DR. JOSE RIZAL MEMORIAL HO SPITAL - Secretary of Health

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 Service

External Services

Outpatient Department Availment of OPD Service – Consultation Page 7 – 8 Issuance of Patient’s Identification Card Page 9

Emergency Room Availment of ER Services – Triage Page 10 – 11 Availment of ER Services – For Admission Page 12 Availment of ER Services – For Referral or Transfer to

Other Health Facility Page 13 Availment of ER Services – For Non-Admission and Discharge

Against Medical Advice (DAMA) Page 14 Admission Section Issuance of Patients Identification Card Page 15 Correction Of Data Page 16 Generation of Admission and Discharge Record Sheet Page 17

Health and Information Management Issuance of Medical Certificate and Certificate of Confinement Page 18 - 19 Issuance of Medico-Legal Certificate Page 20 - 21 Preparation of Certificate of Live Birth Page 22 Preparation of Certificate of Death Page 23 Releasing of Signed Insurance Form/Physician Statement Page 24 - 25 Releasing of Photocopied Laboratory and Diagnostic Result

Discharge Summary and Records of Operation Page 26 - 27 Retrieval and Issuance of Certification for Patients with Discharge

Date Of more than 6 months Page 28 - 29 Laboratory Availment of Laboratory Services Page 30

Radiology Availment of Radiology Services Page 31 - 33

Central Supply Room Availment of Medical and Surgical Supplies Page 34 - 35

Pharmacy Issuance of Drugs and Medicines Page 36

Medical Social Service Availment of Medical Assistance or Discounts to Hospital Services Page 37 - 39 Classification/Re-Classification of Patient Page 40 Enrolment to PHIC through Point of Service Program Page 41

Billing and Claims Issuance of Statement of Accounts (SOA) Page 42 - 43 Verification of PHIC Eligibility Status Page 44

Cashier Payment for various Hospital Charges Page 45 Disbursement of Payments based on approved Disbursement

Vouchers (DV) Page 46 Animal Bite Center Availment of Animal Bite Services – Follow-up Vaccination Page 47

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Availment of Animal Bite Services – New Animal Bite Clients(Category III bite exposure) with Philhealth Page 48

Availment of Animal Bite Services – New Animal Bite Clients(Category II & Category III bite exposure without Philhealth) Page 49

TB-DOTS CLINIC Availment of TB-DOTS Service – New TB DOTS Clients Page 50 Availment of TB-DOTS Service – Follow-up Patient Diagnose as

TB Patient wants to be treated at Rural Health Unit/CityHealth Office Page 51

Availment of TB-DOTS Service – Follow-up Patient Diagnose asTB Patient wants to be treated at the hospital Page 52

Availment of TB-DOTS Service - Enrolled TB Clients Page 53 Procurement Section Purchase of Bidding Documents Page 54

Internal Services Materials and Management Office Requisition and Issuance of Supplies Page 56 Receipt of Goods Page 57

Examinations and Fees & Pricelists List of Laboratory Examinations Page 59 - 64 List of Drugs and Medicines Page 65 - 69 List of Radiology Examinations Page 70 - 80 List of Non-Drugs/Medical Supplies Page 81 - 88 List of Supplies/Procedures in the OPD Page 89

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External Services

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1.Outpatient Department (OPD)Availment of OPD Services

Office/Division: Outpatient Department (OPD)

Classification: Simple

Type of Transaction: G2C – Government to Citizen

Who May Avail: OPD Clients

CHECKLIST OF REQUIREMENTS WHERE TO SECUREOPD Registration Form (ORF) – 1 copy

OPDHospital ID Card

CLIENT STEPS AGENCY ACTION FEES TOBE PAID

PROCESSINGTIME

PERSONRESPONSIBLE

If Old Client:1.a.1 Presents Hospital ID then fillsup ORF.1.a.2 Submits ORF

If New Client / Old Client(Without/Lost ID):1.b.1 Secures Hospital ID1.b.2 Returns to OPDRegistration and presents HospitalID

1.a.1 Requests client to present HospitalID and instructs to fill up ORF1.a.2 Receives ORF and verifies data in thecomputer

1.b .1 Instructs client to secure Hospital ID1.b.2 Verifies data in the computer

NONE

NONE

NONENONE

3 minutes

7 minutes

25 minutes5 minutes

OPD Preregistration

Nurse/MedicalRecords

Staff(MRS)/Document

Controller (DC)

2. Presents self for interview andvital signs checking and waitsname to be called forconsultation

2. Interviews patient regarding their medicalcondition and checks vital signs then issuesqueuing number.

GREEN- Non priorityYELLOW – Urgent, PWD/ Senior Citizen/Pregnant WomenBLUE – Follow-Up on scheduled time

NONE 20 minutes Triage Nurse

3. Presents self for PhysicalConsult

3. Provides Clinical Consultation NONE 20 minutes OPD Physician

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4. Receives instruction fordiagnostics examinations,medications and follow-upcheck-up

4.a.1 Receives Charge Slip thenproceed to cashier for paymentthen returns to OPD.(if applicable)

4. Carries out doctor’s order

For any requested examinations/supplies4.a.1 Issues charge slip and instructs clientto proceed to cashier for payment andreturn to OPD (if applicable)

4.b.1 Instructs client/ patient to proceed todesignated respective units (if applicable)and pertaining to home care and follow-up

*Please seetable belowfor applicablefees

None

15 minutes

10 minutes

ConsultationRoom Nurse /

Cashier

Consultation RoomNurse

TOTAL: If Old Client -1 hour / (1 hour& 15 minutes)

If New Client /Old Client(Without/LostID):

1 hour & 20minutes / 1hour& 35 minutes

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Issuance of Patients Identification CardOffice/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


PROCESSINGTIME

PERSONRESPONSIBLE

1. Fills up ORF 1. Instructs client to completely fill up theORF None 10 minutes OPD Pre

registration NurseFor New Client:2.a Receives Hospital ID

For Old Client (Without/Lost ID)2.b. Submits ORF and Receivescharge slip then proceed to cashierfor payment

2. a Receives filled up ORF encodes datainto computer and Issues Hospital ID.

2.b Receives filled up ORF and verifiesdata in the computer. Issues charge slipand instructs client to proceed to cashierfor payment

None

Php 30.00

10 minutes

20 minutes

Medical RecordsStaff

Medical RecordsStaff / Cashier

3. Returns to OPD, presentscharge slip stamped as paid andreceives Hospital ID

3. Receives charge slip None 2 minutes Medical RecordsStaff

4. Receives Hospital ID 4. Issues Hospital ID None 3 minutes Medical RecordsStaff

TOTAL: Php 30.00 For NewClient -

20 minutes

For Old Client-35 minutes

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2.Emergency Room (ER)Availment of ER Services – Triage Area

Office/Division: Emergency Room



Who May Avail: All Emergency Room Client/s

CHECKLIST OF REQUIREMENTS WHERE TO SECUREHospital ID Admitting Section


PROCESSINGTIME

PERSONRESPONSIBLE

1. Arrives and presentspatient/self to the triage area

If Old PatientPresents Hospital ID andprovide relevant information asnecessary

If New PatientWatchers or Significant Otherswill proceed to admittingsection to secure Hospital ID

1. Directs and assists patients in the triagearea and asks for Hospital ID

Receives Hospital ID and verifies patientdata in the iHOMIS and Logs Client/s.

Advises Client/s or Significant Others tosecure Hospital ID at Admitting Section

None

None

None

2 minutes

3 minutes

15 minutes

Nurse on Duty

Nurse on Duty

Nurse on Duty

2. Cooperates during assessmentand provides necessary data orinformation to healthcareprovider

FOR EMERGENT CLIENT/SSignificant Other will presentHospital ID once the patient isin the ER and Medical &

2. Assesses patients, takes and recordsvital signs and mental status then ask forthe chief complaints and relevant medicalhistory

FOR EMERGENCT CLIENT/SSecuring of Hospital ID’s shall be withheldfor a while and directs clients to ER forprovision of Emergency Medical and

None 5 minutes Nursing on Duty

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Nursing intervention is initiated

FOR URGENT CLIENT/SWaits for further assessmentand/or observation untilEmergent Client’s initialintervention is done

FOR NON-URGENT CLIENT/SProceeds to Out-PatientDepartment (OPD) for furthertreatment during working hours.

Nursing Intervention as necessary

FOR URGENT CLIENT/SAdvises to wait for further assessmentand/or observation and wait until emergentclient/s is served

FOR NON-URGENT CLIENT/SAdvises to proceed to OPD for propertreatment if during working hours

TOTAL: If Old Patient10 minutes

If New Patient22 minutes

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Availment of ER Services – For AdmissionOffice/Division: Emergency Room (ER)



Who May Avail: ER Patient’s for Admission

CHECKLIST OF REQUIREMENTS WHERE TO SECUREConsent for Admission Form Admitting Section


PROCESSINGTIME

PERSONRESPONSIBLE

1. Receives Advice for admissionand signs consent for Admission

1. Gives advice for admission andsecures consent

None 5 minutes Physician on Duty /Nurse on Duty

2. Receives Admission Slip thenproceeds to Admitting Section

2. Gives Admission Slip and Instructs theSignificant Others (S.O.) to go toadmitting section

*(if patient has no S.O., Nurse on Dutyendorses admission slip to admitting sectionofficer)

None 10 minutes Nurse on Duty

TOTAL: 15 minutes

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Availment of ER Services – For Referral or Transfer to Other Health FacilityOffice/Division: Emergency Room (ER)



Who May Avail: ER Patient’s for referral or transfer to other health facility

CHECKLIST OF REQUIREMENTS WHERE TO SECUREClearance Slip – 1 copy CashierRelease of Responsibility Form – 1 copy Emergency Room


PROCESSINGTIME

PERSONRESPONSIBLE

1. Receives advice for referral andproceeds to respective CostCenter then to cashier forsettlement of hospital bills

1. Gives advice for referral and stabilizespatient’s condition prior transport anddirects significant others to proceed torespective cost centers then to cashierfor settlement of hospital bills

ApplicableFees

30 minutes Physician on Duty /Nurse on Duty /

Cashier

2. Returns to ER and givesClearance Slip to ER Nurse forsigning and to security guard priordischarge

2. Receives and signs clearance None 5 minutes Nurse on Duty

If As per patient’s request:Receives and signs Release ofResponsibility Form and pay theambulance conduction fee

Secures signature for Release ofResponsibility

1,000.00 15 minutes Nurse on Duty

TOTAL:Applicablefees +1,000.00

35 minutes

If as perpatient’srequest

15 minutes

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Availment of ER Services – For Non-Admission and Discharge Against Medical AdviceOffice/Division: Emergency Room (ER)



Who May Avail: ER Patient’s for non-admission and Discharge Against Medical Advice (DAMA)

CHECKLIST OF REQUIREMENTS WHERE TO SECURERelease of Responsibility Form – 1 copy Emergency Room


PROCESSINGTIME

PERSONRESPONSIBLE

FOR DAMA:1. Receives and signs consent for

release of responsibility andremove all the contraptionsconnected to the patient’s

1. Gives consent form for release ofresponsibility and inform clients orsignificant others who signed thewaiver that they are the one/s who willremove all the contraptions of thepatient.

*If the client is minor, the nearest kin will signthe waiver

None 3 minutes Physician on Duty /Nurse on Duty

FOR Non-Admission:2. Receives prescription and charge

slip/s then replenish the medicalsupplies and medicines use

2. Gives prescriptions and charge slipand advises to replenish all the suppliesand medicines used prior discharge andproceed to central supply for medicalsupplies and pharmacy for themedication.

*please referto table formedicines

and medicalsupplies

5 minutes Physician on Duty /Nurse on Duty

TOTAL: For DAMA8 minutes

For Non-Admission5 minutes

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3.ADMITTING SECTIONIssuance of Patients Identification Card

Office/Division: Admitting Section



Who May Avail: Patients for admission (New Patient and Old Patient with lost Hospital ID)

CHECKLIST OF REQUIREMENTS WHERE TO SECUREStamped ‘Paid’ charge slip (with OR Number) - (1 copy) Cashier


PROCESSINGTIME

PERSONRESPONSIBLE

1. Provides patient’s data 1. Checks computer of the patient hasexisting hospital record NONE 8 minutes Admitting Staff

2. Receives charge slip 2.a (if patient has existing record) :Issues charge slip and instructs client togo to cashier for payment

2.b (if patient has no existing record):Created Patient’s hospital record numberthen proceeds to Step 4

Php 30.00

NONE

13 minutes

10 minutes

Admitting Staff /Cashier

Admitting Staff

3. Returns to admitting section andpresents charge slip with ORnumber

3. Receives charge slip with OR numberNONE 3 minutes Admitting Staff

4. Receives Patient’s identificationCard

4. Issues Patient’s Identification Card NONE 3 minutes Admitting Staff

TOTAL:

Php 30.00

New Client -21 minutes

Old Client w/oID

27 minutes

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Correction of DataOffice/Division: Admitting Section



Who 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 the Admitting Staff forany corrections on the patients’data.

1. Retrieves the patients data in iHOMISincluding the admission Slip filled-outby the patient/ significant others uponadmission. Instructs the patient topresent any valid document to supportthe changers

NONE 10 minutes Admitting Staff

2. Provides photocopy of any validdocument needed to support thechanges

2. Receives the Valid Document / ID andEdit the Patients data in the computer NONE 10 minutes Admitting Staff

TOTAL: None 20 minutes

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Generation of Admission and Discharge Record SheetOffice/Division: Admitting Section



Who May Avail: For Admission Clients

CHECKLIST OF REQUIREMENTS WHERE TO SECUREAdmission Slip Emergency Room (ER)* Any of the following requirements listed: Member Data Record (MDR) - (1 copy) Any Valid ID (Government Issued ID) - (1 copy)

PhilHealth Office BIR, Post Office, DFA, PSA, SSS, GSIS,

PAG-IBIG, LTO, COMELEC


PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents Admission Slip from ER 1. Receives Admission Slip and Instructsthe Significant Other to assists thepatient in filling the Admission Slip (*ifthe patient is incapacitated: Instruct theSignificant Other in filling theAdmission Slip)


2. Presents any valid document forPHIC verification

2. Verifies Patient’s PHIC Record andClassification NONE 5 minutes Admitting Staff

3. Acknowledges receipt ofrequirements to avail PHIC

3. Informs patient’s category andrequirements needed to avail PHIC NONE 3 minutes Admitting Staff

4. Receives Watcher’s Pass,Patient’s Obligation

4. Issues Watcher’s Pass, PatientsObligation. Inputs data of patient in thecomputer


5. Affixes signature on the datafurnished portion of theAdmission and Discharge Record

5. Prints Admission and DischargeRecord then forwards to EmergencyRoom


TOTAL: 1 hour & 14minutes

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4. HEALTH AND INFORMATION MANAGEMENTIssuance of Medical Certificate and Certificate of Confinement

Office/Division: Health and Information Management (HIM)



Who May Avail: Outpatient and Inpatient

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

Admitting Section / OPD Authorizing Party BIR, Post Office, DFA, PSA, SSS, GSIS,

PAG-IBIG, LTO, COMELECRequest Form - (1 copy)Stamped ‘Paid’ charge slip (with OR Number) - (1 copy)

HIMCashier


PROCESSINGTIME

PERSONRESPONSIBLE

1. Fills up and submits the requestform

1. Receives the Request Form, ValidatesIdentity of the requestor and notifies forany documentary requirements asapplicable

NONE 5 minutes HIM Staff

2. Submits documentary requirementsif applicable

2. Receives documentary requirementsand issues charge slip (*if client can’tprovide documentary requirements,advice clients to secure neededdocuments upon claiming of therequested certificate)


3. Receives Charge Slip 3. Instructs client to go to cashier forpayment Php 30.00 10 minutes HIM Staff /

Cashier4. Submits paid charge slip with OR

number4. Receives charge slip with OR number

and provides instruction on theexpected time of releasing thecertificate.


