SOUTHERN PHILIPPINES MEDICAL CENTER

CITIZEN’S CHARTER
2020 (1ST EDITION)
SOUTHERN PHILIPPINES MEDICAL CENTER

CITIZEN’S CHARTER
2020 (1ST EDITION)
I. Mandate:
The Southern Philippines Medical Center, by virtue of Republic Act 9792, is tasked to provide quality
professional health care services to the people of Mindanao and its surrounding provinces through
upgrading its service facilities.

II. Vision
World-class, service-oriented medical center leading in the provision of healthcare and training in
Mindanao.

III. Mission:
Fueled by our shared commitment to ensure that Filipino people are at the best of health, we will:
• Provide responsive health care services in Southern Philippines.
• With the use of modern technologies, we will be at the forefront of providing preventive, promotive,
curative, palliative, and rehabilitative care across all age groups and ethnicities.
• We shall strive to produce compassionate and outstanding health care professionals and staff
committed to serve Southern Philippines while taking full responsibility for their professional
development and just compensation.
• Engage in ethical and medically relevant researches that will lead to local innovations and improve
the quality of healthcare.
• Establish linkages and networks that will help sustain and support institutional growth and
contribute to improving health systems along the Southern Philippines corridor.
• Finally, we will be accountable for providing a safe and healthy environment for our clients, staff,
and the public through sound waste management and clean and green solutions.

