Republic of the Philippines

Department of Health
HEALTH EMERGENCY MANAGEMENT STAFF

HEARS FIELD REPORT

(Upon learning about the occurrence of an event, the HEMS Coordinator shall immediately inform the DOH-HEMS Operation Center through the
fastest communication means available. Then this Form 1 shall be filled-out and sent ASAP or within 24 hours upon occurrence of the event.)

A. Event Information
Type of Event: GEOLOGIC WEATHER BIOLOGIC MAN-MADE
Volcanic Eruption Typhoon Red Tide Epidemic Poisoning, specify ______________
Earthquake Storm Surge Fish Kills Fire Mass Action, specify____________
Tsunami Drought Locust Explosion Accident, specify ______________
Landslide Cold Spell Infestation Armed Conflict Other, specify HOLY WEEK
Lahar Flashflood Terrorism
Date of Time of AM Exact Location: Batangas Medical Center
Ocurrence: 04/16/19 Occurrence: PM Region: IV-A Province: Batangas Municipality/City: Batangas
Brief Description (How the event happened):
Code White Alert Status: Zero Incident

B. Consequences (Supply as much data as possible within 24 hours)

HEALTH IMPACT POPULATION DISPLACEMENT HEALTH FACILITIES / SERVICES
No. of Deaths: 0 Population displaced? Yes No Number Number
No. of Admitted Patients: 0 No. of Displ. Families: Estimated Available Functional
No. of Outpatients: 0 Actual Public
No. Missing: 0 No. of Disp. Individuals: Actual Hospitals:
Estimated RHUs:
C. Actions Taken (Include information on number and types of services, manpower and supplies provided in the field)
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D. Assistance Needed (Include information on number and types of services, manpower and supplies needed in the field)
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Prepared and Submitted by:
Date Prepared: 04/17/2019 Mobile No.:
Signature: Landline: 043-781-3129
Printed Name: Kim Byron S. de Villa, M.D. Fax No.:
Designation/Office: MO IV/ DRRM-H BATMC Email: hemb.batmc@gmail.com

HEMS-MOO-01-OC-HFR (F)2007 Form3 Rev0

Building 12, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila ● Trunk Line 651-7800 Direct Line: 711-1001
Fax: 711-1002 ● URL: http://www.doh.gov.ph; e-mail: doh_hemsopcen@yahoo.com