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5. Presents documentary requirementsas need for claiming of requestedcertificate

5. Receives documentary RequirementsNONE 5 minutes HIM staff

6. Receives Medical Certificate /Certificate of Confinement and singsthe 1s copy as proof of receipt

6. Release Medical Certificate /Certificate of Confinement*For Request made at 8:00 AM to 11:00AM releasing will be during 1:00 PM to5:00 PM*For Request made at 1:00 PM to 5:00 PMreleasing will be on the next working dayper Hospital Order No. 405 s.2018


TOTAL: Php 30.00 38 minutes

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Issuance of Medico-Legal CertificateOffice/Division: Health and Information ManagementClassification: SimpleType of Transaction: G2C – Government to CitizenWho May Avail: Outpatient and Inpatient




HIMCashier


PROCESSINGTIME

PERSONRESPONSIBLE


1. Receives the Request Form, ValidatesIdentity of the requestor and notifies forany documentary requirements asapplicable

NONE5 minutes

(*excludingwaiting time)

HIM Staff

2. Submits documentary requirements 2. Issues charge slip (*if client can’tprovide documentary requirements,advice clients to secure neededdocuments upon claiming of therequested certificate)


3. Receives Charge Slip 3. Instructs client to go to cashier forpayment Php 50.00 10 minutes HIM Staff / Cashier

4. Submits paid charge slip with ORnumber

4. Receives charge slip with OR numberand provides instruction on theexpected time of releasing thecertificate.

NONE

6 working days(subject to

availability ofAttendingPhysician

HIM Staff

5. Presents documentary requirementsas need for claiming of requestedcertificate

5. Receives documentary RequirementsNONE 5 minutes HIM staff

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6. Receives Medico-legal Certificateand signs the releasing logbook and1st copy of Endorsement Letter asproof of receipt

6. Releases Medico-legal CertificateNONE 3 minutes HIM Staff

TOTAL: Php 50.00 6 days & 28minutes

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Preparation of Certificate of Live BirthOffice/Division: Health and Information Management (HIM)



Who May Avail: Inpatient

CHECKLIST OF REQUIREMENTS WHERE TO SECURE Stamped ‘Paid’ charge slip (with OR Number) - (1 copy) Pink Card - (1 copy)

Cashier Labor/Delivery Room


PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents Pink Card Form 1. Validates the identity of the clients itmust be the client or immediate next ofkin. Receives the Pink Card and Issuescharge slip

None10 minutes(*excluding

waiting time)HIM Staff

2. Receives Charge Slip 2. Instructs client to go to cashier forpayment Php 50.00 10 minutes HIM Staff /

Cashier3. Submits paid charge slip with

OR number3. Receives charge slip with OR number None 2 minutes HIM Staff

3. Provides necessary data for thecompletion of the form anddouble checks the entries

4. Validates, encodes and prints the dataon the Certification of Live Birth form None 30 minutes HIM Staff

4. Receives Instructions and /receives Certified photocopy ofCertification of Live Birth forPHIC use (if necessary)

5. Releases the stamped certifiedphotocopy of Certificate of Live BirthForm. Instructs to proceed to CivilRegistrar for registration and othernecessary reminders

None 5 minutes HIM staff

TOTAL: Php 50.00 57 minutes

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Preparation of Certificate of DeathOffice/Division: Health and Information Management (HIM)




CHECKLIST OF REQUIREMENTS WHERE TO SECUREStamped ‘Paid’ charge slip (with OR Number) - (1 copy) Cashier


PROCESSINGTIME

PERSONRESPONSIBLE

1. Verbalizes request 1. Retrieve the health record withCertificate of Death Form and Issuescharge slip

NONE45 minutes(*excluding

waiting time)HIM Staff

2. Receives Charge Slip 2. Instructs client to go to cashier forpayment

Php 50.00 10 minutes HIM Staff /Cashier

3. Submits paid charge slip with ORnumber

3. Receives charge slip with OR number None 2 minutes HIM Staff

4. Provides necessary data for thecompletion of the form

4. Validates, encodes and prints the dataon the Certification of Death

None 20 minutes HIM Staff

5. Receives instruction on theexpected time of releasing theDeath Certificate

5. Provides instruction on the expectedtime of releasing the death certificate

None

2 working days(*subject to

availability ofattendingphysician

HIM staff

6. Receives Certificate of Deathand signs the logbook and waiverform

6. Releases the Certificate of Death andprovides instructions for registration None 5 minutes HIM Staff

TOTAL: Php 50.00 2 days 1 hour& 22 minutes

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Releasing of Signed Insurance Form / Physician StatementOffice/Division: Health and Information Management







HIMCashier


PROCESSINGTIME

PERSONRESPONSIBLE


1. Receives the Request Form. Validatesidentity of the requestor and notifies forany documentary requirements asapplicable

None5 minutes


HIM Staff

2. Submits documentaryrequirements if applicable andInsurance Form

2. Receives documentary requirementsand issues charge slip/ (*if client can’tprovide documentary requirements.Advice clients to secure neededdocuments upon claiming of the requestedcertificate)


3. Receives instructions on theexpected time of releasing thecompleted insurance form

3. Provides instruction on the releasingschedule None 6 working days HIM Staff

4. Receives Charge slip 4. Issues charge slip and instructs clientsto go to cashier for payment

Php150.00 10 minutes HIM Staff /

Cashier5. Presents paid charge slip with

OR number5. Receives charge slip with OR number None 2 minutes HIM staff

6. Receives completed Insurance 6. Releases Insurance Form None 5 minutes HIM Staff

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Form and signed the releasinglogbook

TOTAL: Php150.00

6 days & 27minutes

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Releasing of Photocopied Laboratory and Diagnostic Result, Discharge Summary,Records of Operation

Office/Division: Health and Information Management







HIMCashier


PROCESSINGTIME

PERSONRESPONSIBLE



None5 minutes


HIM Staff

2. Submits documentaryrequirements if applicable

2. Receives documentary requirementsand issues charge slip/ (*if client can’tprovide documentary requirements.Advice clients to secure neededdocuments upon claiming of the requestedcertificate)


3. Receives Charge slip 3. Issues charge slip and instructs clientsto go to cashier for payment

Php 2.00per copy 10 minutes HIM Staff /

Cashier4. Presents paid charge slip with

OR number and waits for thereleasing of the requested result /form

4. Receives charge slip with OR numberand Photocopies the requested form/result and stamped certified photocopy None 15 minutes HIM staff

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5. Receives Certified photocopy ofrequested form/ result and signsthe releasing logbook

5. Releases Certified Photocopy ofrequested form / result None 5 minutes HIM Staff

TOTAL: Php 2.00per copy 33 minutes

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Retrieval and Issuance of Certification for Patients with Discharge Date of more than 6 months

Office/Division: Health and Information Management




CHECKLIST OF REQUIREMENTS WHERE TO SECURE* Any of the following requirements listed as applicable: Hospital ID - (1 copy) Authorization Letter - (1 copy) Request Letter - (1 copy) Any Valid ID (Government Issued ID) - (1 copy)

Admitting Section / OPD Authorizing Party Requesting Party BIR, Post Office, DFA, PSA, SSS, GSIS,


HIMCashier


PROCESSINGTIME

PERSONRESPONSIBLE



None5 minutes


HIM Staff

2. Submits documentaryrequirements if applicable

2. Receives documentary requirements(*if client can’t provide documentaryrequirements. Advice clients to secureneeded documents upon claiming of therequested certificate)


3. Receives instructions on theexpected time of releasing thecertification

3. Provides instruction on the expectedtime of releasing certificate None 6 working days HIM Staff

4. Receives Charge slip 4. Issues charge slip and instructs clientsto go to cashier for payment Php 30.00 10 minutes HIM Staff /

Cashier5. Submits paid charge slip with OR

number5. Receives charge slip with OR number None 5 minutes HIM staff

6. Presents documentaryrequirements as need for the

6. Receives documentary requirementsand / or Letter Request None 10 minutes HIM Staff

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claiming of requested certificate

7. Receives Medical Certificate andsigns the 1st copy as proof ofreceipt

7. Releases Medical CertificateNone 3 minutes HIM Staff

TOTAL: Php 30.00 6 days & 48minutes

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6.LaboratoryAvailment of Laboratory Services

Office/Division: Laboratory



Who May Avail: Outpatient Clients

CHECKLIST OF REQUIREMENTS WHERE TO SECURELaboratory Request- (1 copy) ER/OPD/Wards

Stamped ‘Paid’ charge slip (with OR Number/MSS Stamped) - (1 copy)Cashier/MSS

Official Receipt - (1 copy)


PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents Laboratory Request 1. Receives and reviews request forcompleteness of data. None 2 minutes Laboratory Staff on

Duty2. Receives Charge Slip proceeds

to cashier for payment2. Issues Charge Slip and Instructs Clientto go to cashier for payment and proceedto laboratory for Specimen Collection

*pleaserefer to table

below forapplicable

fees

30 minutes Laboratory Staff onDuty / Cashier

3. Returns to the Laboratory andpresents Charge Slip / OfficialReceipt marked as “PAID” and /or MSS Stamped Charge Slip ofavailed discount and submitslaboratory sample (urine & stool)

3. Receives Charge Slip and ExtractsBlood / Receives Laboratory Sample

None 10 minutes Laboratory Staff onDuty

TOTAL: *pleaserefer to table

below fortotal

applicablefees

42 minutes

31

7.RADIOLOGYRadiology services

Office/Division: Radiology



Who May Avail: Admitted Clients

CHECKLIST OF REQUIREMENTS WHERE TO SECURERadiology Request - (1 copy) Ward Stations


PROCESSINGTIME

PERSONRESPONSIBLE

1. Nursing staff brings radiologyrequest for and in behalf ofadmitted client

Receives and reviews radiology requestfor correctness of data None 2 minutes Radiologic Staff on

Duty

2. Proceeds to examination Performs requested radiologicNone 30 minutes

RadiologicTechnologist On

Duty3. Receives information for the

charges of the procedureInforms / notifies that charges for theprocedure will be sent to the billing section

Instructs client regarding schedule forrelease of official result X-ray 5 days Ultrasound – 3 days Mammogram – 15 days CT- Scan – 15 days

*pleaserefer totablebelow

None

2 minutes

2 minutes RadiologicTechnologist On

Duty

4. Client goes back to the Ward/ ER Instruct Nursing Staff / Institutional Workerto None 2 minutes Institutional Worker

/ Nursing StaffTOTAL: 38 minutes

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Availment of Radiology servicesOffice/Division: Radiology



Who May Avail: OPD Clients

CHECKLIST OF REQUIREMENTS WHERE TO SECURERadiology Request - (1 copy)Stamped Charge Slip/Official Receipt - (1 copy)

OPDCashier


PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents radiology request

CT scan, Ultrasound and Mammogram:a. Receives schedule and instruction on

the preparation of the procedure

X- RAY:b. Proceed to Step 2

Receives & reviews radiology request forcorrections of data and inputs charges in thecomputer the prints charge slipCT scan, Ultrasound and Mammogram:

a. Gives schedule and instructs on thepreparation of the procedure

X- RAY:b. Proceed to Step 2

None 2 minutes Radiologic Staff onDuty

2. Receives charge slip and proceeds tocashier for payment

Issues charge sip and instructs client to go tocashier payment

*please referto table

below forapplicable

fees

10 minutes Radiologic Staff onDuty / Cashier

3. Returns to Radiology Section andpresents stamped paid charge slip

Performs requested radiologic examinationafter receipt of the stamped charge slip

a.) X-rayb.) CT-scan : Plain procedurec.) CT-scan : Contrast Enhancedd.) Ultrasounde.) Mammogram

None30 minutes30 minutes

1 hour30 minutes30 minutes

Radiologic Staff onDuty

4. Waits for instructions after theprocedure

Instructs clients regarding schedule for releaseof official result X-ray – 7 days Ultrasound – 3days Mammogram – 15 days CT Scan – 15 days

None 2 minutes Radiologic Staff onDuty

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TOTAL: a.) X-ray –44 minutes

b.) CT-scan :Plainprocedure -44 minutes

c.) CT-scan :ContrastEnhanced -1 hr & 14minutes

d.) UltrasoundMammogram44 minutes

34

8.CENTRAL SUPPLY ROOMAvailment of Medical and Surgical SuppliesOffice/Division: Central Supply Room



Who May Avail: OPD- Patients

CHECKLIST OF REQUIREMENTS WHERE TO SECURECharge Slip - - (1 copy) ER/OPD

Stamped ‘Paid’ charge slip (with OR Number / MSS Stamped) - (1 copy) Cashier/MSS


PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents charge slip 1.a Receives Charge Slip and checksavailability of supplies1.b Affixes corresponding amount on thecharge slip1.c Instructs client to proceed to thecashier for payment

*Pleaserefer to thetable below

forapplicable

fees

5 minutes CSR Staff on Duty /Cashier

2. Returns to CSR and presentsOfficial Receipt or StampedCharge Slip from MSS.

2. Receives Official Receipt or StampedCharge Slip from MSS None 10 minutes CSR Staff on Duty

3. Receive supplies 3. Provides available supplies requested None 3 minutes CSR Staff on DutyTOTAL: 18 minutes

35

Availment of Medical and Surgical SuppliesOffice/Division: Central Supply Room



Who May Avail: In- Patients

CHECKLIST OF REQUIREMENTS WHERE TO SECURECharge Slip - (1 copy) Ward Stations


PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents charge slip 1. Receives Charge Slip and checksavailability of supplies and inputscharge in the computer None 3 minute CSR Staff on Duty /

Cashier

2. Receive supplies 2. Provides available supplies requested None 3 minute CSR Staff on DutyTOTAL: None 6 minutes

36

9.PharmacyIssuance of Drugs and Medicines

Office/Division: Pharmacy



Who May Avail: Outpatient

CHECKLIST OF REQUIREMENTS WHERE TO SECUREPrescription - (1 copy) Emergency Room/Outpatient Department

Official Receipts - (1 copy) Cashier


PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents Prescription 1. Checks the completeness andcorrectness of the prescription and themedicines.