IV. Service Pledge:

We, the officials and employees of the Southern Philippines Medical Center pledge and commit to
deliver quality public services as promised in this charter. Specifically, we will:
Serve with integrity. Be prompt and timely. Display procedures, fees and charges. Provide
adequate and accurate information. Be consistent in applying rules. Provide feedback mechanism.
Be polite and courteous. Demonstrate sensitivity and appropriate behavior and professionalism.
Wear proper uniform and identification. Be available during office hours. Respond to complaints.
Provide a comfortable waiting area. Treat everyone equally.
V. List of Services:
Office of the Medical Center Chief .......................................................................................................... 22
External Services ................................................................................................................................... 22
1. Handling of Letters/ Correspondence Received Thru Email/ Courier/ ............................................. 23
Personal Delivery................................................................................................................................ 23
2. Handling of Invitations and Requests for Appointment/ Meeting with the ........................................ 24
Medical Center Chief .......................................................................................................................... 24
3. Processing of Documents for Notarization ...................................................................................... 25
4. Attending to Inquiries ...................................................................................................................... 26
Internal Services .................................................................................................................................... 27
1. Handling of Documents for Appropriate Action................................................................................ 28
2. Issuance of Travel Order (Official Time and Official Business) ........................................................ 30
3. Processing of Flights for SPMC Personnel (Official Business Only) ................................................ 33
Data Privacy Office and Telemed............................................................................................................ 35
Data Privacy Office................................................................................................................................. 35
Internal Services .................................................................................................................................... 35
1. Reporting of Data Breach Incident .................................................................................................. 36
2. Requesting for Data Privacy Orientation ......................................................................................... 38
3. Request for Privacy Impact Assessment ......................................................................................... 39
Telemedicine .......................................................................................................................................... 41
External Services ................................................................................................................................... 41
1. Request for Tele-Psychiatry Service ............................................................................................... 42
2. Request for Tele-Radiology Service................................................................................................ 44
Infection Prevention and Control Unit (IPCU) ........................................................................................ 46
External Services ................................................................................................................................... 46
1. Assessment and Admission for Suspected Patients ....................................................................... 47
2. Needle stick/ sharps injury – Non-COVID Personnel with Negative RT-PCR Test Result ............... 51
3. Needle stick/ sharps injury – Personnel With History of Confirmed COVID Result and/or With
Respiratory Symptoms........................................................................................................................ 53
4. Submission, Assessment and Processing of Restricted Antibiotic Requisition Forms (RARFs) –
Before 1:00PM.................................................................................................................................... 55
5. Submission, Assessment and Processing of Restricted Antibiotic Requisition Forms (RARFs) –
Beyond 1:00PM .................................................................................................................................. 58
Integrated Hospital Operations and Management Program (IHOMP) ................................................... 59
Internal Services .................................................................................................................................... 59
1. Service Request for System and Software Development ................................................................ 60
2. User Account Registration/Update Access Permission ................................................................... 62
3. Scheduling for User Orientation ...................................................................................................... 63
4. Job-Order Request for Technical Support ....................................................................................... 64
Internal Audit Service (IAS) ..................................................................................................................... 66
Internal Services .................................................................................................................................... 66
1. Inspection of Infrastructure Projects and Equipment ....................................................................... 66
2. Inventory of Drugs and Medicines ................................................................................................... 67
Patient Safety and Pharmacovigilance Unit (PSPVU) ........................................................................... 69
External Services ................................................................................................................................... 69
1. Receiving Reports of Sentinel Events (SE) and Serious Reportable Events (SRE) ......................... 69
Patients Assistance Desk (PAD, Malasakit Center) ............................................................................... 71
External Services ................................................................................................................................... 71
Professional Education Training and Development (PETD) ................................................................. 74
External Services ................................................................................................................................... 74
1. Affiliation Program .......................................................................................................................... 74
2. In-Service Training Program ........................................................................................................... 76
.................................................................................................................................................................. 78
3. Related Learning Experience (RLE) Scheduling ............................................................................. 78
.................................................................................................................................................................. 79
Public Assistance and Complaints Desk (PACD) .................................................................................. 81
External Services ................................................................................................................................... 81
1. Filing of Complaints ........................................................................................................................ 81
Internal Services .................................................................................................................................... 83
1. Request of 2nd Copy of Client Satisfaction Survey (CSS) ................................................................ 83
Documents Control Center ..................................................................................................................... 85
Internal Services .................................................................................................................................... 85
1. Control of Documented Information Procedure ............................................................................... 85
2. Updating of Document Masterlist Procedure ................................................................................... 87
3. Document Review, Revision and Approval Procedure .................................................................... 88
Blood Center ............................................................................................................................................ 90
External Services ................................................................................................................................... 90
1. Conduct of Mobile Blood Donation From Potential Program Partners ............................................. 90
2. Blood Donation Process ................................................................................................................. 91
3. Submission of Blood Samples and Blood Units from Mobile Blood Donation .................................. 95
4.Blood Processing ............................................................................................................................. 96
5. Blood Testing .................................................................................................................................. 98
6. Labeling of Plasma Components .................................................................................................. 100
7. Apheresis...................................................................................................................................... 102
8. Individual Issuance ....................................................................................................................... 105
9. Direct Distribution System ............................................................................................................. 108
Blood Transfusion Services (BTS) ....................................................................................................... 110
External Services ................................................................................................................................. 110
1. Issuance of Blood for Deposit for Patients with PHIC Coverage ................................................... 111
2. Issuance of Blood for Deposit for Patients without PHIC Coverage -Cash Transaction for Blood
Processing Fee (BPF) ...................................................................................................................... 113
3. Issuance of Blood for Deposit for Patients without PHIC Coverage - Blood Processing Fee (BPF)
charged to LINGAP/MAIP ................................................................................................................. 115
4. Issuance of Blood for Emergency Borrowing (patients without PHIC coverage) ............................ 117
5. Issuance of Blood for High Risk Patients during the Pandemic/ State of Public Health Emergency
......................................................................................................................................................... 119
6. Issuance of Blood and Blood Product for Blood Program Partners Admitted in other Health Facilities
......................................................................................................................................................... 121
7. Processing and Releasing of Uncrossmatched Blood ................................................................... 123
8. Receiving and Processing of Crossmatching Request .................................................................. 125
9. Processing of Coomb’s Test/Du Testing/Auto Control................................................................... 127
10. Receiving of consumed blood bag for proper disposal ................................................................ 129
11. Receiving of Blood for Deposit from other Blood Service Facilities ............................................. 130
12. Request for Thawing of Fresh Frozen Plasma(FFP) and Cryoprecipitate(CRYO) ....................... 132
13. Releasing of Blood Unit for Transfusion ...................................................................................... 133
14. Request for Transfusion Reaction Study ..................................................................................... 134
Internal Services .................................................................................................................................. 136
1. Issuance of Blood to SPMC Personnel ......................................................................................... 136
Department of Radiology and Imaging Sciences (DORIS) .................................................................. 138
External Services ................................................................................................................................. 138
1. Emergency Department Computed Tomography Scan ................................................................. 138
Scanning time may extend beyond 1 hour and 30 minutes depending on the case and patient
condition. ............................................................................................................................................... 140
2. Emergency Department General X-Ray........................................................................................ 140
result. ...................................................................................................................................................... 142
3. In-Patient Department Computed Tomography Scan .................................................................... 142
4. In-Patient Department General X-Ray .......................................................................................... 144
result. ...................................................................................................................................................... 146
5. In-Patient Department Ultrasonography ........................................................................................ 146
6. INPATIENT DEPARTMENT MAGNETIC RESONANCE IMAGING .............................................. 148
7. Vascular and Interventional Radiology Cath.Lab. Referral ............................................................ 151
8. Vascular and Interventional Radiology Non-Cath.Lab. Referral .................................................... 153
Laboratory .............................................................................................................................................. 154
Clinical Chemistry ................................................................................................................................ 154
External Services ................................................................................................................................. 154
1a. Blood Chemistry Tests (In-patient Department) .......................................................................... 155
1b. Blood Chemistry Tests (Out-patient Department)........................................................................ 157
2. Body Fluid Chemistry Test ............................................................................................................ 159
3a. HbA1c (In-patients) ..................................................................................................................... 160
3b. HbA1C (Out-patient Department) ................................................................................................ 162
Oral Glucose Tolerance Test (OGTT) ............................................................................................... 164
Post-prandial Blood Sugar (PPBS) ................................................................................................... 166
Urine Chemistry Tests ...................................................................................................................... 168
Clinical Chemistry ................................................................................................................................ 169
Internal Services .................................................................................................................................. 169
Acceptance of Reagent and Stocks Delivery .................................................................................... 170
Clinical Internship Training Program ................................................................................................. 171
Clinical Microscopy............................................................................................................................... 173
External Services ................................................................................................................................. 173
Bence Jones Protein......................................................................................................................... 175
Blood Smear for Malarial Parasite .................................................................................................... 176
Body Fluid Analysis .......................................................................................................................... 177
Fecalysis .......................................................................................................................................... 178
Fecalysis .......................................................................................................................................... 179
Fecal Occult Blood............................................................................................................................ 180
Filarial Blood Smear ......................................................................................................................... 181
Kidney Stone Analysis ...................................................................................................................... 182
Paragonimus Sputum Smear ............................................................................................................ 183
Pregnancy Test ................................................................................................................................ 184
Semen Analysis ................................................................................................................................ 185
Tape Peri-Anal Swab Smear ............................................................................................................ 186
Urinalysis .......................................................................................................................................... 187
Urinalysis .......................................................................................................................................... 188
Urine Glucose, Ketone, Protein, pH and Specific Gravity .................................................................. 189
Internal Services ............................................................................................................................... 190
Acceptance of Deliveries of Supplies and Reagents ......................................................................... 190
Affiliation Training (Internship) .......................................................................................................... 191
Issuance of Laboratory Supplies ....................................................................................................... 192
HSSC Laboratory and Drug Testing Unit .............................................................................................. 194
External Services ................................................................................................................................. 194
Collection of Blood Samples ............................................................................................................. 194
ISSUANCE OF SECOND COPY OF RESULTS ............................................................................... 195
PROCESSING OF MOA FOR CONFIRMATORY DRUG TESTING ................................................. 196
Receiving/Processing and Releasing of Results for Confirmatory Drug Testing ................................ 197
Receiving/Processing of Laboratory Specimen and Releasing of Laboratory Results ....................... 199
Receiving of Urine Sample for Confirmatory Drug Testing ................................................................ 201
Receiving/Processing and Releasing of Results for Screening Drug Testing .................................... 202
Scheduling of Drug Testing for School Affiliates and Remote Collection ........................................... 204
Emergency Department Laboratory...................................................................................................... 207
External Services ................................................................................................................................. 207
Processing of Specimen for Clinical Chemistry (Emergency Department Satellite Laboratory) ......... 207
Processing of Specimen for Clinical Microscopy (Emergency Department Satellite Laboratory) ....... 209
Processing of Specimen for Hematology (Emergency Department Satellite Laboratory) .................. 211
Processing of Specimen for Immunology/Serology (Emergency Department Satellite Laboratory) ... 212
Peripheral Blood Smear- COLLECTION ONLY (Emergency Department Satellite Laboratory) ......... 213
Emergency Department Laboratory...................................................................................................... 214
Internal Services .................................................................................................................................. 214
Acceptance of Laboratory Supplies and reagents ............................................................................. 215
Acceptance of Laboratory Supplies and reagents ............................................................................. 216
Affiliation Training (Internship) .......................................................................................................... 217
Test for Processing in General Laboratory ....................................................................................... 218
Test for Referral to General Laboratory ............................................................................................ 219
Hematology .......................................................................................................................................... 222
External Services ................................................................................................................................. 222
1A. Hematology Tests - Out -Patient................................................................................................. 223
1B. Hematology Test – In-patient...................................................................................................... 225
1A. Hematology Tests - Out -Patient................................................................................................. 227
1B. Hematology Test – In-patient...................................................................................................... 229
Hematology .......................................................................................................................................... 231
Internal Services .................................................................................................................................. 231
Acceptance of Deliveries of Supplies and Reagents ......................................................................... 232
Affiliation Process (Medical Technology Internship Program) ........................................................... 233
Evaluation of Products and Supplies................................................................................................. 234
Evaluation of Hematology Equipment ............................................................................................... 235
Issuance of Laboratory Supplies to Designated Units ....................................................................... 236
Issuance of Monthly-Annual Report .................................................................................................. 237
Histopathology ..................................................................................................................................... 239
External Services ................................................................................................................................. 240
1, Processing of Specimens (Autopsy) ............................................................................................. 240
2. Processing of Biopsy Specimens (Histopathology – In Patient) .................................................... 241
3. Processing of Biopsy Specimens (Histopathology – Out Patient).................................................. 244
4. Bone Marrow Aspirate (BMA) Smears (Histopathology- In and Out Patient) ................................. 248
5. Borrowing of Slides and Blocks..................................................................................................... 250
6. cell block/cytology SPECIMEN (in-PATIENT) ............................................................................... 252
7. CELL BLOCK/CYTOLOGY SPECIMEN (WALK-IN AND OUT PATIENT) ..................................... 254
8. Duplicate/Second Copy of Results ................................................................................................ 256
Fine Needle Aspiration BiopsySPECIMEN ( In-PATIENT) ................................................................ 257
 Processing of Flow Cytometry Samples (In and Out Patient Department)......................................... 259
Fine Needle Aspiration Biopsy SPECIMEN (walK-in and out-PATIENT) ........................................... 261
LABORATORY- FINE NEEDLE ASPIRATION BIOPSY: Schedule of Fees ...................................... 263
Frozen Section Biopsy ...................................................................................................................... 263
Processing of Specimens (Immunohistochemical Stains) ................................................................. 264
Pap Smear/ CYP .............................................................................................................................. 270
Processing of Peripheral Blood Smear (PBS) -In and Out Patient) ................................................... 272
RECTAL BIOSPY ............................................................................................................................. 274
Receiving and Releasing of Cadavers .............................................................................................. 275
REVIEW OF SLIDES ........................................................................................................................ 277
Processing of Specimens (Adequacy) .............................................................................................. 280
Histopathology ..................................................................................................................................... 281
Internal Services .................................................................................................................................. 281
1. Acceptance of Delivery of Reagents and Supplies ........................................................................ 282
2. Affiliation (Medical Laboratory Science Internship) ........................................................................ 283
3. Issuance of Laboratory Supplies to Ward...................................................................................... 284
IWNH Laboratory ................................................................................................................................. 286
External Services ................................................................................................................................. 286
1. Collection of Urine/Stool ............................................................................................................... 287
2. Collection of Urine/Stool ............................................................................................................... 288
3. Collection of Urine/Stool ............................................................................................................... 289
4. Blood Extraction (Phlebotomy)...................................................................................................... 290
5. Blood Extraction (Phlebotomy)...................................................................................................... 291
6. Blood Extraction (Phlebotomy)...................................................................................................... 292
7. EXPANDED NEWBORN SCREENING BLOOD COLLECTION .................................................... 293
8. TRAINING ON EXPANDED NEWBORN SCREENING BLOOD COLLECTION ............................ 294
IWNH Laboratory ................................................................................................................................. 295
Internal Services .................................................................................................................................. 296
1. PROVISION OF EXPANDED NEWBORN SCREENING MONTHLY REPORT ............................ 296
Sub-National Laboratory EREID-MBL .................................................................................................. 299
External Services ................................................................................................................................. 299
1a. Diagnostic Services (Inpatient) .................................................................................................. 299
1b. Diagnostic Services (Outpatient) ................................................................................................ 302
2a. Surveillance Services (Bloodborne) ............................................................................................ 305
2b. Surveillance Services (Respiratory) ............................................................................................ 307
3. TUBERCULOSIS BACTERIAL DETECTION (TB-PCR) ............................................................... 309
Sub-National Laboratory EREID-MBL .................................................................................................. 312
Internal Services .................................................................................................................................. 312
1. Acceptance of Deliveries of Supplies and Reagents ..................................................................... 312
2. Evaluation of Products and Supplies............................................................................................. 313
3. Evaluation of EREID-MBL Equipment ........................................................................................... 314
4. Issuance of Monthly-Annual Report .............................................................................................. 315
5. Packing of Valuable Biological Materials (VBM) ............................................................................ 316
Clinical Microbiology............................................................................................................................. 320
External Services ................................................................................................................................. 320
1. Acid Fast Bacilli Stain (AFB), sputum............................................................................................ 320
2. Acid Fast Bacilli Stain (AFB-O), other than sputum ....................................................................... 321
3. Processing of Specimen (Microbiology – Blood Culture; In-Patient) .............................................. 322
4. Processing of Specimen (Culture & Sensitivity Test – Microbiology) ............................................. 323
 5. Giemsa Stain ................................................................................................................................ 324
6. Gram Stain ................................................................................................................................... 325
7. India Ink ........................................................................................................................................ 326
8. Issuance of Blood Culture Vials .................................................................................................... 328
9. KOH preparation ........................................................................................................................... 329
10. Provision of Control Strain Isolates for Research Studies ........................................................... 330
11. Wet Mount .................................................................................................................................. 331
Clinical Microbiology............................................................................................................................. 332
Internal Services .................................................................................................................................. 332
1. Acceptance of Deliveries of Supplies and Reagent ....................................................................... 333
2-A. Affiliation Training (In-service Registered Medical Technologist) ............................................... 334
2-B. Affiliation Training (Medical Technology Interns) ....................................................................... 335
3. Collection & Processing of Environmental Samples ...................................................................... 336
4. Encoding of ARSP Data, and Referral of Clinical Isolates to ARSL-RITM ..................................... 337
5. Issuance of Sterile Containers to Wards ....................................................................................... 338
6. Submission of Hospital’s Antibiogram Report ............................................................................... 339
SPMC CrCL (Certified rHIVda Confirmatory Laboratory) ...................................................................... 341
External Services ................................................................................................................................. 341
1. Submission of laboratory request form for CD4 test ...................................................................... 342
2. Claim the Official Laboratory Result .............................................................................................. 344
3. Submission of laboratory request form for HIV tests ..................................................................... 345
4. Submission of laboratory request form for HIV viral load ............................................................... 347
5. SPMC CrCL (Certified rHIVda Confirmatory Laboratory) .............................................................. 349
Reveiving/Releasing............................................................................................................................. 351
External Services ................................................................................................................................. 351
1. ISSUANCE OF SECOND COPY OF RESULTS ........................................................................... 352
2. Receiving of in-patients requests/samples .................................................................................... 353
3. Receiving of out-patients requests/samples .................................................................................. 354
4. Releasing of laboratory results. ..................................................................................................... 355
Internal Services .................................................................................................................................. 357
1. Operates pneumatic tube system.................................................................................................. 357
Serology and Immunology .................................................................................................................... 360
External Services ................................................................................................................................. 360
1. Serology and Immunology (Inpatient) ........................................................................................... 360
1. Serology and Immunology (Outpatient) ......................................................................................... 362
Water Analysis ..................................................................................................................................... 367
External Services ................................................................................................................................. 367
1. Processing of Water Samples for Physico-Chemical Analysis ...................................................... 367
2. Processing of Water Samples for Bacteriological Analysis ............................................................ 369
Heart Institute......................................................................................................................................... 372
West Wing............................................................................................................................................ 372
External Services ................................................................................................................................. 372
1. ADMISSION OF PATIENTS TO HI- WESTWING WARD ............................................................. 372
2. TRANS-IN/TRANS-OUT OF PATIENTS TO HI- WESTWING WARD ........................................... 373
3. DISCHARGE OF PATIENTS FROM HI- WESTWING WARD....................................................... 374
4. FACILITATION OF PRESCRIBED LABORATORY EXAMINATIONS ........................................... 375
5. FACILITATION OF REQUESTED DIAGNOSTIC PROCEDURES ................................................ 376
Operating Room ................................................................................................................................... 378
External Services ................................................................................................................................. 378
 1. Receiving of Request for Surgery ................................................................................................. 378
2. Admission of OPD Patient Scheduled for Surgery. ....................................................................... 379
3. Perioperative Visit (Health Teaching about the Perioperative Process) ......................................... 380
4. Endorsement of Patient ................................................................................................................ 381
5. Operating Room Procedures ........................................................................................................ 382
PICU .................................................................................................................................................... 385
External Services ................................................................................................................................. 385
1. Providing Close and Specialized Nursing Care to Patients Recovering from the Effects of
Anesthesia and Operation ................................................................................................................ 385
2. Transfer In of Patient from Other Units ......................................................................................... 386
3. Transfer out of Patient to Pay/ Service Wards............................................................................... 387
Recovery Room ................................................................................................................................... 389
External Services ................................................................................................................................. 389
1. Providing Close and Specialized Nursing Care to Patients Recovering from the Effects of
Anesthesia and Operation ................................................................................................................ 390
2. Transferring-out of Patient to Clinical/Critical Units ....................................................................... 391
SICU .................................................................................................................................................... 392
External Services ................................................................................................................................. 392
1. Transfer In of Patient from other Units .......................................................................................... 393
2. Providing Close and Specialized Nursing Care to Patients Recovering from the Effects of
Anesthesia and Operation ................................................................................................................ 394
3. Transfer out of Patient to Pay/ Service Ward ................................................................................ 395
Heart Station ........................................................................................................................................ 396
External Services ................................................................................................................................. 396
1. HI- 2DECHO - SCHEDULING ....................................................................................................... 397
2. 2DECHO PROCEDURE ............................................................................................................... 398
3. 2DECHO – RELEASING of results ............................................................................................... 399
Cardiac Catheterization Laboratory (Cardiac CathLab) ........................................................................ 400
External Services ................................................................................................................................. 400
Cardiovascular Catheterization Laboratory ....................................................................................... 401
Cardiovascular Catheterization Laboratory ....................................................................................... 403
Institute of Psychiatry and Behavioral Medicine ................................................................................. 405
Ward Administrator’s Office .................................................................................................................. 405
External Services ................................................................................................................................. 405
1. Attending to Inquiries .................................................................................................................... 406
2. Handling of letters, correspondence received thru email/ courier/ personal services ..................... 407
3. Granting/denying permission to use IPBM conference rooms/gym ............................................... 409
4. Providing Assistance..................................................................................................................... 410
Ward Administrator’s Office .................................................................................................................. 411
Internal Services .................................................................................................................................. 411
1. All Administrative Concerns Requiring Appropriate Action/s ......................................................... 412
2. Assessment, Signing and Endorsement of Daily Time Record, Pass Slip and Application for leaves
......................................................................................................................................................... 413
3. Attending to meetings/conference of the Execom, Admin Section Heads ..................................... 414
4. Handling of documents, memorandums, orders, circulars for appropriate action .......................... 415
5. Handling request reservation of function room .............................................................................. 416
6. Monitoring of Attendance of Administrative Personnel .................................................................. 417
7. Performance evaluation of Job Order (JO) personnel, regular admin staff .................................... 418
8. Performance/task supervision over out-sourced security services ................................................ 419
Billing Unit ............................................................................................................................................ 421
External Services ................................................................................................................................. 421
1. Provides Statement of Account for MGH patients ......................................................................... 422
2. Assist patients with Philhealth ....................................................................................................... 423
Crisis Intervention Unit ......................................................................................................................... 424
External Services ................................................................................................................................. 424
1. Admission of Patients ................................................................................................................... 425
2. Discharge Planning and Home Instructions .................................................................................. 426
3. Facilitation of Issuance of Certificate of Confinement/ Medical Abstract per request ..................... 428
4.Handling of Patient’s Visitation ....................................................................................................... 429
5. Outpatient General Consultation- CIU (after 5pm,weekends and holidays) ................................... 430
ECG Unit .............................................................................................................................................. 431
External Services ................................................................................................................................. 431
1. Electrocardiogram (ECG) Services for IPBM Patients ................................................................... 432
Laboratory ............................................................................................................................................ 434
External Services ................................................................................................................................. 434
Collection of Specimen: Urine/Stool .................................................................................................. 435
Blood Extraction (Phlebotomy).......................................................................................................... 436
Male and Female Wards ...................................................................................................................... 437
External Services ................................................................................................................................. 437
1. Discharge Planning and Home Instructions .................................................................................. 438
2. Facilitation of Issuance of Certificate of Confinement/ Medical Abstract ........................................ 440
per request ....................................................................................................................................... 440
3. Handling of Patient’s Visitation / Corroborative Interview .............................................................. 441
4. Facilitation of Student Affiliates’ Psychiatric Exposure .................................................................. 442
Medical Unit ......................................................................................................................................... 443
External Services ................................................................................................................................. 443
1. Acceptance for Residency Training Program ................................................................................ 444
2. Consultation and Management of Outpatients .............................................................................. 446
3. Consultation and Management of Emergency Patients ................................................................. 447
4. Consultation and Management of Outpatients in the Community Setting ...................................... 448
5. Consultation and Management of Outpatients in Anxiety Clinic .................................................... 449
6. Evaluation of Forensic Cases, Including Drug Dependency Examination...................................... 450
7. Issuance of Medical Abstract and Medical Certificate ................................................................... 451
8. Psychiatric Evaluation for Employees of Other Institution ............................................................. 452
1. Consultation and Management of Emergency Cases referred to Consultation-Liaison Psychiatry 453
2. Consultation and Management of Non-Emergency Cases referred to Consultation-Liaison
Psychiatry ......................................................................................................................................... 454
3. Issuance of Certificate of Confinement, Discharge Summary, and Medical Abstract ..................... 455
4. Management of Inpatients ............................................................................................................ 456
5. Psychiatric Evaluation for SPMC Employees ................................................................................ 457
Medical Unit ......................................................................................................................................... 458
Internal Services .................................................................................................................................. 458
Consultation and Management of Outpatients in Anxiety Clinic for SPMC Staff ................................ 459
Occupational Therapy .......................................................................................................................... 460
External Services ................................................................................................................................. 460
Conduct of Initial Evaluation (Outpatient, Inpatient) .......................................................................... 461
Conduct of Treatment (Outpatient, Inpatient) .................................................................................... 462
Conduct of Re-Evaluation (Outpatient, In-patient) ............................................................................. 463
Scheduling of Initial-Evaluation (Outpatient, Inpatient) ...................................................................... 464
OPD ..................................................................................................................................................... 465
 External Services ................................................................................................................................. 465
1. Emergency Room Referral (As Primary Service: Preparation for Admission to Psychiatry Ward-CIU)
......................................................................................................................................................... 466
2. Outpatient Department Depot Clinic.............................................................................................. 468
3. Outpatient Department Consultations (General Consultation) ....................................................... 469
4. OPD Client Orientation and Psychoeducation ............................................................................... 471
Nutrition and Dietetics .......................................................................................................................... 472
External Services ................................................................................................................................. 472
1. Conduct of Food Donations for Inpatients ..................................................................................... 473
2. Conduct of Nutrition Education to Outpatients and Watchers ........................................................ 474
3. Processing of Daily Acceptance and Inspection Reports (DAIRs): Foodstuffs .............................. 475
4. Processing of Statement of Accounts (SOA) and Disbursement Vouchers ................................... 476
5. Provision of Meals and Snacks for Inpatients ................................................................................ 477
6. Provision of Meals to Referred Outpatients or Watchers ............................................................... 478
7. Provision of Nutrition Care to Referred Therapeutic Inpatients...................................................... 479
Nutrition and Dietetics .......................................................................................................................... 480
Internal Services .................................................................................................................................. 480
1. Provision of Nutrition Counseling to Referred Personnel ............................................................... 481
Pharmacy ............................................................................................................................................. 482
External Services ................................................................................................................................. 482
1. Provision and Replacement of Emergency Drugs for Service Wards (Charge Transaction- Admitted
Patients) ........................................................................................................................................... 483
2. Provision of All Available Drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Charge
Transaction- Admitted Patients) ........................................................................................................ 485
3. Provision of All Available Drugs/Medicines/Medical Supplies and Other Pharmaceuticals (cash
Transaction – Regular Client) ........................................................................................................... 486
4. Provision of All Available Drugs/Medicines/Medical Supplies and Other Pharmaceuticals (cash
Transaction – Regular Client) ........................................................................................................... 487
5. Provision of All Available Drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Charge to
Donor with Government Funds) ........................................................................................................ 489
Social Service ...................................................................................................................................... 492
External Services ................................................................................................................................. 492
Accept and Document Donations...................................................................................................... 493
Assessment and Classification ......................................................................................................... 494
Family Tracing .................................................................................................................................. 495
Social Work Counselling ................................................................................................................... 496
Referrals ........................................................................................................................................... 497
Pre- discharge planning .................................................................................................................... 498
Home Conduction ............................................................................................................................. 499
Temporary Shelter ............................................................................................................................ 500
Psychological Service .......................................................................................................................... 501
External Services ................................................................................................................................. 501
1. Administer Neuropsychological Test for referred patients ............................................................. 502
2. Conduct Counseling Session per referral (Psychoeducation, Insight Counseling) ......................... 503
3. Full Psychological Assessment Report ......................................................................................... 504
4. Providing NPT for Referred Clients ............................................................................................... 505
5. Scheduling of Neuropsychological Test ........................................................................................ 506
Institute for Women and Newborn Health (IWNH) ............................................................................... 509
AICU .................................................................................................................................................... 509
External Services ................................................................................................................................. 510
Submission of Patient’s Kit for AICU Patients ................................................................................... 510
 OB Ultrasound Services at AICU ...................................................................................................... 511
Onco Tropho Ward ............................................................................................................................... 514
External Services ................................................................................................................................. 514
1. Chemotherapy Treatment and Management for Admitted patients with Gynecologic Malignancies
and Gestational Trophoblastic .......................................................................................................... 514
Center for Maternal Fetal Medicine (CMFM)......................................................................................... 516
External Services ................................................................................................................................. 516
1. HIGH RISK PREGNANCY PRENATAL CONSULTATION ............................................................ 516
Newborn Screening .............................................................................................................................. 519
External Services ................................................................................................................................. 519
1. Newborn Screening ...................................................................................................................... 519
2. Newborn Screening ...................................................................................................................... 520
3. Newborn Screening ...................................................................................................................... 521
Outpatient Department (OPD Main) ...................................................................................................... 523
External Services ................................................................................................................................. 523
1. OPD ONLINE TRAGING .............................................................................................................. 523
2. OPD TELECONSULTATION ........................................................................................................ 525
Dental Clinic ........................................................................................................................................... 527
External Services ................................................................................................................................. 527
Dental Consultation .......................................................................................................................... 527
Dental Procedures ............................................................................................................................ 529
Derma Clinic ........................................................................................................................................... 532
External Services ................................................................................................................................. 532
1. Teledermatology ........................................................................................................................... 532
2. Dispensing of MDT medications to HD patients ............................................................................ 534
3. Receiving inpatient referrals.......................................................................................................... 536
Family Medicine Clinic .......................................................................................................................... 540
External Services ................................................................................................................................. 540
1. General Family and Community Medicine OPD Consultation for Scheduled Appointment ............ 540
2. General Family and Community Medicine OPD Teleconsultation (WEBEX Meeting for Audio-Visual
Consultation) .................................................................................................................................... 541
3. General Family and Community Medicine OPD Teleconsultation (Phone Call) ............................. 542
4. Referral of DFCM OPD Patients to other Departments/Services via Teleconsultation................... 543
5. Issuance of Medical Certificate to OPD Patients (Same Day Consultation)................................... 544
6. Intramuscular Injection of Medications .......................................................................................... 545
7. Referral of patients to National Tuberculosis Program (SPMC TB DOTS) for procurement of anti-TB
meds................................................................................................................................................. 546
8. Residency and Fellowship Training - Application .......................................................................... 547
9. Palliative Care Ward Interdepartmental Referral for COVID-19 Patients ....................................... 548
10. Receiving of OPD patients to National Tuberculosis Program (SPMC TB DOTS) for DSSM and
Sputum GeneXpert ........................................................................................................................... 550
11. Receiving of OPD patients to National Tuberculosis Program (SPMC TB DOTS) for procurement of
anti-TB meds .................................................................................................................................... 551
Personnel Health Services (PHS)......................................................................................................... 554
External Services ................................................................................................................................. 554
Referral of DFCM PHS OPD Patients to other Departments/Services via Teleconsultation .............. 555
PHS OPD Teleconsultation (WEBEX Meeting for Audio-Visual Consultation)................................... 556
PHS OPD Teleconsultation (phone call) ........................................................................................... 557
Scheduled Immunization among Personnel ...................................................................................... 558
Issuance of Medical Certificate to Physical Consult at PHS (Same Day Consultation) ...................... 560
PHS OPD Consultation for Scheduled Appointment ......................................................................... 561
Health Insurance Medical Evaluation Section (HIMES) ....................................................................... 562
Internal Services .................................................................................................................................. 562
1. Evaluation of PHIC Charts – HIMES Main .................................................................................... 563
2. Evaluation of PHIC Charts – HIMES IWNH................................................................................... 564
3. Evaluation of PHIC Charts – HIMES ASU ..................................................................................... 565
4. Evaluation of PHIC-Covid 19 Cases ............................................................................................. 566
Operating Room Nursing Services ....................................................................................................... 567
Internal Services .................................................................................................................................. 567
1. Submission of Request for Surgery............................................................................................... 568
2. Processing of Death Records ....................................................................................................... 569
Housekeeping ........................................................................................................................................ 570
Internal Services .................................................................................................................................. 570
1. Request for Supplies and Materials .............................................................................................. 571
2. Request for Emergency General Cleaning .................................................................................... 572
Security .................................................................................................................................................. 573
External Services ................................................................................................................................. 573
1. Request for CCTV Footage Viewing and Copy ............................................................................. 574
2. Release of Requested Copy of CCTV Footage ............................................................................. 575
3. Issuance of Watcher’s ID .............................................................................................................. 576
4. Replacement of Lost Watcher’s ID ................................................................................................ 577
5. Incident Investigation .................................................................................................................... 578
6. Screening and Interview of Private Security Guard Applicants ...................................................... 579
7. Orientation and OJT of Private Security Guard Applicants ............................................................ 580
8. Issuance of PPE’S to All Security Guards ..................................................................................... 581
Special Care Areas ................................................................................................................................ 582
HIV-AIDS Care Team (HACT) CLINIC ................................................................................................. 582
External Services ................................................................................................................................. 582
1. HIV Counseling and Testing for Outpatients ................................................................................. 583
2. HIV Counseling and Testing for Admitted Patients........................................................................ 584
3. HACT Consultation ....................................................................................................................... 585
4 Tele-Consultation........................................................................................................................... 587
5. Dispensing of Medicine ................................................................................................................. 588
6. Fulfillment of Laboratory Requests................................................................................................ 590
Cardio-Pulmonary Services (CPS) ....................................................................................................... 592
External Services ................................................................................................................................. 592
1. ARTERIAL BLOOD GAS (ABG) EXTRACTION PROCEDURE .................................................... 593
2. ARTERIAL BLOOD GAS (ABG) PROCESSING PROCEDURE ................................................... 595
3. ELECTROCARDIOGRAM (ECG) PROCEDURE .......................................................................... 596
4. MECHANICAL VENTILATOR TRANSPORT ................................................................................ 598
5. SETTLEMENT OF VENTILATOR DAILY USAGE CHARGE ........................................................ 599
6. MECHANICAL VENTILATOR HOOKING PROCEDURE .............................................................. 600
Peritoneal Dialysis Unit ........................................................................................................................ 603
External Services ................................................................................................................................. 603
1. APPLICATION FOR PD Z PACKAGE .......................................................................................... 603
2. PROCESSING OF PD Z PACKAGE BILL ..................................................................................... 604
3. CLAIMING OF PD SOLUTIONS ................................................................................................... 605
4. CHANGE OF EXTENSION CATHETER ....................................................................................... 607
Hemodialysis Unit ................................................................................................................................ 609
External Services ................................................................................................................................. 609
 HEMODIALYSIS TREATMENT FOR IN-PATIENTS ......................................................................... 609
OUT-PATIENT HEMODIALYSIS TREATMENT ................................................................................ 611
OUT-PATIENT HEMODIALYSIS TREATMENT ENROLLMENT ....................................................... 613
Health Information Management Department ...................................................................................... 616
Admitting Section ................................................................................................................................. 616
External Services ................................................................................................................................. 616
Admission of Patient from Emergency Department ........................................................................... 616
Admission of Well-babies with Late Onset Complications ................................................................. 618
Changing or Updating of Admitted Patient’s Personal Information .................................................... 619
Changing or Updating of Patient’s Classification from Charity/Service Ward to Pay Ward, Pay Ward to
Charity/Service Ward ........................................................................................................................ 623
Changing or Updating of Patient’s Personal Information at the Emergency Department ................... 624
Direct Admission of Patients from Out-Patient Department and Referrals ......................................... 627
Issuance of Medical Certificate for Emergency Department Consultation ......................................... 629
Old and New Data Registration for Emergency Department Consultation ......................................... 632
Old and New Data Registration of Patients at Institute for Women and Newborn Health (IWNH)
Emergency Room ............................................................................................................................. 633
Registration for Hyperbaric Procedure .............................................................................................. 634
Registration of Indigenous People (IP) for Emergency Department Consultation .............................. 635
Registration of Unidentified Person for Emergency Department Consultation ................................... 636
Admission of Patient from Institute for Women and Newborn Health (IWNH) Emergency Room ...... 637
Admitting Section ................................................................................................................................. 639
Internal Services .................................................................................................................................. 639
Authentication of In-Patient Registry by PHIC for Closing and Opening of New Registry Logbook ... 640
Change of Admitting Diagnosis ......................................................................................................... 641
Creation of Record and Direct Admission of Newborn Babies at the Nursery Intensive Care Unit
(NICU) .............................................................................................................................................. 642
Creation of Record and Direct Admission of Newborn Babies from Delivery Room, IWNH Operating
Room/Post-Anesthesia Care Unit ..................................................................................................... 644
Receiving of Emergency Department Patients Health Records ......................................................... 645
Receiving of 2nd Page of Admission Cover Sheet and 24-Hours Daily Census from Wards .............. 646
Request for 2nd Copy of Clinical Cover Sheet ................................................................................... 647
Transmittal of ER Health Records to HIMD ....................................................................................... 648
Birth Registration Unit .......................................................................................................................... 649
External Services ................................................................................................................................. 649
Birth Registration of Newborns with Married Parents ........................................................................ 650
Birth Registration (Processing of Certificate of Live Birth for Late Registration) ................................ 652
Birth Registration (Request for Late Registration) ............................................................................. 654
Birth Registration (Single Mothers) ................................................................................................... 656
Birth Registration of Newborns with Unmarried Parents.................................................................... 658
Birth Registration Unit .......................................................................................................................... 660
Internal Services .................................................................................................................................. 660
Birth Registration (Endorsement of Certificate of Live Birth) ............................................................. 661
Birth Registration (Photocopying of Certificate of Live Birth) ............................................................. 662
Cancer Institute .................................................................................................................................... 663
External Services ................................................................................................................................. 663
Patients Data Registration at the Outpatient Cancer Institute- New/Old (Without Yellow Card)......... 664
Provision of Outpatient Health Records for New and Old Patients at the Cancer Institute Outpatient
Department ....................................................................................................................................... 665
Heart Institute ....................................................................................................................................... 667
External Services ................................................................................................................................. 667
 Patients Data Registration at the Heart Institute Outpatient Department- New/Old (Without Yellow
Card) ................................................................................................................................................ 668
Provision of Outpatient Health Record at the Heart Institute Outpatient Department ......................... 669
Renal Dialysis Unit ............................................................................................................................... 671
External Services ................................................................................................................................. 672
PROVISION OF OUTPATIENT HEALTH RECORD AT RENAL DIALYSIS UNIT ............................. 672
Main Office ........................................................................................................................................... 674
External Services ................................................................................................................................. 674
Certificate and Supporting Documents for SSS, GSIS, HDMF and Other Insurances – Previously
Admitted, Outpatient and ER Patients............................................................................................... 674
Certificate of Confinement ................................................................................................................ 676
Death Certificate – Initial Issuance .................................................................................................... 677
Death Certificate – Re-Issuance ....................................................................................................... 679
ISSUANCE OF MEDICAL CERTIFICATE – OUTPATIENT CONSULTATION .................................. 681
Issuance of Medical Certificate – Outpatient Consultation at Satellite Clinics (Heart and Cancer
Institute, RDU, ABTC, HACT) ........................................................................................................... 682
Issuance of Medical Certificate – Previously Admitted, Outpatient and ER Patients ......................... 683
Change or Update of Patient’s Demographic Data at the Outpatient Department ............................. 685
Patients Data Registration at the Outpatient Department- New/Old (Without Yellow Card) ............... 687
Provision of Outpatient Health Records for New and Old Patients at the Outpatient Department ...... 688
Main Office ........................................................................................................................................... 691
Internal Services .................................................................................................................................. 691
ACCESS TO ELECTRONIC/ HARD COPIES OF PATIENT’S HEALTH RECORDS ........................ 691
Receiving of Discharged In-Patients’ Health Records ....................................................................... 693
Request for Retrieval of Patients’ Health Records for Ambulatory Surgery Unit (ASU) and Clinic
(Department) Procedure ................................................................................................................... 694
REQUEST FOR STATISTICAL DATA .............................................................................................. 695
Nutrition and Dietetics Section ............................................................................................................. 697
External Services ................................................................................................................................. 697
1. ISSUANCE OF MARKET ORDERS AND RECEIVING OF DELIVERIES FOR FRONTLINERS AND
PATIENTS SEPARATELY. ............................................................................................................... 697
2. PROCESSING OF DISBURSEMENT VOUCHERS FOR FRONTLINERS AND PATIENTS
SEPARATELY .................................................................................................................................. 698
3. Provision of Enteral Formula to In-patients ................................................................................... 699
4. Provision of Meals to In-patients ................................................................................................... 700
5. PROVISION OF MEALS TO OUT-PATIENTS, AND WATCHERS REFERRED BY MSWS/ PDPU/
WCPU. ............................................................................................................................................. 701
6. PROVISION OF NUTRITION CARE PROCESS TO REFERRED THERAPEUTIC INPATIENTS. 702
7. RECEIVE, AND DISTRIBUTE FOOD DONATIONS FROM OUTSIDE INSTITUTIONS/
ORGANIZATIONS/ COMPANIES TO FRONTLINERS. .................................................................... 704
Internal Services .................................................................................................................................. 706
1. PROVISION OF MEALS AND SNACKS TO FRONTLINERS. ...................................................... 706
Pharmacy ............................................................................................................................................... 708
External Services ................................................................................................................................. 708
1. Provision of All Available Drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Cash
Transaction Pricing for Regular Client) ............................................................................................. 709
2. Provision of All Available Drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Cash
Transaction- Availment of Medicines for Regular Client) ................................................................... 711
3. Provision of All Available Drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Cash
Transaction- Pricing Senior Citizen/PWD)......................................................................................... 712
4. Provision of All Available Drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Cash
Transaction- availment Senior Citizen/PWD) .................................................................................... 714
5. Provision of All Available Drugs/Medicines/Medical Supplies and other Pharmaceuticals (Cash
transaction- PRICING for admitted patients) ..................................................................................... 715
6. Provision of All Available Drugs/Medicines/Medical Supplies and other Pharmaceuticals (Cash
transaction- AVAILMENT- for admitted paying patient) ..................................................................... 716
7. Provision of all Available Drugs/Medicines/Medical Supplies and other Pharmaceuticals ( PHIC
Patient in service ward and Payward) ............................................................................................... 717
8. Replacement of all Available Drugs/Medicines/Medical Supplies and other Pharmaceuticals in the
Emergency Cart ................................................................................................................................ 718
9. Replacement of all Available Drugs/Medicines/Medical Supplies and other Pharmaceuticals ....... 719
10. Provision of All Available Drugs/Medicines/Medical Supplies and other Pharmaceuticals ........... 721
11. Provision of All Available Drugs/Medicines/Medical Supplies and other Pharmaceuticals ........... 722
12. Provision of all Available Drugs/Medicines/Medical Supplies and other Pharmaceuticals ........... 723
13. Provision of all available Drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Charge to
Donor with Government Funds) (OP) for REGULAR STOCKS ......................................................... 724
14. Provision of all available drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Charge to
Donor with Government Funds) (OP) for CONSIGNMENT STOCKS ................................................ 726
15. Provision of all available drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Charge to
Donor with Government Funds) (OP) for CONSIGNMENT STOCKS and REGULAR STOCKS (MIX)
......................................................................................................................................................... 728
16. Provision of all available drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Charge to
Donor with Government Funds) (LINGAP) for REGULAR STOCKS ................................................. 730
17. Provision of all available drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Charge to
Donor with Government Funds) (LINGAP) for CONSIGNMENT STOCKS ........................................ 732
18. Provision of all available drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Charge to
Donor with Government Funds) (LINGAP) for CONSIGNMENT and REGULAR STOCKS ............... 733
19. Provision of all available drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Charge to
Donor with Government Funds) (MAP) for CONSIGNMENT and REGULAR STOCKS .................... 735
20. Provision of All Available Drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Cash
Transaction- Pricing for Regular Client) ............................................................................................ 737
21. Provision of All Available Drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Cash
Transaction- Availment of Medicines for Regular Client) ................................................................... 738
22. Provision of All Available Drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Cash
Transaction- Pricing Senior Citizen/PWD)......................................................................................... 739
23. Provision of All Available Drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Cash
Transaction- availment Senior Citizen/PWD) .................................................................................... 741
24. Provision of All Available Drugs/Medicines/Medical Supplies and other Pharmaceuticals (Cash
transaction- pricing Regular Client) ................................................................................................... 742
25. Provision of All Available Drugs/Medicines/Medical Supplies and other Pharmaceuticals (Cash
transaction- AVAILMENT - Regular Client) ....................................................................................... 743
26. Provision of all Available Drugs/Medicines/Medical Supplies and other Pharmaceuticals ........... 744
27. Provision of all Available Drugs/Medicines/Medical Supplies and other Pharmaceuticals ........... 745
28. Provision of all Available Drugs/Medicines/Medical Supplies and other Pharmaceuticals ........... 746
29. Provision of All Available Drugs/Medicines/Medical Supplies and other Pharmaceuticals (Cash
transaction- PRICING Regular Client)............................................................................................... 747
30. Provision of All Available Drugs/Medicines/Medical Supplies and other Pharmaceuticals (Cash
transaction- AVAILMENT- Regular Client) ........................................................................................ 748
31. Provision of All Available Drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Cash
Transaction- Pricing Senior Citizen/PWD)......................................................................................... 749
32. Provision of All Available Drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Cash
Transaction- availment Senior Citizen/PWD) .................................................................................... 751
33. Provision of all Available Drugs/Medicines/Medical Supplies and other Pharmaceuticals ........... 752
34. Provision of all Available Drugs/Medicines/Medical Supplies and other Pharmaceuticals ........... 753
35. Provision of all Available Drugs/Medicines/Medical Supplies and other Pharmaceuticals ........... 754
36. Provision of all Available Drugs/Medicines/Medical Supplies and other Pharmaceuticals ........... 755
37. Provision of All Available Drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Cash
Transaction PRICING FOR Regular Client) ...................................................................................... 756
38. Provision of All Available Drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Cash
Transaction- Availment of Medicines for Regular Client) ................................................................... 757
39. Provision of All Available Drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Cash
Transaction- Pricing Senior Citizen/PWD)......................................................................................... 758
40. Provision of All Available Drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Cash
Transaction- availment Senior Citizen/PWD) .................................................................................... 760
41. Provision of All Available Drugs/Medicines/Medical Supplies and other Pharmaceuticals (Cash
transaction- PRICING Regular Client)............................................................................................... 761
42. Provision of All Available Drugs/Medicines/Medical Supplies and other Pharmaceuticals (Cash
transaction- AVAILMENT - Regular Client) ....................................................................................... 762
43. Provision of all available drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Charge to
Donor with Government Funds) (OP) for REGULAR STOCKS ......................................................... 763
44. Provision of all available drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Charge to
Donor with Government Funds) (OP) for CONSIGNMENT STOCKS ................................................ 765
45. Provision of all available drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Charge to
Donor with Government Funds) (OP) for CONSIGNMENT STOCKS and REGULAR STOCKS (MIX)
......................................................................................................................................................... 767
46. Provision of all available drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Charge to
Donor with Government Funds) (LINGAP) for REGULAR STOCKS ................................................. 769
47. Provision of all available drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Charge to
Donor with Government Funds) (LINGAP) for CONSIGNMENT STOCKS ........................................ 771
48. Provision of all available drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Charge to
Donor with Government Funds) (LINGAP) for CONSIGNMENT and REGULAR STOCKS ............... 772
49. Provision of all available drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Charge to
Donor with Government Funds) (MAP) for CONSIGNMENT and REGULAR STOCKS .................... 774
50. Provision of All Available Drugs/Medicines/Medical Supplies and other Pharmaceuticals (Charge to
Patients Account).............................................................................................................................. 776
51. Provision of All Available Drugs/Medicines/Medical Supplies and other Pharmaceuticals (Charge to
Patients Account).............................................................................................................................. 778
52. Provision of All Available Drugs/Medicines/Medical Supplies and other Pharmaceuticals (Charge to
Patients Account).............................................................................................................................. 780
53. Provision of all available drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Charge to
Donor with Government Funds) (OP) for REGULAR STOCKS ......................................................... 781
54. Provision of all available drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Charge to
Donor with Government Funds) (OP) for CONSIGNMENT STOCKS ................................................ 783
55. Provision of all available drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Charge to
Donor with Government Funds) (OP) for CONSIGNMENT STOCKS and REGULAR STOCKS (MIX)
......................................................................................................................................................... 785
56. Provision of all available drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Charge to
Donor with Government Funds) (LINGAP) for REGULAR STOCKS ................................................. 787
57. Provision of all available drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Charge to
Donor with Government Funds) (LINGAP) for CONSIGNMENT STOCKS ........................................ 789
58. Provision of all available drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Charge to
Donor with Government Funds) (LINGAP) for CONSIGNMENT and REGULAR STOCKS ............... 790
59. Provision of all available drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Charge to
Donor with Government Funds) (MAP) for CONSIGNMENT and REGULAR STOCKS .................... 792
60. Provision of all Available Drugs/Medicines/Medical Supplies and other Pharmaceuticals ........... 794
61. Provision of All Available Drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Pricing
for Special Prescription Form for Dangerous Drugs) ......................................................................... 795
62. Provision of All Available Drugs/Medicines/Medical Supplies and Other Pharmaceuticals-
(Availment for Special Prescription Form for Dangerous Drugs) ....................................................... 797
63. Acceptance of Pharmacy Students for Minor (200 hours) and Major (360 hours) Hospital Pharmacy
Internship Program. .......................................................................................................................... 799
64. Provision of chemotherapy drugs and antibiotics to Children’s Cancer Institute patients. ............ 800
65. Pharmacy Services ..................................................................................................................... 803
 66. Pharmacy Services ..................................................................................................................... 805
67. Pharmacy Services ..................................................................................................................... 806
68. Pharmacy Services ..................................................................................................................... 808
69. Pharmacy Services ..................................................................................................................... 810
Medical Social Work Section (MSWS) .................................................................................................. 812
Main Office ........................................................................................................................................... 813
External Services ................................................................................................................................. 813
1. Assessment and Classification ..................................................................................................... 813
Process in the Assessment and Classification of patients in accordance to AO 51-A, series of 2000.
......................................................................................................................................................... 813
2. Managing Medical Assistance to No watcher Patients .................................................................. 814
3. CADAVER RELEASE ................................................................................................................... 816
4 .POINT OF SERVICE .................................................................................................................... 817
5. REFERRALS ................................................................................................................................ 818
6. Process of Encoding Lingap Assistance ....................................................................................... 819
Children’s Cancer Institute ................................................................................................................... 820
External Services ................................................................................................................................. 820
1. Assessment and Classification of Patients .................................................................................... 821
2. Process of Availing Lingap Assistance .......................................................................................... 822
3. Process of Encoding Lingap Assistance ....................................................................................... 823
4. Process of Availing Referrals ........................................................................................................ 824
Emergency Room ................................................................................................................................ 825
External Services ................................................................................................................................. 825
1. Assessment and Classification of Patient...................................................................................... 826
2. Availment of Point of Service (POS) Philhealth ............................................................................. 827
3. Process of Availing Referrals for Medical Assistance .................................................................... 829
HIV-AIDS Care Team (HACT) .............................................................................................................. 830
External Services ................................................................................................................................. 830
HIV Counseling and Testing ............................................................................................................. 831
Post Test Counseling........................................................................................................................ 832
Classification of Patient According to their Financial Capability......................................................... 833
Provision of Medical Assistance ........................................................................................................ 834
Referral for Temporary Shelter ......................................................................................................... 835
Ward Rounds.................................................................................................................................... 836
Heart Institute ....................................................................................................................................... 837
External Services ................................................................................................................................. 837
1. Process in availing classification, discount and medical assistance for OPD patients ................... 838
2. Process in availing classification and assessment for Admitted Patients with/ without plan of surgery
......................................................................................................................................................... 839
3. Process for OPD/ Admitted Z-Package Patients ........................................................................... 841
4. Pre-admission Planning and Counselling for OPD and Z- package patients ............................... 842
5. Referral and networking for OPD/ admitted patients for fund sourcing (Outgoing) ........................ 843
6. Process on availing Point of Service for Non-Phic Patients ........................................................... 845
7. Facilitation of hospital bill of May-Go-Home (MGH) patients, in excess to Philhealth. .................. 846
8. Releasing of Cadaver ................................................................................................................... 847
Institute for Women and Newborn Health (IWNH) ................................................................................ 849
External Services ................................................................................................................................. 849
1. Assessment and Classification ..................................................................................................... 849
2. Cadaver Release .......................................................................................................................... 850
3. Facilitating of No Watcher ............................................................................................................. 851
 4. POS Enrolment- For Mothers........................................................................................................ 852
5. POS Enrolment- For Additional Dependent................................................................................... 853
6. Referrals ....................................................................................................................................... 854
7. Process of Encoding Lingap Assistance ....................................................................................... 855
8. Receiving and Safekeeping of Personal Belongings .................................................................... 856
9. Releasing of Personal Belongings to Legitimate Claimant ............................................................ 857
Outpatient Department ......................................................................................................................... 859
External Services ................................................................................................................................. 859
1. Classification of Patient and Provision of Consultation Discount ................................................... 859
2. Process on availing Medical assistance. ....................................................................................... 860
3. Facilitating Hospital Bill-ASU......................................................................................................... 861
4. Facilitating Referrals ..................................................................................................................... 862
5. Process of Encoding Lingap Assistance ....................................................................................... 863
Ortho .................................................................................................................................................... 865
External Services ................................................................................................................................. 865
Assessment and Classification of Patient ......................................................................................... 865
Availment of Point of Service (POS) Philhealth ................................................................................. 866
Process of Availing Referrals ............................................................................................................ 868
Patient Discharge Planning Unit (PDPU) .............................................................................................. 870
External Services ................................................................................................................................. 870
1. Facilitation of Pending Blood Transaction ..................................................................................... 870
2. Hospital Bill Assistance of Overstaying Patients ........................................................................... 871
Facilitating Hospital Bill Assistance ................................................................................................... 871
Emergency Room and Trauma Complex ............................................................................................. 873
External Services ................................................................................................................................. 873
1. TRIAGING AND CONSULTATION PROCEDURE ........................................................................ 873
(EMERGENCY DEPARTMENT / EMERGENCY MEDICINE) ........................................................... 873
2. TRIAGING AND CONSULTATION TO DIFFERENT CLINICAL DEPARTMENTS ........................ 876
3. ADMISSION PROCESS (ALL CLINICAL DEPARTMENTS) ......................................................... 878
4. DISCHARGE PROCEDURE ON OUTPATIENT CASES .............................................................. 880
(MAY GO HOME, HAMA, TRANSFER TO HOSPITAL OF CHOICE) ............................................... 880
Diving and Hyperbaric Medicine Unit ................................................................................................... 882
External Services ................................................................................................................................. 882
1. HYPERBARIC OXYGEN THERAPY (HBOT) CONSULTATION ................................................... 883
2. HYPERBARIC OXYGEN THERAPY (HBOT)................................................................................ 885
Nursing in Special Care Areas and Institutes ...................................................................................... 888
ICU Cluster .......................................................................................................................................... 888
Internal Services .................................................................................................................................. 888
ICU ADMISSION .............................................................................................................................. 889
COVID-ICU ADMISSION .................................................................................................................. 891
Transfer Out of Patient to other Unit ................................................................................................. 893
SAFEKEEPING OF PERSONAL BELONGINGS/VALUABLES OF PATIENTS ADMITTED IN THE ICU
......................................................................................................................................................... 896
POST MORTEM CARE OF COVID Patients (Suspect, Probable and Confirmed) ............................ 898
Special Laboratory ................................................................................................................................ 901
External Services ................................................................................................................................. 901
1. Endorectal and Endoanal Ultrasound Procedure .......................................................................... 902
2. ELECTROCARDIOGRAPHY (ECG) ............................................................................................. 904
3. EEG Procedure for Admitted Patients ........................................................................................... 906
4. ENDOSCOPY UNIT: SCHEDULING AND PROCEDURE ............................................................ 908
 5. Transrectal Ultrasound Guided Prostate Biopsy Procedure .......................................................... 910
FINANCE SERVICES .............................................................................................................................. 912
Billing ................................................................................................................................................... 912
External Services ................................................................................................................................. 912
1. Preparation of Statement of Accounts ........................................................................................... 913
2. Processing of PhilHealth Claims ................................................................................................... 915
3. Availing of PHIC Benefit................................................................................................................ 917
4. Payward Accomodation – Heart Institute ...................................................................................... 918
5. Releasing of Statement of Accounts ............................................................................................. 919
Cashier................................................................................................................................................. 920
External Services ................................................................................................................................. 920
1. RELEASING OF CHECK .............................................................................................................. 921
2. COLLECTION OF PAYMENT ....................................................................................................... 922
3. RELEASING OF PETTY CASH .................................................................................................... 923
4. RELEASING OF REFUND............................................................................................................ 924
5. Refund of Unserved Procedure or Medicine (CHEQUE REFUND for refund above Php 15,000.00)
......................................................................................................................................................... 925
PHIC and Claims .................................................................................................................................. 926
Z Benefits Package Main...................................................................................................................... 926
External Services ................................................................................................................................. 926
1. Inquiry on PhilHealth Eligibility ...................................................................................................... 927
Give PHIC mandatory requirements ................................................................................................. 927
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays. .............................. 927
2. Securing of Pre-Authorization Request and Member Empowerment Form ................................... 928
Issue Pre-authorization Request and Member Empowerment Forms ............................................... 928
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays. .............................. 928
3. SUBMISSION OF PRE-AUTHORIZATION REQUESTS .............................................................. 929
Transmit Pre-Authorization Requests and Member Empowerment Forms to PhilHealth Regional
Office XI............................................................................................................................................ 929
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays. .............................. 929
Office of the Medical Center Chief

