

PCPAccFrm E-4D1F1 Rev2014

28 GIST
29 Hepatic Mass
30 Liver Abscess
31 Lower Gastrointestinal Bleeding
32 Pancreatitis

R93.2
K75.0
K85.9
TOTAL

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

Page 19 of 47

PCPAccFrm E-4D1F1 Rev2014

NEPHROLOGY

ICD 10

1 Urinary Tract Infection

2 Urinary Tract Infection, Complicated
3 Nephrolithiasis
4 Acute Pyelonephritis
5 Chronic Kidney Disease
6 Nephrotic Syndrome
7 Nephritic Syndrome
8 Obstructive Uropathy
9 Uremia
10 Hyperurecemia
11 Acute Cystitis
12 Urinary Tract Infection, Recurrent
13
14
15
16
17
18
19
20
21
22
23
24
25

N39.0
N39.0
N20.0
N10
N18.8
N04.9
N00.0
N13.6
N19
N30.0
N39.0

TOTAL
We attest to the truthfulness of the above documentation:
Chairman, Dept. of Medicine

# of Cases

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
IM cases)
than 1 ff-up
than 1 ff-up/# of
Cases)

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
Page 20 of 47

PCPAccFrm E-4D1F1 Rev2014

ENDOCRINOLOGY

ICD 10

1 Diabetes Mellitus Type 2

2 Diabetes Mellitus Type 1
3 Euthyroid
4 Toxic Goiter
5 Hyperthyroidism
6 Hyperthyroidism, Graves Disease
7 Hyperthyroidism, Non-toxic goiter
8 Hypokalemic Periodic Paralysis
9 Hypothyroidism
10 Neuropathic foot
11 Impaired Glucose Tolerace
12 Hashimoto's Disease
13
14
15
16
17
18
19
20
21
22
23
24
25

E11.9
E10.9
E05.0
E05.9
E05.0
E03.0
G72.3
E89.0

E06.3

TOTAL
We attest to the truthfulness of the above documentation:
Chairman, Dept. of Medicine

# of Cases

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
IM cases)
than 1 ff-up
than 1 ff-up/# of
Cases)

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
Page 21 of 47

PCPAccFrm E-4D1F1 Rev2014

HEMATOLOGY

ICD 10

1 Idiopathic Thrombocytopenic Purpura

2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

D69.3

TOTAL
We attest to the truthfulness of the above documentation:
Chairman, Dept. of Medicine

# of Cases

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
IM cases)
than 1 ff-up
than 1 ff-up/# of
Cases)

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
Page 22 of 47

PCPAccFrm E-4D1F1 Rev2014

NEUROLOGY

ICD 10

1 Bell's Palsy
2 Benign Paroxysmal Positional Vertigo
3 Cluster Headache
4 Cerebrovascular Accident, Hemorrhagic
5 Cerebrovascular Accident, Infarct
6 Tension Headache
7 Contussion, Occipital area
8 Transient Ischemic Attack
9 Seizure Disorder
10 Spinal Cord Compression
11 Intracranial Mass
12 Post Gliotic Seizure
13 Mental Retardation
14 Parkinson's Disease
15 Anxiety Disorder
16 Syncope
17 Menstrual Migraine
18 Migraine Headache
19 Sciatica
20 Subarachnoid Hemorrhage
21 Disc Herniation
22 Insomnia
23 Lacunar Infarct
24 Major Depressive Disorder
25 Somatoform Disorder

G51.0
H81.1
G44.0
I61.9
I63.9
G44.2
S06.20
G45.9
R56.8
G95.2

F79.8
G20
F41.1
F48.8
N94.3
G43.9
M54.39
I60.9

I63.9
F33.9
F45.8
TOTAL

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

# of Cases

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
IM cases)
than 1 ff-up
than 1 ff-up/# of
Cases)

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
Page 23 of 47

PCPAccFrm E-4D1F1 Rev2014

ONCOLOGY

ICD 10

1 Gastric CA
2 Lymphoma
3 Micropapillary Ca of the Thyroid
4 Chronic Myelogenous Leukemia
5 Fibrocystic Change
6 Myoma uteri
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