Fills prescription if available. For unfilledprescription, give proper instruction toclients

None 3 minutes Pharmacist/Pharmacy Clerk

2. Receives order of payment thenproceed to cashier for payment

2. Issues order of payment and instructsthe client to pay to the cashier.

*please referto table

below forapplicable

fees

10 minutesPharmacist/

Pharmacy Clerk /Cashier

3. Presents Official Receipt 3. Receives Official Receipt & dispensesmedicine None 2 minutes Pharmacist/

Pharmacy Clerk4. Checks and receives purchasedmedicines.

4. Gives proper instruction on dispensedmedicine in dosage/frequency & intake None 3 minutes Pharmacist/

Pharmacy ClerkTOTAL: None 18 minutes

37

10. Medical Social ServiceAvailment of medical assistance or discounts to hospital services

Office/Division: Medical Social Service (MSS)



Who May Avail: ER/OPD 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)

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

MSS Service Card Quantified Free Services (QFS) Logbook (if applicable) MSS

Any of listed requirements, as applicable- Certificate of Indigency - (1 copy)- 4P’s ID - (1 copy)- Senior Citizen ID - (1 copy)- PWD ID - (1 copy)- BHW ID - (1 copy)- Barangay Official ID - (1 copy)

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

Office- Rural Health Unit / DOH Regional Office- DILG


PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents charge slip/SOA/Order ofPayment Slip & MSS Service Cardand any documentary requirements,as applicable.

1. Checks and updates/revalidates MSSCard & electronic record in the computer &receives any documentary requirements(as applicable) then checks statement ofaccount and compute possible discount ormedical assistance to be provided toclient, or possible cost sharing.

None 3 minutesSocial worker on

Duty

2. Acknowledges medical assistanceavailed or signs logbook ofQuantified Free Services(QFS)

2. Indicates amount discounted/assisted oramount to be paid at the charge slips/SOA None 5 minutes Social Worker on

duty

3. For clients with counterpartpayment: Proceeds to cashier forpayment before going to the cost

3. Instruct client to proceed to the cashier forpayment before proceeding to the costcenters for the services needed

*Amount tobe paid may

vary

5 minutesSocial Worker on

duty

38

centers for the services needed.

3.a For clients classified asPoor/Indigent: Proceeds to the costcenters for the services needed.

3.a Instructs client to proceed to the costcenter to avail the services needed.

dependingon discount

given

None5 minutes Social Worker on

duty

TOTAL: 13 minutes

39

Availment of medical assistance or discounts to hospital servicesOffice/Division: Medical Social Service (MSS)



Who May Avail: IN Patients

CHECKLIST OF REQUIREMENTS WHERE TO SECURE MSS Service Card - (1 copy) Quantified Free Service (QFS) Logbook (as applicable) MSS Section

Statement of Account (SOA) - (1 copy) Billing & Claims


PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents statement of accountand MSS Service Card

1. Checks statement of account andcompute possible discount or medicalassistance to be provided to client, orpossible cost sharing.

None 3 minutes Social Worker onDuty

2. Acknowledges medicalassistance availed or signslogbook of Quantified FreeService (QFS).

2. Provides medical assistance/discountbased on classification or waivesexcess for NBB clients then recorddischarges.


3. Proceeds to cahier for paymentand/or clearance.

3. Instruct patients to proceed to thecashier for their payments and/orclearance.

*Amount tobe paid may

varydependingon discount

given

5 minutes Social Worker onDuty

TOTAL: 13 minutes

40

Classification/Re-classification of patientOffice/Division: Medical Social Service (MSS)



Who May Avail: Walk IN or Referred Patients (In- Patients, ER clients, OPD)

CHECKLIST OF REQUIREMENTS WHERE TO SECUREMSS Service Card MSS Section*Any of Documentary Requirements as applicable:- Certificate of Indigency/4 p’s ID - (1 copy)- Senior Citizen ID - (1 copy)- PWD ID - (1 copy)

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

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

Office- Rural Health Unit / DOH Regional Office- DILG


PROCESSINGTIME

PERSONRESPONSIBLE

1. For NEW Clients:Undergoes interview andpresents necessarydocuments, if needed.

1. Interviews and assesses client’s socio-economic status and coping capacityand Orients patient/watcher on thescope & limitation of hospital services,cost sharing, including policies insettling hospital bill.


2. Receives MSS Service Card 2. Assigns client with social classificationand issues MSS Service Card None 3 minutes Social Worker on

Duty3. For OLD Clients:

Presents MSS Service Card3. Updates data/revalidates MSS Service

Card. None 5 minutes Social Worker onDuty

TOTAL: New Client -33 minutes

Old Client –5 minutes

41

Enrolment to PHIC through Point of Service ProgramOffice/Division: Medical Social Service (MSS)



Who May Avail: Admitted clients/patients

CHECKLIST OF REQUIREMENTS WHERE TO SECURE* Any of listed documentary requirements (as applicable)- 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

PERSONRESPONSIBLE

1. Asks information how to accessPHIC enrolment, and securesneeded requirements asinstructed.

1. Provides information and instructswatcher or patient for therequirements. None 5 minutes Social Worker on

Duty

2. Presents documentaryrequirements and receivesPMRF.

2. Checks completeness of requireddocuments and provides PhilhealthMembership Registration Form(PMRF)

None 2 days Social Worker onDuty

3. Fills up the PhilhealthMembership Registration Form(PMRF).

3. Instructs and assists qualified clients tofill up information required at thePhilhealth Membership RegistrationForm (PMRF).

None 4 hours Social Worker onDuty

4. Waits for the completion of theon site registration to PHIC.

4. Encodes data at Point of Servicesystem and issues note as proof ofPHIC enrolment then instructswatcher/patient to proceed to thePHIC Claims Section.


TOTAL: None 2 days,4 hours& 15 minutes

42

11. Billing And ClaimsIssuance of Statement of Accounts (SOA)

Office/Division: Billing and Claims



Who May Avail: In-Patients

CHECKLIST OF REQUIREMENTS WHERE TO SECURENone None


PROCESSINGTIME

PERSONRESPONSIBLE

1. Requests for SOA If No PhilHealth Membership1.a Prints SOA once “tag cleared” by thecost centers

If With PhilHealth Membership1.b Incorporate PHIC benefits in the SOAthen print one “tag cleared” by the costcenters

None

None

20 minutes

20 minutes

B/C FrontlineStaff

B/C Frontline Staff

If No PhilHealth Membership2.a Receives SOA and signsreceiving logbook

If With PhilHealth Membership2.b Receives SOA and signspertinent PhilHealth Documents

2. Releases SOA and instructs clients toproceed to MSS/Malasakit Center asapplicable, then last to Cashier’s forpayment

None

None

3 minutes

3 minutes

B/C FrontlineStaff

B/C Frontline Staff

TOTAL: 23 minutes

43

Issuance of Statement of Accounts (SOA)Office/Division: Billing and Claims



Who May Avail: Out-Patients

CHECKLIST OF REQUIREMENTS WHERE TO SECURENone None


PROCESSINGTIME

PERSONRESPONSIBLE

1. Requests for SOA If No PhilHealth Membership1.a Prints SOA

If With PhilHealth Membership1.b Incorporate PHIC benefits in the SOAthen print once done

None

None

20 minutes

20 minutes

B/C FrontlineStaff

B/C Frontline StaffIf No PhilHealth Membership2.a Receives SOA and signsreceiving logbook

If With PhilHealth Membership2.b Receives SOA and signspertinent PhilHealth Documents &receiving logbook

2. Releases SOA and instructs clients toproceed to MSS/Malasakit Center asapplicable, then last to Cashier’s forpayment

None

None

3 minutes

3 minutes

B/C FrontlineStaff

B/C Frontline Staff

TOTAL: 23 minutes

44

Verification of PHIC Eligibility StatusOffice/Division: Billing and Claims



Who 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 patients 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

- Employeer- BIR, Post Office, DFA, PSA, SSS, GSIS,

PAG-IBIG, LTO, COMELEC


PROCESSINGTIME

PERSONRESPONSIBLE

1. Request for PHIC Eligibility Status 1. Asks client of some key pointinformation for searching and verifiesPHIC Eligibility Status in PHICPortal/eClaims*if YES – Proceed to Step 3*if NO – Instructs clients to submitdocumentary requirements as stated in thePHIC/eClaims Portal

None 3 minutes B/C FrontlineStaff

2. Submits documentaryrequirements

2. Receives documentary requirements None 3 minutes B/C FrontlineStaff

3. Receives information that he/shecan now avail PHIC benefits

3. Informs clients that he/she can availPHIC benefits None 3 minutes B/C Frontline

StaffTOTAL: None 9 minutes

45

12. CashierPayment for various hospital charges

Office/Division: Cashier



Who May Avail: Out-Patient/ Walk-In Clients/ In-Patients

CHECKLIST OF REQUIREMENTS WHERE TO SECURE* Any of listed documentary requirements, as applicable- Charged Slip - (1 copy)- Order Form of Payment - (1 copy)- Statement of Account (SOA) - (1 copy)

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


PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents charge Slip/Order Formof Payment/Statement of Account(SOA)

1. Receives charge Slip/ Order Form ofPayment/Statement of Account (SOA). None 2 minutes Collecting

officer

2. Pays the amount 2. Receives and counts the payment ApplicableFees 5 minutes Collecting

Officer3. Receives the Official /Receipt ofpayment and counts the change (ifany)

3. Issues Official Receipt and gives thechange (if any). None 3 minute Collecting

officer

TOTAL: 10 minutes

46

Disbursement of Payments based on approved Disbursement Vouchers (DV)Office/Division: Cashier



Who May Avail: Suppliers, Contractors

CHECKLIST OF REQUIREMENTS WHERE TO SECURE* Any of listed documentary requirements, as applicable- Company ID - (1 copy)- Special Power of Attorney (SPA) - (1 copy)- Original Official Receipt (OR) - (1 copy)

- Employer- Public Attorneys’ Offices- Transacting Company


PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents documentaryrequirements

1. Receives documentary requirementsNone 5 minutes

Cashier/Disbursing

Officer2. Signs DV and Receives thepayment

2. Instructs the suppliers/payee to sign DV& to issue official receipt and releases thepayment

None 3 minutesCashier/

DisbursingOfficer

3. Issues official Receipt 3. Receives Official Receipt2 minutes

Cashier/Disbursing

Officer4. Receives the documentaryrequirements

4. Provides client copy of documentaryrequirements. None 3 minutes

Cashier/Disbursing

OfficerTOTAL: None 13 minutes

47

13. Animal Bite Treatment CenterAvailment of Animal Bite Services – Follow-up Vaccination

Office/Division: Animal Bite Treatment Center (ABTC)



Who May Avail: Animal Bite Clients for Follow-up Vaccination

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


PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents Rabies Post-ExposureProphylaxis Card

1. Receives Rabies Post-ExposureProphylaxis Card None 3 minutes ABTC Manager

2. Receives vaccination 2. Administers vaccine to client/patient None 5 minutes ABTC Manager3. Receives further instructions 3. Instructs client/patient for follow-up

doses indicated in the card None 3 minutes ABTC Manager

TOTAL: 11 minutes

48

Availment of Animal Bite ServicesOffice/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



PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents self and waits forinstructions.

1. Receives client/patient and givesinstructions. None 3 minutes ABTC Manager

2. Receives charge slip 2. Issues charge slip and instructs patientto proceed to Pharmacy and CSR to getvaccines and supplies

* Pleaserefer to table

below forapplicable

fees

15 minutes

ABTC Manager

3. Returns to ABTC and givessupplies and vaccines foradministration

3. Receives supplies and administersvaccines None

1 hourABTC Manager

4. Waits for further instructions 4. Provides Rabies Post-ExposureProphylaxis Card indicating the datesof follow up doses

None5 minutes

ABTC Manager


49

Availment of Animal Bite ServicesOffice/Division: Animal Bite Treatment Center (ABTC)Classification: SimpleType of Transaction: G2C – Government to CitizenWho May Avail: New Animal Bite Clients (Category II & Category III bite exposure without PhilHealth)



PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents self and waits forinstructions.

1. Receives client/patient and givesinstructions. None 3 minutes ABTC Manager

2. Receives charge slip andproceeds to Pharmacy andCentral Supply Room then toCashier for payment

2. Issues charge slip and Instructsclient/patient to proceed to Pharmacy andCentral Supply Room then to Cashier forpayment

* Pleaserefer to table

below forapplicable

fees

15 minutesABTC Manager

Cashier

3. Returns to ABTC and givessupplies and vaccines foradministration

3. Receives supplies and administersvaccines None

1 hourABTC Manager

4. Waits for further instructions 4. Provides Rabies Post-ExposureProphylaxis Card indicating the dates offollow up doses

None5 minutes

ABTC Manager


50

14. TB-DOTS CLINICAvailment of TB-DOTS Service – New TB DOTS Clients

Office/Division: TB-DOTS Clinic



Who May Avail: New TB DOTS Clients

CHECKLIST OF REQUIREMENTS WHERE TO SECURENONE NONE


PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents self and fills upattended patient list logbook andwaits name to be called forconsultation

1. Receives client/patient and givesinstructions. NONE 30 minutes TB-DOTS Nurse

2. Presents self for PhysicianConsult

2. Provides Clinical Consultation NONE 10 minutes Physician

3. Receives instruction by the TB-DOTS Nurse

3. Provides instructions pertaining tolaboratory and diagnostics then advise tofollow-up per physician’s schedule given

NONE 3 minutes TB-DOTS Nurse

TOTAL: 43 minutes

51

Availment of TB-DOTS Service – Follow-up Patient (TB-DOTS Client)Office/Division: TB-DOTS Clinic



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

CHECKLIST OF REQUIREMENTS WHERE TO SECURENONE NONE


PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents self and fills upattended patient list logbook andwaits name to be called forconsultation




3. Receives NTP Referral Form andfurther instructions

3. Prepares and Issues NTP ReferralForm then gives further instructions. NONE 3 minutes TB-DOTS Nurse

TOTAL: 43 minutes

52

Availment of TB-DOTS Service – Follow-up Patient (TB-DOTS Client)Office/Division: TB-DOTS Clinic



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

CHECKLIST OF REQUIREMENTS WHERE TO SECUREPHIC Note Billing/Claims Section


PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents self and fills up attendedpatient list logbook and waits nameto be called for consultation




3.a For client/patient with PhilHealth:Proceeds to Philhealth Sectionand asks for PHIC note

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

3.a For client/patient with PhilHealth:Instructs patients to go the PhilHealthSection