External Services
1. Handling of Letters/ Correspondence Received Thru Email/ Courier/
Personal Delivery
The process of handling letters/correspondence received thru email, courier, or personal
delivery covers activities from receipt of letter up to sending a reply/response letter.
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays

Office/Division: Office of the Medical Center Chief (MCC Office)

Classification: Simple
Type of Transaction: G2C, G2B, G2G
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Letter/correspondence Requesting individual/office/agency
Receiving copy, checklist/ record/ proof of Requesting individual/office/agency
receipt (whichever is applicable)
Contact details of the sender/sender’s Requesting individual/office/agency
authorized representative (as deemed
necessary)
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
A. Email: A. Email:
1. Send letter/ 1. Open/Check email. None Urgent: Administrative
correspondence to Acknowledge/ 1 Day Staff
coh.spmc@gmail.com forward/refer to and Non-urgent: MCC Office
coordinate with 2 Days
offices/persons
concerned for
appropriate action.

B. Courier/Personal B. Courier/Personal
Delivery: Delivery:
1. Present the letter/ 1. Check/screen/ None Urgent: Administrative
correspondence receive the letter/ 1 Day Staff
together with the correspondence Non-urgent: MCC Office
checklist/record/ 2 Days
receiving copy.
2. Confirm/ 2. Provide the client None Urgent: Administrative
Acknowledge with the name of 1 Day Staff
response to letter/ office, contact Non-urgent: MCC Office
correspondence/ number/person and 2 Days
email. other details related
to the letter/
correspondence, as
deemed necessary.
 TOTAL: None A. Email:
Urgent:
2 Days
Non-urgent:
4 Days
B. Courier/
Personal
Delivery:
Urgent:
2 Days
Non-urgent:
4 Days

2. Handling of Invitations and Requests for Appointment/ Meeting with the

Medical Center Chief
The process of handling invitations and requests for appointment/ meeting with the Director
covers activities from receipt of invitation/request letter up to sending a reply/response letter.
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays

Office/Division: Office of the Medical Center Chief

Classification: Simple
Type of Transaction: G2C, G2B, G2G
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Letters/correspondence/invitations/programs Requesting individual/office/agency
(whichever is applicable)
Checklist, record/proof of receipt, receiving Requesting individual/office/agency
copy, documented requests/messages
(whichever is applicable)
Contact details of requester/authorized Requesting individual/office/agency
representative
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
A. Email: A. Email: None 1 day Administrative
1. Send letter/ 1. Open/Check email. Staff
correspondence to Acknowledge/ MCC Office
coh.spmc@gmail.com forward/refer to and
coordinate with
offices/persons
concerned for
appropriate action.

B. Courier/Personal B. Courier/Personal
Delivery: Delivery:
1. Present the letter/ 1. Check/screen/ 30 minutes
correspondence receive the letter/
together with the correspondence
checklist/record/
receiving copy.
2. Confirm/ 2. Coordinate with the None 2 days Administrative
Acknowledge Medical Center Chief Staff
response to letter/ and respond to the Medical Center
correspondence/ invitation / request (thru Chief
email email or by phone). MCC Office
 2.1 If the invitation / None Administrative
request is approved, Staff
post on the Director’s MCC Office
calendar.
TOTAL: None A. Email:
3 days
B. Courier/
Personal
Delivery:
2 days, 30
minutes

3. Processing of Documents for Notarization

The processing of documents for notarization covers activities from receipt of documents for
notarization up to releasing
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays

Office/Division: Office of the Medical Center Chief

Classification: Simple
Type of Transaction: G2C, G2B, G2G
Who may avail: SPMC Clinical Departments / Offices / Units / Sections, other
Government and Non-government Agencies/Offices/Units, and
individuals with Memorandum of Agreement/Understanding and official
dealings with SPMC
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Final draft (already reviewed and approved by the SPMC Legal Office; Offices/Agencies/Units
Legal Office and/or Chief Administrative Officer) with concerned
signatures of SPMC witness and those from the
other party
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Send/Present the 1. Check/Screen/ None 5 minutes Administrative
final draft with Receive the document. Staff
signatures of the MCC Office
SPMC witness and
those from the other
party.
1.1 Take appropriate None 1 day Medical Center
action/sign/ approve Chief II
the paper/document. MCC Office
2. Wait for feedback or 2. Coordinate with the None Urgent: 1 Day Administrative
follow up and receive contact person for Non-urgent: 5 Staff
notarized document. notarization of the Days MCC Office
document at the Legal
Note: Client may pick Office and send back
up the document at the to agency/unit/
MCC Office, if offices concerned.
preferred.
TOTAL: None Urgent: 2
Days;
Non-urgent:
6 Days
4. Attending to Inquiries
This is the process of attending to inquiries (e.g. hospital procedures and policies, location and
direction of department/office/unit)
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays

Office/Division: Office of the Medical Center Chief

Classification: Simple
Type of Transaction: G2C
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Specific details of the concern Requesting individual
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Visit Office of the 1. Analyze patient None 1 hour Administrative
Medical Center Chief inquiries Staff
to provide details of MCC Office
the inquiry 1.1 Provide
specific instruction/
explanation based
on existing policies
and procedures
and /or give
specific directions.
TOTAL: None 1 hour
Office of the Medical Center Chief

Internal Services
1. Handling of Documents for Appropriate Action
Handling of papers/documents for appropriate action/ signing/ approval of the Medical Center
Chief on matters related to Medical, Allied-Medical, Fiscal, Health Operations and Administration,
and Nursing Operations/ Services, including those from other units under the Office of the Medical
Center Chief
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays

Office/Division: Office of the Medical Center Chief

Classification: Simple
Type of Transaction: G2G
Who may avail: All SPMC Clinical Departments, Offices, Units, and Sections
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Documents/papers for appropriate action/ All SPMC Clinical Departments, Offices, Units, and
signing/approval of the Medical Center Chief Sections
Checklist/record/receiving copy (whichever is All SPMC Clinical Departments, Offices, Units, and
applicable) Sections
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Present the 1. Check the None Per paper/ Administrative
paper/document/letter paper/ document document: 2 Staff
together with the and its Minutes MCC Office
checklist/record/ completeness/
receiving copy correctness
against the
checklist/record/
receiving copy

1.1 Wait until the 1.1 Sign the 5 minutes Administrative

checking of paper/ checklist or Staff
document is completed record/receiving MCC Office
copy and return to
Note: If urgent, client
proceed to Step No.3
2. Leave the paper/ 2. Label/mark/tag None Per page: 1 Administrative
document in the office. the page/s of the Minute Staff
paper/ document MCC Office
Note: May follow up by to be acted upon/
phone or request MCC signed/ approved
staff to call office once by the Medical
acted upon/ signed by Center Chief
the Medical Center
Chief.
3. Wait for feedback or 3. Take None Urgent: Medical Center
follow up status, as appropriate 30 Minutes; Chief
needed. action/sign/ Non-urgent: MCC Office
approve the 2 days
paper/document.

3.1 Give feedback/ 5 minutes Administrative

update on status, Staff
as needed MCC Office
4. Claim the 4. Release the None Urgent: Administrative
paper/document that paper/document 10 Minutes; Staff
was acted upon / that was acted Non-urgent: MCC Office
signed / approved by upon / signed / 1 Day
the Medical Center approved by the
Chief at the MCC Medical Center
Office. Chief.

4.1 For papers/ 5 minutes

documents to be Administrative
sent to concerned Staff
offices/ units, MCC Office
coordinate with the
MCC Liaison
Officer / other
assigned
personnel).
TOTAL: None Urgent:
58 Minutes;
Non-urgent:
3 Days, 13
Minutes
2. Issuance of Travel Order (Official Time and Official Business)
The process of issuing a travel order, whether on Official Time or on Official Business, to the
personnel
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays

Office/Division: Office of the Medical Center Chief

Classification: Simple
Type of Transaction: G2G
Who may avail: SPMC Personnel with Travel on Official Business or Official Time
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Department Personnel Order/ Department Department of Health
Circular, signed approved by Medical Center
Chief
Invitation Letter Other government agencies
Court Order / Subpoena Trial Courts
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit the name/s 1. Receive the None 5 minutes Administrative
of attendees listed on submitted Staff
the Department document. MCC Office
Personnel Order /
Department Circular / 1.1 Check the None 5 minutes Administrative
Invitation Letter / the date and venue of Staff
Court Order. the event. MCC Office

1.2 Identify if the None 5 minutes Administrative

travel is on Official Staff
Time or Official MCC Office
Business

A. For Department
Personnel Order/
Department
Circular/ Invitation
Letter
1.3 Encode and 1 day Administrative
print two copies of Staff
the Travel Order. MCC Office

1.4 Sign the two 2 days Medical Center

copies of the Chief II
Travel Order. MCC Office

B. For Court
Order / Subpoena
1.3 Encode and 1 day Administrative
print three copies Staff
of the Travel MCC Office
Order

1.4 Sign the three 2 days Medical Center

copies of the Chief II
Travel Order MCC Office
A. For Department A. For Department Administrative
Personnel Order/ Personnel Order/ Staff
Department Circular/ Department MCC Office
Invitation Letter Circular/ Invitation
2. Claim the Travel Letter
Order from MCC 2. Release one None 5 minutes
Office copy of the Travel
Order with
signature of the
Medical Center
Chief.

B. For Court Order / B. For Court

Subpoena Order / Subpoena
2. Receive the Travel 2. Send one copy None 1 day Administrative
Order delivered by the of the signed Staff/
Liaison Officer of Travel Order with Liaison Officer
MCC Office the Court Order / MCC Office
Subpoena to the
concerned clinical
department, and
another to the
Health Information
Management
Department
(HIMD) /
concerned unit,
coordinate with
the MCC Liaison
Officer / other
assigned
personnel.
TOTAL: None For
Department
Personnel
Order/
Department
Circular/
Invitation
Letter:
3 days, 10
minutes

For Court
Order /
Subpoena
4 days, 5
minutes
3. Processing of Flights for SPMC Personnel (Official Business Only)
Securing flights for SPMC Personnel whose travel are considered as Official Business and where
the event/venue is outside of Davao City and that land travel is the less ideal option.
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays

Office/Division: Office of the Medical Center Chief

Classification: Simple
Type of Transaction: G2G
Who may avail: SPMC Personnel with Travel on Official Business
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Preferred flight details and airline Requesting individual/office
List and Personal Information of passenger(s) Requesting individual/ office
Invitation Letter/ Department Personnel Order / Department of Health / Other Government Agencies
Department Circular, signed approved by the
Medical Center Chief
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit the preferred 1. Check None 5 minutes Administrative
flight details and airline, completeness and Staff
list of passengers and receive the MCC Office
their information, and documents
approved invitation
submitted by the
letter / department
personnel order /
personnel.
department circular.
2. Wait for feedback or 2. Check None 1 day Administrative
follow up status, as availability of Staff
needed. preferred flights. MCC Office

If available:
2.1. Proceed to
booking.

If unavailable:
2.1. Inquire for the
next preferred
schedule until a
new schedule is
set, then proceed
to booking

2.2. Print two

copies of the
booking
confirmation and
the latest online
statement of
SPMC with the
booked airline.
3. Claim hard copy of 3. Release one None 5 minutes
the booking copy of the hard
confirmation copy of the
booking
confirmation to the
requesting
personnel.

3.2 File the

booking
confirmation and
latest online
statement of the
booked airline,
together with the
approved invitation
letter / department
personnel order /
department circular
as office records
TOTAL: None 1 day and 10
minutes
Data Privacy Office and Telemed

Data Privacy Office

Internal Services
1. Reporting of Data Breach Incident
To ensure that data breaches are well-managed and if deemed necessary, reported to the National
Privacy Commission.
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Data Privacy Office (DPO)

Classification: Simple
Type of Transaction: G2G
Who may avail: All SPMC’s Employees
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Data Breach Incident Report Form Data Privacy Office
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Presents duly 1. Verifies None 5 minutes Administrative
accomplished Data completeness of Assistant I
Breach Incident the request form. DPO
Report form to the 1.1. Instructs 5 minutes Administrative
Data Privacy Office. client to make a Assistant I
follow up one (1) DPO
working day after
the submission of
the form.
1.2. Evaluates 1 day Data Protection
Data Breach Officer
Incident Report DPO
form.

If breach needs
committee
intervention: 2 hours Data Protection
1.3 Schedules a Officer
committee DPO
meeting within 24
hours after
evaluation results
has been released
and informs the
data breach
management
committee.
If breach needs
no committee
intervention:
1.3. Case will be 5 minutes Data Protection
listed in the Officer
annual report of DPO
minor data breach
cases.
2. Return to Data If breach needs None
Privacy Office, after committee
one (1) working day intervention:
for the evaluation 2. Instructs client 5 minutes Administrative
result. and the Assistant I
concerned DPO
employees to
attend the
committee
meeting.
If breach needs
no committee
intervention:
2. Informs client 5 minutes Administrative
that their case will Assistant I
 be listed in the DPO
annual report of
minor data breach
cases.
3. Attends scheduled 3. Discuss None 4 hours Data Breach
committee meeting, courses of action Management
within one (1) working for the data Committee
day after the breach. DPO
evaluation result has 3.1. Prepares 1 day Data Protection
been released. Data Breach Officer
documents. DPO
3.2. Submits data 30 minutes Data Protection
breach report to Officer
Executive DPO
Management
Committee.
3.3. Reports Data 30 minutes Personal
Breach to the Information
National Privacy Controller /
Commission Data Protection
(within 72 hours Officer
after Data Breach MCC/DPO
Incident Report
was submitted to
the Data Privacy
Office).
4. Returns to Data 4.1 Provides copy None 5 minutes Administrative
Privacy Office, one (1) of minutes of the Assistant I
working day after the meeting to client. DPO
committee meeting for 4.2 Includes data 5 minutes Administrative
the result of the breach in annual Assistant I
committee discussion. report. DPO
TOTAL: None If breach
needs
committee
intervention:
2 days, 7
hours, 25
minutes
If breach
needs no
committee
intervention:
2 days, 55
minutes
2. Requesting for Data Privacy Orientation
To ensure that SPMC’s employees are knowledgeable with the necessary data privacy information
and updates, departments/sections/units are encouraged to have their staff oriented on Data
Privacy Law.
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Data Privacy Office (DPO)

Classification: Simple
Type of Transaction: G2G
Who may avail: SPMC departments/sections/units
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Orientation Request Form Data Privacy Office
2. List of Participants Requesting Unit / Office
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Presents duly 1. Verifies the None 5 minutes Administrative
accomplished completeness of Assistant I
Orientation Request the request form DPO
Form and List of then instructs
Participants to the client to wait for
Data Privacy Office. the confirmation
call within one (1)
working day.
1.1. Checks 1 day Administrative
availability of the Assistant I
speaker and DPO
reserve a venue.
1.2. Confirms via 5 minutes Administrative
phone call the Assistant I
schedule and DPO
venue to the
client.
1 day, 10
TOTAL: None
minutes
3. Request for Privacy Impact Assessment
To ensure that SPMC’s new data processing procedures are registered with the National Privacy
Commission.
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Data Privacy Office (DPO)

Classification: Highly Technical
Type of Transaction: G2G
Who may avail: All Offices / Units
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Process Registration Request Form Data Privacy Office
2. Process Flow associated with data
Requesting Unit / Office
processing procedure
3. Forms associated with data processing
Requesting Unit / Office
procedure
4. Documents and/or Report Templates
Requesting Unit / Office
associated with data processing procedure
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present duly 1. Verifies the None 10 minutes Administrative
accomplished completeness of Assistant I
Process Registration the request form DPO
Request Form and its and its
attachments (process attachments.
flow, forms, 1.1. Confirms 5 minutes Administrative
documents and/or release schedule Assistant I
report templates) to of the Pre-PIA DPO
the Data Privacy evaluation result
Office. to client.
1.2. Assesses 3 days Compliance
documents and Officer for
fills out Pre-PIA Privacy
evaluation form. DPO
2. Return to Data 2. Release the None 5 minutes Administrative
Privacy Office, after Pre-PIA Assistant I
three (3) working days evaluation result. DPO
for the Pre-PIA
evaluation result. If the result will
not require a PIA:
2.1. Advises the 5 minutes Administrative
client to terminate Assistant I
the request. DPO

If the result will

require a PIA:
2.1. provide the 5 minutes Administrative
client with release Assistant I
schedule of the DPO
PIA evaluation
result.
2.2. Evaluate 2 weeks Compliance
documents and Officer for
fills out the PIA Privacy
evaluation form. DPO
2.3. Reviews the 1 week Data Protection
process flow, Officer
forms involved, DPO
documents and/or
report templates.
3. Return to Data 3. Release the 5 minutes Administrative
Privacy Office, after PIA evaluation Assistant I
three (3) weeks for result. DPO
the PIA evaluation
result. If the results
suggest no
revisions on the
submitted
documents:
3.1. Endorses the 1 day Data Protection
documents for Officer
registration to the DPO
National Privacy
Commission.
If the results
suggest some
revisions on the
submitted
documents:
3.1. Returns the 10 minutes Administrative
submitted Assistant I
documents to DPO
client for revision.
TOTAL: None If the result
will not
require a PIA:
3 days, 25
minutes

If the result
will require a
PIA:
A. If the results
suggest no
revisions on
the submitted
documents:
3 weeks, 4
days, 30
minutes
B. If the results
suggest some
revisions on
the submitted
documents:
3 weeks, 3
days, 40
minutes
Data Privacy Office and Telemed

Telemedicine

External Services
1. Request for Tele-Psychiatry Service
Hospitals from outside Davao City may partner with SPMC to avail of the Tele.
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: IT Research and Training Institute for Telemedicine

Classification: Complex
Type of Transaction: G2G
Who may avail: 1. Government Hospitals
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Letter of Intent (LOI) Client hospital
2. License to Operate Client hospital
3. Tele-Psychiatry administrator/staff (1 Client hospital
doctor and nurse/s)
6. IT Staff Client hospital
7. Internet Connection Client hospital
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Send letter of intent 1. Acknowledges None 1 Day Administrative
addressed to the receipt of the Assistant I
Medical Center Chief letter and Telemedicine
via mail or email. forwards to the
office of the
Medical Center
Chief.
1.1. Refers None 1 day Administrative
request to the Assistant I
Medical Center Telemedicine
Chief for approval.

1.2. Approves/ None 2 weeks Medical Center

takes appropriate Chief
action. SPMC

If not approved:
1.3. Email letter of None 1 day Administrative
disapproval. Assistant I
Telemedicine
If approved:
1.3. Ask for the None 1 day Administrative
following Assistant I
requirements thru Telemedicine
email:
A. License To
Operate
B. List of Tele-
Psychiatry
administrator/staff
(1 doctor and
nurse/s)
C. List of IT Staff
D. Internet
Service provider
and connection
speed
2. Submits the 2. Acknowledges None 1 day Administrative
following receipt of email Assistant I
requirements to and verifies Telemedicine
SPMC Telemed: information given.
A. License to Operate
B. List of Tele-
Psychiatry
administrator/staff (1
doctor and nurse/s)
C. List of IT Staff
D. Internet Service
provider and
connection speed
3. Awaits draft MOA. 3. Makes a draft None Administrative
of the Officer III
Memorandum of Telemedicine
Agreement (MOA)
with the list of
corresponding
procedure.
3.1. Reviews the MOA 3.1. Forwards the
then sends draft MOA to
changes/corrections, IPBM, Legal
to SPMC via email. Office for review
and approval of
the Medical None
Center Chief
3.2. Approves and 3.2. Forwards the 1 Month
signs the MOA then approved MOA to
sends back to SPMC the client hospital
via mail. for review via
email.
3.3. Applies the
changes/ None
corrections and
sends the MOA
back to the client
for approval.
3.4 Sends the None
approved MOA to
the client hospital
via mail (DHL or
PHILPOST)
5.5 Forwards the
signed MOA to None
the Legal office for
notarization.
5.6. Provides a
copy to each of
the signatories. None

TOTAL: NONE 1 month, 2

weeks, 3
days
2. Request for Tele-Radiology Service
Hospitals from outside Davao City may partner with SPMC to avail of the Tele.
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: IT Research and Training Institute for Telemedicine

Classification: Complex
Type of Transaction: G2G
Who may avail: 1. Government Hospitals
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Letter of Intent (LOI) Client hospital
2. License to Operate Client hospital
3. Modality (X-ray, Ultrasound, etc.) Client hospital
4. PACS/RIS (Novarad, Carestream, Life Client hospital
Sys, Fuji, GE, etc.)
5. Radiologic Technologists (Trained by Client hospital
SPMC & PACS Service Provider)
6. IT Staff Client hospital
7. Internet Connection Client hospital
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Send letter of intent 1. Acknowledges None 1 Day Administrative
addressed to the receipt of the Assistant I
Medical Center Chief letter and Telemedicine
via mail or email. forwards to the
office of the
Medical Center
Chief.
1.1. Refers None 1 day Administrative
request to the Assistant I
Medical Center Telemedicine
Chief for approval.

1.2. Approves/ None 2 weeks Medical Center

takes appropriate Chief
action. SPMC

If not approved:
1.3. Email letter of None 1 day Administrative
disapproval. Assistant I
Telemedicine
If approved:
1.3. Ask for the None 1 day Administrative
following Assistant I
requirements thru Telemedicine
email:
A. License To
Operate
B. Modality (X-ray,
Ultrasound, etc.)
C. PACS/RIS
(Novarad,
Carestream, Life
 Sys, Fuji, GE,
etc.)
D. Radiologic
Technologists
(Trained by SPMC
& PACS Service
Provider)
E. List of IT Staff
F. Internet Service
provider and
connection speed
2. Submits the 2. Acknowledges None 1 day Administrative
following receipt of email Assistant I
requirements to and verifies Telemedicine
SPMC Telemed: information given.
A. License to Operate
B. Modality (X-ray,
Ultrasound, etc.)
C. PACS/RIS
(Novarad,
Carestream, Life Sys,
Fuji, GE, etc.)
D. Radiologic
Technologists
(Trained by SPMC &
PACS Service
Provider)
E. List of IT Staff
F. Internet Service
provider and
connection speed
3. Submits existing 3. Makes a draft None Administrative
rates of the of the Officer III
procedure. (Xray, CT Memorandum of Telemedicine
Scan, Ultrasound, Agreement (MOA)
etc.) and attaches rates
to the draft MOA
with the list of
doctor’s
professional fees
and its
corresponding
procedure.
3.1. Forwards the None
draft MOA to the
Radiology 1 Month
department, Legal
Office for review
and approval of
the Medical
Center Chief
3.1. Reviews the MOA 3.2. Forwards the None
then sends approved MOA to
changes/corrections, the client hospital
to SPMC via email. for review via
email.
3.3. Applies the None
changes/
corrections and
sends the MOA
back to the client
for approval.
3.2. Approves and 3.4 Sends the None
signs the MOA then approved MOA to
sends back to SPMC the client hospital
via mail.
 via mail (DHL or
PHILPOST) None
5.5 Forwards the
signed MOA to
the Legal office for
notarization. None
5.6. Provides a
copy to each of
the signatories.
TOTAL: NONE 1 month, 2
weeks, 3
days

Infection Prevention and Control Unit (IPCU)

External Services
1. Assessment and Admission for Suspected Patients
Walk-in patients or referred patients from Isolation Gym (accompanied by Triage Isolation Nurse)
or from an ambulance from other hospitals or from the airport (accompanied by healthcare
provider) are assessed at Isolation Facility I, and if deemed admissible, are then admitted to any
of the COVID wards.