C16.9
C85.9
C73
C92.1
D25.9

TOTAL
We attest to the truthfulness of the above documentation:
Chairman, Dept. of Medicine

# of Cases

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
IM cases)
than 1 ff-up
than 1 ff-up/# of
Cases)

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
Page 24 of 47

PCPAccFrm E-4D1F1 Rev2014

DERMATOLOGY

ICD 10

1 Pyoderma Gangenosum
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL
We attest to the truthfulness of the above documentation:
Chairman, Dept. of Medicine

# of Cases

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
IM cases)
than 1 ff-up
than 1 ff-up/# of
Cases)

0.11%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

0.00%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
Page 25 of 47

PCPAccFrm E-4D1F1 Rev2014

RHEUMATOLOGY

ICD 10

1 Rheumatoid Arthritis
2 Gouty Arthritis
3 Osteoarthritis
4 Musculoskeletal Strain
5 Bursitis
6 Costochondritis
7 Fracture, Hip
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

M06.99
M10.09
M19.99
M62.69
M71.5

TOTAL
We attest to the truthfulness of the above documentation:
Chairman, Dept. of Medicine

# of Cases

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
IM cases)
than 1 ff-up
than 1 ff-up/# of
Cases)

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
Page 26 of 47

PCPAccFrm E-4D1F1 Rev2014

ALLERGOLOGY & IMMUNOLOGY

1 Allergic Dermatitis
2 Allergic Rhinitis
3 Contact Dermatitis
4 Hypersensitivity Reaction
5 Urticaria
6 Dishidrotic Eczema
7 PND secondary to Allergic Rhinitis
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

# of Cases

L23.9
J30.4
L25.9
T78.4
T78.3

TOTAL
We attest to the truthfulness of the above documentation:
Chairman, Dept. of Medicine

ICD 10

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
IM cases)
than 1 ff-up
than 1 ff-up/# of
Cases)

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
Page 27 of 47

PCPAccFrm E-4D1F1 Rev2014

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

Page 28 of 47

PCPAccFrm E-4D1F1 Rev2014

Hospital:

East Avenue Medical Center

Admissions:

OPD Census

Case-load (case census per year) and results of care

Month/Year:

1 Hypertension
2 Essentially Normal
3 Hypertensive Cardiovascular Disease
4 Congestive Heart Failure
5 Dilated Cardiomyopathy
6 Stable Angina
7 Acute coronary Syndrome
8 Ischemic Heart Disease
9 Atrial Fibrillation
10 Rheumatic Heart Disease
11 Valvular Heart Disease
12 Chronic Venous Insufficiency
13 Dyslipidemia
We attest to the truthfulness of the above documentation:
Chairman, Dept. of Medicine

Enter the
Month and Year

MARCH 2015

ICD 10

I10.9
Z10.1
I11.9
I50.0
I42.0
I20.8
I25.9
I48
I09.9
I38
E78.9

# of Cases

128
65
42
21
11
9
6
6
2
2
2
1
2

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
IM cases)
than 1 ff-up
than 1 ff-up/# of
Cases)

8.27%
4.20%
2.71%
1.36%
0.71%
0.58%
0.39%
0.39%
0.13%
0.13%
0.13%
0.06%
0.13%

Enter the place

of census i.e.
Ward, ICU, ER,
OPD

Enter Total IM
Admisssions (Patient
person count) for the
Month

1,547

Total IM Admissions:

CARDIOLOGY

Enter Name of
Hospital

0
0

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

Manually cou
number of de
disease entit
your monthly
and enter her

Yellow boxes
automatically
computed fro
Manually cou
entered in th
disease entit
boxes. DO NO
your monthly
ANYTHING ON
census and e
YELLOW BOXE
here.