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

NONE 3 minutes TB-DOTS Nurse

4. Returns to TB-DOTS Clinic thenpresents PHIC Note

4. Receives PHIC Note and enroll patientas TB Client NONE 30 minutes TB-DOTS Nurse

5. Receives NTP ID Card andinstructions for follow-upschedule

5. Issues NTP ID Card then givesinstructions for follow-up schedule NONE 3 minutes TB-DOTS Nurse

TOTAL: w/ PHIC1 hour and16 minutes

w/o PHIC43 minutes

53

Availment of TB-DOTS Service – Follow-Up PatientOffice/Division: TB-DOTS Clinic



Who May Avail: Enrolled TB Clients

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


PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents NTP ID Card and waitsfor instructions

1. Receives NTP ID Card and givesinstructions NONE 3 minutes TB-DOTS Nurse

2. Receives Anti-TB medication andinstructions for follow-upschedule

2. Gives Anti-TB medication and instructsfor follow-up schedule. NONE 3 minutes TB-DOTS Nurse

TOTAL: 6 minutes

54

15.Procurement ServicePurchase of Bidding Documents

Office/Division: Procurement



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. Presents Letter of Intent (LOI) andValid ID

1. Receives and reviews LOI and ID thenissues Charge Slip to Suppliers/Bidderand directs bidder/suppliers to Cashier forpayment

None 15 minutesProcurement

Officer/Staff/BACSecretariat

2. Presents Official Receipt toProcurement Unit

2. Receives Official Receipt and issuesbidding documents None 25 minutes

ProcurementOfficer/Staff/BAC

SecretariatTOTAL: None 40 minutes

55

Internal Services

56

1.Materials Management OfficeRequisition and Issuance of Supplies

Office/Division: Materials Management Office



Who May Avail: End Users

CHECKLIST OF REQUIREMENTS WHERE TO SECURERequisition - (1 copy)Issue Slip (RIS) form - (1 copy) Materials Management Office


PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents self and inputs item forrequisition at the computer andinforms MMO staff once done

1. Assist clients and prints RIS forrecording and assigns control number None 5 minutes MMO staff

2. Receives filled RIS 2. Returns the RIS to the end user andinstructs to proceed to SAO Office forcounter signature and to the MCC officeapproval

None 30 seconds MMO staff

3. Submits approved RIS 3. Issues requested items None 30 minutes MMO staffTOTAL: 36 minutes

57

Receipt of GoodsOffice/Division: Materials Management Office



Who May Avail: In-Patient Clients

CHECKLIST OF REQUIREMENTS WHERE TO SECURE- Delivery Receipt- Sales Invoice- Acknowledgement Receipt

Supplier


PROCESSINGTIME

PERSONRESPONSIBLE

1. Presents documentaryrequirements of goods for delivery

1. Receives documentary requirementspresented. Checks if delivery are inconformity with the specificationsstipulated in the Purchase Order.

None 5 minutes MMO staff

2. Receives document wit stamp as“Received”

2. Signs when in order and gives a copy ofthe receipt to the client None 5 minutes MMO

TOTAL: 10 minutes

58

EXAMINATIONS AND FEES & PRICELISTS

59

List of Laboratory Examination Fees (as of December 6, 2019)(* subject for change)

Examination RateStandard Senior Citizen

24 Hour Urine collection for protein (AGAPE) 600.00 480.00ABG (AGAPE) Panel A 1,900.00 1,520.00ABG (AGAPE) Panel B 2,100.00 1,680.00AFB STAIN - -AFP 1,800.00 1,440.00AFP (AGAPE) 1,800.00 1,440.00Albumin (AGAPE) 180.00 144.00Albumin / A/G Ratio 85.00 68.00Alkaline Phosphatase 350.00 280.00Alkaline Phosphatase (AGAPE) 450.00 360.00Amylase (AGAPE) 1,400.00 1,120.00ANA - EIA (AGAPE) 1,800.00 1,440.00Anti HAV (Quantitative) AGAPE 980.00 784.00Anti-HAV (AGAPE) 500.00 400.00Anti-HAV (IgM) or Hep. A (EIA) AGAPE 1,100.00 880.00Anti-HBc IgM (Quanti/Vidas) AGAPE 1,800.00 1,440.00Anti-HBe (Quanti/Vidas) AGAPE 1,600.00 1,280.00Anti-HBs (Quanti/Vidas) AGAPE 950.00 760.00Anti-HBs (Rapid) AGAPE 380.00 304.00Anti-HBs Determination 165.00 132.00Anti-HCV (IgM) or Hepatitis C (EIA) AGAPE 950.00 760.00APTT 450.00 360.00APTT (AGAPE) 450.00 360.00ASO 100.00 80.00ASO Titer (AGAPE) 600.00 480.00B1B2 (AGAPE) 300.00 240.00Beta HCG (AGAPE) 1,500.00 1,200.00Bilirubin 250.00 200.00Bilirubin (Total, Direct & Indirect) AGAPE 500.00 400.00BIOPSY 1,000.00 800.00BIOPSY (LARGE) + frieght (P500) 1,100.00 880.00BIOPSY (MEDIUM) + freight (P375) 875.00 700.00BIOPSY (SMALL)+ freight (P 275) 675.00 540.00Biopsy PF (Dr. Harold L. Tee) 1,000.00 800.00Blood Bag 450 ml. (single) 155.00 124.00Blood Culture / sensi (AGAPE) 2,700.00 2,160.00Blood Culture 2 sites Packages (AGAPE) 4,900.00 3,920.00

60

Blood Donor Screening 1,500.00 1,200.00Blood Donor Screening (PNRC) 1,800.00 1,440.00BLOOD DONOR SCREENING (ZNMC) 1,500.00 1,200.00Blood Typing with Rh 90.00 72.00Body Fluid Aspirate Culture & Sensi (AGAPE) -BSMP (DJRMH) 50.00 40.00BUA 95.00 76.00BUN 140.00 112.00BUN (AGAPE) 180.00 144.00C3 (AGAPE) 970.00 776.00CA 125 (AGAPE) 2,500.00 2,000.00CA 19-9 (AGAPE) 4,850.00 3,880.00Calcium 275.00 220.00Calcium (Ionized) (AGAPE) 900.00 720.00Calcium Total (AGAPE) 300.00 240.00Cardiac Triage (AGAPE) 3,900.00 3,120.00Cardiac Triage Package (Trop T & pro BNP) AGAPE 5,650.00 4,520.00CBC only 150.00 120.00CBC with Platelet 210.00 168.00CBC with Platelet (AGAPE) 250.00 200.00CBC, PLT(AGAPE) 250.00 200.00CEA (AGAPE) 2,000.00 1,600.00Cell Block/ Cytology Biopsy (NORTH) + Professional Fee 850.00 680.00Cell Count and Diff count (Peritoneal Fluid) 1,400.00 1,120.00Chloride 275.00 220.00Chloride (AGAPE) 380.00 304.00Cholesterol 95.00 76.00Cholesterol (HDL) AGAPE 300.00 240.00Cholesterol (Total) AGAPE 150.00 120.00Creatinine 135.00 108.00Creatinine (AGAPE) 150.00 120.00Crossmatching 70.00 56.00CRP (C-Reactive Protein) AGAPE 600.00 480.00CSF Glucose (AGAPE) 400.00 320.00CSF Protein (AGAPE) 700.00 560.00CTBT (Clotting Time/Bleeding) 70.00 56.00Culture and Sensi (Wound Culture) (AGAPE) 1,800.00 1,440.00D-Dimer (AGAPE) 2,500.00 2,000.00DAT/Combs Test 70.00 56.00Dengue Antibody (AGAPE) 1,500.00 1,200.00Dengue Antibody Determination 550.00 440.00

61

Dengue Dou Package (NS1 Ag, IgM, IgG) AGAPE 1,500.00 1,200.00Dengue NS1 Ag 300.00 240.00Dengue NS1 Package (OKD) 1,800.00 1,440.00Differential Count 40.00 32.00Discharge Culture & Sensitivity Test (AGAPE) 2,150.00 1,720.00ESR 135.00 108.00ESR (AGAPE) 450.00 360.00FBS 95.00 76.00Fecalysis (AGAPE) 50.00 40.00Fecalysis (AGAPE) 30.00 24.00Fecalysis only 30.00 24.00Fecalysis with Occult Blood 130.00 104.00FORMALIN 10% 10.00 8.00FORMALIN 10% 100 ml. 16.30 13.04FORMALIN 10% 1000 ml. 163.00 130.40FORMALIN 10% 150 ml. 24.45 19.56FORMALIN 10% 200 ml. 32.60 26.08FORMALIN 10% 250 ml. 40.75 32.60FORMALIN 10% 300 ml. 48.90 39.12FORMALIN 10% 350 ml. 57.05 45.64FORMALIN 10% 400 ml. 65.20 52.16FORMALIN 10% 500 ml. 81.50 65.20FORMALIN 10% 600 ml. 97.80 78.24FORMALIN 10% 700 ml. 114.10 91.28FORMALIN 10% 800 ml. 130.40 104.32FORMALIN 10% 90 ml. 14.67 11.74FORMALIN 10% 900 ml. 146.70 117.36Fresh Frozen Plasma/ Platelet Concentrate 1,000.00 800.00FT3 880.00 704.00FT4 900.00 720.00Gene expert - -GLOBULIN (djrmh) 85.00 68.00Glucose (FBS/RBS) AGAPE 100.00 80.00Gram Stain 50.00 40.00GS & CS Vaginal Discharge 2,750.00 2,200.00H. Pylori Determination 295.00 236.00H. Pylori Determination (AGAPE) 500.00 400.00Hba 1C 792.00 633.60Hba 1C (AGAPE) 700.00 560.00HBeAg (Quanti/Vidas) AGAPE 1,600.00 1,280.00HBs Ag 185.00 148.00

62

HBsAg (Quanti/Vidas) AGAPE 850.00 680.00HCV 330.00 264.00HDL (AGAPE) 300.00 240.00HDL / LDL 135.00 108.00Hematocrit 45.00 36.00Hematocrit (AGAPE) 50.00 40.00Hemoglobin 45.00 36.00Hepatitis Profile 6,480.00 5,184.00Histopathology - Large 2,000.00 1,600.00HIV 165.00 132.00Ionized Calcium -KOH Preparation 35.00 28.00LDH (Agape) 880.00 704.00Lipase (AGAPE) 1,800.00 1,440.00Lipid Profile (Package) 550.00 440.00Magnesium (AGAPE) 380.00 304.00Micral Test (AGAPE) 350.00 280.00Microalbumin/Creatinine ratio (semi-quantitative) AGAPE 600.00 480.00Occult Blood (AGAPE) 600.00 480.00Occult Blood (AGAPE) 450.00 360.00Occult Blood only 100.00 80.00Oral Glucose Tolerance Test (OGGT) 75 grms. 460.00 368.00Oral Glucose Tolerance Test 50 grms. (SW) 375.00 300.00Packed Red Blood Cells 1,500.00 1,200.00Paragonimus -PBS (Bloodline) 1,000.00 800.00Peripheral Smear (OKD) 1,200.00 960.00Phosphorus (AGAPE) 380.00 304.00Platelet ATM Count Only 115.00 92.00PLATELET CONCENTRATE (ZANORTE) 1,000.00 800.00Pleural Fluid AFB smear (AGAPE) 950.00 760.00Pleural Fluid Analysis (Color, Character, Cell Count, Glucose, LDH) AGAPE 1,900.00 1,520.00Pleural Fuid culture&sensi (AGAPE) + Gram Stain 2,700.00 2,160.00Potassium (K plus) (AGAPE) 380.00 304.00POTASSIUM - GERONIMO 450.00 360.00Potassium K plus 275.00 220.00Pregnancy Test 80.00 64.00PRO BNP (Quanti-Vidas) AGAPE 3,500.00 2,800.00Prothrombin Time (INR) DerivedFibrinogen, Protime % Activity 450.00 360.00Protime (AGAPE) 450.00 360.00Protime (OKD) 500.00 400.00

63

PSA 330.00 264.00PSA Quantitative (AGAPE) 1,800.00 1,440.00PTT (AGAPE) 310.00 248.00RBC Count (DJRMH) MC 30.00 24.00RBS /(Wet Method) 95.00 76.00RBS Strips 85.00 68.00Reticulocyte count 150.00 120.00Reticulocyte Count (AGAPE) 300.00 240.00Reticulocyte count (OKD) 500.00 400.00RHEUMATOID FACTOR (R.F) AGAPE) 600.00 480.00Salmonella 600.00 480.00Salmonella (AGAPE) 700.00 560.00Serum Proteins (TPAG - package) AGAPE 500.00 400.00SGOT (AST) 125.00 100.00SGOT (AST) AGAPE 300.00 240.00SGPT (ALT) 115.50 92.40SGPT (ALT) AGAPE 300.00 240.00Sodium & Potassium 550.00 440.00Sodium (AGAPE) 380.00 304.00Sodium (Na+) 275.00 220.00Sodium, Potassium & Calcium 550.00 440.00Sodium, Potassium (AGAPE) 760.00 608.00Sodium, Potassium, Chloride (AGAPE) 760.00 608.00Sputum Culture & Sensi (AGAPE) Endotracheal Asp. GS/CS 1,980.00 1,584.00Sputum Examination for P. Westermanii - -Stool Culture & Sensitivity Test (AGAPE) 2,200.00 1,760.00T3 (AGAPE) - -T3 (AGAPE) 880.00 704.00T4 (AGAPE) 880.00 704.00T4 (AGAPE, SNR.) 704.00 563.20Total Calcium (AGAPE) 250.00 200.00TOTAL PROTEIN (djrmh) 85.00 68.00Total Protein, AG Ratio (TPAG for body fluids) AGAPE 1,200.00 960.00Total Proteins (AGAPE) 180.00 144.00TPAG 350.00 280.00Triglycerides 245.00 196.00Triglycerides (AGAPE) 300.00 240.00Trop T (Quanti) AGAPE 2,000.00 1,600.00TROP-I (QUANTITATIVE-VIDAS) AGAPE 2,250.00 1,800.00Trop-I (rapid) AGAPE 950.00 760.00Troponin I 331.20 264.96

64

Troponin T 1,004.00 803.20Troponin T (rapid) AGAPE 1,300.00 1,040.00TSH (AGAPE) 950.00 760.00TSH, T3, T4 (AGAPE) 2,250.00 1,800.00Typhidot (IgM & IgG) AGAPE 700.00 560.00Typhidot (IgM/IgG) OKD 1,100.00 880.00Urinalysis (U/A) 50.00 40.00Urinalysis Automated 150.00 120.00Urine Albumin 45.00 36.00Urine Albumin/Creatinine ratio (AGAPE) 1,500.00 1,200.00Urine Culture and Sensi (AGAPE) 1,200.00 960.00VDRL / RPR 100.00 80.00WBC 40.00 32.00WHOLE BLOOD 1,800.00 1,440.00Whole Blood (Blood Donor Screening) 1,800.00 1,440.00Wound Discharge or Abscess AFB / AFB Staining (Body Fluids & abscess) AGAPE 950.00 760.00Wound Discharge or Abscess AFB/AFB Staining )Body Fluids & Abscess (Sen.Citizen) AGAPE