Availability of Service: 24 hours, Monday to Sunday, including Holidays

Office/Division: Isolation I
Classification: Simple
Type of Transaction: G2C
Who may avail: COVID-19 PUI Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Referral form and/or accompanying Referring facility.
healthcare provider, if available.
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Presents self (with 1. Receives None 5 minutes Triage Nurse
accompanying patient and asks Isolation I
healthcare provider, if patient to fill out
available) to Isolation I the Data
Nurse. Information Sheet.
2. Fills out the Data 2. Registers None 5 minutes Triage Nurse
Information Sheet patient. Isolation I
then returns the form
to the nurse. 2.1. Takes None 5 minutes Triage Nurse
patient’s vital Isolation I
signs.

2.2. Interviews None 10 minutes Triage Nurse

patient about Isolation I
history of travel,
possible exposure
of PUI/COVID-19
positive patients,
and onset of signs
and symptoms.

2.3. Places patient None 5 minutes Triage Nurse

in holding area Isolation I
and instructs
patient to observe
social distancing
and to always
wear their mask.

2.4. Encodes None 5 minutes Clerk

patient’s Isolation
information and Medical
prints clinical Records
cover sheet for
 the chart
development.

2.5. Fills out and None 8 minutes

completes the Charge Nurse
Case Investigation Isolation I
Form (CIF).

2.6. Prepares None 5 minutes Charge Nurse

complete Patient’s Isolation I
Chart (compiled
the clinical cover
sheet, the
diagnostic
requests, RITM
form, and the
CIF).

2.7. Endorses None 5 minutes Charge Nurse

patient and Isolation I
patient’s chart to
Internal Medicine
(IM) Resident
Physician (adults)
or Pediatric
Medicine (Pedia)
Resident
Physician (pedia).

2.8. Orders None 5 minutes Resident

patient’s Physician
diagnostic IM/Pedia
procedures in the
patient’s chart.

2.9. Encodes None 5 minutes Resident

diagnostic Physician
procedures (CBC, IM/Pedia
NPS/OPS, and
Xray) in the
Segworks
Hospital
Information
System
(SEGHIS).

2.10. Carries out None 10 minutes Charge Nurse

physician’s order Isolation I
for diagnostic
procedure.

2.11. None 5 minutes Triage/Charge

Accompanies Nurse
patient to Isolation I
Roentgenogram
or laboratory area
and endorses
doctor’s request to
Radiologic
Technologist/Medi
cal Technologist
on duty
3. Submits self for 3. Performs None 10 minutes RadTech
radiologic and radiologic exam Isolation I
laboratory exams. on the patient.
3.1. Performs the None 15 minutes MedTech
following lab Isolation I
exams on the
patient:
a. CBC
b.
Nasopharyngeal
swab (NPS) and
Oropharyngeal
swab (OPS)

3.2. Processes None 2 hours RadTech/

the images/ MedTech
specimen then Isolation I
relays the result to
the nurse.

3.3. Informs the None 5 minutes Charge Nurse

Resident- Isolation I
Physician on duty
about the results
and the availability
of the results for
evaluation.

3.4. Evaluates the None 1 hour Resident

diagnostic results Physician
and classifies IM/Pedia
patient based on IDS consultants
established
disposition
protocols. Refers
patient to
Infectious
Diseases resident
rotator/consultant.

Patient
Disposition:

A. If for Resident
discharge: Physician
IM/Pedia

- Writes None 5 minutes Resident

discharge Physician
form. IM/Pedia

- Informs patient None 5 minutes Charge Nurse

of may go Isolation I
home status.

- Provides None 5 minutes Resident

health Physician
teachings IM/Pedia

- Sends chart to None 10 minutes Nurse

billing and Attendant
prepares for Isolation I
discharge

B. If for
admission:
Writes referral None 20 minutes Resident
form for the Physician
admission of the IM/Pedia
patient:
For Mild Cases:
Refer to makeshift
facilities.
For Moderate and
Severe Cases:
Refer to SPMC
Isolation Facilities
or to Converted
Isolation Wards or
Converted
Isolation ICUs.

3.5 Advises None 10 minutes Resident

patient for Physician
admission and IM/Pedia
explains the
reason for
admission and the
location of where
to be admitted
based on severity
level and explains
for the watcher
protocol.

3.6 Provides the None 5 minutes Resident

consent for Physician
admission and IM/Pedia
have the
patient/patient’s
family/legal
guardian to have it
signed.

3.7. Informs None 5 minutes Charge Nurse

patient of Isolation I
admission.

3.8. Endorses
patient to nurse None 10 minutes Charge Nurse
on duty of Isolation I
designated
admitting place of
patient.

3.9. Transports None 10 minutes Nurse

patient to Attendant
designated Isolation I
admitting place.
TOTAL: NONE If patient is
discharged:
5 hours and
13 minutes

If patient is
admitted:
5 hours and
48 minutes
2. Needle stick/ sharps injury – Non-COVID Personnel with Negative RT-PCR
Test Result
Catering to personnel/ affiliates whom have sustained sharps/ needle stick injuries in the hospital.
Availability of Service: 24 hours, Monday to Sunday, including Holidays

Office/Division: Infection Prevention and Control Unit (IPCU)/ Medical Center Chief
Classification: Simple
Type of Transaction: G2C
Who may avail: All healthcare providers
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Needle Stick & Sharp Object Injury Infection Prevention and Control Unit
Report Form
CLIENTS STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Reports needle 1. Informs None 5 minutes Infection
stick injury. personnel to Control Nurse
contact IPCU first, IPCU
for initial
classification:

For personnel with

negative RT-PCR
results:
1.1 Advises to None 5 minutes ICN
proceed to outside IPCU
IPCU office.

1.2. Assesses the None 5 minutes ICN

degree of exposure. IPCU
- Presence of
punctured skin.
- Presence of
bleeding.
- Depth of needle
penetration.
- Visibility of blood
contamination on
syringe and
needle.

Asks if first aid

done immediately
after the incident.
Checks if the
wound is cleaned
and disinfected.
2. Identifies the 2.1 Reviews and None 5 minutes ICN
source patient documents health IPCU
history of source
patient to determine
risk in acquiring
bloodborne
infection.
Vaccination history
corresponding
dates received is
indicated.

2.1 Writes narrative None 5 minutes ICN

incident report. IPCU
Specifically
identifies the
occurrence of the
incident and
inflicted extremity.
3. Identifies risks and 3. Discusses None 5 minutes ICN
receives counselling Prevention and IPCU
and education Control of
needlestick. Health
teaching include:
a. No blood
donation, organ,
and semen.
b. Inform possible
risks associated
with
breastfeeding
and pregnancy.
c. Explains
precaution to
avert disease
transmission to
close contact
e.g. safe sex, no
sharing of razor
or any item
which may be
blood
contaminated.
d. The victim
acknowledges
the rendered
health
teachings.
4. Proceeds to PHS 4. Refers and None 5 minutes ICN
(Personnel Health accompanies client IPCU
Services) or ER triage to Personnel Health
Services (PHS) for
personnel (Outside
the JICA building)
Or at the
Emergency Room
(for asymptomatic
personnel).
TOTAL: NONE 35 minutes
3. Needle stick/ sharps injury – Personnel With History of Confirmed COVID
Result and/or With Respiratory Symptoms
Catering to personnel/ affiliates whom have sustained sharps/ needle stick injuries in the hospital.
Availability of Service: 24 hours, Monday to Sunday, including Holidays

Office/Division: Infection Prevention and Control Unit/ Medical Center Chief

Classification: Simple
Type of Transaction: G2C
Who may avail: All healthcare providers
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Needle Stick & Sharp Object Injury Infection Prevention and Control Unit
Report Form
CLIENTS STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Reports needle 1. Informs None 5 minutes Infection
stick injury. personnel to Control Nurse
contact first IPCU IPCU
for initial
classification:

For personnel with

history of Confirmed
RT-PCR results: ICN
1.1. Conducts phone None 5 minutes IPCU
interview using the
needle stick injury
form.

2. Assesses the None 5 minutes ICN

degree of exposure. IPCU

- Presence of
punctured skin

- Presence of
bleeding

- Depth of needle
penetration

- Visibility of blood
contamination on
syringe and
needle
 Ask if first aid done
immediately after the
incident. Checks if
the wound is cleaned
and disinfected.

2. Identifies the 2. Reviews and None 5 minutes ICN

source patient documents health IPCU
history of source
patient to determine
risk in acquiring
bloodborne infection.
Vaccination history
corresponding dates
received is indicated.

2.1 Writes narrative None 5 minutes ICN

incident report. IPCU
Specifically identifies
the occurrence of the
incident and inflicted
extremity.
3. Identifies risks and 3. Discusses None 5 minutes ICN
receives counselling Prevention and IPCU
and education Control of
needlestick. Health
teaching include:
a. No blood
donation, organ,
and semen.
b. Inform possible
risks associated
with
breastfeeding and
pregnancy.
c. Explains
precaution to
avert disease
transmission to
close contact e.g.
safe sex, no
sharing of razor
or any item which
may be blood
contaminated.
d. The victim
acknowledges the
rendered health
teachings.
4. Proceeds to PHS 4. Informs PHS gym None 5 minutes ICN
(Personnel Health NOD that a patient IPCU
Services gym) or per for check-up
advise by PHS proceeds to the area
physician. or as per advise of
PHS physician.
TOTAL: NONE 35 minutes
4. Submission, Assessment and Processing of Restricted Antibiotic
Requisition Forms (RARFs) – Before 1:00PM
All requested restricted antibiotics prescribed by Resident Physicians and Consultants from
different Medical Departments (Internal Medicine, Obstetrics and Gynecology, Oncology,
Orthopedics, General Surgery and Pediatrics) are submitted through Restricted Antibiotic
Requisition Forms (RARFs) to the Antimicrobial Stewardship (AMS) Committee for approval.
Availability of Service: 8am to 4pm, Monday to Friday, excluding Holidays.

Office/Division: Antimicrobial Stewardship (AMS) Committee/ Infection Control and

Prevention Unit (IPCU)
Classification: Simple
Type of Transaction: G2G
Who may avail: Resident Physicians, Medical Interns, Medical Clerks and
Consultants
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Completely filled out Restricted Antibiotic Nursing wards
Requisition Forms (RARFs).
- minimum of three (3) copies per patient.
- for patients with last dose, one (1) copy of
RARF is allowed to be processed.

If the restricted antibiotic requested is on Nursing wards (patient’s chart, laboratory

Antibiotic Holiday (ampicillin + sulbactam, results)
piperacillin + tazobactam, ceftazidime
and/or colistin):
Gram Stain and Culture Sensitivity (GSCS)
Result is required.

If GSCS Result is still pending during the Nursing wards (patient’s chart)
time of requisition:
The name of the IDS Consultant which the
antibiotic is conferred to is written on the
RARF.

CLIENTS STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Submits the filled 1. Receives and None 10 minutes Clinical/AMS
out RARFs and GSCS checks the Pharmacist
result, if applicable, completeness of IPCU
then logs the patient’s the filled out RARFs
name in their and identify if the
corresponding
logbook (Main RARF is for
Building, IWNH approval or not.
Building, ICU
Complex, CCI For RARFs that
Building). don’t need
approval: None 15 minutes Clinical/AMS
1.1. Updates the Pharmacist
patients Kardex (for IPCU
old patients) and
fills out new Kardex
(for newly admitted
patients)
None 30 minutes Clinical/AMS
1.2 Process the Pharmacist
RARFs with their IPCU
corresponding
control numbers
and sort them per
ward and date.

For RARFs that

need approval: None 15 minutes Clinical/AMS
1.1. Updates the Pharmacist
patients Kardex (for IPCU
old patients) or fills
out new Kardex (for
newly admitted
patients). Checks
the infectious
diagnosis
None 30 minutes Clinical/AMS
1.2 Processes the Pharmacist
RARFs with its IPCU
corresponding
control numbers.
None 10 minutes Clinical/AMS
1.3 Logs the ward Pharmacist
where the RARFs IPCU
are in need for
approval.
None 1 hour Clinical/AMS
1.4 Calls the 30minutes Pharmacist
assigned physician IPCU
to take the
appropriate action
for RARFs that are
need for approval.
None 1 hour 30 IDS Consultant/
1.2. Picks up minutes Rotator or
RARFs to perform AMS-Trained
rounds in the Physician
clinical areas then Internal
provides Medicine,
recommendations Pediatrics,
on RARFs in the Obstetrics-
patient’s chart and Gynecology
returns the
approved RARFs to
the AMS

For both
beforehand
approved and
those that have
just been
approved: None 30 minutes Clinical/AMS
Pharmacist
1.3 Sorts the IPCU
approved RARFs
per ward and per
date None 15 minutes Clinical/AMS
Pharmacist
2. Logs all IPCU
approved RARFs in
the logbook. None 30 minutes Clinical/AMS
Pharmacist
3. Distributes IPCU
RARFs to their
designated satellite None 10 minutes Pharmacist on
pharmacies. duty (satellite
pharmacies)
4. The Pharmacist
on Duty
acknowledges the
RARFs and sign in
the logbook .
TOTAL: NONE For RARFs
that don’t
need
approval:
2 hours and
20 minutes

For RARFs
that need
approval:
5 hours 30
minutes
5. Submission, Assessment and Processing of Restricted Antibiotic
Requisition Forms (RARFs) – Beyond 1:00PM
All requested restricted antibiotics prescribed by Resident Physicians and Consultants from
different Medical Departments (Internal Medicine, Obstetrics and Gynecology, Oncology,
Orthopedics, General Surgery and Pediatrics) are submitted through Restricted Antibiotic
Requisition Forms (RARFs) to the Antimicrobial Stewardship (AMS) Committee for approval.
Availability of Service: 8am to 4pm, Monday to Friday, excluding Holidays.

Office/Division: Antimicrobial Stewardship (AMS) Committee/ Infection Control and

Prevention Unit (IPCU)
Classification: Simple
Type of Transaction: G2C
Who may avail: Resident Physicians, Medical Interns, Medical Clerks and
Consultants
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Completely filled out Restricted Nursing wards.
Antibiotic Requisition Forms (RARFs), one
(1) copy.
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Filled out and 1. Receives and None 5 minutes Clinical/AMS
approved by the IDS checks the Pharmacist
Consultant/IDS completeness of IPCU
Rotator and/or AMS- the filled out and
Trained Phyiscian approved RARFs
RARFs and GSCS
result, if applicable,
then logs the patient’s 1.2. Provides None 5 minutes Clinical/AMS
name in the logbook. control number Pharmacist
and date to RARF IPCU
then returns the
form to the
requesting
physician and
asks them to fill
out the
acknowledgment
logbook.
 TOTAL NONE 15 minutes

Integrated Hospital Operations and Management

Program (IHOMP)

Internal Services
1. Service Request for System and Software Development
Processing request for new requirements or changes in all IT-supported application systems
handled by IHOMP
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Integrated Hospital Operations and Management Program (IHOMP)

Classification: Highly Technical
Type of Transaction: G2G
Who may avail: SPMC employees/end-users for IT-supported application systems
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Complete and duly signed service 1. Web browser URL: 10.1.80.35/hisdmc >
request form (SRF) downloadable forms
2. IHOMP office
2. Attachments such as memo, Requesting individual/office
circular, advisory, screenshots,
templates, if applicable.
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit completely 1. Receive SRF None 5 minutes Document
filled out request form. and attachments; Specialist
Check for the IHOMP
completeness of
information and
proper
signatories.

1.1. Provide an None 5 minutes Document

acknowledged Specialist
copy of SRF to IHOMP
the client.

1.2. Inform user None 5 minutes Document

for the queuing Specialist
status. IHOMP
2. Participate in data 2. Review SRF. None 1 week for Business
gathering session. minor; Analyst
1 month for IHOMP
major
2.1. Conduct None Business
consultative Analyst
meeting. IHOMP

2.2. Prepares None Business

Business Analyst
Requirement IHOMP
Document (BRD).

2.3. Secure None Business

signed BRD. Analyst
IHOMP
3. Attend in mockup 3. Coordinate with None 1 week for System
presentation and end-users for minor; Engineer
approval schedule. 1 month for IHOMP
major
3.1. Present System
mockup and None Engineer
estimated request IHOMP
timeline.

3.2. Secure System

signed Functional None Engineer
Requirement IHOMP
Document (FRD).
4. Participate in client 4. Coordinate with None 1 week Quality
acceptance testing end-users for Assurance
schedule. Engineer
IHOMP
4.1. Conduct None Quality
client acceptance Assurance
testing. Engineer
IHOMP
4.2. Secure None Quality
signed test case Assurance
document. Engineer
IHOMP
5. Participate in 1. Inform end-user None 5 minutes Project
upload monitoring and about the upload Coordinator
then verify deployed status. IHOMP
request.
2. Monitor None 1 week Quality
deployment/imple Assurance
mentation phase. Engineer
IHOMP
3. Secure signed None 1 day
CVFA in SRF for Document
completion. Specialist
IHOMP
TOTAL: NONE *1month,
1day and
. 20minutes for
minor

*2months, 2
weeks, 1 day
and 20
minutes for
major
2. User Account Registration/Update Access Permission
Registration of User’s Account and Updating of Access Permission for Hospital Information
System, Electronic Health Record System, EHR Mobile Application, Picture Archiving
Communication Systems – Radiology Information System, Manage Anywhere System, Daily Time
Record Systems, Medical Assistance Program System, Accounting Trail System, Virtual Library
System, Lingap Utilization System, and Marquette’s Universal System for Electrocardiography
System.

Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Integrated Hospital Operations and Management Program (IHOMP)

Classification: Simple
Type of Transaction: G2G
Who may avail: SPMC employees
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. User Account Form IHOMP Office (for printed copy);
HIS Homepage under Downloadable Forms
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit completely 1. Receive and None 5 minutes Computer
filled-up User Account verify filled-up Maintenance
Form. User Account Technologist II
Form IHOMP
1.1. Register/ None 5 minutes (Knowledge
update the user’s Management
access. Unit)
2. Test the registered 2 Check the None 5 minutes CMT II
/updated access user’s account if IHOMP
permission. it is successfully (Knowledge
log-in. Management
Unit)
 TOTAL: 15 minutes

3. Scheduling for User Orientation

User Account Orientation Permission for Hospital Information System, Electronic Health Record
System, EHR Mobile Application, Picture Archiving Communication Systems – Radiology
Information System, Manage Anywhere System, Daily Time Record Systems, Medical Assistance
Program System, Accounting Trail System, Virtual Library System, Lingap Utilization System, and
Marquette’s Universal System for Electrocardiography System.

Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Integrated Hospital Operations and Management Program (IHOMP)

Classification: Simple
Type of Transaction: G2G
Who may avail: SPMC employees
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Training & Orientation Form IHOMP Office (for printed copy);
HIS Homepage under Downloadable Forms
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit completely 1. Receive and None 5 minutes Administrative
filled-up Training & verify filled-up Assistant II
Orientation Form Training & IHOMP
orientation form. (Knowledge
Management
Unit)
If orientation is
urgent and/or
trainor is
available:
1.1. Conducts None 30 minutes
orientation on the
specified
 information
system.

If orientation is
non-urgent and/or
trainor is not
available:
1.2 Set schedule None 2 hours
of orientation/
training and
informs client to
come back on the
scheduled date of
orientation.
TOTAL: 2 hours and
35 minutes

4. Job-Order Request for Technical Support

Brief description of the service here. You may list down the services indicated in your JO form.
Availability of Service: 7:00 am to 4:00 pm and 8:00 pm to 4:00 am Monday to Friday,
9:00 am to 5:00 pm and 8:00 pm to 4:00 am Saturday to Sunday

Office/Division: IHOMP
Classification: Simple
Type of Transaction: G2G
Who may avail: SPMC employees/departments/offices/sections/units
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
ICT and Technical Assistance Request IHOMP Office
Form HIS Homepage Downloadable Forms: URL/link
here
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
Phone Call:
1. Calls IHOMP None 10 minutes Administrative
helpdesk and conveys 1. Verifies Assistant 2
details of their technical concern, IHOMP
concern. conduct phone Helpdesk
troubleshooting.

Walk-in Request
1. Proceed to IHOMP 1. Verifies None 10 minutes Administrative
helpdesk and technical concern Assistant 2
and instructs IHOMP
client to fill out 2 Helpdesk
copies of ICT and
Technical
 Assistant Request
Form
2. Fill up ICT and 2. Receive and None 10 minutes Administrative
Technical Assistant checks Assistant 2
Request Form. completeness of IHOMP
form then gives Helpdesk
duplicate copy to
the client.

2.1 Forwards the 10 minutes Administrative

request to Assistant 2
technical IHOMP
personnel. Helpdesk

2.2. Conducts 1 hour Position_of_per

troubleshooting/ son_resp
technical support. Area_of_assign
ment
3. Acknowledgement 3. Endorse the None 10 minutes Position_of_per
of troubleshooting/ ICT equipment to son_resp
Support received by client. Area_of_assign
signing the JO form. ment
TOTAL: None Phone Call:
10 minutes

Walk-in
Request:
1 hour 30
minutes
 Internal Audit Service (IAS)

Internal Services

1. Inspection of Infrastructure Projects and Equipment

Inspection of Infrastructure Projects for Final Billing and Delivery of Equipment
Availability of Service: 8:00am-5:00pm, Monday to Friday, except Holidays

Office/Division: Internal Audit Services Staff (IAS)

Classification: Simple
Type of Transaction: G2G – Government to Government
Who may avail: Materials Management Section (MMS)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Letter Invitation for Inspection, Materials Management Section (MMS)
Infrastructure project inspection report
2. Other documents/attachments deemed Responsible Unit
necessary
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submits Letter 1. Stamps None 5 minutes Internal Auditor
Invitation for “Received” and IAS
Inspection of affix initial, time
Infrastructure and date on the
project/equipment Letter Invitation.
with attached
supporting 1.1. Records 5 minutes Internal Auditor
documents. details in IAS
Incoming
Logbook.

5 minutes
 1.2. Files received Internal Auditor
copy of letter. IAS
4 hours
1.3. Conducts Internal Auditor
inspection as IAS
scheduled.
10 minutes
1.4. Fills-out two Internal Auditor
signed copies of IAS
Inspection
Checklist for MMS
and IAS.
20 minutes
1.5. Files Internal Auditor
Inspection IAS
Checklist and
other supporting
documents.
TOTAL: 4 hours and
45 minutes

2. Inventory of Drugs and Medicines

Inventory of Drugs and Medicines from Pharmacy including all satellite units
Availability of Service: 8:00am-5:00pm, Monday to Friday, except Holidays

Office/Division: Internal Audit Services Staff (IAS)

Classification: Simple
Type of Transaction: G2G – Government to Government
Who may avail: Pharmacy Section
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Letter Invitation for Inventory Pharmacy Section
2. Other documents/attachments deemed Responsible Unit
necessary
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submits Letter 1. Stamps None 5 minutes Internal Auditor
Invitation for Inventory “Received” and IAS
of drugs and affix initial, time
medicines. and date on the
Letter Invitation.

1.1. Records 5 minutes Internal Auditor

details in Incoming IAS
Logbook.
1.2. Files received 5 minutes Internal Auditor
copy of letter. IAS

1.3. Conducts 1 day Internal Auditor

inventory as IAS
scheduled.

1.4. Files
Inventory 20 minutes Internal Auditor
Checklist and IAS
other supporting
documents.
TOTAL: 1 day and
35 minutes
 Patient Safety and Pharmacovigilance Unit (PSPVU)

External Services

1. Receiving Reports of Sentinel Events (SE) and Serious Reportable Events

(SRE)
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Patient Safety and Pharmacovigilance Unit (PSPVU)

Classification: Complex
Type of Transaction: G2C
Who may avail: 1. Personnel
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Information on events that lead to the Serious Concerned area
Reportable Events (SRE) or Sentinel Events
(SE)
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE
1. Report Serious 1. Obtain pertinent none 20 minutes Administrative
Reportable Events information Staff
(SRE) or Sentinel regarding the SRE PSPVU
Events (SE) to PSPVU. or SE.

1.1 Investigate and If patient’s chart Nurses

validate the is readily PSPVU
incident. available:
1 day
 If patients’ chart
is already
forwarded to
Health
Information
Management
Department
(HIMD):
7 days

1.2 Document the 1 hour Administrative

incident in the Staff
SRE/SE Form and PSPVU
Corrective Action
Monitoring Log.
TOTAL: None If patient’s chart
is readily
available:
1 day, 1 hour
and 20
minutes
If patients’ chart
is already
forwarded to
Health
Information
Management
Department
(HIMD):
7 days, 1 hour
and 20
minutes
 Patients Assistance Desk (PAD, Malasakit Center)

External Services

1. Processing and Approval of medical assistance to eligible and indigent

patients.
Availability of Service: 7:00 am to 7:00 pm, Monday to Friday and
8:00 am to 5:00 pm, Holidays and Saturdays.

Office/Division: SPMC MALASAKIT CENTER (PAD OFFICE) -MAIN

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients (Out-patient and In-Patient)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Hospital Request (Laboratory, X-ray, Doctor or Billing Section
Prescriptions, Hospital bill and etc. )
1. Endorsement letter Social Service and DOH central Office
2. Any of the following Identification
Documents:
I.D, Client,
Special Power of Attorney (SPA) Legal Office
YELLOW CARD HIMD
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present Hospital 1. Verifies all the None 5 minutes Administrative
request, Endorsement documents Aide I
letter and presented at the PAD Office
Identification counter and
Documents to the Pad interview the
office receiving bearer for
counter. additional details
needed and
his/her
relationship to the
patient.

1.1 Provide a None 5 minutes Administrative

number/claim stub Aide I
and instruct the PAD Office
patient to wait for
their number to be
called.

1.2 Prepares the None 10 minutes Administrative

documents to be Aide I
process. PAD Office

1.3 Validate the None 15 minutes Administrative

endorsement Officer III
letter. PAD Office

1.4 Encode the None 20 minutes Administrative

Hospital Request Aide I
together with its PAD Office
endorsement
letter to the MAP
system and
Indicate the
corresponding
Control number to
the request.

1.5 Process the None 15 minutes Administrative

documents and Aide I
indicate the PAD Office
approved amount,
Control number
and attach the
Guarantee letter
to the Hospital
request.
2. When number is 2. Validate the None 10 minutes Administrative
called, submits claim request/s together Aide I
stub and receives with its guarantee PAD Office
requested documents. letter and verify
the relationship of
the claimant to the
patient then
release the
document/s.
TOTAL: None 1 hour and 20
minutes
 Professional Education Training and Development
(PETD)

External Services

1. Affiliation Program
Processing of initial or renewal of contract for affiliation of students from outside institutions for
training to SPMC
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Professional Education, Training and Development (PETD) Office

Classification: Complex
Type of Transaction: G2C , G2B, G2G
Who may avail: All institutions/ schools, universities, colleges requiring hospital
exposure for different categories (Medical students, Nursing,
Midwifery, Med. Lab Sciences, Health care sciences, Social
Work,Radiologic Technology, Respiratory Therapy, Pharmacy,
Physical Therapy, Nutrition and Dietetics, ) for their Related
Learning Experience (RLE)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Letter of intent addressed to the office Sending institution
of the Medical Center Chief.
 1. Contract of Affiliation (COA) PETD Office
2. CHED Recognition of the institution CHED
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submits letter of 1. Receives letter None 5 minutes Administrative
intent to the office of of intent. Staff
the Medical Center Office of the
Chief. Medical Center
Chief

1.1 Discuss the New Medical Center

decision whether Applicants: Chief
to accept or reject 1 day MCC Office/
request. Renewals: Chief
5 minutes Training Officer
PETD

1.2 Receives the 5 minutes Administrative

approved letter. Staff
PETD
If approved:
2. Receives Contract 2. Provides None 10 minutes Administrative
of Affiliation (COA) Contract of Staff
document and Affiliation PETD
accomplishes needed document and
requirements. gives instruction
on how to fill up
and number of
documents to
submit and
attachments.
CHED
Recognition of the
said course must
be included.
3. Submits signed 3. Receives COA None 5 minutes Administrative
COA with attached already signed by Staff
CHED accreditation school officials. PETD
from school.

3.1. Facilitates None 2 days Administrative

completion of Staff
signatures from PETD
SPMC.