Page 29 of 47

PCPAccFrm E-4D1F1 Rev2014

14 Left Atrial Enlargement
15 Angina Pectoris
16 Venous Valve Reflux
17 Thyrotoxic Heart Disease
18
19
20
21
22
23
24
25

I20.0
E05.9

TOTAL

INFECTIOUS DISEASES

1 Measles
2 Syphilis
3 Systemic Viral Infection
4 Cellulitis
5 Herpes Zoster Infection
6 Varicella Zoster Infection
7 Ascariasis
8 Acute Tonsillopharyngitis
9 Sexually Transmitted Infection
10 Viral Exanthem
11 Plantar Fascitis
12 Chalazion
13 Carbuncle
We attest to the truthfulness of the above documentation:
Chairman, Dept. of Medicine

1
1
1
1

301

ICD 10

B05.9
A53.0
B34.9
L03.9

B77.9
J06.8

H00.1

# of Cases

3
3
2
3
2
1
1
5
1
1
1
1
1

0.06%
0.06%
0.06%
0.06%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
19.46%

0.00%
0.00%
0.00%
0.00%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
0.00%

Type here the

10 code of the
Primary diagn

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
IM cases)
than 1 ff-up
than 1 ff-up/# of
Cases)

0.19%
0.19%
0.13%
0.19%
0.13%
0.06%
0.06%
0.32%
0.06%
0.06%
0.06%
0.06%
0.06%

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
Page 30 of 47

PCPAccFrm E-4D1F1 Rev2014

1
1
2

14 Sinusitis
15 Spondylitis
16 Rheumatic Fever
17
18
19
20
21
22
23
24
25
TOTAL

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

29

0.06%
0.06%
0.13%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
1.87%

0.00%
0.00%
0.00%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
0.00%

Page 31 of 47

PCPAccFrm E-4D1F1 Rev2014

PULMONARY MEDICINE

ICD 10

1 Community Acquired Pneumonia

2 Pulmonary Tuberculosis
3 Upper Respiratory Tract Infection
4 COPD
5 Pleural Effusion
6 Extrapulmonary TB
7 Bronchial Asthma
8 Allergic Cough
9 Emphysema
10 Pneumothorax
11 Pulmonary Congestion
12 Pulmonary Mass prob Malignant
13 Lower Respiratory Tract Infection
14 Consolidation
15
16
17
18
19
20
21
22
23
24
25

J18.9
A16.2
J06.9
J44.9
J90
A18.2
J45.99
R05
J44.0
J93.9
J81
R91

TOTAL

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

# of Cases

67
102
28
4
4
1
13
3
1
1
1
1
1
1

228

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
IM cases)
than 1 ff-up
than 1 ff-up/# of
Cases)

4.33%
6.59%
1.81%
0.26%
0.26%
0.06%
0.84%
0.19%
0.06%
0.06%
0.06%
0.06%
0.06%
0.06%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
14.74%

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
0.00%
Page 32 of 47

PCPAccFrm E-4D1F1 Rev2014

GASTROENTEROLOGY

1 Acute Gastritis
2 Acute Gastroenteritis
3 Cholecystolithiasis
4 Cholelithiasis
5 Dyspepsia
6 GERD
7 Hapatitis A Infection
8 Hepatitis B Infection
9 Functional Constipation
10 Peptic Ulcer Disease
11 Chronic Diarrhea
12 Diverticulitis
13 Bleeding Peptic Ulcer Disease
14 Colonic New Growth
15 Gastric Outlet Obstruction
16 Hepatic Mass
17 Obstructive Jaundice
18 Viral Hepatitis
19 Acute Pancreatitis
20 Hemorrhoid
21 Gallbladder Polyp
22 Esophageal Varices
23 Fatty Liver
24 Fecal Impaction
25 Drug-induced hepatitis
26 Ileus
27 Cirrhosis
We attest to the truthfulness of the above documentation:
Chairman, Dept. of Medicine

ICD 10

K29.1
A09
K80.2
K80.2
K30.9
K21.9
B15.9
B16.9
K59.0
K27.9
A09
K57.2
K27.4
D48.9
K56.6
R93.2
R17
B19.9
K85.9
I84.9
K74.6
K76.0
K56.4
K71.6
K56.7