760.00 608.00

65

List of Drugs and Medicines (as of December 2, 2019) (*subject for change)

DRUGS AND MEDICINES DESCRIPTIONUNIT COST

Standard Senior Citizen

ACETYLCYSTEINE

100MG SACHET 11.70 9.36

200 mg SACHET9.75 7.813.00 10.4

600 mg TABLET 32.50 26ACICLOVIR 400MG TABLET 29.25 23.4ADENOSINE 3MG/ML, 2ML AMP 3,380.00 2704

ALBUMIN (HUMAN) 20%, 50 ml (ALBUMAX)2,860.00 22882,275.00 1820

ALLOPURINOL100 mg TABLET 1.95 1.56300 mg TABLET 4.20 3.36

ALUMINUM + MAGNESIUM(HYDROXIDE) 200MG TABLET 1.10 0.88

AMINOPHYLLINE 250MG/10ML, AMP 24.50 19.6

AMLODIPINE10MG TABLET 0.55 0.445MG TABLET 0.45 0.36

AMOXICILLIN500 mg CAPSULE 1.80 1.44

250MG/5ML 49.40 39.52

AMPICILLIN250MG VIAL 10.80 8.64500 mg VIAL 10.10 8.08

ATENOLOL 50MG TABLET 3.90 3.12ANTI TETANUS SERUM 1,500 IU AMP 107.35 85.88

ANTI-RABIESIMMUNOGLOBULIN (EQUINE) 200 IU. 5 ML VIAL (EQUIRAB)

1,619.95 1295.961,544.40 1235.52

ASCORBIC ACID500MG TABLET 1.95 1.56100MG/5ML, 60ML SYRUP 35.10 28.08

ASPIRIN 80 MG TABLET 0.80 0.64

ATORVASTATIN

10MG TABLET 3.90 3.1220 mg TABLET 5.15 4.1240 MG TABLET 9.10 7.2880 MG TABLET 29.90 23.92

ATROPINE SULFATE 1MG/ML (ATROPAN) 9.85 7.88

ATRACURIUM 10mg/ml, 2.5 ml AMP140.65 112.52113.65 90.92

AZITHROMYCIN 500 mg TABLET14.15 11.3219.75 15.8

500 mg vial 546.00 436.8BIPERIDEN 2 mg TABLET 8.95 7.16BISACODYL 10MG SUPPOSITORY 27.00 21.6

BETAHISTINE 16MG TABLET 13.00 10.424MG TABLET 39.00 31.2

BUDESONIDE 250 mcg/ml, 2 ml NEBULE 58.50 46.8BUPIVACAINE 0.5% (PLAIN) 10ML 812.50 650BUPIVACAINE HEAVY 5MG/ML, 4ML AMPULE 1,209.00 967.2

BUTORPHANOL 2MG/ML, 1ML 552.50 442

CALCIUM GLUCONATE 10%, 10 ml VIAL (CALCILYTE) 22.40 17.92

CARBOFROST125 mcg/ml, 0.5ml (replacement)

299.00 239.2

292.50 234

250mcg/ml 403.00 322.4

66

CARVEDILOL 6.25MG TABLET 1.85 1.48

CAPTOPRIL 25 MG TABLET 0.80 0.64

CEFALEXIN100 mg/ml, 10 ml DROPS 20.50 16.4

500MG CAPSULE 5.85 4.68

CEFAZOLIN 1G 21.00 16.8

CEFIXIME20 mg/ml, 10 ml DROPS 195.00 156200MG CAPSULE 11.65 9.32

CEFUROXIME 500 mg TABLET 11.35 9.08750 mg VIAL 24.55 19.64

CEFOTAXIME500 mg VIAL (CEFOTAX) 61.65 49.32500 mg VIAL (HAXIM) 64.35 51.48

CEFTAZIDIME 1G VIAL 61.10 48.88CELECOXIB 200MG CAPSULE 4.55 3.64CEFTRIAXONE 1 G Vial 23.95 19.16CETIRIZINE 2.5MG/ML, 10ML ORAL DROPS 55.90 44.72CHLORAMPHENICOL 1G VIAL 35.55 28.44CHLORPROMAZINE 100 MG TAB 2.10 1.68CIPROFLOXACIN 200MG/VIAL 30.15 24.12

CLARITHROMYCIN500mg tablet 16.95 13.56250MG/5ML 218.40 174.72

CLINDAMYCIN300 mg mg CAPSULE 8.45 6.76150MG/ML, 4ML 106.30 85.04

CLONAZEPAM 2 mg TABLET 9.15 7.32CLONIDINE 150MCG/ML 144.20 115.36CLOPIDOGREL 75MG TABLET 2.55 2.04

CLOZAPINE 100 mg 11.05 8.84

CO-AMOXICLAV 400MG/57MG PER 5ML, 70ML 299.00 239.2

COLCHICINE 500MCG 1.90 1.52

DEXAMETHASONE 4MG/ 2ML 21.90 17.52

D5 0.3 NaCl 500 ml 51.25 41

60.80 48.64

D5 0.9 NaCL 1L 63.40 50.72

D5 IMB 500ML 60.80 48.64

D5 LR1 L BOTTLE 44.05 35.24

500 ml 62.20 49.76

D5 NM 1 L 63.40 50.72

D5 NSS 1 L 63.40 50.72

D10 WATER 500ML 58.50 46.8

63.40 50.72

D50 WATER 50 ML 49.40 39.52

DIGOXIN 250MG/2ML AMP 142.10 113.68

DIGOXIN 250 MCG TABLET4.25 3.45.30 4.246.50 5.2

DIAZEPAM (Yellow Prescription) 5 mg/ml, 2 ml AMPULE (ANXIOL)82.30 65.84107.60 86.08

DIPHENHYDRAMINE 50MG/ML, 1ML 39.10 31.28DIVALPROEX SODIUM 500MG TABLET ER 20.80 16.64DOBUTAMINE 50 mg/ml, 5 ml AMPULE (DOBUMIN) 325.00 260DOMPERIDONE 10 mg TABLET (MOTILIA) 2.50 2

67

DOPAMINE 40 mg/ml, 5 ml AMPULE (MYOCARD)56.20 44.9650.50 40.461.65 49.32

ENALAPRIL 5MG TABLET 5.85 4.68

ENOXAPARIN0.6 ML 1,038.70 830.96

344.20 275.360.4 ML 791.70 633.36

EPINEPHRINE 1MG/ML, 1ML AMP 34.35 27.48

ERYTHROMYCIN OINTMENT 0.5%, 5G TUBES 231.40 185.12

FENTANYL (Yellow Prescription)50 mcg/ml, 2 ml AMPULE (FRESANYL) 97.30 77.84

50 mcg/ml, 2 ml AMPULE (SUBLIMAX) 76.55 61.24

FERROUS SOLUTION 60ML SYRUP 42.25 33.8

FINASTERIDE 5 mg TABLET12.00 9.610.65 8.52

FLUCONAZOLE 150MG Capsule 79.30 63.44FLUPENTIXOL 20MG/ML 416.00 332.8FOLIC ACID 5 mg TABLET 2.70 2.16FUROSEMIDE 10 mg/ml, 2ml AMPULE 9.20 7.36GABAPENTIN 300 mg CAPSULE (GABAVEX) 7.70 6.16

GLICLAZIDE 60 mg TABLET19.60 15.6814.30 11.44

80 mg TABLET 4.25 3.4GENTAMICIN 40 mg/ml (80mg/2ml) AMPULE 5.45 4.36

HALOPERIDOL5 MG TABLET

4.00 3.25.15 4.12

5MG/ML, 1ML AMP 585.00 468HEPATITIS BIMMUNOGLOBULIN 0.5 ml VIAL 1,886.30 1509.04

HYDRALAZINE 20MG/ML AMP 22.35 17.88HYDROCORTISONE 250MG VIAL 53.55 42.84

HYOSCINE N-BUTYL BROMIDE 10 mg TABLET7.80 6.244.45 3.56

HYOSCINE N-BUTYL BROMIDE 20 MG/ML AMPULE 27.15 21.72IBUPROFEN 100MG/5ML SYRUP 29.75 23.8

INSULINM70/30 VIAL 143.00 114.4R VIAL 135.20 108.16

ISOSORBIDE MONONITRATE30 mg TABLET SR 15.60 12.4860 mg TABLET SR 7.80 6.24

IRON SUCROSE 20MG/ML, 5MLAMPULE 148.60 118.88IOHEXOL 300MG/ML, 50ML VIAL 1,417.00 1133.6ISOXSUPRINE 5MG/ML AMP 365.30 292.24

KETAMINE (Yellow Prescription) 50 mg/ml, 10 ml VIAL (ETAMINE)974.00 779.2784.30 627.44

KETOROLAC 30MG/ML , 1ML (KETRAL) 19.80 15.84

LAMOTRIGINE 100 mg TABLET24.00 19.235.10 28.08

LEVOFLOXACIN 50mg tab 6.50 5.2LIDOCAINE + EPINEPHRINE 20 mg/Ml, 1.8 Ml AMPULE 27.55 22.04LIDOCAINE 2% 50ML VIAL 61.75 49.4LITHIUM CARBONATE 450MG MR TABLET 6.25 5

LOSARTAN50MG TABLET 1.00 0.8100MG TABLET 2.85 2.28

LORATIDINE 10MG TABLET 1.95 1.56

68

MAGNESIUM SULFATE 250 mg/mL AMPULE 23.40 18.72MANNITOL 200 mg/ml, 500 ml 107.15 85.72METHYLDOPA 250MG TABLET 15.70 12.56

METHYLPREDNISOLONE4 mg TABLET 11.70 9.3616 mg TABLET 12.35 9.88

METHOTREXATE 25 mg/ml, 2ml VIAL 123.50 98.8METOCLOPRAMIDE 5 mg/ml, 2 ml 4.45 3.56

METRONIDAZOLE 5MG/ML, 100ML VIAL19.30 15.4417.90 14.32

MIDAZOLAM (YellowPrescription) 5mg/ml, 1 ml AMPULE (DORMIZOL)

70.70 56.56102.55 82.0474.35 59.48

MONOBASIC SODIUM ( fleetenema) BOTTLE 281.45 225.16

MONTELUKAST5MG TABLET 10.40 8.3210MG TABLET 9.70 7.76

MORPHINE SULFATE (YellowPrescription) 10 mg/ml, 1 ml AMPULE 143.00 114.4

MUPIROCIN 5 g OINTMENT 102.70 82.16

MULTIVITAMINSCapsule 1.95 1.5660 ML BOTTLE 30.25 24.2

NALBUPHINE 10MG/ML, 1ML AMP 70.60 56.48NICARDIPINE 1MG/10ML 361.95 289.56NOREPINEPHRINE 10MG/10ML 1,196.00 956.8NYSTATIN 100,000 units 286.00 228.8OLANZAPINE 10 mg TABLET 13.00 10.4

OMEPRAZOLE40MG VIAL 36.35 29.08

20 MG CAPSULE1.10 0.881.00 0.8

ONDANSETRON 2MG/ML, 4ML AMP 100.65 80.52ORAL REHYDRATION SALT 20.5 grams SACHET 5.80 4.64OXACILLIN 500MG VIAL 26.00 20.8OXYTOCIN 10 IU/ml AMPULE 9.40 7.52

PARACETAMOL150 mg/ml, 2 ml AMPULE 6.35 5.08250 mg SUPPOSITORY 34.20 27.36500MG TABLET 1.30 1.04

PENICILLIN G 1,000,000 UNITS 7.45 5.96

PLAIN NSS1 L 41.85 33.4850 ML BOTTLE 29.10 23.28

PLAIN NSS IRRIGATION 1L BOTTLE 49.10 39.2857.75 46.2

PLAIN LR 1 L 57.75 46.2PHENOBARBITAL (3 Rx) 30MG TABLET 3.50 2.8PHENYTOIN 50MG/ML AMP 975.00 780PIPERACILLIN + TAZOBACTAM 4.5G VIAL 152.75 122.2PHYTOMENADIONE 10MG/ML, 1ML 29.25 23.4POTASSIUM CHLORIDE 750mg tab 15.60 12.48POTASSIUM CITRATE 1080mg TABLET 10.40 8.32PROPRANOLOL 10MG 9.15 7.32

QUETIAPINE100 mg TABLET 44.75 35.8200MG TABLET 41.70 33.36

RANITIDINE25mg/ML, 2ML AMPULE 5.00 4

4.30 3.44

69

150mg TABLET 1.00 0.80.85 0.68

RABIES IMMUNOGLOBIN(HUMAN) 150 IU/ml, 2ml vial 4,420.00 3536

RABBIES VACCINE 2.5IU/ML, 1ML 2,327.30 1861.84

ROSUVASTATIN10MG TABLET 5.15 4.1220 mg TABLET 8.30 6.64

SERTRALINE 50MG TABLET 9.10 7.28SEVOFLURANE 250ML BOTTLE 6,485.95 5188.76SALBUTAMOL INHALER 100MCG/ACTUATION 90.80 72.64SILVER SULFADIAZINE 500 grams 300.00 240

1,157.00 925.6SIMVASTATIN 20 mg TABLET 4.55 3.64

SODIUM BICARBONATE8.4% IV VIAL (HOSPIRA) 143.00 114.484MG/ML, 20 ML AMPULE 234.00 187.2

STERILE WATER 50 mL 26.55 21.24TAMOXIFEN 20 mg TABLET 9.10 7.28TETANUS TOXOID 0.5ML AMP 44.70 35.76TRAMADOL 50 mg/ml, 1 ml AMPULE 10.90 8.72TRANEXAMIC ACID 100 mg/ml, 5 ml AMPULE 17.15 13.72TRIMETAZIDINE 35 mg TABLET 5.45 4.36URSODEOXYCHOLIC ACID 500MG TABLET 110.95 88.76VERAPAMIL 2.5MG/ML 1,115.75 892.6