3.2. Informs None 5 minutes Administrative

school to pick up Staff
signed COA PETD
3. Receives fully 4.1 Receives the None 5 minutes PETD Staff
signed COA for notarized COA
notarization and
returns 1 copy of
the notarized
document to PETD
Office.
TOTAL: None 3 days and 35
minutes
for new
applicants;

2 days and 40
minutes for
renewal
2. In-Service Training Program
Processing of requests for in-service training
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Professional Education, Training and Development Office

Classification: Complex
Type of Transaction: G2C , G2B, G2G
Who may avail: Personnel from requesting institutions
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Endorsement to Medical Center Chief II Requesting institution
through Chief Training Officer
2. Resume with attached 2 x 2 picture In-service trainee applicant
3. Photocopy: valid PRC card (if In-service trainee applicant
applicable), PNA Card (for nurses)
4. Photocopy: certificate of employment Requesting institution
5.Photocopy: medical certificate and drug Medical certificate - SPMC HSSC or may be
test result issued by sending institution
 Drug test result – SPMC Drug Test Center
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submits letter of 1. Receives letter None 5 minutes Administrative
intent to PETD Office of intent. Staff
PETD

1.1 Sends a None 5 minutes Chief

response letter Training Officer
with the list of PETD
requirements to
the requesting
institution for
compliance
before desired
commencement of
training.
2. Submits the 2. Receives and In_Service 10 minutes Administrative
complete checks the Training Staff
requirements at least requirements. If Program: PETD
one working day prior the requesting Refer to the
to training, party is a private list of fees.
accomplishes the institution, the
training agreement, staff issues a Notarization
proceeds to the Legal statement of fee:
Office for notarization account. P 100
of documents and
settles the
corresponding training
fee, if applicable.

2.1 Orients on None 30 minutes Administrative

SPMC General Staff
Policies, PETD
Expectation and
Responsibilities
and issues duty
schedule, DTR,
endorsement and
clinical area of
exposure.
3. The trainee 3. Orients, None 1 to 6 months Staff in the
undergoes the training teaches and (depending on assigned area
program under the supervises the the applied of exposure
supervision of the trainee. training
SPMC staff in the program)
assigned area of
exposure.

4. At the end of 4. Issues the post None 15 minutes Administrative

training contract, the training evaluation Staff
trainee evaluates the form and gives the PETD
training program. certificate of
Once completed, the training
trainee submits the completion.
complied form to
PETD staff in-charge.

TOTAL: In_Service 1 to 6 months

Training (depending
Program: on the
Refer to applied
the list of training
fees. program), 1
hour and 5
minutes
 Notarizatio
n fee:
P 100

IN SERVICE TRAINING PROGRAMS FEES

Antimicrobial Stewardship Training Program P3000

ASU Training Program for Nurses P3000
Blood Bank Specialty Training for Med Tech P2000
Burn Nursing Training Program P3000
Cath Lab Training Program for Nurses and Med Techs P3000
Clin. Chemistry Specialty Training for Med Techs P1000
Clin.Microbiology Specialty Training for Med Techs P2000
Clin.Microscopy Specialty Training for Med Techs P1000
Critical Care Training Program for Nurses P3000
Emergency Nursing Training Program P3000
Endoscopy Nursing Training Program P3000
Cardiovascular Intensive Care Training Program P3000
Hematology Specialty Training for Med Techs P1000
Hemodialysis Technician Training Program P3000
Hemodialysis Training Program for Nurses P3000
Histopathology Specialty Training for Med Techs P1000
Hospital Dentistry Training Program P3000
Maternal and Child Training Program for Nurses P3000
Minimally Invasive Surgery Training Program for Nurses P3000
Ophthalmology Nursing Training Program P3000
PACU Nursing Training Program P3000
Pediatric Oncology Training Program for Nurses P3000
Perioperative Nursing Training Program P3000
Psychiatry Nursing Training Program P3000
Rad Tech Training Program in Computed Tomography P3000
Rad Tech Training Program in MRI P3000
Rad Tech Training Program in Ultrasound P3000
Serology Specialty Training for Med Techs P1000
Training Program for CSSD P3000
Nursing Training Program on Infection Prevention and Control P1000
Ward Training Program for Nurses P3000
Wound Care Training Program P3000

3. Related Learning Experience (RLE) Scheduling

Scheduling of Students’ RLE of Affiliating Schools
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Professional Education, Training and Development Office

Classification: Complex
Type of Transaction: G2C , G2B, G2G
Who may avail: Clinical Instructors/students from requesting institutions
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Completely signed and updated PETD office and Affiliated School
COA/MOA for affiliation of students
2. Approved slots for affiliation PETD office
3. Accredited clinical instructor for the RLE Affiliated School
4. List of names and proposed areas and Affiliated School ; SPMC Drug Test Unit
schedules (5 days prior to rotation) with
medical clearance and drug test results.
5. Receipt of payment for the assigned slot Cashier
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Attends slotting and 1. Schedules None 4 hours once a Administrative
secure slots for slotting time and year for Staff/ Chief
rotation disseminates slotting Training Officer
information to all PETD
affiliating schools

1.2 Gives a draft None 1 week Administrative

of the agreed Staff/ Chief
upon schedules to Training Officer
all schools for final PETD
approval.

1.3 Sends final None ______ Administrative

schedule to all Staff/ Chief
concerned. Training Officer
PETD
2. Submits 2. Receives and Refer to 10 minutes Administrative
communication for checks the approved Staff
RLE scheduling of communication if list of fees PETD
students at least 5 it coincides with
days before the the slots allotted
rotation. to the school
during slotting.
Issues bill for the
slots that will be
used.

3. Receives proof of 3. Issues proof of None 10 minutes PETD Staff

payment to be payment and
presented to the area endorses it to the
of clinical exposure. clinical
coordinator.
TOTAL: Refer to 5 days, 4
approved hours and 20
list of fees minutes

STUDENT AFFILIATION PROGRAM FEES

General Orientation Fee P100/student

General Area Orientation Fee for CI P70 / day

Nutrition and Dietetics P50/day

Dentistry P50/day

Medicine 1st/2nd year: P20/student/hr

3rd year : P60/day
P30/ half day or less
 Public Assistance and Complaints Desk (PACD)

External Services

1. Filing of Complaints

Availability of Service: 8:00 am to 5:00 pm, Monday to Sunday.

Office/Division: Public Assistance and Complaints Desk (PACD) - Main

Classification: Complex
Type of Transaction: G2C, G2G
Who may avail: 1. SPMC Clients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
None None
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Approach the staff 1. Listens to None 1 hour and 30 Administrative
at the main hospital client’s concerns/ minutes Officer
PACD counter and complaints. PACD
convey the details of
his/her 1.1. Asks client to None 30 minutes Administrative
concerns/complaints. fill out the Officer
complaint form. PACD
2. Fills out the 2. Receives None 30 minutes Administrative
complaint form for the complaint form Officer
details of their and informs the PACD
concerns/complaints. client to wait for
the result of the
investigation.

2.1 Issues NCAR None 30 minutes Administrative

form to concerned Officer
department/ PACD
section/unit for
investigation and
response.

2.2 Receives the None 3 days Administrative

result of Officer
investigation and PACD
response thru
NCAR form within
3 days.
3. Follow-up on 3. Updates the None 1 hour Administrative
his/her complaint after client on the result Officer
3 days. of the PACD
investigation and
action taken.
TOTAL: None 3 days, 4
hours
 Public Assistance and Complaints Desk (PACD)

Internal Services

1. Request of 2nd Copy of Client Satisfaction Survey (CSS)

Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Public Assistance and Complaints Desk PACD - Main

Classification: Simple
Type of Transaction: G2G
Who may avail: 1. SPMC Departments / Sections / Units
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Letter of request Requesting Office
 CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submits letter of 1. Receives letter None 5 minutes Administrative
request to PACD. of request. Officer
PACD

1.1 Prints/ None 5 minutes Administrative

photocopies the Officer
CSS. PACD

1.2 Releases the None 5 minutes Administrative

CSS. Officer
PACD
TOTAL: None 15 minutes
 Documents Control Center

Internal Services

1. Control of Documented Information Procedure

Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Documents Control Center

Classification: Simple
Type of Transaction: G2G
Who may avail: 1. SPMC Departments/Offices/Sections/Units
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Documents such as, Quality Objectives, Requesting Office
Work Instruction, Policy, Form, Manual
of Procedures
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submits draft copy 1. Checks for the None 1 day Doctor/
of documents thru document Administrative
email. identification, Officer/
revision number, Administrative
date of effectivity Assistant
and compliance DCC
with the
recommended
template/s.

If with comments
& corrections:
1.1. Reply thru None 1 day Doctor/
email. Administrative
Officer/
Administrative
If without Assistant
comments & DCC
corrections:
1.1 Gives None 1 day Doctor/
instructions to Administrative
proceed with Officer/
printing. Administrative
Assistant
DCC

2. Submits corrected 2. Double checks None 10 minutes Doctor/

hard copy of correctness of file Administrative
documents printed. Officer/
Administrative
Assistant
If printed copy is DCC
correct:
2.1. Reproduce 5 minutes Doctor/
the original copies Administrative
and stamp as Officer/
follows: Administrative
• Original copies: Assistant
“master copy” DCC
• Duplicate copy:
“controlled”

If otherwise:
2.1. Give 5 minutes Doctor/
instructions Administrative
accordingly. Officer/
Administrative
Assistant
DCC
3. Secures controlled 3. Updates None 5 minutes Doctor/
copy of document/s. distribution list Administrative
and instructs Officer/
client to sign. Administrative
Assistant
DCC

3.1. Releases None 5 minutes Doctor/

controlled copy of Administrative
documents. Officer/
Administrative
Assistant
 DCC
TOTAL: None 2 days and 25
minutes

2. Updating of Document Masterlist Procedure

Process for the review of changes in ISO documents.
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Documents Control Center (DCC)

 Classification: Simple
Type of Transaction: G2G
Who may avail: 1. SPMC Departments/Offices/Sections/Units
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Copy of Old and Updated Document Requesting Office
Masterlist/s

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Submits old and 1. Checks None 5 minutes Doctor/
updated copies of submitted Administrative
document masterlists. documents and Officer/
verifies with Administrative
mastercopy. Assistant
DCC
If with
inconsistencies:
Doctor/
1.1. Returns None 5 minutes
Administrative
documents to
clients and give Officer/
instructions Administrative
accordingly. Assistant
DCC
If without
inconsistencies:
1.1. Reproduces None 5 minutes Doctor/
documents and Administrative
stamp as follows: Officer/
• Original copies: Administrative
“master copy” Assistant
• Duplicate copy: DCC
“controlled”
2. Secures controlled 2. Releases None 5 minutes Doctor/
copy of document controlled copy of Administrative
masterlist/s. documents. Officer/
Administrative
Assistant
DCC
TOTAL: 15 minutes

3. Document Review, Revision and Approval Procedure

Process for the review of changes in ISO documents.
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.
Office/Division: Documents Control Center (DCC)
Classification: Simple
Type of Transaction: G2G
Who may avail: 1. SPMC Departments/Offices/Sections/Units
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Copy of Old and Current Controlled Requesting Office
Documents
2. Document Change Notice Form Document Control Center
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submits controlled 1. Checks None 10 minutes Doctor/
and revised copy of changes made on Administrative
the documents. the document. Officer/
Administrative
Assistant
If changes are DCC
warranted:
1.1. Provide None 5 minutes Doctor/
Document Administrative
Change Notice Officer/
(DCN) form and Administrative
instructs client to Assistant
fill out the form. DCC
If not, advise
accordingly.
2. Fills out Document 2. Double checks None 5 minutes Doctor/
Change Notice form. correctness of Administrative
document Officer/
template used Administrative
then instructs Assistant
client to secure DCC
approval of the
DCN form from
Medical Center
Chief.
3. Submits approved 3. Checks None 5 minutes Doctor/
Document Change completeness of Administrative
Notice form. forms and Officer/
attachments. Administrative
Assistant
DCC

3.1. If complete, None 5 minutes Doctor/

reproduce revised Administrative
document and Officer/
DCN form. Stamp Administrative
as follows: Assistant
-All original copies DCC
shall be stamped
with “master copy”
and “controlled”
for the duplicate
copy.
4. Secures controlled 4. Releases None 5 minutes Doctor/
copy of revised controlled copy of Administrative
documents and DCN documents and Officer/
from. DCN form. Administrative
Assistant
DCC
TOTAL: None 35 minutes
 Blood Center

External Services

1. Conduct of Mobile Blood Donation From Potential Program Partners

Information regarding mobile blood donation to program partners
Availability of Service: 8:00 am to 5:00 pm, Monday to Sunday, Except Christmas, New Year and
Good Friday
 Office/Division: Davao Blood Center
Classification: Simple
Type of Transaction: G2C, G2G, G2B
Who may avail: Blood Program Partners Potential Donors
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Letter of request to conduct mobile Program Partners
blood donation.
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1.Submits Letter of 1.Receipt of Letter None 30 minutes DBC Head
Request to conduct of request to Chief Med Tech
Mobile Blood conduct Mobile Donor
Donation Blood Donation Recruitment
Officer
2. Set Schedule
for Blood Program
or Mobile Blood
Donation
Orientation
TOTAL: None 30 minutes

2. Blood Donation Process

Selection of suitable donors, proper blood collection and appropriate donor care during blood
collection process
Availability of Service: 8:00 am to 5:00 pm, Monday to Sunday
Blood Donor Acceptance: Schedule time 8:00 am to 3 pm, Monday to Sunday except Christmas,
New Year & Good Friday

Office/Division: Davao Blood Center

Classification: Simple
Type of Transaction: G2C, G2G, G2B
Who may avail: All Blood donors:
 Patient with Donor
 Patient Directed Donor
 Patient With Blood Type Specific Donor
 Donor With Pledge of Commitment
 Walk in Donors
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Valid ID (1 original ) Government Agency
PRC, SSS, GSIS, PAG-IBIG, POSTAL,
Barangay ID, School, Passport

In case not available:

NBI Clearance
Police Clearance
Voter’s Affidavit

Company ID, School Private Agency

2. Blood Request Form Attending Physician

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present official 1. Present official None 2 minutes Guard on duty
blood request to the blood request to
guard to get que the guard for
number card securing cue 3 minutes
number card
1.1 Instruct client
to proceed inside
the waiting area
and wait for their
turn to be called

2. Present Official 2.1 Verifies for None 5 minutes Officer of the

Blood Request: complete data Day
information of the
patient
2.2 Instruct client
to proceed to
Issuance and
Distribution front
desk officer

3. Proceed to 3 1. Receives None 5 minutes Issuance and

Issuance and client’s donor Distribution
Distribution front desk 3.1.1. Pre- staff
officer and present: screen donor MedTech
 Official Blood
Request 3.1.2 Issuance of
 Donor’s personal data
Identification sheet and donor
Card history
 Pledge of questionnaire
commitment
3.1.3 Instruct
donor to
completely fill up
the form
4 Proceed to Facility 4. Verifies DHQ None 35 minutes Physician
Based Section and for correctness of Med Tech
Submit donor’s information Nurse
document 4.Pre-health Phlebotomist
check, physical
examination, final
interview and
hemoglobin
determination
4.2 Instruct to
proceed to
bleeding room for
blood collection
4.3 Allow donor
to rest
4.4 Issue of
claim stub during
blood donation
4.5 Determine
donor’s condition
to allow release
from blood
collection area
4.6 Instruct the
donor to give the
claim stub to the
client.
4.7 presents
blood request
and claim stub to
distribution and
issuance front
desk officer for
further instruction
TOTAL: 1.Schedule I hour
of donor

acceptance
2.
Schedule
of Issuance
of blood
and blood
product
3.
Schedule
of fees

1. DAVAO BLOOD CENTER - Schedule of Donor Acceptance

Type of Donation Donor Acceptance Time

 8:00 AM TO 11:00 AM
Platelet Concentrate Apheresis Derived
 1 PM to 3 PM
 Blood Donation the following day
in the afternoon
Facility Based Donor  8 AM to 12 NN
 Patient Directed Donor  1 PM to 3 PM
 Blood Type Specific Donor
 Pledge of Commitment Donor
 Walk in

2. DAVAO BLOOD CENTER - Schedule of Issuance of blood and blood products

 Time of Donation Issuance
 8:00 AM to 12:00 NN Regular Days:
Monday to Friday:
 3:00 PM to 8:00 PM
Saturday to Sunday
 3:00 PM to 5:00 PM

Lean Months: (January to March)

Monday to Friday:
 3:00 PM to 8:00 PM
Saturday to Sunday
 3:00 pm to 5:00 PM
 1:00 PM to 3:00 PM Regular Days:
Monday to Friday
 The next day
10:00 AM to 8:00 PM
(Monday to Friday)

 10:00 AM to 5:00 PM
(Saturday to Sunday)

Lean Months: (January to March)

 A day after tomorrow at

3:00 PM to 8:00 PM
(Monday to Friday)

3:00 PM to 5:00 PM
(Saturday to Sunday)

Platelet Concentrate Apheresis Derived After blood donation process

 2:00 PM to 3:00 PM  3:00 PM to 8:00 PM
(Monday to Friday)

 3:00 Pm to 5:00 PM
(Saturday to Sunday)

Patient Directed Donor 3 days after donation

Type Specific Donor  8:00 AM to 8:00 PM
 8:00 AM to 3:00 PM (Monday to Friday)
 8:00 to 5:00 PM
(Saturday to Sunday)

Walk in Donor  After 1 month from day of collection

 8:00 AM to 3:00 PM  Anytime in case of emergency

3. DAVAO BLOOD CENTER - Schedule of Fees:

Blood Products Blood Patient is an Blood Donor

Processing Fee active Program and Direct Blood Galloner
Partner Dependents
Red Cell
 Whole P 1,800.00 P 950.00 P 600.00 FREE
Blood
 PRBC P 1,500.00 P 600.00
Platelet
Concentrate P 1,000.00 P 850.00 P 300.00 FREE
Cryoprecipitate P 1,000.00 P 850.00 P 300.00 FREE
Cryosupernate P 1,000.00 P 850.00 P 300.00
Fresh Frozen
Plasma P 1,000.00 P700.00 P 200.00 FREE
3. Submission of Blood Samples and Blood Units from Mobile Blood Donation
Blood samples and blood units collected from mobile blood donation are transported and
submitted by BCUs or DBC Mobile Blood Team.
Availability of Service: 8:00 am to 5:00 pm, Monday to Sunday
Blood Donor Acceptance: Schedule time 8:00 am to 3 pm, Monday to Sunday except Christmas,
New Year & Good Friday

Office/Division: Davao Blood Center

Classification: Highly Technical
Type of Transaction: G2G
Who may avail: 1. Blood Collecting Units (BCUs) of partner LGUs
2. Mobile Blood Team
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Donor History Questionnaire (DHQ) Davao Blood Center
2. Serial Number Davao Blood Center
3. EDTA and Plain Tubes matches Davao Blood Center
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1 Submits filled up 1. Checks and 30 minutes Med Tech
Donor Form, serial reconciles serial Nurse
number of blood units, number, Donor None
EDTA and Plane history
Tube, and blood questionnaire,
samples. EDTA and Plain
tubes matches.
1.1 Receives
blood sample from
blood units (EDTA
and Plain Tube).
2. Submission of 2. Receives blood None 30 minutes Med Tech
blood units. units in the thermo Production Staff
chest container for
processing
(production
section) and blood
samples for
testing (serology
section).
TOTAL: 1 hours
4.Blood Processing
Processing and Storage of blood and blood products
Availability of Service: 8:00 am to 8:00 pm, Monday to Friday
8:00 to 5:00 pm. Saturday, Sunday & Holidays
Except Christmas, New Year & Good Friday

Office/Division: Davao Blood Center

Classification: Highly Technical
Type of Transaction: G2C
Who may avail: All donors
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Donor History Questionnaires  Facility Based Collection
 Mobile Blood Donation Collection
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1.Receipt of units and 1.1 Received None 3 minutes Production Staff
documentation blood units from Med Tech
Mobile Blood
Donation and
Facility Based
Collection
None 2 minutes
1.2 Record using
Donor Session
Collection List
None 2 minutes
1.3 Sort according
to type of blood
bag used and
intended blood
product
preparation None 3 minutes

1.4 Reweighing
1.4.a Recheck
blood volume None Refer to
schedule of
1.5 Process blood and
according to blood blood product
product processing
preparation None
2 minutes

1.5.a Determine
acceptability on None
blood product 8 minutes
specifications

1.6 Store blood

product based on
Production
Record Book
Stock Inventory
Worksheet
1.6.1 Document
on Production
Record Book and
Stock Inventory
Worksheet
1.6.2 Encode
data from
Production
 Record Book into
NBBNETS
TOTAL: Refer to 30
schedule minutes
of blood
and blood
product
processing

DAVAO BLOOD CENTER – Schedule of blood and blood product processing

BLOOD AND BLOOD

PRODUCTS MANUAL T-ACE
45 minutes 41 minutes
Packed Red Blood Cells
1 hour & 14 minutes 1 hour & 5 minutes
Platelet Concentrate
46 minutes 42 minutes
Fresh Frozen Plasma
I hour & 28 minutes 1 hour & 20 minutes
Cryopecipitate
5. Blood Testing
Testing of blood sample of blood donors in adherence to testing algorithms
Performing ABO/RH(D) grouping on donor blood samples

Availability of Service: 8:00 am to 5:00 pm, Monday to Sunday

Blood Donor Acceptance: Schedule time 8:00 am to 3 pm, Monday to Sunday
Except Christmas, New Year & Good Friday

Office/Division: Davao Blood Center

Classification: Highly Technical
Type of Transaction: G2G, G2C, G2B
Who may avail:  Mobile Blood Donation Collection
 Facility Based Collection
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Donor History Questionnaire (DHQ)  Mobile Blood Donation Collection
2. Serological Worksheet  Facility Based Collection
3. Blood Samples
3.1 EDTA
3.2 Plain Tubes
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1.Submission of 1.1 Receipt of None 30 minutes Serology Staff
Donor history Donor history Med Tech
Questionnaire, questionnaires,
Serological Blood samples
Worksheet and Blood (EDTA and Plain
Samples Tubes) and
Serological
Worksheet
1.2. Arrange serial
number in the test
tube rack.
1.3. determine
acceptability of
blood samples
selection and
rejection
None 1 day
2. Testing of
Blood Samples
2.1. Prepares
protocol for blood
typing and
serological testing
2.2 Perform blood
grouping
procedure (170
samples in 1
batch running)
2.3 Perform blood
testing based on 5
parameters: (122
sample per batch
test):

 Hepatitis B
 Hepatitis C
 HIV
 Syphilis None 2 days
  Malaria

3. Labeling and
Recording
122 blood 3 days, 30
TOTAL: samples minutes
/batch
serological
testing,
labeling
and
recording
170 blood
samples
/batch
blood
typing
6. Labeling of Plasma Components
Proper labeling of Fresh Frozen Plasma, Cryoprecipitate and Cryosupernate
Availability of Service: 8:00 am to 8:00 pm, Monday to Friday
8:00 to 5:00 pm. Saturday, Sunday & Holidays
Except Christmas, New Year & Good Friday

Office/Division: Davao Blood Center

Classification: Highly Technical
Type of Transaction: G2C
Who may avail: Processed and stored plasma and derivatives units
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Serological Worksheet  Facility Based Collection
 Mobile Blood Donation Collection
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1.Preparation of units 1.Generate blood None 10 minutes Production Staff
8 units/packed label print out Med Tech
through
NBBNETS

2. Generated
blood label print
out cross check
with tracer book

3. Check fresh
frozen plasma,
cryoprecipitate
and
cryosupernate
according:
3.1.a Serial
Number
3.1.b Blood
Type
3.1.c Extraction
Date
3.1.d Expiration
Date
3.1.e
Serological
test results

4. Pull out units

from
Quarantine
Blood
Freezer

5. Double check
print out label
sticker with serial
number, blood
type and date of
extraction.

6.Affix correct
blood sticker on
the corresponding
units

7. Store blood
units.

8. Document the
blood product to
blood stock
inventory for
distribution

9. Endorse units
to issuance and
distribution
section

TOTAL: 8 10 minutes
units/packe
d
7. Apheresis
Client donor suitable for platelet apheresis procedure
Availability of Service: 8:00 am to 5:00 pm, Monday to Sunday
Blood Donor Acceptance: Schedule time 8:00 am to 3 pm, Monday to Sunday except Christmas,
New Year & Good Friday

Office/Division: Davao Blood Center

Classification: Highly Technical
Type of Transaction: G2C
Who may avail: 1. Clients with donor
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Valid ID (1 original ) Government Agency
PRC, SSS, GSIS, PAG-IBIG, POSTAL,
Barangay ID, School, Passport

In case not available:

NBI Clearance
Police Clearance
Voter’s Affidavit
Private Agency
Company ID, School

2. Official Blood Request - Platelet Attending Physician

Concentrate
Apheresis
Derived
3. Claiming of donated blood unit:
 Blood Transport Box  Personal
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present official 1. Present official None 2 minutes Guard on Duty
blood request to the blood request to
guard to get que the guard for
number card securing cue
number card 3 minutes
1.1 Instruct client
to proceed inside
the waiting area
and wait for their
turn to be called

2. Present Official 2.1 Verifies for None 5 minutes Officer of the

Blood Request complete data day
information of the Med Tech
patient
2.2 Instruct client
to proceed to
Issuance and
Distribution front
desk officer

3. Proceed to 3. Receives None 15 minutes Med Tech

Issuance and client’s donor
Distribution front desk 3.1.3. Check
officer and present: candidate donor’s
vein if accepted
  Official Blood 3.1.2 Pre-screen
Request donor
 Donor’s 3.1.3 Issuance of
Identification personal data
Card sheet and donor
history
questionnaire
3.1.4 Instruct
donor to
completely fill up
the form

4. Proceed to Facility 4. Verifies DHQ None 6 hours Doctor

Based Section and for correctness of Med Tech
Submit donor’s information Nurse
document

4.1 Pre-health
check, physical
examination and
hemoglobin
determination
4.2 Instruct
donor to wait for
Pre-platelet count,
if passed with
platelet
requirement.
4.3 Collect blood
sample for
serological testing
4.4 Ask donor to
come back at 2
p.m. in the
afternoon for final
check up
4.5 Instruct to
proceed to
bleeding room for
blood collection
4.6 Allow donor
to rest
4.7 Determine
donor’s condition
to allow release
from blood
collection area
4.8 Instruct
client to present
blood request to
distribution and
issuance front
desk officer
5. Presents Official 5. Receives blood None 20 minutes Med Tech
Blood request at the request and issue
Issuance and billing form
Distribution front desk 5.1 Instructs to
officer pay at SPMC
cashier at the
main building
.