# of Cases

21
9
3
12
15
6
2
12
3
15
2
2
6
2
2
2
2
2
2
6
1
1
1
1
1
1
1

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
IM cases)
than 1 ff-up
than 1 ff-up/# of
Cases)

1.36%
0.58%
0.19%
0.78%
0.97%
0.39%
0.13%
0.78%
0.19%
0.97%
0.13%
0.13%
0.39%
0.13%
0.13%
0.13%
0.13%
0.13%
0.13%
0.39%
0.06%
0.06%
0.06%
0.06%
0.06%
0.06%
0.06%

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
Page 33 of 47

PCPAccFrm E-4D1F1 Rev2014

Irritable bowel Disease
Alcoholic Liver Disease
Ascites
Acid Peptic Disease
Acute Cholecystitis
Amebic Liver Abscess
Caustic Ingestion

1
1
2
2
1
1
1

0.06%
0.06%
0.13%
0.13%
0.06%
0.06%
0.06%

142

9.18%

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

TOTAL
0

0.00%

NEPHROLOGY
2
3 UTI
4 Nephrolithiasis
5 Ureterolithiasis
6 Pyelonephritis
7 Nephrotic syndrome
8 Chronic Kidney Disease
9 Hypokalemic Periodic Paralysis
10 Acute Glomerulonephritis
11 Diabetic Nephropathy
12 Cystolithiasis
13 Electrolyte Imbalance
14 Hyperurecemia
15 Nephritic Syndrome
We attest to the truthfulness of the above documentation:
Chairman, Dept. of Medicine

ICD 10

N39.0
N20.0
N12
N04.9
N19
G72.3
N00.9
NO8.3
N21.0
E87.8
N00.0

# of Cases

49
15
2
4
2
11
4
3
2
1
2
1
1

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
IM cases)
than 1 ff-up
than 1 ff-up/# of
Cases)

3.17%
0.97%
0.13%
0.26%
0.13%
0.71%
0.26%
0.19%
0.13%
0.06%
0.13%
0.06%
0.06%

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
Page 34 of 47

PCPAccFrm E-4D1F1 Rev2014

16 Hyponatremia
17 Acute Kidney Injury
18 Renal Cyst
19 Hyperkalemia
20 Nephropathy
21 Non obstructing microlithiases
22
23
24
25

E87.1
Q61.0
E87.5
N28.9
J84.0

1
1
1
1
1
1

0.06%
0.06%
0.06%
0.06%
0.06%
0.06%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

103

6.66%

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

TOTAL

1
2
ENDOCRINOLOGY
3 Diabetes Mellitus, Type II
4 Hyperthyroidism
5 Hypothyroidism
6 Clinically euthyroid
7 Non-healing wound
8 Diffuse goiter
9 Hypokalemia
10 Hypoaldosteronism
11 Nodular goiter
12 Thyroid Cyst
13
14
15
We attest to the truthfulness of the above documentation:
Chairman, Dept. of Medicine

ICD 10
E11.9
E05.9
E03.9

E01.0
E87.5
E27.4
E04.9

# of Cases

59
33
7
6
5
8
1
1
4
1

0.00%

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
3.81%
0.00%
IM
cases)
than 1 ff-up
than 1 ff-up/# of
2.13%
0.00%
Cases)

0.45%
0.39%
0.32%
0.52%
0.06%
0.06%
0.26%
0.06%
0.00%
0.00%
0.00%

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
#DIV/0!
#DIV/0!
#DIV/0!
Page 35 of 47

PCPAccFrm E-4D1F1 Rev2014

16
17
18
19
20
21
22
23
24
25

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

Page 36 of 47

PCPAccFrm E-4D1F1 Rev2014

0.00%

#DIV/0!