VITAMIN B COMPLEX 100mg/100mg/1mg AMPULE39.00 31.242.35 33.88

100MG/5MG/50MCG TABLET 1.80 1.44ZINC SOLUTION 60ML Syrup 54.60 43.68

70

List of Radiology Examinations (as of December 6, 2019)Examination

RATEStandard Senior Citizen

Abdomen Supine 200.00 160.00Abdomen Upright 200.00 160.00Abdomen, Left decubitus 200.00 160.00Abdomen, Right Decubitus 200.00 160.00Abdomen, upper (liver, GB, HBT, Spleen, Pancreas) UTZ 1,000.00 800.00Abdomen, Upright/Supine Views 400.00 320.00Abdomen, whole UTZ 1,200.00 960.00Adbomen, Whole 1,200.00 960.00Agape - 2D Echo 3,200 3,200.00 2,560.00AGAPE - KUB UTZ 800.00 640.00AGAPE 2D ECHO (3,200) new 3,200.00 2,560.00Agape-2D Echo (Pedia) 3,500.00Agape-2D Echo - 2,900 2,900.00 2,320.00Agape-2D echo - 3,200 (ADULT) 3,200.00 2,560.00Agape-2D echo - 3,500 (PEDIA) 3,500.00Agape-Breast UTZ 750.00 600.00Agape-chest (includes determinatin of pleural/ cardiac effusion) UTZ 750.00 600.00Agape-Cranial UTZ 750.00 600.00Agape-fetal Biometry w/ CAS UTZ 1,350.00 1,080.00Agape-Fetal biometry/Pelvis UTZ 550.00 440.00Agape-Fetal Biometry/Pelvis w/ recording UTZ 1,250.00 1,000.00agape-Fetal biophysical Profile Scoring UTZ 750.00 600.00Agape-Gender Only (UTZ) 200.00 160.00Agape-Inguinal UTZ 750.00 600.00Agape-Kidney only UTZ 600.00 480.00AGAPE-KUB 800.00 640.00Agape-KUB/HBT (UTZ) 800.00 640.00Agape-KUBP UTZ 1,150.00 920.00Agape-Liver only (UTZ) 600.00 480.00Agape-lower Abdomen UTZ 1,150.00 920.00Agape-Neck UTZ 750.00 600.00Agape-Non-pregnant Transabdominal, pelvic UTZ 600.00 480.00Agape-Non-pregnant Transvaginal, pelvic UTZ 750.00 600.00Agape-Pelvis AP 420.00 336.00Agape-pregnant Transrectal, pelvic UTZ 950.00 760.00agape-prostate gland Transabdominal (UTZ) 600.00 480.00Agape-prostate gland Transrectal UTZ 750.00 600.00Agape-Scrotal UTZ 750.00 600.00

71

Agape-Single Organ UTZ 600.00 480.00Agape-Soft Tissue 650.00 520.00Agape-Thoracolumbar APL 465.00 372.00agape-Thyroid UTZ 600.00 480.00Agape-Transvaginal Fetal Biometry UTZ 750.00 600.00Agape-Upper Abdomen UTZ 1,150.00 920.00Agape-UTZ guided para/Thoracentesis 1,600.00 1,280.00Agape-Venous Scan 3,000.00 2,400.00Agape-Whole Abdomen UTZ 1,450.00 1,160.00ANKLE AP ONLY, LEFT 200.00 160.00ANKLE AP ONLY, RIGHT 200.00 160.00Ankle APL, one side 350.00 280.00ANKLE LATERAL ONLY, LEFT -ANKLE LATERAL ONLY, RIGHT 200.00 160.00Ankle Mortise View (one side) 350.00 280.00Arm AP Only, One side 200.00 160.00Arm AP only, One side (Pedia) 200.00Arm APL, One side 350.00 280.00Arm APL, One side (Pedia) 300.00Arm Lat. Only, One side 200.00 160.00Arm Lat. Only, One side (Pedia) 200.00Biophysical Scoring (BPS) UTZ 850.00 680.00BOTH ANKLE APL (ADULT) 700.00 560.00BOTH FEET APO ADULT 700.00 560.00BOTH FEET APO PEDIA 600.00BOTH KNEE APL (ADULT) 700.00 560.00BOTH KNEES APL PEDIA 600.00BOTH LEG APL ADULT 700.00 560.00BOTH LEG APL PEDIA 600.00BOTH LEG APL PEDIA 600.00BOTH THIGH APL 800.00 640.00BOTH THIGH APL -BOTH THIGH APL 800.00 640.00BOTH WRIST APL PEDIA 600.00Breast UTZ 850.00 680.00Breast(UTZ) 850.00 680.00C - ARM ( 30 minutes to 1 hour, w/o print-out) 1,000.00 800.00C - ARM ( additional for every hour beyond, w/o print-out) 500.00 400.00C - ARM ( less than 30 minutes with print-out) 800.00 640.00C - ARM ( less than 30 minutes without print-out) 700.00 560.00C - ARM (30 minutes to 1 hour, with print-out) 1,500.00 1,200.00

72

C - ARM (additional for every hour beyond, w/ print-out 700.00 560.00Calcaneous Tangential/Lat. 350.00 280.00CD-R 13.00 10.40Cervical Lateral only 200.00 160.00Cervical Open Mouth (atlas & axis) 200.00 160.00CERVICAL SPINE (both Obliques) 400.00 320.00Cervical Spines AP-Lateral 400.00 320.00Cervico-Thoracic AP/L 400.00 320.00Chest AP/PA Portable 200.00 160.00Chest AP (Adult) 200.00 160.00Chest AP (Pedia) 200.00CHEST AP (PEDIA) 200.00CHEST AP REPEAT 200.00 160.00CHEST AP/PA (PEDIA)Chest Apicolordotic View 200.00 160.00Chest APL (Adult) 400.00 320.00Chest APL (Pedia) 300.00Chest APL Portable (pedia) 300.00Chest Lat. Decubitus (left) 200.00 160.00Chest Lat. Decubitus (right) 200.00 160.00Chest Lateral View Only 200.00 160.00Chest PA (ADULT) 200.00 160.00CHEST PA (PEDIA) 200.00CHEST PA REPEAT 200.00 160.00Chest PAL (ADULT) 400.00 320.00Chest PAL (PEDIA) 300.00Chest UTZ 850.00 680.00Clavicle AP 200.00 160.00Coccyx APL 400.00 320.00Corazon- TVS 1,000.00 800.00CRANIAL PLAIN 2,800.00 2,240.00Cranial UTZ 850.00 680.00CROSS-TABLE LATERAL 1 VIEW 200.00 160.00CT Scan Cranial - DMC 3,500.00 2,800.00CT-Scan Contrast Syringe kit 1,560.00 1,248.00Dipag-TVS 900.00 720.00DJRMH - IVP 3,000.00 2,400.00DJRMH BPS-DOPPLER FETAL/MATERIAL 2,200.00 1,760.00DJRMH BREAST 1,000.00 800.00DJRMH CHEST 900.00 720.00DJRMH CHEST W/ MARKINGS 1,000.00 800.00

73

DJRMH CRANIAL 900.00 720.00DJRMH CT ANGIO 6,300.00 5,040.00DJRMH CT CHEST PLAIN 3,900.00 3,120.00DJRMH CT CHEST W/ CONTRAST 4,400.00 3,520.00DJRMH CT CRANIAL PLAIN 3,600.00 2,880.00DJRMH CT CRANIAL WITH CONTRAST 4,000.00 3,200.00DJRMH CT CRANIO-FACIAL PLAIN 4,300.00 3,440.00DJRMH CT CRANIO-FACIAL W/ CONTRAST 4,800.00 3,840.00DJRMH CT EXTREMITIES 4,300.00 3,440.00DJRMH CT EXTREMITIES WITH CONTRAST 4,500.00 3,600.00DJRMH CT FACIAL PLAIN 3,600.00 2,880.00DJRMH CT FACIAL WITH CONTRAST 4,000.00 3,200.00DJRMH CT JOINTS 3,785.00 3,028.00DJRMH CT LOWER ABDOMEN PLAIN 4,000.00 3,200.00DJRMH CT LOWER ABDOMEN WITH CONTRAST 3,900.00 3,120.00DJRMH CT MASTOIDS 3,900.00 3,120.00DJRMH CT NASOPHARYNX 3,900.00 3,120.00DJRMH CT NASOPHARYNX WITH CONTRAST 4,400.00 3,520.00DJRMH CT NECK PLAIN 3,750.00 3,000.00DJRMH CT NECK WITH CONTRAST 4,300.00 3,440.00DJRMH CT ORBIT 3,900.00 3,120.00DJRMH CT PARANASAL SINUSES PLAIN 3,900.00 3,120.00DJRMH CT PARANASAL SINUSES WITH CONTRAST 4,500.00 3,600.00DJRMH CT PELVIS PLAIN 4,000.00 3,200.00DJRMH CT PELVIS WITH CONTRAST 4,300.00 3,440.00DJRMH CT PITUITARY GLAND PLAIN 4,300.00 3,440.00DJRMH CT PITUITARY GLAND WITH CONTRAST 4,800.00 3,840.00DJRMH CT SCREENING SINUS 3,600.00 2,880.00DJRMH CT SELLA TURSICA PLAIN 3,900.00 3,120.00DJRMH CT SELLA TURSICA WITH CONTRAST 4,300.00 3,440.00DJRMH CT SINGLE ORGAN 3,785.00 3,028.00DJRMH CT SPINE (CERVICAL/THORACIC/LUMBAR) 4,300.00 3,440.00DJRMH CT SPINE WITH CONTRAST 4,500.00 3,600.00DJRMH CT STONOGRAM 4,300.00 3,440.00DJRMH CT TEMPORAL BONE 3,875.00 3,100.00DJRMH CT TRIPHASIC LIVER SCAN 5,800.00 4,640.00DJRMH CT UPPER ABDOMEN PLAIN 4,000.00 3,200.00DJRMH CT UPPER ABDOMEN WITH CONTRAST 4,200.00 3,360.00DJRMH CT WHOLE ABDOMEN PLAIN 4,300.00 3,440.00DJRMH CT WHOLE ABDOMEN W/ CONTRAST 4,800.00 3,840.00DJRMH DOPPLER CAROTID (BOTH) 6,000.00 4,800.00

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DJRMH DOPPLER CAROTID (SINGLE) 3,200.00 2,560.00DJRMH DOPPLER LOWER EXT. (SINGLE) 3,200.00 2,560.00DJRMH DOPPLER LOWER EXTREMITY (BOTH) 6,000.00 4,800.00DJRMH DOPPLER TWIN 5,000.00 4,000.00DJRMH DOPPLER UPPER EXTREMITY (BOTH) 6,000.00 4,800.00DJRMH DOPPLER UPPER EXTREMITY (SINGLE) 3,200.00 2,560.00DJRMH HBT 1,000.00 800.00DJRMH HYSTEROSALPINGOSONOGRAPHY 5,000.00 4,000.00DJRMH INGUINAL 800.00 640.00DJRMH KUB 1,000.00 800.00DJRMH KUBP 1,200.00 960.00DJRMH LOWER ABDOMEN 1,000.00 800.00DJRMH NECK 1,000.00 800.00DJRMH ORBIT WITH CONTRAST 4,700.00 3,760.00DJRMH PELVIC AFI ONLY 400.00 320.00DJRMH PELVIC BPS 1,200.00 960.00DJRMH PELVIC CAS 2,000.00 1,600.00DJRMH PELVIC TAS 900.00 720.00DJRMH PELVIC TAS 800.00 640.00DJRMH PELVICTRUS 950.00 760.00DJRMH PELVIS TAS 3D 1,200.00 960.00DJRMH PROSTATE TAS 800.00 640.00DJRMH PROSTATE TRUS 900.00 720.00DJRMH SCROTAL 900.00 720.00DJRMH SINGLE ORGAN 800.00 640.00DJRMH SINGLETON 3D 2,700.00 2,160.00DJRMH SINGLETON 4D 3,200.00 2,560.00DJRMH SOFT TISSUE SUPERFACIAL 800.00 640.00DJRMH THYROID 900.00 720.00DJRMH TRANSVAGINAL (TVS OB) 950.00 760.00DJRMH TRANSVAGINAL (TVS) 850.00 680.00DJRMH TRANSVAGINAL (TVS) 3D 1,500.00 1,200.00DJRMH TRANSVAGINAL (TVS) DOPPLER 1,000.00 800.00DJRMH TRIPLET 3D 3,700.00 2,960.00DJRMH TRIPLET 4D 4,200.00 3,360.00DJRMH TWIN 3D 3,200.00 2,560.00DJRMH TWIN 4D 3,700.00 2,960.00DJRMH TWIN CAS 3,000.00 2,400.00DJRMH UPPER ABDOMEN 1,000.00 800.00DJRMH UTZ GUIDED BIOPSY 8,200.00 6,560.00DJRMH UTZ GUIDED DRAINAGE 8,200.00 6,560.00

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DJRMH WHOLE ABDOMEN 1,400.00 1,120.00DJRMH WHOLE ABDOMEN W/ PELVIC 1,500.00 1,200.00DJRMH WHOLE ABDOMEN W/ PROSTATE 1,500.00 1,200.00DRYVIEW FILM 166.40 133.12DVD-R 15.60 12.48Elbow APL, one side 350.00 280.00Elbow (AP only), one side 200.00 160.00Elbow AP only (1 side) 200.00 160.00Elbow AP Only, One side (Pedia) 200.00 160.00Elbow APL one side (pedia) 300.00Elbow APL, both sides (Pedia) 600.00Elbow APL, One side (Pedia) 300.00Elbow Lat. Only, One side (Pedia) 200.00Face Lateral View 200.00 160.00Facial Bone (AP) 200.00 160.00FEET APO Bilateral 700.00 560.00Femur AP only 200.00 160.00Femur APL, one side 400.00 320.00Fetal Biometry/Pelvis 550.00 440.00Finger APL 350.00 280.00Foot APO, one side 350.00 280.00Foot APL, one side 350.00 280.00Foot APL, one side (Pedia) 300.00Foot APO one side (Pedia) 300.00FOOT LATERAL, ONE SIDE 200.00 160.00Forearm AP only, One side (Pedia) 200.00forearm APL (Adult) 350.00 280.00Forearm APL (one side) 350.00 280.00Forearm APL both sides (Pedia) 600.00Forearm APL, One side (Pedia) 300.00Forearm Lateral only 200.00 160.00GDC- Barium Enema 3,875.00 3,100.00GDC-4D Ultrasound 1,500.00 1,200.00GDC-Breast 1,000.00 800.00GDC-Chest 1,000.00 800.00GDC-Chest with markings 1,200.00 960.00GDC-Cranial 1,000.00 800.00GDC-Fetal Biometry 550.00 440.00GDC-Fetal Biophysical Profile 800.00 640.00GDC-Hepatobiliary (HBT) UTZ 850.00 680.00GDC-Inguinal/Scrotal 1,000.00 800.00