If with billing form: 6.1 Receipt of None 15 minutes

6. Pays for the bill at Official receipt
the SPMC Cashier and photocopy of
 documents for
If with billing form and medically assisted
medical assisted clients.
clients: 6.2 Prepare for
6. Photocopy of the transport:
following:  Blood unit
 Official Blood  Individual
Request Transmittal
 Guaranteed form
Letter  Blood
 Bill form Tracer
book

6.3 Release of
blood unit
TOTAL: Refer to 1 day
approved
schedule
of fees

DAVAO BLOOD CENTER - Schedule of Donor Acceptance

Type of Donation Donor Acceptance Time

 8 AM to 11 AM
 Blood Donation Collection at
3 P.M in the afternoon
Platelet Concentrate Apheresis Derived
 1 PM to 3 PM
 Blood Donation Collection the
following day 3:00 PM in the
afternoon

DAVAO BLOOD CENTER - Schedule of Fees

Procedure Processing Fee

Platelet Concentrate Apheresis Derived P 14,000.00

8. Individual Issuance
Receipt of blood request to issuance of blood and blood products
Availability of Service: 8:00 am to 8:00 pm, Monday to Friday
8:00 to 5:00 pm. Saturday, Sunday & Holidays
Except Christmas, New Year & Good Friday

Office/Division: Davao Blood Center

Classification: Simple
Type of Transaction: G2C, G2G, G2B
Who may avail: 1. SPMC, Program Partners & Other Hospital Clients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Blood Request Form Attending Physician
2. Billing Form Davao Blood Center
3. Official Receipt SPMC Cashier
4. Guaranteed Letter LINGAP - Local
OFFICE OF THE PRESIDENT
PCSO
DSWD
LGU
DOH
5. Referral Form Davao Blood Center
6. Claim Stub Davao Blood Center
7. Individual Transmittal Form Davao Blood Center
8. Claiming of donated blood unit: Blood Transfusion Service Facilities :
 Blood Insulated Transport Box  Admitting Hospitals
 Dialysis Centers
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present official 1. Present official None 2 minutes Guard on duty
blood request to the blood request to
guard to get que the guard for
number card securing cue
number card 3 minutes
1.1 Instruct client
to proceed inside
the waiting area
and wait for their
turn to be called

2.Presents Official 2.Receipt blood None 30 minutes Issuance and

Blood Request request and Distribution
issues billing slip Staff Med Tech

2.1 If patient is 2.1. Instructs to

admitted outside pay for the bill at
SPMC with billing the SPMC
form: Cashier (main
 If with billing building)
form
2.1.a Photocopy
 If with billing of the following:
form and
medical
 assisted  Official
clients. Blood
Request
 Guarantee
d Letter
 If walk in
donor with 2.1..b Present of
billing form Photocopy of the
following:
 Blood
Request
 Claim Stub
 Authorizati
on Letter
with 3
specimen
signatures
of the
donor

2.2 If patient admitted

at Southern 2.2.1 Issue billing
Philippines Medical and referral slip
Center: 2.2.1.a Instruct to
 PHIC Member proceed to SPMC
– Blood
Transfusion
Services (BTS)

If blood unit is not

available at SPMC
instruct client to
bring insulated
transport box and
 Non – PHIC issue blood unit at
Member Davao Blood
Center
2.2.b Issue billing
slip and instruct
to pay at SPMC
 Present cashier (main
documents If building)
with billing
form and 2.2.c Receipt of
medical Photocopy of the
assisted following:
clients  Official
Blood
Request
 Guarantee
 If walk in d Letter
donor with
billing form 2.2.d Issues billing
form and instruct
to pay

2.2.e Receipt of
Photocopy of the
following:
 Blood
Request
 Claim Stub
 Authorizati
on Letter
with 3
specimen
 signatures
of the
donor

3. For Prepares
for transport:
 Blood Unit
 Individual
Transmittal
form
 Blood
Tracer
Book

4. Release of
Blood units
 If blood unit
required is
not
available at
SPMC –
BTS
issuance of
blood unit
is at Davao
Blood
Center.
TOTAL Refer to 35
approved minutes
Schedule
of fees

DAVAO BLOOD CENTER - Schedule of Fees:

Blood Products Blood Processing Patient is an Blood Donor and

Fee active Program Direct Blood Galloner
Partner Dependents
Red Cell
 Whole P 1,800.00 P 950.00 P 600.00 FREE
Blood
 PRBC P 1,500.00 P 600.00
Platelet
Concentrate P 1,000.00 P 850.00 P 300.00 FREE
Cryoprecipitate P 1,000.00 P 850.00 P 300.00 FREE
Cryosupernate P 1,000.00 P 850.00 P 300.00
Fresh Frozen
Plasma P 1,000.00 P700.00 P 200.00 FREE
9. Direct Distribution System
Receipt of blood request to issuance of blood and blood product to direct distribution services to
blood Service facility

Availability of Service: 8:00 am to 5:00 pm, Monday to Sunday

8:00 am to 3 pm, Monday to Sunday except Christmas,
New Year & Good Friday

Office/Division: Davao Blood Center

Classification: Highly Technical
Type of Transaction: G2B, G2G
Who may avail: Blood Service Facilities: Brokenshire Hospital
Integrated
Davao del Sur Provincial Hospital San Pedro Hospital
Southern Philippines Medical Center Anda Riverview Medical
Center
Davao Doctors’ Hospital Metro Davao Medical
Research
Davao Adventist Hospital Ricardo Limso Medical
Center
Medical Mission Hospital - Davao City Tebow Cure
Good Shepherd Hospital Gig Oca Seamens’ Hospital
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Purchase Order Hospital Blood Transfusion Services (BTS)
2. Delivery Receipt Southern Philippines Medical Center (SPMC)
3. email address Hospital BTS
4. Disposition Form Davao Blood Center
5. Journal Entry Voucher SPMC Accounting
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1.Submits of Bulk 1.1. Receipts of None 2 days Distribution
Delivery Request and Bulk Staff
purchase order 2 days Delivery request Med Tech
before scheduled and Purchase
pick-up. order: verifies
Submission will either request, assess
be through fax, email blood stock
or phone call. inventory for
availability in the
blood stock
available to be
served.
1.2 Preparation
and inspection of
blood units.
1.3
Documentation
and validation:
  Purchase
Order
 Disposition
Form
 Delivery
Receipt

1.4 Final packing

and issuance
2. Pick up of blood 2.Verifies and Refer to day 1 hour Med Tech
units according to cross check: and time
schedule  Disposition schedule
Form
 Delivery
Receipt

2.2 Issues
duplicate copies
of delivery receipt
and
Refer to 2 days,
TOTAL: approved 1 hour
schedule
of fees and
pick-up
schedules

DAVAO BLOOD CENTER - Schedule of Fees:

Blood Products Blood Processing Fee

Red Cell
 Whole Blood P 1,800.00
 PRBC
P 1,500.00
Platelet Concentrate
P 1,000.00
Cryoprecipitate P 1,000.00
Cryosupernate P 1,000.00
Fresh Frozen Plasma
P 1,000.00

DIRECT DISTRIBUTION SCHEDULE - Schedule as follows:

BLOOD SERVICE FACILITY DAY SCHEDULE PICK UP TIME

 Davao del Sur
Provincial Hospital MONDAY MORNING
 Southern Philippines 1:00 PM
Medical Center
 Davao Doctor’s 1:00 PM
Hospital 3:00 pm
 Davao Adventist TUESDAY 3:00 PM
Hospital
 Medical Mission 3:00 PM
Group Hospital –
Davao City
 Good Shepherd
Hospital
 Southern Philippines 1:00 PM
Medical Center
 Brokenshire Hospital WEDNESDAY
Integrated Health 3:00 PM
Ministries, Inc
 San Pedro Hospital 1:00 PM
3:00 PM
 Anda Riverview THURSDAY
Medical Center 3:00 PM
 Metro Davao Medical
& Research Center
 Southern Philippines 1:00 PM
Medical Center FRIDAY
 Ricardo Limso 3:00 PM
Medical Center

Blood Transfusion Services (BTS)

External Services
1. Issuance of Blood for Deposit for Patients with PHIC Coverage
Issuance of blood for future needs of the patient; Blood Processing Fee (BPF) charged to PHIC.
Availability of Service: 24 Hours a day; 7 days a week (24/7)

Office/Division: Blood Transfusion Service

Classification: Simple
Type of Transaction: G2C
Who may avail: All SPMC Patients with request for blood
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Blood Request Form (properly filled up) Attending Physician
(1 original)

2. Official Blood Typing Result Ward Nurse

3. Blood Transaction Slip Davao Blood Center
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Secure priority 1. Instruct client to None 2 minutes Security Guard
number find a seat and BTS
wait for their turn
2. Present the 2.Receive and None 5 minutes Medical
following documents; verify Blood Technologist /
a. Blood Request Request, Official Administrative
b. Official Blood Blood Typing Assistant/
Typing Result Result and Blood Administrative
c. Blood Transaction Transaction Slip Aide
Slip (for clients with 2.1 Check blood BTS
blood donor) stock inventory
and assign
Note: Without blood donation
donor, client signs identification (ID)
Pledge of number of blood
Commitment

3.Charge Blood Refer to 3 minutes Medical

Processing Fee Schedule of Technologist /
(BPF) and Fees for Administrative
crossmatching Blood Assistant/
to PHIC in Processing Administrative
Hospital Fee and Aide
Information Schedule of BTS
System(HIS) Fees for
Blood
Transfusion
 Service
Tests

3. Read and sign 3.Generate None 5 minutes Medical

Waiver of Deposit Waiver of Deposit Technologist /
and Administrative
Crossmatching Assistant/
Request from HIS Administrative
Aide
BTS
4. Receive 4. Issue None 3 minutes Medical
Crossmatching Crossmatching Technologist /
Request, charge slip, Request, charge Administrative
EDTA Tube, and copy slip, EDTA tube, Assistant/
of Waiver of Deposit and copy of Administrative
Waiver of Deposit Aide
BTS
4.1 Instruct client
to proceed to
ward and submit
Crossmatching
Request, charge
slip, and EDTA
tube to ward
nurse.
TOTAL: 18 minutes

SCHEDULE OF FEES
Blood Processing Fee

Blood Product Blood Patient is an Blood Donor *Blood

Processing Active Program and Direct Galloner
Fee Partner Dependents
Red Cell
Whole Blood 1,800.00 1,100.00 600.00 FREE
PRBC 1,500.00 950.00 600.00 FREE

Platelet Concentrate 1,000.00 850.00 300.00 FREE

Cryoprecipate 1,000.00 850.00 300.00 FREE
Cryosupernate 1,000.00 850.00 300.00 FREE
Fresh Frozen Plasma 1,000.00 750.00 200.00 FREE

Note: Blood processing fees for Fresh Frozen Plasma (FFP) and cryoprecipitate for members
(with member’s ID) of the Hemophilia Association of Davao is 500.00 per unit.

*A Galloner is a blood donor that consistently donate blood up to 9 times.

SCHEDULE OF FEES
Blood Transfusion Service Tests

PRODUCT/SERVICE Full C3 SC D
DESCRIPTION Payment
Crossmatching 850.00 750.00 750.00 Not Applicable
Auto Control 395.00 395.00 316.00 Not Applicable
Coomb’s Test(Direct) 395.00 395.00 316.00 Not Applicable
Indirect Coomb’s 395.00 395.00 316.00 Not Applicable
Platelet 200.00 120.00 FREE FREE
Concentrate
Fresh Frozen Plasma 200.00 120.00 FREE FREE
Du variant 180.00 Not Not Not Applicable
Applicable Applicable
2. Issuance of Blood for Deposit for Patients without PHIC Coverage -Cash
Transaction for Blood Processing Fee (BPF)
Issuance of blood for future needs of the patient; BPF paid in cash
Availability of Service: 24 Hours a day; 7 days a week (24/7)

Office/Division: Blood Transfusion Service

Classification: Simple
Type of Transaction: G2C
Who may avail: All SPMC Patients with request for blood
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Blood Request Form (properly filled up) Attending Physician
(1 original)

2. Official Blood Typing Result Ward nurse

3. Blood Transaction Slip (for clients with Davao Blood Center
blood donor)
4. Official Receipt Cashier
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Secure priority 1. Instruct client to None 2 minutes Security Guard
number find a seat and BTS
wait for their turn
2. Present the 2.Receive and None 5 minutes Medical
following documents; verify Blood Technologist/
a. Blood Request Request, Official Administrative
b. Official Blood Blood Typing Assistant/
Typing Result Result, Blood Administrative
c. Blood Transaction Transaction Slip Aide
Slip BTS
2.1 Check blood
Note: Without blood stock inventory
donor, client sign and assign
Pledge of donation
Commitment identification
number (ID) of
blood
 3. Pay at the Cashier 3. Issue charge Refer to 20 minutes Medical
slip for Blood Schedule of Technologist/
Processing Fee Fees for Administrative
(BPF) and Blood Assistant/
crossmatching Processing Administrative
and Instruct client Fee Aide
to go to Cashier and BTS
for payment Schedule of
Fees for
Blood
Transfusion
Service
Test
4. Present Blood 4. Receive and None 3 minutes Medical
Request with check Blood Technologist/
Official Receipt of Request with Administrative
BPF and Official Receipt of Assistant/
crossmatching BPF and Administrative
crossmatching Aide
BTS

5. Read and sign 5. Generate None 5 minutes Medical

Waiver of Deposit Waiver of Deposit Technologist/
and Administrative
Crossmatching Assistant/
Request from HIS Administrative
Aide
BTS
6. Receive 6. Issue None 3 minutes Medical
Crossmatching Crossmatching Technologist/
Request, charge slip Request, charge Administrative
for crossmatching, slip for Assistant/
EDTA tube and copy crossmatching, Administrative
of Waiver of Deposit EDTA tube and Aide
BTS
copy of Waiver of
Deposit
6.1 Instruct client
to submit
crossmatching
request, charge
slip for
crossmatching,
and EDTA tube to
ward nurse
TOTAL: 38 minutes

SCHEDULE OF FEES
Blood Processing Fee

Blood Product Blood Patient is an Blood Donor *Blood

Processing Active Program and Direct Galloner
Fee Partner Dependents
Red Cell
Whole Blood 1,800.00 1,100.00 600.00 FREE
PRBC 1,500.00 950.00 600.00 FREE

Platelet Concentrate 1,000.00 850.00 300.00 FREE

Cryoprecipate 1,000.00 850.00 300.00 FREE
Cryosupernate 1,000.00 850.00 300.00 FREE
Fresh Frozen Plasma 1,000.00 750.00 200.00 FREE

Note: Blood processing fees for Fresh Frozen Plasma (FFP)and cryoprecipitate for members (with
member’s ID) of the Hemophilia Association of Davao is 500.00 per unit.
*A Galloner is a blood donor that consistently donate blood up to 9 times.

SCHEDULE OF FEES
Blood Transfusion Service Tests

PRODUCT/SERVICE Full C3 SC D
DESCRIPTION Payment
Crossmatching 850.00 750.00 750.00 Not Applicable
Auto Control 395.00 395.00 316.00 Not Applicable
Coomb’s Test(Direct) 395.00 395.00 316.00 Not Applicable
Indirect Coomb’s 395.00 395.00 316.00 Not Applicable
Platelet 200.00 120.00 FREE FREE
Concentrate
Fresh Frozen Plasma 200.00 120.00 FREE FREE
Du variant 180.00 Not Applicable Not Applicable Not Applicable

3. Issuance of Blood for Deposit for Patients without PHIC Coverage - Blood
Processing Fee (BPF) charged to LINGAP/MAIP
Issuance of blood for future needs of the patient Blood Processing Fee (BPF) Charge to
LINGAP/MAIP
Availability of Service: 24 Hours a day; 7 days a week (24/7)

Office/Division: Blood Transfusion Service

Classification: Simple
Type of Transaction: G2C
Who may avail: SPMC Patients with request for blood
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Blood Request Form (properly filled up) Attending Physician
(1 original, 1 photo copy)

2. Official Blood Typing Result (1original,1 Ward Nurse

photo copy)
3. Guarantee Letter (1original,1 photo LINGAP/PAD Office
copy)
4. Request Assistance Form ( RAF ) LINGAP/PAD Office
(1original,1 photo copy)

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Secure priority 1. Instruct client to None 2 minutes Security Guard
number find a seat and BTS
wait for their turn
2. Present the 2.Receive and None 5 minutes Medical
following documents: verify Blood Technologist/
a. Blood Request, Request, Official Administrative
b. Official Blood Blood Typing Assistant/
Typing Result, Result and Blood Administrative
c. Blood Transaction Transaction slip Aide
Slip (for clients with BTS
blood donor) 2.2 Check blood
stock inventory
and assign
 Note: Without blood donation ID
donor, client sign number of blood
Pledge of
Commitment
3. Proceed to 3.Issue charge Refer to 2 hours Medical
LINGAP/PAD Office slip for BPF and Schedule of Technologist/
Crossmatching Fees for Administrative
and instruct client Blood Assistant/
to go to Processing Administrative
Lingap/PAD Office Fee Aide
for financial BTS
assistance
4. Present Blood 4. Receive Blood None 3 minutes Medical
Request, charge slip Request, charge Technologist/
for BPF, blood typing slip for BPF and Administrative
result, RAF, and crossmatching, Assistant/
Guarantee letter RAF, and Administrative
Guarantee letter Aide
BTS
5. Read and sign 5. Generate Refer to 5 minutes Medical
Waiver of Deposit Waiver of Deposit, Schedule of Technologist/
and Fees for Administrative
Crossmatching Blood Assistant/
Request from HIS. Transfusion Administrative
Service Aide
Tests BTS
6. Receive 6. Issue None 5 minutes Medical
Crossmatching Crossmatching Technologist/
Request, charge slip, Request, charge Administrative
and EDTA tube. slip for Assistant/
crossmatching, Administrative
and EDTA tube, Aide
and instruct client BTS
to submit to ward
nurse.
TOTAL: 2 hours and
20 minutes

SCHEDULE OF FEES
Blood Processing Fee

Blood Product Blood Patient is an Blood Donor *Blood

Processing Active Program and Direct Galloner
Fee Partner Dependents
Red Cell
Whole Blood 1,800.00 1,100.00 600.00 FREE
PRBC 1,500.00 950.00 600.00 FREE

Platelet Concentrate 1,000.00 850.00 300.00 FREE

Cryoprecipate 1,000.00 850.00 300.00 FREE
Cryosupernate 1,000.00 850.00 300.00 FREE
Fresh Frozen Plasma 1,000.00 750.00 200.00 FREE

Note: Blood processing fees for Fresh Frozen Plasma (FFP)and cryoprecipitate for members (with
member’s ID) of the Hemophilia Association of Davao is 500.00 per unit.

*A Galloner is a blood donor that consistently donate blood up to 9 times.

SCHEDULE OF FEES
Blood Transfusion Service Tests

PRODUCT/SERVICE Full C3 SC D
DESCRIPTION Payment
Crossmatching 850.00 750.00 750.00 Not Applicable
Auto Control 395.00 395.00 316.00 Not Applicable
Coomb’s Test(Direct) 395.00 395.00 316.00 Not Applicable
Indirect Coomb’s 395.00 395.00 316.00 Not Applicable
Fresh Frozen Plasma 200.00 120.00 FREE FREE
Du variant 180.00 Not Applicable Not Applicable Not Applicable

4. Issuance of Blood for Emergency Borrowing (patients without PHIC

coverage)
Transaction of borrowed blood by Attending Physician for emergency cases.
Availability of Service: 24 Hours a day; 7 days a week (24/7)

Office/Division: Blood Transfusion Service

Classification: Simple
Type of Transaction: G2C,G2G
Who may avail: 1. All SPMC Patients with emergency request for blood
2. Attending Physician
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Blood Request Form Attending Physician
2. Blood Typing Result Ward nurse
CLIENT STEPS FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Attending 1. Receive and None 2 minutes Medical
physician, present check Blood Technologist
Blood Request Form Request and BTS
and Official Blood Official Blood
Typing Result Typing result
1.1 Check blood
stock inventory
2. Fill out and sign in 2. Instruct None 5 minutes Medical
the Worksheet for Attending Technologist
borrowed blood Physician to fill BTS
and Pledge of out Worksheet for
Commitment borrowed blood
and Pledge of
Note: Commitment
Validity of borrowed
blood is only 12 hours
3. Receive 3. Generate None 3 minutes Medical
Crossmatching Crossmatching Technologist
Request, bill for request and bill BTS
 crossmatching and accordingly
EDTA tube

4. Pay crossmatching 4. Instruct client Refer to 30 minutes Medical

fee at the Cashier or to pay Schedule of Technologist
ask financial crossmatching fee Fees for BTS
assistance at at the Cashier, or Blood
LINGAP/PAD Office, ask financial Transfusion
and collect blood assistance at Service
sample for LINGAP/PAD Tests
crossmatching Office, and collect
blood sample for
crossmatching
5. Submit blood 5. Receive and None 3 minutes Medical
sample and check both blood Technologist/
crossmatching sample and Administrative
request, and receive crossmatching Assistant/
claim stub request Administrative
5.1 Issue claim Aide
stub, and endorse BTS
blood sample to
Crossmatching
Staff for
processing
TOTAL: 45 minutes

SCHEDULE OF FEES
Blood Processing Fee

Blood Product Blood Patient is an Blood Donor *Blood

Processing Active Program and Direct Galloner
Fee Partner Dependents
Red Cell
Whole Blood 1,800.00 1,100.00 600.00 FREE
PRBC 1,500.00 950.00 600.00

Platelet Concentrate 1,000.00 850.00 300.00 FREE

Cryoprecipate 1,000.00 850.00 300.00 FREE
Cryosupernate 1,000.00 850.00 300.00 FREE
Fresh Frozen Plasma 1,000.00 750.00 200.00 FREE
Note: Blood processing fees for Fresh Frozen Plasma (FFP) and cryoprecipitate for members
(with member’s ID) of the Hemophilia Association of Davao is 500.00 per unit.

*A Galloner is a blood donor that consistently donate blood up to 9 times.

SCHEDULE OF FEES
Blood Transfusion Service Tests

PRODUCT/SERVICE Full Payment C3 SC D

DESCRIPTION
Crossmatching 850.00 750.00 750.00 Not Applicable
Auto Control 395.00 395.00 316.00 Not Applicable
Coomb’s Test(Direct) 395.00 395.00 316.00 Not Applicable
Indirect Coomb’ 395.00 395.00 316.00 Not Applicable
Platelet 200.00 120.00 FREE FREE
Concentrate
Fresh Frozen Plasma 200.00 120.00 FREE FREE
Du variant 180.00 Not Applicable Not Applicable Not Applicable
5. Issuance of Blood for High Risk Patients during the Pandemic/ State of
Public Health Emergency
Transaction of blood for patients infected with highly infectious disease during pandemic.
Availability of Service: 24 Hours a day; 7 days a week (24/7)

Office/Division: Blood Transfusion Service

Classification: Simple
Type of Transaction: G2C,G2G
Who may avail: 1. All SPMC Patients with emergency request for blood
2. Attending Physician
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Blood Request Form Attending Physician
2. Official Blood Typing Result Ward nurse
CLIENT STEPS FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Attending 1. Receive and None 2 minutes Medical
physician, present check Blood Technologist/
Blood Request Form Request and Administrative
and Official Blood Official Blood Assistant/
Typing Result Typing result Administrative
1.1 Check blood Aide
stock inventory BTS
2. Fill out and sign in 2. Charge Blood 5 minutes Medical
the Worksheet for Processing Fee to Technologist/
borrowed blood PHIC or Attending Administrative
and Pledge of Physician to Assistant/
Commitment if no transact for Administrative
PHIC coverage borrowing of blood Aide
if no PHIC BTS
coverage
3. Receive 3. Generate None 5 minutes Medical
Crossmatching Crossmatching Refer to Technologist/
Request, bill for request and bill Schedule of Administrative
crossmatching and crossmatching Fees for Assistant/
EDTA tube accordingly. Blood Administrative
Transfusion Aide
 Service BTS
Tests
4. Submit properly 4. Receive and None 2 minutes Medical
filled up check properly Technologist/
crossmatching filled up Administrative
request and blood crossmatching Assistant/
sample request and Administrative
4.1 Receive claim patient’s blood Aide
stub sample BTS
Note: Releasing of 5. Place 10 minutes Medical
results after 2 hours crossmatching Technologist/
request in an oven Administrative
for hot air Assistant/
sterilization for 10 Administrative
minutes before Aide
test will be done BTS
TOTAL: 24 minutes

SCHEDULE OF FEES
Blood Transfusion Service Tests

PRODUCT/SERVICE Full Payment C3 SC D

DESCRIPTION
Crossmatching 850.00 750.00 750.00 Not Applicable
Auto Control 395.00 395.00 316.00 Not Applicable
Coomb’s Test(Direct) 395.00 395.00 316.00 Not Applicable
Indirect Coomb’ 395.00 395.00 316.00 Not Applicable
Platelet 200.00 120.00 FREE FREE
Concentrate
Fresh Frozen Plasma 200.00 120.00 FREE FREE
Du variant 180.00 Not Applicable Not Applicable Not Applicable
6. Issuance of Blood and Blood Product for Blood Program Partners Admitted
in other Health Facilities
Issuance of blood for future needs of the patient admitted in other hospital
Availability of Service: 8:00 PM- 8:00AM during OFF hours of Davao Blood Center

Office/Division: Blood Transfusion Service

Classification: Simple
Type of Transaction: G2B,G2G
Who may avail: 1. Patients from other health institution
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Blood Request Form (properly filled up) Attending Physician
(1 original)
2. Official Blood Typing Result Ward nurse
3. Card Withdrawal Slip Blood Program Coordinator
4. Recommended Transport box Blood Service Facility where patient is admitted
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Secure priority 1. Instruct client to None 2 minutes Security guard
number find a seat and BTS
wait for their turn
2. Present the 2. Receive and None 5 minutes Medical
following: verify Blood Technologist/
a) Blood Request Request, Official Administrative
b) Official Blood Blood Typing Assistant/
Typing Result Result, and Card Administrative
c) Card Withdrawal Withdrawal slip Aide
slip 2.1 Check blood BTS
d)Transport box stock inventory
3. Client proceed to 3. Charge BPF Refer to 20 minutes Medical
the cashier for accordingly Schedule of Technologist/
payment as to blood Fees of Administrative
component Blood Assistant/
requested
 3.1 Instruct client Processing Administrative
to pay at the Fee Aide/
cashier
BTS
4. Present Official 4. Check blood None 5 minutes Medical
Receipt of BPF request form and Technologist/
Official Receipt Administrative
4.1 Get blood unit Assistant/
from blood bank Administrative
ref and write on Aide
the blood request BTS
form the donation
ID number of
blood and the
date of expiry
5.Client signs in the 5. Prepare None 5 minutes Medical
transmittal slip and transmittal slip Technologist/
issuance logbook and record the Administrative
transaction in Assistant/
issuance logbook Administrative
Aide
BTS
6. Check and receive 6. Check and None 5 minutes Medical
blood unit and the verify transmittal Technologist/
transmittal slip slip and the blood Administrative
6.1 Transport blood unit for issuance Assistant/
using the 6.1 Issue blood Administrative
recommended unit stored in Aide
transport box with ice recommended BTS
pack transport box with
ice pack and
instruct client to
proceed directly to
the blood bank
section of the
hospital where the
patient is
admitted.
TOTAL: 42 minutes
7. Processing and Releasing of Uncrossmatched Blood
In some situation patients may require life-saving blood transfusion before crossmatching can be
completed.
Availability of Service: 24 Hours a day; 7 days a week (24/7)

Office/Division: Blood Transfusion Service

Classification: Simple
Type of Transaction: G2C
Who may avail: All SPMC Patients with emergency request of blood
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Blood Request Form Attending Physician
2. Official Blood Typing Result Ward nurse
3. Patient’s Blood Sample in EDTA tube Attending Physician
4. Recommended transport box for blood Ward nurse
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Attending Physician 2. Receive, check None 2 minutes Medical
present Blood and verify Blood Technologist
Request and Official Request and BTS
Blood Typing result official Blood
and transact for Typing
release of result.
uncrossmatched
blood
2. Receive, fill out and 2. Issue Waiver 5 minutes Medical
sign Waiver for for Technologist
Uncrossmatched Uncrossmatched BTS
blood blood. Refer to
Schedule of
2.1 Receive and fill 2.1 Generate Fees for
out Crossmatching Crossmatching Blood
Request and Request and Processing
transfusion record charge BPF and Fee/
crossmatching fee Refer to
to PHIC. Schedule of
Note: Patient with Fees for
no PHIC Blood
coverage: Transfusion
Attending Service
Physician may Tests
transact for
borrowed blood
3. Submit properly 3. Receive and None 3 minutes Medical
filled up Waiver for check Waiver for Technologist
uncrossmatched uncrossmatched BTS
blood, Crossmatching blood,
Request, Blood Crossmatching
Transfusion Record, Request, Blood
and patient’s blood Transfusion
sample Record, and
patient’s blood
sample
4. Receive blood and 4. Assign blood None 10 minutes Medical
affix trodat/name and and perform blood Technologist
signature in the typing on both BTS
compatibility logbook patient and donor
and in the transfusion blood sample.
record. 4.1 Attach
4.1 Transport blood to uncrossmatched
ward in a compatibility label
recommended on blood unit with
transport box. stamped “retyped”
4.2 Check and
verify results and
blood unit for
issuance
4.3 Encode in HIS
and release blood
TOTAL: 20 minutes
8. Receiving and Processing of Crossmatching Request
Crossmatching is a test done before blood transfusion to determine if donor’s blood is compatible
with that of the patient.