TOTAL
125

1
2
HEMATOLOGY
3 Iron deficiency Anemia
4 Idiopathic Thrombocytopenic Purpura
5 Polycythemia Vera
6 Autoimmune Hemolytic Anemia
7 Anemia Etiology to be Determined
8 Anemia secondary to UGIB
9 Anemia, Refractory
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
We attest to the truthfulness of the above documentation:
Chairman, Dept. of Medicine

ICD 10
D50.9
D69.3
D45
D59.1
D64.9
D50.0

# of Cases

2
2
2
1
3
1
1

8.08%

0.00%

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
0.13%
0.00%
IM
cases)
than 1 ff-up
than 1 ff-up/# of
0.13%
0.00%
Cases)

0.13%
0.06%
0.19%
0.06%
0.06%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

0.00%
0.00%
0.00%
0.00%
0.00%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
Page 37 of 47

PCPAccFrm E-4D1F1 Rev2014

0.00%

#DIV/0!

TOTAL
12

1
2
NEUROLOGY
3 Cerebrovascular Disease, Infarct
4 Cerebrovascular Disease, Hemorrhagic
5 Transient Ischemic Attack
6 Tension Headache
7 Benign Paroxysmal Positional Vertigo
8 Migraine
9 Spinal Cord Compression
10 Seizure Disorder
11 Lacunar Infarct
12 Bell's Palsy
13 Myofascial Pain Syndrome
14 Vasovagal Syncope
15 Peripheral Neuropathy
16 Sciatica secodary to herniated disc
17 Stroke in the Young
18 Cluster Headache
19 Facial nerve Paralysis
20 Intracranial Mass
21 Carpal Tunnel Syndrome
22 Multiple Sclerosis
23 Lateral Rectus Palsy
24 Disc Herniation
25 Major Depressive Disorder
26 thalamocapniloganglioma mass
We attest to the truthfulness of the above documentation:
Chairman, Dept. of Medicine

ICD 10
I63.9
I61.9
G45.9
G44.2
H81.1
G43.9
G95.2
R56.8
I63.9
G51.0
M79.08
F48.8
G62.9
M54.39
I64
G44.0
G51.0
G56.0
G35
G80.9

# of Cases

70
13
5
10
6
8
4
4
3
3
13
1
2
3
1
1
1
1
1
1
1
1
1
1

0.78%

0.00%

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
4.52%
0.00%
IM
cases)
than 1 ff-up
than 1 ff-up/# of
0.84%
0.00%
Cases)

0.32%
0.65%
0.39%
0.52%
0.26%
0.26%
0.19%
0.19%
0.84%
0.06%
0.13%
0.19%
0.06%
0.06%
0.06%
0.06%
0.06%
0.06%
0.06%
0.06%
0.06%
0.06%

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
Page 38 of 47

PCPAccFrm E-4D1F1 Rev2014

0.00%

TOTAL

1
2
ONCOLOGY
3 Mass, Abdominal, probably malignant
4 Mass, Anterior neck, probably malignant
5 Breast Cancer
6 Endometrial Ca
7 Cervical papillary Adenocarcinoma
8 Mass, Retroperitoneal
9 Ovarian New Growth
10 Pulmonary metastasis of neck mass
11 Colonic new growth
12 Malignant Neoplasm of Duodenum
13 HCC probably Metastatic
14 Prostate CA
15 Gastric malignancy
16 Mass, Bladder
17 Lipoma
18 Fibroadenoma
19 Mass, Breast
20 Mass, hypogastric
21 Mass, Anal, probably malignant
22 Anal adenocarcinoma
23 Hepatic Renal Cyst
24
25
We attest to the truthfulness of the above documentation:
Chairman, Dept. of Medicine

155

ICD 10
C76.2
C49.0
C50.9
C54.1
C53.9
C48.0
D39.1
C78.3
D48.9
C17.0
C22.0
C61
C16.9
D41.4

# of Cases

3
4
2
1
1
2
5
1
2
1
1
2
1
1
2
1
1
1
4
1
1

10.02%

#DIV/0!

0.00%

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
0.19%
0.00%
IM
cases)
than 1 ff-up
than 1 ff-up/# of
0.26%
0.00%
Cases)

0.13%
0.06%
0.06%
0.13%
0.32%
0.06%
0.13%
0.06%
0.06%
0.13%
0.06%
0.06%
0.13%
0.06%
0.06%
0.06%
0.26%
0.06%
0.06%
0.00%
0.00%
0.00%

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
#DIV/0!
#DIV/0!
#DIV/0!
Page 39 of 47

PCPAccFrm E-4D1F1 Rev2014

0.00%

TOTAL

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

DERMATOLOGY

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

38

ICD 10

# of Cases

2.46%

#DIV/0!