76

GDC-Kidney Urinary Bladder (KUB) UTZ -GDC-KUB 850.00 680.00GDC-KUB-Prostate 1,200.00 960.00GDC-Lower Abdomen UTZ 1,200.00 960.00GDC-Mass big 1,000.00 800.00GDC-Mass small 800.00 640.00GDC-Musculoskeletal -GDC-neck 1,000.00 800.00GDC-Pelvic Transabdominal UTZ 600.00 480.00GDC-Pelvis (transvaginal) 800.00 640.00GDC-Prostate (transrectal) 800.00 640.00GDC-Single Organ 700.00 560.00GDC-Thyroid 1,000.00 800.00GDC-UGIS 3,875.00 3,100.00GDC-UGIS -GDC-Ultrasound Guidance 1,000.00 800.00GDC-Upper abdomen UTZ 1,200.00 960.00GDC-Whole abdomen UTZ 1,500.00 1,200.00GUIDED BIOPSY - UTZ 9,600.00 7,680.00GUIDED THORACENTESIS - UTZ 9,600.00 7,680.00HAND (AP only) 200.00 160.00Hand AP/O, one side 350.00 280.00Hand APL View, one side 350.00 280.00Hand APO one side (Pedia) 300.00 240.00Hand lateral only, bilateral Pedia 300.00 240.00Hip APL, one side 400.00 320.00Hip AP only 200.00 160.00Hip, Judet View, one side 200.00 160.00Humerous (arm) APL, one side 350.00 280.00INGUINOSCROTAL UTZ 850.00 680.00JUDET VIEW 200.00 160.00Kidneys, Ureters and Bladders (KUB) UTZ 1,000.00 800.00KNEE AP ONLY, LEFT 200.00 160.00KNEE AP ONLY, RIGHT 200.00 160.00Knee APL, one side 350.00 280.00Knee APL, one side (Pedia) 300.00KNEE Lateral view only (1 side) 200.00 160.00Knee Tangential View 200.00 160.00KNEES BILATERAL (1 VIEW) 350.00 280.00KNEES BILATERAL APL 700.00 560.00KUB UTZ 1,000.00 800.00

77

KUB X-Ray 200.00 160.00KUBP 1,000.00 800.00KUBP (Kidneys, Urinary Bladder, Prostate) UTZ 1,000.00 800.00LAMDAG PELVIC (transabd) 700.00 560.00LAMDAG TRANSRECTAL 800.00 640.00LAMDAG TVS 800.00 640.00LEG 1 SIDE (1 VIEW) 200.00 160.00Leg AP only (one side) 200.00 160.00LEG APL (1 SIDE) 350.00 280.00LEG BILATERAL (1 VIEW) 350.00 280.00LEG BILATERAL APL 700.00 560.00Leg Lat. only (one side) 200.00 160.00Lower Abdomen UTZ 1,000.00 800.00Lower Extremities APL Pedia (1 side) 300.00Lumbar Spine APL 400.00 320.00Lumbar Spine both Oblique 400.00 320.00Lumbo Sacral APL 400.00 320.00LUMBOSACRAL AP ONLY 200.00 160.00Lumbosacral lateral only 200.00 160.00MAGACA - 2D ECHO 3,500.00 2,800.00MAGACA-ARTERIAL DUPLEX (BOTH LOWER LIMBS) 6,800.00 5,440.00Mammogram 1,500.00 1,200.00MANDIBLE 1 VIEW ONLY 200.00 160.00MANDIBLE AP 200.00 160.00Mandible APO (0ne side) 400.00 320.00MANDIBLE LATERAL 1 VIEW 200.00 160.00MAPET- PELVIC-900 900.00 720.00MAPET- PELVIC-UTZ 800.00 640.00MAPET-BPS UTZ 1000 1,000.00 800.00MAPET-PELVIC UTZ (TWINS)1200 1,200.00 960.00MAPET-PELVIC-UTZ 700 700.00 560.00MAPET-TVS UTZ 900.00 720.00Mastoids(Towne's View) 200.00 160.00Nasal Bone (Water's View) 200.00 160.00Nasal, Water's & Lat. 400.00 320.00Nose Lateral Soft Tissue 200.00 160.00OKD-4D UTZ 1,400.00 1,120.00OKD-AFI 200.00 160.00OKD-BPS w/ NST 1,100.00 880.00OKD-Fetal Biometry 800.00 640.00OKD-fetal gender -

78

OKD-NST 300.00 240.00OKD-Pelvic 600.00 480.00OKD-Transrectal (900) 900.00 720.00OKD-Transrectal 800 800.00 640.00OKD-TVS 800.00 640.00OKD-w/o NST 800.00 640.00OKDI BPS TWINS 1,700.00 1,360.00Optic Foramen (Rhese) 200.00 160.00Orbit PA 200.00 160.00Others (Any Single Organ) UTZ 750.00 600.00PARACENTHESIS GUIDED 9,600.00 7,680.00Paranasal Sinuses (AP, Water's, Lateral) 600.00 480.00Paranasal Sinuses (Water's View only) 200.00 160.00Patella, LAT/Tangential 350.00 280.00PELVIC INLET & OUTLET 400.00 320.00Pelvic utz 750.00 600.00Pelvis / Pregnancy Evaluation UTZ 750.00 600.00Pelvis AP 200.00 160.00PELVIS LAT. ONLY 200.00 160.00Prostate only UTZ 850.00 680.00READING ONLY ONE VIEW 35.00 28.00Sacro-coccygeal APL 400.00 320.00Sacroiliac Joints 200.00 160.00Scapula AP 200.00 160.00Scoliosis Series 800.00 640.00Sella turcica 200.00 160.00Shoulder AP (one side) 200.00 160.00Shoulder Scapular Y 200.00 160.00Single Organ 750.00 600.00Skeletal Survey (ADULT) 1,800.00 1,440.00Skeletal Survey (PEDIA) 200.00Skull APL 400.00 320.00SKULL 1 VIEW ONLY 200.00 160.00SKULL AP view 200.00 160.00SKULL APL 400.00 320.00Skull Lateral only 200.00 160.00Skull Towne's view 200.00 160.00Submentovertex view 200.00 160.00TAUB HERNANDO PELVIC-UTZ 800 800.00 640.00TAUB-BPS 1,500.00 1,200.00TAUB-PELVIC 1,000.00 800.00

79

TAUB-TVS 800.00 640.00Temporo-Mandibular Joint (open & close mouth) one side 350.00 280.00Testes UTZ 850.00 680.00Thigh AP Only, one side 200.00 160.00Thigh APL, one side 400.00 320.00Thigh Lat. Only, one side 200.00 160.00Thoracic Cage AP 200.00 160.00Thoracic Cage APL 400.00 320.00Thoracic Cage Oblique (one side) 200.00 160.00Thoracic Spine (both Obliques) 400.00 320.00Thoracic Spine AP only 200.00 160.00Thoracic Spine APL 400.00 320.00Thoraco-Lumbar AP/L 400.00 320.00THORACOLUMBAR AP ONLY 200.00 160.00Thumb AP or PA/LAT 200.00 160.00Thyroid 850.00 680.00Thyroid(UTZ) 850.00 680.00Transrectal UTZ 850.00 680.00Transvaginal UTZ 850.00 680.00Water's view 200.00 160.00WOMEN'S HUB- TVS Gyne 800.00 640.00WOMEN'S HUB-PELVIC 550.00 440.00WOMEN'S HUB-TVS (750) 750.00 600.00Wrist APL, one side 350.00 280.00Wrist (AP only) 200.00 160.00Wrist (Carpal Bridge), one side 200.00 160.00Wrist (Carpal Tunnel), one side 200.00 160.00Wrist Adult Bilateral 700.00 560.00Wrist APL, one side (pedia) 300.00Wrist Ulnar Flexion, one side 200.00 160.00Wrist, Radial Flexion, one side 200.00 160.00ZANORTE CT angio 4,200.00 3,360.00ZANORTE CT Chest Plain 3,950.00 3,160.00ZANORTE CT Chest with Contrast 5,925.00 4,740.00ZANORTE CT CRANIAL PLAIN 2,800.00 2,240.00ZANORTE CT cranial w/ contrast 4,200.00 3,360.00ZANORTE CT Extremities 4,100.00 3,280.00ZANORTE CT Extremities with Contrast 6,150.00 4,920.00ZANORTE CT Joints 3,600.00 2,880.00ZANORTE CT Knee 3,600.00 2,880.00ZANORTE CT Liver (single organs) 3,460.00 2,768.00

80

ZANORTE CT Lower Abdomen Plain 3,600.00 2,880.00ZANORTE CT Lower Abdomen with Contrast 5,400.00 4,320.00ZANORTE CT Mastoids 3,950.00 3,160.00ZANORTE CT Nasopharynx 5,000.00 4,000.00ZANORTE CT Nasopharynx with Contrast 7,500.00 6,000.00ZANORTE CT Neck Plain 4,100.00 3,280.00ZANORTE CT Neck with Contrast 6,150.00 4,920.00ZANORTE CT Orbits 3,600.00 2,880.00ZANORTE CT Paranasal Sinuses Plain 5,000.00 4,000.00ZANORTE CT Paranasal Sinuses with Contrast 7,500.00 6,000.00ZANORTE CT Pelvis Plain 3,600.00 2,880.00ZANORTE CT Pelvis with Contrast 5,400.00 4,320.00ZANORTE CT Pituitary Gland 3,600.00 2,880.00ZANORTE CT Pituitary Gland with Contrast 5,400.00 4,320.00ZANORTE CT SCAN FACIAL 2,800.00 2,240.00ZANORTE CT Screening Sinus 2,200.00 1,760.00ZANORTE CT Sinuses 3,600.00 2,880.00ZANORTE CT Spine 4,300.00 3,440.00ZANORTE CT Spine with Contrast 6,450.00 5,160.00ZANORTE CT Stonogram 5,000.00 4,000.00ZANORTE CT Temporal Bone 3,600.00 2,880.00ZANORTE CT TRIPACK SYRINGE 770.00 616.00ZANORTE CT TRIPHASIC 9,000.00 7,200.00ZANORTE CT Upper Abdomen Plain 3,900.00 3,120.00ZANORTE CT Upper Abdomen with Contrast 5,850.00 4,680.00ZANORTE CT Whole Abdomen Plain 6,000.00 4,800.00ZANORTE CT Whole Abdomen with Contrast 9,000.00 7,200.00ZANORTE CT- 3D Recon Thoracolumbar spine 8,600.00 6,880.00

81

List of Non-Drugs/Medical/Surgical Supplies (as of November30, 2019)

ITEM UNIT RATEStandard Senior Citizen

Absorbent cotton roll 188.50 150.80Adhesive Plaster tube 2,600.00 2,080.00AED Pads unit 3,900.00 3,120.00Alcohol pad box 110.50 88.40Alcohol pad, with 70% Isoprophyl, 100's box 110.50 88.40Alcohol, 70% Isoprophyl, 1 gallon gal 676.00 540.80Alcohol, 70% Isoprophyl, 500mL box 3,042.00 2,433.60Anesthesia Face Mask #1 infant pc 361.40 289.12Anesthesia Face Mask Adult Medium pc 361.40 289.12Anesthesia Face Mask adult-Large pc 361.40 289.12Anesthesia Face Mask adult-Small pc 416.00 332.80Anesthesia Face Mask adult-Small pc 361.40 289.12Anesthesia Face Mask pedia-Large pc 689.00 551.20Anesthesia Face Mask pedia-Small pc 416.00 332.80Armsling adult pc 62.40 49.92Armsling pedia pc 71.50 57.20Autoclave indicator roll 273.00 218.40Bag valve mask adult pc 1,612.00 1,289.60Bag valve mask child/pedia pc 1,544.40 1,235.52Bag valve mask infant pc 1,544.40 1,235.52Bag valve mask infant/neonate pc 1,935.05 1,548.04Bedpan pc 83.53 66.82Biological indicator pc 123.45 98.76Biological indicator box 6,500.00 5,200.00Biological indicator box 6,240.00 4,992.00Blood Administration Set pc 117.00 93.60Bone Wax, 2.5g pc 603.20 482.56BP apparatus accessory, Rubber arm cuff w/ cloth adult pc 513.50 410.80BP apparatus accessory, Rubber arm cuff w/ cloth infant pc 513.50 410.80BP apparatus accessory, Rubber arm cuff w/ cloth pedia pc 513.50 410.80BP apparatus accessory, Rubber arm cuff w/ cloth pedia pc 676.00 540.80BP apparatus pedia unit 1,284.40 1,027.52Breathing circuit/system, adult pc 1,014.00 811.20Breathing circuit/system, Jackson Rees pc 3,640.00 2,912.00Breathing circuit/system, pedia pc 806.00 644.80Cervical collar adult pc 494.00 395.20Cervical collar infant pc 647.40 517.92Cervical collar pedia pc 570.67 456.54Chest tube thoracostomy Drainage bottle pc 1,436.50 1,149.20Chest tube thoracostomy Drainage bottle pc 1,436.50 1,149.20

82

Closed wound suction drainage system pc 1,430.00 1,144.00Closed wound suction drainage system pc 2,600.00 2,080.00Colostomy bag adult, 25x15cm pc 18.85 15.08Colostomy bag pedia, 20x14cm pc 18.85 15.08Condom catheter large, 20's box 455.00 364.00Condom catheter medium, 20's box 643.50 514.80Condom catheter small, 20's box 455.00 364.00Cotton Applicator Stick pack 43.26 34.61CTG recording paper pack 747.50 598.00Disinfectant tablet, 100's jar 2,593.50 2,074.80ECG cream tube 361.40 289.12ECG electrode pc 13.00 10.40ECG electrode pc 11.70 9.36ECG suction cap pc 650.00 520.00ECG tracing paper (WELCH ALLYN) roll 715.00 572.00ECG tracing paper 50mmx30m roll 52.00 41.60ECG tracing paper 80mmx20m roll 83.20 66.56ECG tracing paper 80mmx20m roll 83.20 66.56Elastic bandage 2"x5yards roll 23.83 19.06Elastic bandage 4"x5yards pack 327.60 262.08Elastic bandage 6"x5yards (12 rolls/pack) pack 436.80 349.44Electrocautery grounding pad pc 650.00 520.00Electrocautery pencil w/ tip pc 695.50 556.40Endotracheal tube 2.0 box 572.00 457.60Endotracheal tube 2.5 box 325.00 260.00Endotracheal tube 3.0 box 403.00 322.40Endotracheal tube 3.5 box 421.20 336.96Endotracheal tube 3.5 box 630.50 504.40Endotracheal tube 4.0 box 421.20 336.96Endotracheal tube 4.5 box 351.00 280.80Endotracheal tube 5.0 box 572.00 457.60Endotracheal tube 5.0 box 533.00 426.40Endotracheal tube 5.5 box 546.00 436.80Endotracheal tube 6.0 box 494.00 395.20Endotracheal tube 6.0 box 429.00 343.20Endotracheal tube 6.5 box 988.00 790.40Endotracheal tube 7 box 572.00 457.60Endotracheal tube 7.5, 10's box 1,014.00 811.20Endotracheal tube 8.0 box 429.00 343.20Epidural set G.18 pc 1,170.00 936.00Epidural set G.18 pc 1,170.00 936.00Face mask, earloop, 50's box 62.40 49.92Face mask, earloop, 50's box 62.40 49.92Face mask, N-95, 20's box 1,170.00 936.00Face mask, with eye shield, 25/pack pack 2,730.00 2,184.00Feeding tube Fr. 10 pc 10.40 8.32