Availability of Service: 24 Hours a day; 7 days a week (24/7)

Office/Division: Blood Transfusion Service
Classification: Simple
Type of Transaction: G2C
Who may avail: All SPMC Patients for blood transfusion
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Crossmatching Request with charge slip Attending Physician/Ward nurse
attached either paid, charge to PHIC or
approved by LINGAP/MAIP
2. Patient’s blood sample, 2 ml. in EDTA Attending Physician/Ward nurse
tube.
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Secure priority 1.Instruct client to None 2 minutes Medical
number. find a seat and Technologist
wait for their turn BTS
2. Present 2. Receive and None 10 minutes Medical
crossmatching check Technologist/
request, patient’s crossmatching Administrative
blood sample, and request Assistant/
charge slip for Note: Administrative
crossmatching a) Crossmatching Aide
BTS
 request must be
accomplished
legibly and
correctly
b) Incomplete
data will not be
accepted.
c.) If unpaid, not
charged to PHIC,
or without
approval from
LINGAP/PAD
Office request will
not be accepted.
2.1 Check and
verify patient’s
blood sample:
name and other
patient’s identifier
must coincide with
the request.
Note:
a) Incomplete
label on blood
sample will not be
accepted
b) Clotted and
hemolyzed blood
sample is
unacceptable.
Subject for repeat
3. Receive claim stub collection.
2.2 Encode
request in the HIS
2.3 Issue claim
stub
3. Process None 2 hours Medical
crossmatching (1 hour for Technologist
stat/priority BTS
crossmatching
)
4. Present claim stub 4. Prepare results None 10 minutes Medical
and receive and release Technologist/
crossmatching result crossmatching Administrative
result Assistant/
Administrative
Aide
BTS
TOTAL: 2 hours and
22 minutes
9. Processing of Coomb’s Test/Du Testing/Auto Control
Coomb’s test detect antibodies attached to the surface of red blood cells used to diagnose certain
blood disorders; Auto control use to rule out an autoantibody;
Du testing is a test for weak RH (D) antigen of the Rh blood group system

Availability of Service: 24 Hours a day; 7 days a week (24/7)

Office/Division: Blood Transfusion Service
Classification: Simple
Type of Transaction: G2C
Who may avail: SPMC Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Request for Coomb’s Test/Du testing, Attending Physician/Ward nurse
Auto Control
2. Patient’s blood sample, 2 ml. in EDTA Ward nurse
tube.
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Secure priority 1.Instruct client to None 2 minutes Security Guard
number. find a seat and BTS
wait for their turn
2. Present request for 2. Receive, check 10 minutes Medical
Coomb’s Test/Du and verify request. Technologist/
testing, Auto Control. Administrative
Note: Assistant/
a) Request must Administrative
be accomplished BTS
 legibly and
correctly.
b) Incomplete
data will not be
accepted.
c.) If unpaid, not
charged to PHIC,
or without
approval from
LINGAP/MAIP
request will not be
accepted.
2.1 Check and
verify patient’s
blood sample.
Note:
a) Incomplete
label on blood
sample will not be
accepted
b) Clotted and
hemolyzed blood
sample is
unacceptable.
Subject for repeat
collection

2.2 Encode
request in the HIS
3. Receive claim stub 3. Issue claim None 5 minutes Medical
stub Technologist/
Administrative
Assistant/
Administrative
Aide
BTS
4. Process the None 2 hours Medical
test (1 hour for Technologist/
4.1 Prepare priority/stat Administrative
printed results request) Assistant/
Administrative
Aide
BTS

4. Present claim stub 4. Release test None 2 minutes Medical

and receive test result result Technologist/
Administrative
Assistant/
Administrative
Aide
BTS

TOTAL: 2 hours and

19 minutes
10. Receiving of consumed blood bag for proper disposal
Return of blood bag after transfusion for proper disposal.
Availability of Service: 24 Hours a day; 7 days a week (24/7)

Office/Division: Blood Transfusion Service

Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: 1. SPMC Patients with Blood Transfusion
2. Nurse/Nursing Attendant
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Consumed blood bag Ward Nurse
2. Crossmatching result with Transfusion Ward Nurse
Record (completely filled-up)
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Secure priority 1. Instruct client to None 2 minutes Security Guard
number. find a seat and BTS
wait for their turn
 2. Present consumed 2. Receive and None 3 minutes Medical
blood bag with check consumed Technologist/
completely filled-up blood bag Administrative
crossmatching result Assistant/
with transfusion Note: Consumed Administrative
record. blood bag with Aide
needle still BTS
attached will not
be accepted.

2.1 Encode date

and time received
in the HIS

3. Receive copy of 3. Return to the None 2 minutes Medical

crossmatching result client the original Technologist/
with transfusion copy of the Administrative
record transfusion record Assistant/
3.1 Instruct client Administrative
to give to ward Aide
nurse the copy of
the transfusion
record
TOTAL: 7 minutes

11. Receiving of Blood for Deposit from other Blood Service Facilities
Securing of blood for patient’s blood needs from other authorized Blood Service Facilities.
Availability of Service: 24 Hours a day; 7 days a week (24/7)

Office/Division: Blood Transfusion Service

Classification: Simple
Type of Transaction: G2C
Who may avail: All SPMC Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Transmittal Slip Issuing blood service facilities
2. Official blood typing result Ward nurse
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Secure priority 1.Instruct client to None 2 minutes Guard on Duty
number. find a seat and BTS
wait for their turn
2. Present blood unit, 2. Receive and None 5 minutes Medical
transmittal slip and check blood unit, Technologist/
official blood typing transmittal slip, Administrative
result and official blood Assistant/
typing result Administrative
Aide
Note: BTS
a) blood without
transmittal slip is
not acceptable
b) unacceptable if
blood do not
conform with
the standard.
3. Read and affix 3. Prepare waiver Refer to 10 minutes Medical
signature in waiver of of deposit, schedule of Technologist/
deposit crossmatching fees Administrative
request, and Blood Assistant/
charge Transfusion Administrative
crossmatching fee Service Aide
to PHIC Tests
Note: if no PHIC
coverage, client
may pay at the
cashier, or ask
assistance from
LINGAP/PAD
Office
4.Receive client’s 4. Issue client’s None 5 minutes Medical
copy of waiver of copy of waiver of Technologist/
deposit, deposit, Administrative
crossmatching crossmatching Assistant/
request, charge slip request, charge Administrative
for crossmatching slip for Aide
and EDTA tube. crossmatching, BTS
and EDTA tube.

4.1 Instruct client

to submit
crossmatching
request with
attached charge
slip and EDTA
tube to ward
nurse.

TOTAL: 22 minutes

SCHEDULE OF FEES
Blood Transfusion Service Tests

PRODUCT/SERVICE Full Payment C3 SC D

DESCRIPTION
Crossmatching 850.00 750.00 750.00 Not Applicable
Auto Control 395.00 395.00 316.00 Not Applicable
Coomb’s Test(Direct) 395.00 395.00 316.00 Not Applicable
Indirect Coomb’ 395.00 395.00 316.00 Not Applicable
Platelet 200.00 120.00 FREE FREE
Concentrate
Fresh Frozen Plasma 200.00 120.00 FREE FREE
Du variant 180.00 Not Applicable Not Applicable Not Applicable
12. Request for Thawing of Fresh Frozen Plasma(FFP) and
Cryoprecipitate(CRYO)
Prior to administration, FFP and CRYO is thawed at 37 degrees centigrade in a thawing machine.
Availability of Service: 24 Hours a day; 7 days a week (24/7)
Office/Division: Blood Transfusion Service
Classification: Simple
Type of Transaction: G2C,G2G
Who may avail: 1.All SPMC patients with request for FFP or CRYO
2. Nurse/ Nursing Attendant
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Thawing Request Properly filled up with Ward nurse
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Present Thawing 1. Receive and None 2 minutes Medical
request check request for Technologist/
thawing. Administrative
Assistant/
 Administrative
Aide
BTS
2. Issue claim stub None 3 minutes Medical
and instruct client to Technologist/
endorse it to ward Administrative
nurse Assistant/
Administrative
Aide
BTS
3. Thaw FFP or None 30 minutes Medical
Cryo Technologist/
Administrative
Assistant/
Administrative
Aide
BTS
2. Withdraw FFP or 4. After thawing, None 5 minutes Medical
CRYO for transfusion store FFP in blood Technologist/
bank refrigerator Administrative
while Cryo in room Assistant/
temperature Administrative
Aide
BTS

TOTAL: 40 minutes

13. Releasing of Blood Unit for Transfusion

Withdrawal of crossmatched blood for transfusion.
Availability of Service: 24 Hours a day; 7 days a week (24/7)

Office/Division: Blood Transfusion Service

Classification: Simple
Type of Transaction: G2C
Who may avail: All SPMC Patients for Blood Transfusion
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Properly filled up Crossmatching Ward nurse
Result/Transfusion Record
2. Recommended Transport box Ward nurse
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Nurse ward/Nursing 1. Receive, check None 3 minutes Medical
Attendant present and encode in HIS Technologist
 crossmatching result the date and time BTS
with transfusion blood is issued
record 1.1 Record in the
worksheet for
Release of Blood
for Transfusion
2. Retrieve from None 3 minutes Medical
blood bank Technologist
refrigerator the BTS
blood unit for
issuance
2. Check and
verify the blood for
issuance with the
crossmatching
result
2. Check, receive, and 3. Issue blood unit None 4 minutes Medical
Affix Trodat/printed to ward Technologist
name and signature in nurse/nursing BTS
the crossmatching attendant
result/transfusion 3.1 Affix
record and in the Trodat/signature
compatibility logbook in the
2.1 Transport blood in crossmatching
a recommended result with
transport box transfusion record
and in the
Compatibility
logbook.
TOTAL: 10 minutes

14. Request for Transfusion Reaction Study

A transfusion reaction occurs when a body has an adverse response to blood transfusion.
Availability of Service: 24 Hours a day; 7 days a week (24/7)

Office/Division: Blood Transfusion Service

Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: 1.SPMC patients with transfusion reaction
2. Ward nurse
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Crossmatching Result Ward Nurse
2. Donor unit with transfusion reaction Ward Nurse
3. Blood Transfusion Reaction Registry Ward Nurse
Form
4. Transfusion Record Ward Nurse
5. Post transfusion Blood sample of patient Ward Nurse
(EDTA and yellow top)
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Ward nurse submit 1. Receive and None 5 minutes Medical
properly filled up check Transfusion Technologist
Transfusion Reaction Reaction Registry BTS
Registry form form
2. Return blood unit 2. Check blood None 2 hours Medical
for investigation and unit for Technologist
Crossmatching result investigation and BTS
with transfusion Crossmatching
record result with
1.2 Submit post transfusion record
transfusion blood for clerical error
sample (EDTA tube 2.1 Check pre and
and yellow top) post transfusion
blood sample for
hemolysis
2.2 Perform
crossmatching
both on pre and
post transfusion
samples
2.3 Perform Direct
Coomb’s test on
post transfusion
sample
2.4 Record all
observations and
results
3.Forward result None 2 hours Medical
of the transfusion Technologist
reaction study to BTS
Pathologist for
review
3. Receive result of 4. Call up ward to None 5 minutes Medical
the transfusion inform result is Technologist
reaction study ready for pick up BTS
4.1 Release result
and file BTS copy
TOTAL: 4 hours and
10 minutes
 Blood Transfusion Services (BTS)

Internal Services

1. Issuance of Blood to SPMC Personnel

SPMC personnel can avail blood if the personnel actively participated in the hospital’s blood
donation program.
Availability of Service: 24 Hours a day; 7 days a week (24/7)
Office/Division: Blood Transfusion Service
Classification: Simple
Type of Transaction: G2G
Who may avail: All SPMC employees who are blood donors
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Blood Request Form Nurse ward
2. Blood typing result Nurse ward
3. Blood Withdrawal Slip SPMC Blood Program Coordinator
 CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present blood 1. Receive and None 5 minutes Medical
request and official check blood Technologist/
blood typing result request and Administrative
2. Blood Withdrawal official blood Assistant/
Slip typing result Administrative
Aide
1.1 Verify history
of blood donation
in the masterlist of
SPMC blood
donor
1.2 Check
availability of
blood and assign
donation number
of blood unit
1:3 Instruct client
to fill out
withdrawal slip
2.1 Encode and Refer to 10 minutes Medical
charge Blood Schedule of Technologist/
Processing Fee Fees for Administrative
(BPF) and Blood Assistant/
crossmatching fee Processing Administrative
2. Affix signature in c/o PHIC in HIS Fee/ Aide
waiver of deposit 2.2 Generate Refer to
waiver of deposit Schedule of
and Fees for
crossmatching Blood
request. Transfusion
Service
Tests
3. Receive copy of 3.Issue client’s None 2 minutes Medical
waiver of deposit, copy of waiver of Technologist/
crossmatching deposit, Administrative
request with attached crossmatching Assistant/
charge slip, and request with Administrative
EDTA tube and charge slip, and Aide
proceed to ward EDTA tube.

3.1 Instruct client

to proceed to
ward and submit
Crossmatching
request with
attached charge
slip and EDTA
tube to nurse
ward

TOTAL: 17 minutes
 Department of Radiology and Imaging Sciences
(DORIS)

External Services

1. Emergency Department Computed Tomography Scan

CT imaging.
Availability of Service: 7:00am to 11:00am, Monday to Sunday

Office/Division: Department of Radiological & Imaging Sciences (DORIS) – JICA

Building – Lower Ground
Classification: Simple
Type of Transaction: G2C
Who may avail: CLEAN patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Completely filled-out CT Scan request
Doctor
form (SPMC-F-RAD-05)
2. Official Receipt for paid CT-Scan
Cashier
procedure
3. Contrast Media History and Assessment
Form (SPMC-F-RAD-01) and pertinent VIP; Doctor
clearances
4. Complete materials for CT-Scan
Pharmacy
procedures
5. Bowel Preparation Instruction Form
Radiology Nurse
(SPMC-F-RAD-26)
6. Claim Stub (SPMC-F-RAD-06) Radiologic Technologist/Ancillary Personnel
FEES TO PROCESSING PERSON
CLIENT STEPS AGENCY ACTION
BE PAID TIME RESPONSIBLE
1. Wait for the nursing 1. Receives, Radiologist
aide who will assesses and (Senior
transport the patient approves 15 minutes Radiology
to the CT-Scan request from the resident rotator)
room. requesting
physician
through Viber
Online account
(09156610486)

1.1 Checks
approved CT
Scan requests None
from Viber
Online account Administrative
(09156610486) 5 minutes Officer II
Radiology
1.2 Encodes Ancillary
approved CT Services
requests in HIS

1.3 Informs ward

of the schedule 5 minutes Nurse II
and gives CT Scan
instructions. Radiology
2. Verify patient’s 45 minutes RadTech III
name and CT Scan
performs Radiology
procedure.
2.1 Provides 5 minutes Nurse II
post- procedural CT Scan
care and Radiology
instructions.
2. Undergo CT Scan
2.2 Examine 2 days Radiologist
procedure and
images and (Junior
present materials None
provide Radiology
initial/preliminary resident rotator)
reading
1 day
2.3 Referral of Radiologist
preliminary (Junior
reading and Consultants/
finalizing of result Fellows in
for releasing charge &
Consultants)

3. Contacts DORIS 3. Verifies patient’s

JICA (local 4502) HRN Administrative
for the CT-Scan Officer II
official result. 3.1 Sends the None 5 minutes Radiology
official result to Ancillary
patient and/or to Services
requesting
 physician’s email
address.

TOTAL: Refer to 3 days, 20

approved minutes
schedule
of fees

Notes:

1) May cater ER clean patients from 11:00am to 7:00am, Monday to Sunday when
examination room is available due to lesser covid cases scanning during this time.
2) Radiologists may suggest more appropriate study/ies for the indication or purpose of the
study, subject to agreement with the primary service.
3) If request and screening forms are not complete, the Radiology resident reserves the right
to disapprove request and screening forms until said forms are correctly and completely
filled.
4) Patient may expect delays in the time of their procedure in the event of other patients
requiring urgent/emergent attention or during machine maintenance.
Scanning time may extend beyond 1 hour and 30 minutes depending on the case and patient condition.

2. Emergency Department General X-Ray

Diagnostic x-ray imaging.
Availability of Service: 24 hours, Monday to Sunday.

Office/Division: Department of Radiological & Imaging Sciences (DORIS) – Main

Building
Classification: Simple
Type of Transaction: G2C
Who may avail: COVID Screening Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. HR number Requesting Physician
2. Claim Stub Radiologic Technologist/Ancillary Personnel
3. Identification Card
Government and Private Institutions
(Patient or Representative)
FEES TO PROCESSING PERSON
CLIENT STEPS AGENCY ACTION
BE PAID TIME RESPONSIBLE
1. Receives and
Verifies request
in the HIS.

1.2 Prints
examination
Please Administrative
1. Wait for the nursing request and
refer to Officer II
aide who will sends to Radtech
approved 5 minutes Radiology
transport the patient through Online
schedule of Ancillary
to the X-ray room. Messenger.
fees Services
1.3 Calls
Radtech at local
4348 to confirm
sent examination
request.
2. Calls patient 5 minutes RadTech III
name, prepares General
materials and Radiology
instructs patient
on what to do.

2.1 Conducts 30 minutes RadTech III

procedure. General
Radiology

2.2 Instructs 5 minutes RadTech III

patient to return General
to observation Radiology
area and to
inform their nurse
or doctor that
2. Undergo the x-ray their X-ray is
procedure. already None
performed.

2.3 Examine
images and 1 hour, 30 Radiologist
provide minutes (Junior
initial/preliminary Radiology
reading. resident rotator)

2.4 Referral of
preliminary Radiologist
reading and 30 minutes (Senior ER
finalizing of result resident/Junior
for releasing. Consultants/
Fellows in
charge &
Consultants)

3. Verifies patient’s
HRN
Administrative
3. Contacts DORIS 3.1 Sends the Officer II
JICA (local 4502) official result to None 5 minutes Radiology
for X-ray result. patient and/or to Ancillary
requesting Services
physician’s email
address.
 TOTAL: Refer to 2 hours, 50
approved minutes
schedule
of fees

Notes:

1) Waiting time may be extended if radiologic technologist are attending

a. Resuscitation and emergent cases
b. Patients with more than one examination
c. Uncooperative/Combatant

2) Initial results are provided and images are directly available for wet reading or viewing from
the respective requesting department’s station.

3) Studies that require thorough diagnostic investigation may require extended schedule of
result.

3. In-Patient Department Computed Tomography Scan

CT imaging.
Availability of Service: 7:00 am to 11:00am CLEAN Scanning, Monday to Sunday
11:00 am to 7:00 am COVID Scanning, Monday to Sunday

Office/Division: Department of Radiological & Imaging Sciences (DORIS) – JICA

Building – Lower Ground
Classification: Simple
Type of Transaction: G2C
Who may avail: CLEAN and COVID Inpatients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Completely filled-out CT Scan request
Doctor
form (SPMC-F-RAD-05)
2. Official Receipt for paid CT-Scan
Cashier
procedure
3. Contrast Media History and Assessment
Form (SPMC-F-RAD-01) and pertinent VIP; Doctor
clearances
4. Complete materials for CT-Scan
Pharmacy
procedures
5. Bowel Preparation Instruction Form
Radiology Nurse
(SPMC-F-RAD-26)
6. Claim Stub (SPMC-F-RAD-06) Radiologic Technologist/Ancillary Personnel
FEES TO PROCESSING PERSON
CLIENT STEPS AGENCY ACTION
BE PAID TIME RESPONSIBLE
1. Wait for the nursing 1. Receives, Radiologist
aide who will assesses and (Senior
transport the patient approves 15 minutes Radiology
to the CT-Scan request from the resident rotator)
room. requesting
physician
through Viber
Online account
(09156610486)

1.1 Checks
approved CT
Scan requests None
from Viber
Online account Administrative
(09156610486) 5 minutes Officer II
Radiology
1.2 Encodes Ancillary
approved CT Services
requests in HIS

1.3 Informs ward

of the schedule 5 minutes Nurse II
and gives CT Scan
instructions. Radiology
2. Verify patient’s 45 minutes RadTech III
name and CT Scan
performs Radiology
procedure.

2.1 Provides 5 minutes Nurse II

post- procedural CT Scan
care and Radiology
instructions.
2. Undergo CT Scan
procedure and
2.2 Examine Radiologist
present materials None
images and 10 hours (Junior
provide Radiology
initial/preliminary resident rotator)
reading

2.3 Referral of Radiologist

preliminary 2 hours (Junior
reading and Consultants/
finalizing of result Fellows in
for releasing charge &
Consultants)
 3. Contacts DORIS 3. Verifies patient’s
JICA (local 4502) HRN
for the CT-Scan
Administrative
official result. 3.1 Sends the
Officer II
official result to
None 5 minutes Radiology
patient and/or to
Ancillary
requesting
Services
physician’s email
address.

TOTAL: Refer to 13 hours, 20

approved minutes
schedule
of fees

Notes:

1) Radiologists may suggest more appropriate study/ies for the indication or purpose of the
study, subject to agreement with the primary service.
2) If request and screening forms are not complete, the Radiology resident reserves the right
to disapprove request and screening forms until said forms are correctly and completely
filled.
3) Patient may expect delays in the time of their procedure in the event of other patients
requiring urgent/emergent attention or during machine maintenance.
4) Scanning time may extend beyond 1 hour and 30 minutes depending on the case and
patient condition.

4. In-Patient Department General X-Ray

Diagnostic x-ray imaging.
Availability of Service: 24 hours, Monday to Sunday.

Office/Division: Department of Radiological & Imaging Sciences (DORIS) – JICA

Building
Classification: Simple
Type of Transaction: G2C
Who may avail: COVID In-Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. HR number HIMD
2. Examination Stub/Claim Stub Radiologic Technologist/Ancillary Personnel
3. Identification Card
Government and Private Institutions
(Patient or Representative)
FEES TO PROCESSING PERSON
CLIENT STEPS AGENCY ACTION
BE PAID TIME RESPONSIBLE
1. Receives and
Verifies request
in the HIS.

1.2 Prints
examination
Please Administrative
1. Wait for the nursing request and
refer to Officer II
aide who will sends to Radtech
approved 5 minutes Radiology
transport the patient through Online
schedule of Ancillary
to the X-ray room. Messenger.
fees Services
1.3 Calls
Radtech at local
4348 to confirm
sent examination
request.
2. Conducts None 15 minutes RadTech III
procedure in General
respective Radiology
wards.

2.1 Examine 1 hour, 30 Radiologist

images and minutes (Junior
provide Radiology
initial/preliminary resident rotator)
2. Undergo the reading
Portable x-ray
Procedure in 2.4 Referral of 30 minutes Radiologist
respective wards. preliminary (Junior
reading and Consultants/
finalizing of result Fellows in
for releasing charge &
Consultants)

3. Verifies patient’s
HRN
Administrative
3.1 Sends the
3. Contacts DORIS Officer II
official result to
JICA (local 4502) None 5 minutes Radiology
patient and/or to
for X-ray result. Ancillary
requesting
Services
physician’s email
address.

TOTAL: Refer to 2 hours, 25

approved minutes
schedule
of fees

Notes:
 1) Waiting time may be extended if radiologic technologist are attending
a. Patients with more than one examination
b. Pediatric and geriatric patient
c. Uncooperative/combatant patient

3) Studies that require thorough diagnostic investigation may have extended schedule of
result.

5. In-Patient Department Ultrasonography

Diagnostic Ultrasound.
Availability of Service: 11:00 am to 7:00 am COVID Scanning, Monday to Sunday
Office/Division: Department of Radiological & Imaging Sciences (DORIS) – JICA
Building – Ultrasound Room
Classification: Simple
Type of Transaction: G2C
Who may avail: COVID Inpatients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Request Form (SPMC-F-RAD-12) Nurse Station
2. Claim Stub (SPMC-F-RAD-06) Radiologic Technologist/Ancillary Personnel
FEES TO PROCESSING PERSON
CLIENT STEPS AGENCY ACTION
BE PAID TIME RESPONSIBLE
1. Receives,
assesses and
approves
request from the
requesting
physician
through Viber
Online account
(09156610486)
1. Wait for the nursing
1.1 Checks Administrative
aide who will
approved CT Officer II
transport the patient
Scan requests None 5 minutes Radiology
to the Ultrasound
from Viber Ancillary
room.
Online account Services
(09156610486)

1.2 Encodes
approved CT
requests in HIS

1.3 Informs ward

of the schedule
and gives
instructions.
2. Reports on the 2. Instructs
schedule of representative
procedure together for pre-
with the procedural Sonographer III
attendant/nurse/resi requirement Ultrasound
None 5 minutes
dent doctor and Radiology
submit request,
schedule stub and
materials to
Sonographer
3. Calls patient Sonographer III
name, checks Ultrasound
compliance to 10 minutes Radiology
pre-procedural
requirement

3.1 prepares
scanning room
and instructs
3. Undergo ultrasound patient on what
procedure to do. None

3.2 Conducts 1 hour Radiologist

procedure. (Junior
Radiology
resident rotator)
3.3 Provides
post- procedural 5 minutes
instructions,
Gives claim stub
and schedule of
 the release of
result to patient
and instructs
attendant that
they can return to
their room or
ward.

3.4 Examine
images and 23 hours Radiologist
provide (Junior
initial/preliminary Radiology
reading. resident rotator,
Junior
Consultants/
Fellows in
charge)

3.5 Referral of 1 hour Consultant

preliminary
reading and
finalizing of result
for releasing.
4. Contacts DORIS 4. Verifies patient’s
JICA (local 4502) HRN
for the CT-Scan
Administrative
official result. 4.1 Sends the
Officer II
official result to
None 5 minutes Radiology
patient and/or to
Ancillary
requesting
Services
physician’s email
address.

TOTAL: Refer to 1 day, 2,

approved hours, 30
schedule minutes
of fees

Notes:

1) If request forms are not complete, the Administrative Aide/Radiologic

Technologist/Radiologist reserves the right to return request forms until said forms are
completely filled up in order to perform a proper ultrasound examination
2) Patients will be rescheduled if pre-procedural preparations are not carried out by the
patient.
3) Radiologists may require the presence of the primary service in order to assist the patients
especially for adjustment/removal of contraptions, as well as, if procedure has high risk for
complications.
4) Patients may expect delays in the time of their ultrasound examination in the event of other
patients requiring urgent/emergent attention, ongoing procedures such as biopsies or
during ultrasound machine maintenance.
5) Emergency cases must be endorsed by a member of the health care team in order to avoid
delays.
6) Studies that require thorough diagnostic investigation may require extended schedule of
result.
7) For Payward and NICU patients, proceed directly to the Ultrasound room for scheduling.

6. INPATIENT DEPARTMENT MAGNETIC RESONANCE IMAGING

Diagnostic MR imaging.
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except holidays.