0.00%

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
0.00%
#DIV/0!
IM
cases)
than 1 ff-up
than 1 ff-up/# of
0.00%
#DIV/0!
Cases)

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
Page 40 of 47

PCPAccFrm E-4D1F1 Rev2014

0.00%

TOTAL

1
2
RHEUMATOLOGY
3 Rheumatoid Arthritis
4 Gouty Arthritis
5 Osteoarthritis
6 Systemic Lupus Erythematosus
7 Musculoskeletal Strain
8 Costochondritis
9 Fracture
10 Spondylosis, cervical spine
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
We attest to the truthfulness of the above documentation:
Chairman, Dept. of Medicine

ICD 10
M06.99
M10.09
M19.99
M32.9

# of Cases

2
10
16
1
22
14
4
1

0.00%

#DIV/0!

#DIV/0!

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
0.13%
0.00%
IM
cases)
than 1 ff-up
than 1 ff-up/# of
0.65%
0.00%
Cases)

1.03%
0.06%
1.42%
0.90%
0.26%
0.06%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
Page 41 of 47

PCPAccFrm E-4D1F1 Rev2014

0.00%

TOTAL

1
2
ALLERGOLOGY & IMMUNOLOGY
3 Acute Anaphylaxis
4 Hypersensitivity Reaction, not specified
5 Hypersensitivity Reaction, Drug Induced
6 Eczema
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
We attest to the truthfulness of the above documentation:
Chairman, Dept. of Medicine

70

ICD 10
T78.4
T88.7

# of Cases

1
1
1
1

4.52%

#DIV/0!

0.00%

% of patients
with one or more
% of Total OPD # of patientthan 1 follow-up
IM Cases (# of
cases with
(# of patients
cases/Total OPD one or more
with one more
0.06%
0.00%
IM
cases)
than 1 ff-up
than 1 ff-up/# of
0.06%
0.00%
Cases)

0.06%
0.06%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

0.00%
0.00%
#DIV/0!
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#DIV/0!
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#DIV/0!
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#DIV/0!
#DIV/0!
#DIV/0!
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Page 42 of 47

PCPAccFrm E-4D1F1 Rev2014

0.00%

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

#DIV/0!

Page 43 of 47

Philippine College of Physicians

PCPAccFrm E-4D1F2 Rev2014

OPD Census

SUMMARY OF CENSUS

East Avenue Medical Center

HOSPITAL
Month/Year

January 2015

# of Cases

% of Total OPD IM
Cases (# of
cases/Total OPD IM
cases)

# of patientcases with one

or more than 1
ff-up

% of patients with
one or more than 1
follow-up (# of
patients with one
more than 1 ff-up/#
of Cases)

376
119
229
198
161
263
550
138
3
24
144
2

17.04%
5.39%
10.38%
8.97%
7.29%
11.92%
24.92%
6.25%
0.14%
1.09%
6.52%
0.09%

24
6
14
22
17
18
40
8
1
0
8
0

6.38%
5.04%
6.11%
11.11%
10.56%
6.84%
7.27%
5.80%
33.33%
0.00%
5.56%
0.00%

Cardiology
Infectious Diseases
Pulmonary Medicine
Gastroenterology
Nephrology
Endocrinology
Hematology
Neurology
Oncology
Dermatology
Rheumatology
Allergology & Immunology

Total IM OPD Cases

Total IM OPD Patients

SUMMARY OF CENSUS
HOSPITAL

2,207
1,341

158
11.78%

Total Patients with follow-up

Total Pts w/ ff-up/Total OPD IM Cases

OPD Census
East Avenue Medical Center

Month/Year
% of Total OPD IM
Cases (# of
cases/Total OPD IM
cases)