83

Feeding tube Fr. 12, 75's box 747.50 598.00Feeding tube Fr. 14 pc 14.95 11.96Feeding tube Fr. 14, 30's box 689.48 551.58Feeding tube Fr. 16 pc 12.35 9.88Feeding tube Fr. 16 pc 12.35 9.88Feeding tube Fr. 16, silicon pc 390.00 312.00Feeding tube Fr. 18, 20's box 689.48 551.58Feeding tube Fr. 18, 50's box 689.48 551.58Feeding tube Fr. 5 pc 7.48 5.98Feeding tube Fr. 5 pc 7.48 5.98Feeding tube Fr. 8 pc 7.48 5.98Feeding tube Fr. 8 pc 7.48 5.98Foley balloon catheter, 2-way Fr.12,10's box 324.68 259.74Foley balloon catheter, 2-way, Fr.10,10's pc 32.89 26.31Foley balloon catheter, 2-way, Fr.14 box 214.50 171.60Foley balloon catheter, 2-way, Fr.16 box 328.90 263.12Foley balloon catheter, 2-way, Fr.16 box 370.50 296.40Foley balloon catheter, 2-way, Fr.18 box 370.50 296.40Foley balloon catheter, 2-way, Fr.8 pc 33.80 27.04Foley balloon catheter, 3-way, Fr. 24 pc 130.00 104.00Foley balloon catheter, 3-way, Fr.18 pc 143.00 114.40Gloves, Elbow length 6.0, 25 pairs/box box 3,640.00 2,912.00Gloves, Elbow length 7.0, 25 pairs/box box 3,640.00 2,912.00Gloves, Elbow length 7.5, 25 pairs/box box 3,640.00 2,912.00Gloves, Surgical 6.0 box 1,106.30 885.04Gloves, Surgical 7.0 box 1,111.50 889.20Gloves, Surgical 7.5 box 1,106.30 885.04Gloves, Surgical 8.0 box 1,111.50 889.20Goggles pc 231.87 185.49Hand Sanitizer 1L bot 1,495.00 1,196.00Heparin lock box 1,170.00 936.00Heparin lock box 1,170.00 936.00Hospital gauze plain roll 1,445.60 1,156.48Hospital gauze w/ x-ray roll 1,561.30 1,249.04Hydrogen peroxide bot 32.50 26.00Hypoallergenic Plaster, 12's box 343.20 274.56Ice bag pc 93.60 74.88Ice bag pc 125.32 100.26ID wrist band adult white box 387.40 309.92ID wrist band child blue box 387.40 309.92ID wrist band child pink box 387.40 309.92Infusion set w/ burette, Soluset pc 117.00 93.60Infusion set w/ burette, Soluset, Needle-Free pc 153.40 122.72Infusion set, Macroset, 25's pack 442.00 353.60Infusion set, Macroset, needleless pcs 182.00 145.60Infusion set, Microset, 25's pack 357.50 286.00

84

Infusion set, Microset, needleless pcs 182.00 145.60IV Cannula G.18 box 1,534.00 1,227.20IV Cannula G.20 box 1,534.00 1,227.20IV Cannula G.22 box 1,534.00 1,227.20IV Cannula G.24 box 1,833.00 1,466.40IV Cannula G.26 box 2,619.50 2,095.60IV Cannula G.26 box 3,133.00 2,506.40IV Dressing box 301.60 241.28IV Starter Kit pc 100.61 80.49IV Wrist Splint, infant/neonate pc 68.25 54.60Kelly pad pc 520.00 416.00Kidney basin pc 14.95 11.96Kidney basin pc 14.30 11.44Lubricating jelly tube 136.50 109.20Medicine cup 30mL, 100's pack 754.00 603.20Nebulizing kit with mask adult, 100's box 4,940.00 3,952.00Nebulizing kit with mask pedia, 100's pc 50.41 40.33Nebulizing kit with mask pedia, 100's pc 50.41 40.33Needle G.19 box 148.20 118.56Needle G.21 box 162.50 130.00Needle G.21 box 148.20 118.56Needle G.22 box 179.40 143.52Needle G.22 box 148.20 118.56Needle G.23 box 156.00 124.80Needle G.26 box 148.20 118.56Operative Dressing - Opsite, 20x10cm pc 315.90 252.72Operative Dressing - Opsite, 25x10cm pc 335.40 268.32Operative Dressing - Opsite, 9.5x8.5cm pc 219.70 175.76Oral airway #0, 60mm, black pc 27.30 21.84Oral airway #1, 70mm, white pc 28.60 22.88Oral airway #1, 70mm, white pc 31.59 25.27Oral airway #2, 80mm, green pc 43.91 35.13Oral airway #3, 90mm, yellow pc 32.50 26.00Oral airway #3, 90mm, yellow pc 43.91 35.13Oral airway #4, 100mm, red pc 32.50 26.00Oral airway #4, 100mm, red pc 41.60 33.28Oral airway #5, 110mm, blue pc 32.50 26.00Oral airway #5, 110mm, blue pc 41.60 33.28Oral care kit pc 279.50 223.60Oxygen face mask neonate/infant pc 67.60 54.08Oxygen face mask neonate/infant pc 39.00 31.20Oxygen face mask pedia pc 43.47 34.78Oxygen face mask with reservoir, adult pc 205.40 164.32Oxygen face mask with reservoir, adult pc 84.50 67.60Oxygen nasal cannula adult pc 19.50 15.60Oxygen nasal cannula infant pc 21.45 17.16

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Oxygen nasal cannula pedia pc 19.50 15.60Penrose drainage tube 1" pc 29.51 23.61Penrose drainage tube 1/2" pc 20.80 16.64Penrose drainage tube 1/4" pc 32.50 26.00Penrose drainage tube 1/4" pc 18.20 14.56Pill crusher pc 3.90 3.12Pill crusher pc 195.00 156.00Pill cutter pc 387.40 309.92Plaster of paris 4 inches roll 109.20 87.36Plaster of paris 4 inches roll 109.20 87.36Plaster of paris 6 inches roll 130.00 104.00Plaster of paris 6 inches roll 130.00 104.00Pleural Puncture Set pc 845.00 676.00Polypropylene mesh pc 2,340.00 1,872.00Povidone lodine 10% gal 877.50 702.00Povidone lodine 7.5% gal 936.00 748.80Povidone lodine 7.5% gal 936.00 748.80Scrub brush pc 45.50 36.40Shoe cover pc 4.37 3.49Shoe cover pc 5.54 4.43Skin stapler pc 247.00 197.60Specimen cup (Stool) pc 7.09 5.67Specimen cup 120-150 mL pc 19.50 15.60Specimen cup 50-60mL (Urine/Sputum) pc 5.01 4.00Spinal needle G.23, 25's box 2,597.40 2,077.92Spinal needle G.23, 25's box 2,574.00 2,059.20Spinal needle G.25, 25's (B Braun) box 1,692.60 1,354.08Spinal needle G.25, 25's (Mc Bride) box 2,597.40 2,077.92Steam Chemical Integrator, 100's pack 1,105.00 884.00Sterilization bag, 100mm x 30m reel 1,418.30 1,134.64Sterilization bag, 200mm x 30m reel 2,548.00 2,038.40Stockinette roll 3,250.00 2,600.00Stopcock, 3-way, 50/box box 1,079.00 863.20Stopcock, 3-way, 50/box box 1,079.00 863.20Stylet, intubating guide wire, Fr 8 pc 409.50 327.60Stylet, intubating guide wire, large, F.14 pc 104.00 83.20Suction bottle pc 3,900.00 3,120.00Suction bottle pc 3,900.00 3,120.00Suction catheter fr.10 box 585.00 468.00Suction catheter fr.12 box 451.75 361.40Suction catheter fr.14 box 468.00 374.40Suction catheter fr.16 (50's) box 406.25 325.00Suction catheter fr.18 box 411.45 329.16Suction catheter fr.5 box 451.75 361.40Suction catheter fr.8 box 468.00 374.40Suction poole set/drain pc 247.00 197.60

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Suction poole set/drain pc 247.00 197.60Surgical blade #10 box 383.50 306.80Surgical blade #10 box 383.50 306.80Surgical blade #11 box 364.00 291.20Surgical blade #15 box 383.50 306.80Surgical blade #15 box 351.00 280.80Surgical blade #15 box 364.00 291.20Surgical blade #15 box 432.25 345.80Surgical blade #20 box 383.50 306.80Surgical blade #21 box 383.50 306.80Surgical blade #21 box 400.40 320.32Surgical blade #21, with handle pc 84.50 67.60Surgical blade #22 box 383.50 306.80Surgical cap, 100's box 175.50 140.40Suture, Chromic 0 w/ round needle box 585.00 468.00Suture, Chromic 1/0 w/ cutting needle box 455.00 364.00Suture, Chromic 1/0 w/ cutting needle box 572.00 457.60Suture, Chromic 1/0 w/ round needle box 403.00 322.40Suture, Chromic 1/0 w/ round needle box 403.00 322.40Suture, Chromic 2/0 w/ cutting needle box 416.00 332.80Suture, Chromic 2/0 w/ round needle box 416.00 332.80Suture, Chromic 3/0 w/ cutting needle box 416.00 332.80Suture, Chromic 3/0 w/ round needle box 403.00 322.40Suture, Chromic 3/0 w/ round needle box 403.00 322.40Suture, Chromic 4/0 w/ cutting needle box 416.00 332.80Suture, Chromic 4/0 w/ round needle box 455.00 364.00Suture, Chromic 4/0 w/ round needle box 416.00 332.80Suture, Chromic 5/0 w/ round needle box 585.00 468.00Suture, Novosyn 3/0 w/ round needle, 36's box 12,740.00 10,192.00Suture, Polypropylene 0 w/ round needle, 36's box 19,107.40 15,285.92Suture, Polypropylene 2/0 w/ cutting needle, 36's box 21,450.00 17,160.00Suture, Polypropylene 2/0 w/ round needle,12's box 17,550.00 14,040.00Suture, Polypropylene 3/0 w/ cutting needle, 24's box 11,570.00 9,256.00Suture, Polypropylene 3/0 w/ round needle, 36's box 20,800.00 16,640.00Suture, Polypropylene 4/0 w/ cutting needle, 24's box 11,440.00 9,152.00Suture, Polypropylene 4/0 w/ round needle, 36's box 20,800.00 16,640.00Suture, Polypropylene 5/0 w/ round needle, 36's box 20,800.00 16,640.00Suture, Silk 0 w/ cutting needle box 400.40 320.32Suture, Silk 0 w/out needle box 585.00 468.00Suture, Silk 0 w/out needle MERSILK, 12's box 2,299.70 1,839.76Suture, Silk 0 w/out needle MERSILK, 12's box 2,299.70 1,839.76Suture, Silk 1/0 w/ cutting needle box 585.00 468.00Suture, Silk 1/0 w/ round needle box 585.00 468.00Suture, Silk 2/0 w/ cutting needle, 12's box 585.00 468.00Suture, Silk 2/0 w/ round needle box 507.00 405.60Suture, Silk 2/0 w/out needle MERSILK, 12's box 2,197.00 1,757.60

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Suture, Silk 2/0 w/out needle, 12's box 585.00 468.00Suture, Silk 2/0 w/out needle, 12's box 400.40 320.32Suture, Silk 3/0 w/ cutting needle, 12's box 585.00 468.00Suture, Silk 3/0 w/ round needle box 585.00 468.00Suture, Silk 3/0 w/ round needle box 585.00 468.00Suture, Silk 3/0 w/out needle MERSILK, 12's box 2,197.00 1,757.60Suture, Silk 3/0 w/out needle, 12's box 585.00 468.00Suture, Silk 4/0 w/ cutting needle box 585.00 468.00Suture, Silk 4/0 w/ cutting needle box 585.00 468.00Suture, Silk 4/0 w/ round needle box 585.00 468.00Suture, Silk 4/0 w/ round needle box 585.00 468.00Suture, Silk 4/0 w/out needle box 400.40 320.32Suture, Silk 4/0 w/out needle MERSILK, 12's box 1,947.40 1,557.92Suture, Silk 4/0 w/out needle MERSILK, 12's box 1,947.40 1,557.92Suture, Silk 5/0 w/ cutting needle box 767.00 613.60Suture, Vicryl 0 w/ round needle, 36's box 21,361.60 17,089.28Suture, Vicryl 1/0 w/ round needle, 36's box 17,446.00 13,956.80Suture, Vicryl 2/0 w/ round needle, 36's box 18,850.00 15,080.00Suture, Vicryl 2/0 w/ round needle, 36's box 17,924.40 14,339.52Suture, Vicryl 3/0 w/ cutting needle pc 314.16 251.33Suture, Vicryl 3/0 w/ round needle, 36's box 10,920.00 8,736.00Suture, Vicryl 4/0 w/ cutting needle, 36's box 10,920.00 8,736.00Suture, Vicryl 4/0 w/ cutting needle, 36's box 16,380.00 13,104.00Syringe, 0.5ml insulin box 1,300.00 1,040.00Syringe, 0.5ml insulin box 1,170.00 936.00Syringe, 10cc box 383.50 306.80Syringe, 1ml insulin box 310.70 248.56Syringe, 20cc, 50's box 533.00 426.40Syringe, 3cc box 227.50 182.00Syringe, 50cc, 20's box 520.00 416.00Syringe, 50cc, 20's box 819.00 655.20Syringe, 50cc, 40's box 936.00 748.80Syringe, Asepto pc 39.00 31.20Thoracic catheter Fr. 32 pc 292.50 234.00Tongue depressor non-sterile box 52.00 41.60Tongue depressor sterile box 58.50 46.80Tourniquet pc 26.00 20.80Tracheostomy care kit kit 325.00 260.00Ultrasound gel 250 grams bot 92.11 73.68Ultrasound gel 250 grams bot 84.50 67.60Umbilical Cord clamp box 582.40 465.92Underpad pack 195.00 156.00Urine bag adult pack 182.00 145.60Ventilator tubing pc 1,495.00 1,196.00Ventilator tubing (Clear Therm) filter pc 715.00 572.00Ventilator tubing/ Breathing System pc 1,014.00 811.20

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Wadding sheet roll 39.00 31.20Wadding sheet roll 42.90 34.32Wound drain pc 1,924.00 1,539.20

89

List of Supplies/Procedure at OPD (* subject for change)Supplies/Procedures Rate

Standard Senior CitizenSpecimen cup (urine/sputum) 5.20 4.16Specimen cup (stool) 7.50 6.00Nebulizing kit 39.65 31.72

Cotton applicator stick 10.00 8.00Tongue depressor 1.00 0.80

ECG 200.00 160.00

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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 and compliesand records all feedback submitted.Feedback requiring answers are forwarded to the relevant officesand they are required to answer within three (3) days of the receiptof 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 designated dropbox 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)

91

LIST OF OFFICES

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

Hospital, Main Building(065) 213-6222/(065) 213-6421

Emergency Room (E.R) Dr. Jose Rizal MemorialHospital, Main Building

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

Admitting Section Dr. Jose Rizal MemorialHospital, Main Building

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

Health 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