# of patientcases with one

or more than 1
ff-up

% of patients with
one or more than 1
follow-up (# of
patients with one
more than 1 ff-up/#
of Cases)

Philippine College of Physicians

PCPAccFrm E-4D1F2 Rev2014

FEBRUARY 2015
Cardiology
Infectious Diseases
Pulmonary Medicine
Gastroenterology
Nephrology
Endocrinology
Hematology
Neurology
Oncology
Dermatology
Rheumatology
Allergology & Immunology

Total IM OPD Cases

Total IM OPD Patients

# of Cases

0
0
147
1
0
0
0
0
0
1
0
0

149
879

% of Total OPD IM
Cases (# of
cases/Total OPD IM
cases)

# of patientcases with one

or more than 1
ff-up

% of patients with
one or more than 1
follow-up (# of
patients with one
more than 1 ff-up/#
of Cases)

0.00%
0.00%
6.66%
0.05%
0.00%
0.00%
0.00%
0.00%
0.00%
0.05%
0.00%
0.00%

0
0
0
1
0
0
0
0
0
0
0
0

#DIV/0!
#DIV/0!
0.00%
100.00%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
0.00%
#DIV/0!
#DIV/0!

Total Patients with follow-up

Total Pts w/ ff-up/Total OPD IM Cases

1
0.11%

Philippine College of Physicians

PCPAccFrm E-4D1F2 Rev2014

OPD Census

SUMMARY OF CENSUS

East Avenue Medical Center

HOSPITAL
Month/Year

MARCH 2015

# of Cases

Cardiology
Infectious Diseases
Pulmonary Medicine
Gastroenterology
Nephrology
Endocrinology
Hematology
Neurology
Oncology
Dermatology
Rheumatology
Allergology & Immunology

301
29
228
133
103
125
12
155
38
0
70
4

1,198
1,547

Total IM OPD Cases

Total IM OPD Patients

SUMMARY OF CENSUS

# of patientcases with one

or more than 1
ff-up

% of patients with
one or more than 1
follow-up (# of
patients with one
more than 1 ff-up/#
of Cases)

13.64%
1.31%
10.33%
6.03%
4.67%
5.66%
0.54%
7.02%
1.72%
0.00%
3.17%
0.18%

0
0
0
0
0
0
0
0
0
0
0
0

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
#DIV/0!
0.00%
0.00%

0
0.00%

Total Patients with follow-up

Total Pts w/ ff-up/Total OPD IM Cases

OPD Census
East Avenue Medical Center

HOSPITAL
Months/Year
January 2015
FEBRUARY 2015

% of Total OPD IM
Cases (# of
cases/Total OPD IM
cases)

# of Cases

% of Total OPD IM
Cases (# of
cases/Total OPD IM
cases)

# of patientcases with one

or more than 1
ff-up

% of patients with
one or more than 1
follow-up (# of
patients with one
more than 1 ff-up/#
of Cases)

PCPAccFrm E-4D1F2 Rev2014

# of Cases

% of Total OPD IM
Cases (# of
cases/Total OPD IM
cases)

# of patientcases with one

or more than 1
ff-up

% of patients with
one or more than 1
follow-up (# of
patients with one
more than 1 ff-up/#
of Cases)

677
148
604
332
264
388
562
293
41
25
214
6

19.05%
4.16%
16.99%
9.34%
7.43%
10.92%
15.81%
8.24%
1.15%
0.70%
6.02%
0.17%

24
6
14
23
17
18
40
8
1
0
8
0

3.55%
4.05%
2.32%
6.93%
6.44%
4.64%
7.12%
2.73%
2.44%
0.00%
3.74%
0.00%

MARCH 2015
Cardiology
Infectious Diseases
Pulmonary Medicine
Gastroenterology
Nephrology
Endocrinology
Hematology
Neurology
Oncology
Dermatology
Rheumatology
Allergology & Immunology

Total IM OPD Cases

Total IM OPD Patients

3,554
3,767

Philippine College of Physicians

Total Patients with follow-up

Total Pts w/ ff-up/Total OPD IM Cases

159
4.22%