Office/Division: Department of Radiological & Imaging Sciences (DORIS) – JICA

Building – Lower Ground
Classification: Complex
Type of Transaction: G2C
Who may avail: Clean In-patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Completely filled-out MRI request form
Doctor
(SPMC-F-RAD-09)
2. Contrast Media History and Assessment
Form (SPMC-F-RAD-01) and pertinent Doctor
clearances
3. Complete materials for MRI procedures Pharmacy
4. Magnetic Resonance Environment
Screening Form for Individual Radiologic Technologist
(SPMC-F-RAD-03
5. Magnetic Resonance Procedure
Doctor
Screening Form for Patients
6. Bowel Preparation Instruction Form
Doctor
(SPMC-F-RAD-26)
7. Claim Stub (SPMC-F-RAD-06) Radiologic Technologist/Ancillary Personnel
8. (2) Negative RT-PCR test done at least Attending Physician
5 days apart
FEES TO PROCESSING PERSON
CLIENT STEPS AGENCY ACTION
BE PAID TIME RESPONSIBLE
1. Receives,
1. Wait for the nursing
assesses and
aide who will
approves
transport the patient
request from the
to the MRI room.
requesting
physician
through Viber
Online account
(09156610486)

1.1 Checks Administrative

approved MRI Officer II
request from None 5 minutes Radiology
Viber Online Ancillary
account Services
(09156610486)

1.2 Encodes
approved MRI
request in HIS

1.3 Informs ward

of the schedule
and gives
instructions.
2. Reports on the 2. Checks
schedule of compliance to
procedure together pre-procedural
with the and procedural
attendant/nurse/req requirements,
uesting physician
Nurse II or
and submit request 2.1 Prepares
RadTech III
to the Nurse/ patient materials None 30 minutes
MRI Radiology
Radiologic and IV line for
Technologists at procedures with
the MRI Zone II contrast
station (JICA Lower
Ground or 2.2 Instructs
Mindanao Heart patient to
Center proceed to
 designated
waiting zone
area and wait
for the name to
be called

3. Undergo MRI 3. Performs 1 hour RadTech III

procedure and procedure. MRI Radiology
present materials
(Zone III) 3.1 Provides
post- procedural
care and 5 minutes Nurse II
instructions, MRI Radiology

3.2 Examine Radiologist

images and (Junior
None
provide 5 days Radiology
initial/preliminary resident rotator)
reading

3.3 Referral of Radiologist

preliminary (Junior
reading and 2 days Consultants/
finalizing of result Fellows in
for releasing charge &
Consultants)

4. Contacts DORIS 4. Verifies patient’s

JICA (local 4502) HRN
for the CT-Scan
Administrative
official result. 4.1 Sends the
Officer II
official result to
None 5 minutes Radiology
patient and/or to
Ancillary
requesting
Services
physician’s email
address.

TOTAL: Refer to 7 days, 1

approved hour, 45
schedule minutes
of fees

Notes:

1) Radiologists may suggest more appropriate study/ies for the indication or purpose of the
study, subject to agreement with the primary service.
2) If request and screening forms are not complete, the Ancillary staff/ Radiologic
Technologist/ Radiologist reserves the right to return request and screening forms until said
forms are completely filled.
3) Patient may expect delays in the time of their procedure in the event of other patients
requiring urgent/emergent attention or during machine maintenance.
4) Emergency cases must be endorsed by a member of the health care team in order to avoid
delays.
5) Scanning time may extend up to 3 hours depending on the case (e.g. Whole
Abdomen/Pelvis, MRI Liver, MR Angiogram, MR Spectroscopy, and MR Arthrogram.
and patient condition.
6) Initial results are provided and images are directly available for wet reading or viewing from
the respective requesting department’s station.
7. Vascular and Interventional Radiology Cath.Lab. Referral
Availability of Service: 8:00 am to 5:00 pm for Elective Procedures
24 Hrs. for Stat Procedures

Office/Division: Department of Radiology & Imaging Sciences (DORIS) – Main

Classification: Complex
Type of Transaction: G2C
Who may avail: In-Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Referral form send through Viber Doctor
2. Photocopy of Results of Previous Patient
Imaging and Laboratories
3. CD/Film of Previous Imaging Patient
4. (2) Negative RT-PCR test done at least Attending Physician
5 days apart
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Gives the 1.1 Receives and None 30 minutes Attending
Laboratory/CT assess the Physician
Scan/Xray/Ultrasound condition of the
result/s and CD copy patient.
of Imaging to 1.2 Completes
Attending Physician referral form and
refers to VIR
through VIBER
online account
(09156610486) for
the contemplated
procedure

2. Waits in the ward 2. Interviews the None 30 minutes Medical

for the VIR residents patient for Specialist
to make rounds pertinent history VIR Section
and physical
examination.
Discuss the
procedure, bene
fits, risks and
costs
 Signs and
completes
request form,
lab request,
and
prescriptions
 Secures
consent for the
procedure
2.1 Gives
instructions and
list of
requirements for
the procedure
including Imaging
request form,
laboratory
request, and
prescriptions.
3. Accomplishes 3. Monitors and Please refer 10 days Resident
requirements for follows up patient to table of Rotator
scheduling in the ward fees
4. Informs the VIR 4. Schedules the None End of Resident
resident doctor if procedure as transaction Rotator
materials are soon as possible
complete
TOTAL: None 10 days & 1
hour
8. Vascular and Interventional Radiology Non-Cath.Lab. Referral
Availability of Service: 8:00 am to 5:00 pm for Routine Procedures
24 Hrs. for Stat Procedures

Office/Division: Department of Radiology & Imaging Sciences (DORIS) – Main

Classification: Simple
Type of Transaction: G2C
Who may avail: In-Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Referral form Doctor
2. Photocopy of Results of Previous Patient
Imaging and Laboratories
3. CD/Film of Previous Imaging Patient
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Gives the 1. Receives and None 30 minutes Attending
Laboratory/CT assess the Physician
Scan/Xray/Ultrasound condition of the
result/s and CD copy patient.
of Imaging to 1.2 Completes
Attending Physician referral form and
refers to VIR
through VIBER
online account
(09156610486) for
the contemplated
procedure

2. Waits in the ward 2. Interviews the None 30 minutes Medical

for the VIR residents patient for Specialist
to make rounds pertinent history VIR Section
and physical
examination.
Discuss the
procedure, bene
fits, risks and
costs
 Signs and
completes
request form,
lab request,
and
prescriptions
 Secures
consent for the
procedure
2.1 Gives
instructions and
list of
requirements for
the procedure
including Imaging
request form,
laboratory
request, and
prescriptions.
3. Accomplishes 3. Monitors and Please refer 1 day Resident
requirements for follows up patient to table of Rotator
scheduling in the ward fees
4. Informs the VIR 4. Schedules the None End of Resident
resident doctor if procedure as transaction Rotator
materials are soon as possible
complete
 TOTAL: None 1 day & 1
hour

Laboratory

Clinical Chemistry

External Services
1a. Blood Chemistry Tests (In-patient Department)
Routine Blood Chemistry tests for admitted patients.

Albumin, Alkaline Phosphatase, ALT (SGPT), Amylase, AST (SGOT), Bilirubin (Total, Direct,
Indirect), Blood Urea Nitrogen, Calcium, Chloride, Creatinine, CRP Quantitative, Fasting Blood
Sugar (FBS), Lactate Dehydrogenase (LDH), Lipid Profile, Lithium, Magnesium, Phosphorous,
Potassium, Random Blood Sugar (RBS), Sodium, Total Cholesterol, Total Protein, Triglycerides,
Uric Acid
Availability of Service: Everyday, 24 hours a day

Office/Division: Department of Pathology and Laboratories – Chemistry Section

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients (In-patients)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Request for Blood Chemistry Doctor/Nurse
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present request to 1. Encodes Chemistry 2 minutes Administrative
receiving clerk. request to Request Officer/
Hospital Fees (Refer Administrative
Information to approved Aide
System (HIS) schedule of
fees)
2. Go back to ward 2. Collects blood None 20 minutes Phlebotomist
and wait for requests from
phlebotomist to collect receiving area and
blood from patient. sorts them
according to
patient location.
2.1. Proceeds to None 20 minutes Phlebotomist
the wards and
locates patient.
Identifies patient
and prepares for
blood collection.
2.2 Explains None 5 minutes Phlebotomist
procedure to
patient/watcher,
verifies patient
adherence to
fasting
requirement (if
any)
2.3 Collects blood None 5 minutes Phlebotomist
sample from the
patient and labels
sample.
2.4 Sends sample None 2 minutes Phlebotomist
and request to
laboratory via
Pneumatic Tube
System.

2.5 Receives and None 2 minutes Administrative

verifies sample Officer/
and request; Administrative
Aide
checks-in sample
to HIS

None 20 minutes Medical

2.6 Barcodes Technologist
blood samples
and proceeds to
deliver sample
and request to
Chemistry
Section. None 20 minutes Medical
2.7 Centrifuge Technologist
samples and
verifies test
requests. None 20 minutes Medical
2.8 Checks serum Technologist
Integrity and loads
blood samples to
Chemistry
Analyzer None 1 hour Medical
2.9 Waits for Technologist
analyzer to finish
processing;
checks and
validates results
generated by the
analyzer. None 1 minute Medical
2.10 Releases Technologist
result through
computer.
TOTAL: Refer to 2 hours 57
approved minutes
schedule
of fees
1b. Blood Chemistry Tests (Out-patient Department)
Routine Blood Chemistry tests for Out-patients.

Albumin, Alkaline Phosphatase, ALT (SGPT), Amylase, AST (SGOT), Bilirubin (Total, Direct,
Indirect), Blood Urea Nitrogen, Calcium, Chloride, Creatinine, CRP Quantitative, Fasting Blood
Sugar (FBS), Lactate Dehydrogenase (LDH), Lipid Profile, Lithium, Magnesium, Phosphorous,
Potassium, Random Blood Sugar (RBS), Sodium, Total Cholesterol, Total Protein, Triglycerides,
Uric Acid
Availability of Service: 5:30 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Department of Pathology and Laboratories – Chemistry Section

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients (Out-patient and Walk-In patients)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Request for Blood Chemistry Doctor
2. Yellow Card HIMD
3. Official Receipt for paid Blood Chemistry Cashier
Request
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present yellow card 1. Verifies request Chemistry 5 minutes Administrative
and official receipt to and payment in Request Officer/
receiving clerk. the system. Fees (Refer Administrative
1.2 Gives priority to approved Aide
number, prints schedule of
request and fees)
Instructs patient to
proceed to blood
extraction area.
2. Proceed to Blood 2. Calls patient None 1 minute Phlebotomist
extraction area for and collects the
blood sample priority number.
collection 2.1 Verifies
Patient Identity None 1 minute Phlebotomist
with the blood
request form
2.2 Explains None 3 minutes Phlebotomist
procedure to
patient, verifies
patient adherence
to fasting
requirement (if
any)
2.3 Collects blood None 5 minutes Phlebotomist
sample from the
patient and labels
sample.
2.4 Gives claim None 1 minute Phlebotomist
stub to patient and
instructs them to
claim result at
window 3 after 3-4
hours.
2.5 Barcodes None 15 minutes Medical
blood samples Technologist
and proceeds to
 deliver sample
and request to
Chemistry
Section.
2.6 Centrifuge None 20 minutes Medical
samples and Technologist
verifies test
requests.
2.7 Checks serum None 20 minutes Medical
Integrity and loads Technologist
blood samples to
Chemistry
Analyzer
2.8 Waits for None 1 hour Medical
analyzer to finish Technologist
processing;
checks and
validates results
generated by the
analyzer.
2.9 Releases None 1 minute Medical
result through Technologist
computer.

3. Present Claim stub 3. Collects claim None 3 minutes Administrative

to window 3. stub, prints and Officer/
releases results. Administrative
Aide
TOTAL: Refer to 2 hours 15
approved minutes
schedule
of fees
2. Body Fluid Chemistry Test
Diagnostic Body Fluid Chemistry tests (Protein and Sugar)

Availability of Service: Everyday, 24 hours a day

Office/Division: Department of Pathology and Laboratories – Chemistry Section

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients (In-patients)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Request for Body Fluid Chemistry test Doctor/Nurse
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit Body Fluid 1. Encodes Chemistry 5 minutes Administrative
Specimen with request to Request Officer/
request to receiving Hospital Fees (Refer Administrative
clerk. Information to approved Aide
System (HIS) schedule of
1.1 Checks fees)
specimen; verifies
specimen label
and request;
accepts
specimen.
2. Goes back to ward 2. Barcodes None 5 minutes Administrative
and wait for result. sample and brings Officer/
it to chemistry Administrative
section. Aide
2.1 Transfer None 15 minutes Medical
aliquot to tube and Technologist
centrifuge.
2.3 Load sample None 1 hour Medical
to chemistry Technologist
analyzer; validate
and release result
through computer.

TOTAL: Refer to 1 hour 25

approved minutes
schedule
of fees
3a. HbA1c (In-patients)

Availability of Service: Everyday, 24 hours a day

Office/Division: Department of Pathology and Laboratories – Chemistry Section

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients (In-patients)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Request for Blood Chemistry Doctor/Nurse
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present request to 1. Encodes Chemistry 2 minutes Administrative
receiving clerk. request to Request Officer/
Hospital Fees (Refer Administrative
Information to approved Aide
System (HIS) schedule of
fees)
2. Go back to ward 2. Collects blood None 20 minutes Phlebotomist
and wait for requests from
phlebotomist to collect receiving area and
blood from patient. sorts them
according to
patient location.
2.1. Proceeds to None 20 minutes Phlebotomist
the wards and
locates patient.
Identifies patient
and prepares for
blood collection.
2.2 Explains None 5 minutes Phlebotomist
procedure to
patient/watcher.
2.3 Collects blood None 5 minutes Phlebotomist
sample from the
patient and labels
sample.
2.4 Sends sample None 2 minutes Phlebotomist
and request to
laboratory via
Pneumatic Tube
System.

2.5 Receives and None 2 minutes Administrative

verifies sample Officer/
and request; Administrative
checks-in sample Aide
to HIS

2.6 Barcodes None 3 minutes Medical

blood sample and Technologist
proceeds to
deliver sample
and request to
Chemistry
Section.

2.7 Prepares None 1 hour Medical

sample for Technologist
processing; loads
sample to
machine; checks
and validates
results generated
by the analyzer.
2.10 Releases None 1 minute Medical
result through Technologist
computer.

TOTAL: Refer to 2 hours

approved
schedule
of fees
3b. HbA1C (Out-patient Department)

Availability of Service: 5:30 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Department of Pathology and Laboratories – Chemistry Section

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients (Out-patient and Walk-In patients)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Request for Blood Chemistry Doctor
2. Yellow Card HIMD
3. Official Receipt for paid Blood Chemistry Cashier
Request
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present yellow card 1. Verifies request Chemistry 5 minutes Administrative
and official receipt to and payment in Request Officer/
receiving clerk. the system. Fees (Refer Administrative
1.2 Gives priority to approved Aide
number, prints schedule of
request and fees)
Instructs patient to
proceed to blood
extraction area.
2. Proceed to Blood 2. Calls patient None 1 minute Phlebotomist
extraction area for and collects the
blood sample priority number.
collection 2.1 Verifies
Patient Identity None 1 minute Phlebotomist
with the blood
request form
2.2 Explains None 3 minutes Phlebotomist
procedure to
patient.
2.3 Collects blood None 5 minutes Phlebotomist
sample from the
patient and labels
sample.
2.4 Gives claim None 1 minute Phlebotomist
stub to patient and
instructs them to
claim result at
window 3 after 3-4
hours.
2.5 Barcodes None 15 minutes Medical
blood samples Technologist
and proceeds to
deliver sample
and request to
Chemistry
Section.
2.6 Prepares None 1 hour Medical
sample for Technologist
 processing; loads
sample to
machine; checks
and validates
results generated
by the analyzer.
2.7 Releases None 1 minute Medical
result through Technologist
computer.

3. Present Claim stub 3. Collects claim None 3 minutes Administrative

to window 3. stub, prints and Officer/
releases results. Administrative
Aide
TOTAL: Refer to 1 hour 35
approved minutes
schedule
of fees
Oral Glucose Tolerance Test (OGTT)

Availability of Service: 5:30 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Department of Pathology and Laboratories – Chemistry Section

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients (Out-patient and Walk-In patients)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Request for Blood Chemistry Doctor
2. Yellow Card HIMD
3. Official Receipt for paid Blood Chemistry Cashier
Request
4. Glucose Powder Pharmacy
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present yellow card 1. Verifies request Chemistry 5 minutes Administrative
and official receipt; and payment in Request Officer/
submits glucose the system. Fees (Refer Administrative
powder to receiving 1.2 Gives priority to approved Aide
clerk number, prints schedule of
request and fees)
Instructs patient to
proceed to blood
extraction area.
1.3 Endorses
glucose powder to
Chemistry section.
2. Proceed to Blood 2. Calls patient None 1 minute Phlebotomist
extraction area for and collects the
blood sample priority number.
collection 2.1 Verifies
Patient Identity None 1 minute Phlebotomist
with the blood
request form
2.2 Explains None 3 minutes Phlebotomist
procedure to
patient, verifies
patient adherence
to fasting
requirement
2.3 Collects blood None 5 minutes Phlebotomist
sample from the
patient and labels
sample. Give
glucose solution
to patient.
Instructs patient to
wait for next
extraction.
2. Drinks glucose 2. Takes note of None 5 minutes Phlebotomist
solution; returns to patient due time
waiting area and waits for next extraction
for name to be called after patient has
for next blood finished drinking
extraction. glucose load
2.1 Calls patient None 3 hours Phlebotomist
for next due blood
extraction for 1st
hour, 2nd hour and
3rd hour; collects
samples and
labels tube.
2.2 Gives claim None 5 minutes
stub to patient and Phlebotomist
instructs them to
claim result at
window 3 after 3-4
hours.
2.3 Barcodes and
endorses tubes to
chemistry section.
2.4 Centrifuge
samples and
verifies test
requests.
2.7 Checks serum
Integrity and loads
blood samples to
Chemistry
Analyzer
2.8 Waits for
analyzer to finish
processing;
checks and
validates results
generated by the
analyzer.
2.9 Releases
result through
computer.
3. Present Claim stub 3. Collects claim None 3 minutes Administrative
to window 3. stub, prints and Officer/
releases results. Administrative
Aide
TOTAL: Refer to 2 hours 15
approved minutes
schedule
of fees
Post-prandial Blood Sugar (PPBS)

Availability of Service: 5:30 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Department of Pathology and Laboratories – Chemistry Section

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients (Out-patient and Walk-In patients)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Request for Blood Chemistry Doctor
2. Yellow Card HIMD
3. Official Receipt for paid Blood Chemistry Cashier
Request
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present yellow card 1. Verifies request Chemistry 5 minutes Administrative
and official receipt to and payment in Request Officer/
receiving clerk the system. Fees (Refer Administrative
1.2 Gives priority to approved Aide
number, prints schedule of
request and fees)
Instructs patient to
proceed to blood
extraction area.

2. Proceed to Blood 2. Calls patient None 1 minute Phlebotomist

extraction area for and collects the
blood sample priority number.
collection 2.1 Verifies
Patient Identity None 1 minute Phlebotomist
with the blood
request form
2.2 Explains None 3 minutes Phlebotomist
procedure to
patient, verifies
patient adherence
to fasting
requirement
2.3 Collects None 10 minutes Phlebotomist
baseline blood
sample from the
patient and labels
sample. Instructs
patient to
consume full meal
and come back
after 2 hours for
next extraction.
2. Consumes full meal 2. Verifies time of None 2 hours and 5 Phlebotomist
and goes back to full-meal minutes
laboratory for consumption and
extraction after 2 collects blood
hours sample.
2.1 Gives claim None 1 minutes Phlebotomist
stub to patient and
instructs them to
claim result at
window 3 after 3-4
hours.
2.3 Barcodes and None 5 minutes Phlebotomist
endorses tubes to
chemistry section.
2.4 Centrifuge None 10 minutes Medical
samples. Technologist
2.7 Checks serum None 5 minutes Medical
Integrity and loads Technologist
blood samples to
Chemistry
Analyzer
2.8 Waits for None 30 minutes Medical
analyzer to finish Technologist
processing;
checks and
validates results
generated by the
analyzer.
2.9 Releases None 1 minute Medical
result through Technologist
computer.
3. Present Claim stub 3. Collects claim None 3 minutes Administrative
to window 3. stub, prints and Officer/
releases results. Administrative
Aide
TOTAL: Refer to 3 hours 20
approved minutes
schedule
of fees
Urine Chemistry Tests
Diagnostic Urine Chemistry tests (Timed and Random)

Urine Albumin, Urine Calcium, Urine Chloride, Urine Creatinine , Urine Glucose, Urine Potassium,
Urine Sodium

Availability of Service: Everyday, 24 hours a day (In-patients)

5:30 am to 5:00 pm, Monday to Friday, except Holidays. (Out-patients)

Office/Division: Department of Pathology and Laboratories – Chemistry Section

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients (In-patients, Out-patients, walk-in)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Request for Urine Chemistry Doctor/Nurse
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present Urine 1. Encodes Chemistry 5 minutes Administrative
Chemistry request to request to Request Officer/
receiving clerk. Hospital Fees (Refer Administrative
Information to approved Aide
System (HIS) schedule of
1.1 Gives urine fees)
container to
patient/watcher
and provides
instruction on
urine collection.
2. Collects patient 2. Checks None 5 minutes Administrative
urine and submits specimen; verifies Officer/
specimen to receiving specimen label Administrative
clerk along with and request; Aide
request. accepts
specimen.
(provide claim
stub for Out-
patients and
instruct client to
claim result after 2
hours)
2.1 Barcodes None 5 minutes Medical
urine sample and Technologist
brings it to
chemistry section.
2.2 Measure urine None 20 minutes Medical
volume (for timed Technologist
 urine); transfer to
tube and
centrifuge urine
sample.
2.3 Load urine to None 1 hour Medical
chemistry Technologist
analyzer; validate
and release result
through computer.
3. Present claim stub 3. Collects claim None 3 minutes Administrative
to window 3 and claim stub, prints and Officer/
result (Out-patients releases results. Administrative
only) Aide
TOTAL: Refer to 1 hour 38
approved minutes
schedule
of fees

Laboratory

Clinical Chemistry

Internal Services
Acceptance of Reagent and Stocks Delivery

Office/Division: Department of Pathology and Laboratories – Chemistry Section

Classification: Simple
Type of Transaction: G2B
Who may avail: Affiliated Suppliers
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Acknowledgement Receipt Supplier
2. Requisition and Issuance Slip Stocks in-charge
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Delivers 1. Checks and None 30 minutes MMS
reagents/stocks receives reagents department
and presents and stocks; signs consignment in-
acknowledgement acknowledgement charge
receipt to Materials receipt.
Management
Section.
2. Presents signed 2. Prints requisition None 1 hour Laboratory
acknowledgement and Issuance Stocks in-
receipt to laboratory slip; brings to charge
stocks in-charge; designated (Administrative
gives copy of signatories for Assistant)
receipt to chemistry signature; gives
section. signed RIS to
laboratory aide
for withdrawal at
MMS.
2.1 Brings RIS None 30 minutes Laboratory aide
to MMS;
withdraws
stocks and
delivers to
chemistry
section
2.2 Receives none 1 hour Medical
stocks and Technologist
logs in
inventory
logsheet;
Labels and
stores
reagents
and
supplies.
 TOTAL 3 hours

Clinical Internship Training Program

Office/Division: Department of Pathology and Laboratories – Chemistry Section

Classification: Highly technical
Type of Transaction: G2B
Who may avail: Affiliated Schools
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Intern endorsement letter and Schedule Clinical Instructor/ Coordinator
2. Intern Evaluation Forms Clinical Instructor/ Coordinator
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Clinical instructor/ 1. Receives none 5 minutes Medical
coordinator endorsement Technologist
endorses interns to letter, schedule
section head along and evaluation
with endorsement forms and files
letter, interns’ documents in
schedule of duties designated
and evaluation folder.
forms
2. Clinical instructor/ 2. Orients interns none 1 hour Medical
coordinator leaves on tasks and Technologist
interns in responsibilities
designated area in the area.
3. Interns report to 3. Assigns tasks none 20 days Medical
designated area in and observes Technologist
accordance to performance
assigned schedule of each intern;
of duties. grades them
and records
evaluation in
the evaluation
forms
provided.
4. Clinical Instructor 4. Endorses none 2 minutes Medical
collects evaluation evaluation Technologist
forms forms to
Clinical
Instructor.
20 days, 1
TOTAL hour and 7
minutes
 Chemistry Section Schedule of Fees
TEST FEES
Albumin 155.00
Alkaline Phosphatase 185.00
ALT (SGPT) 180.00
Amylase 325.00
AST (SGOT) 185.00
Bilirubin (Total, Direct, Indirect) 190.00
Blood Urea Nitrogen 185.00
Calcium 185.00
Chloride 195.00
Creatinine 175.00
CRP Quantitative 450.00
Fasting Blood Sugar (FBS) 120.00
HbA1c 440.00
Lactate Dehydrogenase (LDH) 265.00
Lipid Profile 570.00
Lithium 300.00
Magnesium 235.00
Oral Glucose Tolerance Test 480.00
Phosphorous 335.00
Post Prandial Blood Sugar (PPBS) 240.00
Potassium (blood/urine) 150.00
Random Blood Sugar (RBS) 120.00
Sodium (blood/urine) 150.00
Total Cholesterol 175.00
Total Protein 140.00
Triglycerides 240.00
Uric Acid 145.00
24 hour urine Albumin 175.00
24 hour urine Calcium 180.00
24 hour urine Creatinine 180.00
24 hour urine Chloride 200.00
24 hour urine Potassium 180.00

LIST OF SERVICES

Classification Type of Transaction

Services Simple Complex Highly G2C G2B G2G
3 days 7 days Technical Gov’t to Gov’t to Gov’t
20 days Client Business to
Gov’t
External Services
1. APT’S Test  
2. Bence Jones Protein  
3. Blood Smear for Malarial  
Parasite
4. Body Fluids Analysis  
5. Fecalysis  
6. Fecal Occult Blood  
7. Filarial Blood Smear  
8. Kidney Stone Analysis  
9. Paragonimus Sputum  
Smear
10. Pregnancy Test  
11. Semenalysis  
12. Tape Peri-Anal Swab  
Smear
13. Urinalysis  
14. Urine Glucose, Ketone,  
Protein, pH and Specific
Graviy
Internal Services
1. Acceptance of deliveries of 
supplies and reagents 
2. Affiliation Training  
(Internship)
3. Issuance of laboratory 
supplies (container, etc.) to 
satellite labs (E.R., IWNH,
CCI and HSSC)

Laboratory

Clinical Microscopy

External Services
APT’s Test
Differentiates fetal blood from maternal blood found in newborn’s stool or vomit.

Office/Division: Department of Pathology and Laboratories – Clinical Microscopy

Classification: Simple
Type of Transaction: G2C
Who may avail: All Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Completely filled up laboratory request Attending Physician/Respective Wards
form (name, age/sex, hospital registration
number, date, ward, laboratory
examination desired and attending
physician).
2. Specimen Sample Patient
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit specimen 1. Receive None 5 minutes Laboratory
sample specimen Information
1.1 Inform the Clerk
patient/
representative on
claiming of result

2. Wait for the 2. Record in None 5 minutes Medical

laboratory result receiving logbook Technologist
2.1 Check-in the
specimen to LIS

2.2 Process the 45 minutes

specimen

2.3 Validate and 5 minutes

Release result

TOTAL: *Refer to 1 hr
the
approved
schedule of
fees
Bence Jones Protein
Test used most often to diagnose multiple myeloma.

Office/Division: Department of Pathology and Laboratories – Clinical Microscopy

Classification: Simple
Type of Transaction: G2C
Who may avail: All Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Completely filled up laboratory request Attending Physician/Respective Wards
form (name, age/sex, hospital registration
number, date, ward, laboratory
examination desired and attending
physician).
2. Specimen Sample Patient
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit specimen 1. Receive None 5 minutes Laboratory
sample specimen Information
1.1 Inform the Clerk
patient/
representative on
claiming of result

2. Wait for the 1. Record in None 5 minutes Medical

laboratory result receiving logbook Technologist
2.1 Check-in the
specimen to LIS

2.2 Process the 1 hr and 15

specimen minutes

2.3 Validate and 5 minutes

Release result

TOTAL: *Refer to 1 hour and 30

the minutes
approved
schedule of
fees
Blood Smear for Malarial Parasite
This provides microscopic examination of blood for malaria diagnosis.

Office/Division: Department of Pathology and Laboratories – Clinical Microscopy

Classification: Simple
Type of Transaction: G2C
Who may avail: All Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Completely filled up laboratory request Attending Physician/Respective Wards
form (name, age/sex, hospital registration
number, date, ward, laboratory
examination desired and attending
physician).
2. Specimen Sample Patient
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit specimen 1. Receive None 5 minutes Laboratory
sample specimen Information
1.1 Inform the Clerk
patient/
representative on
claiming of result

2. Wait for the 2. Record in None 5 minutes Medical

laboratory result receiving logbook Technologist
2.1 Check-in the
specimen to LIS

2.3 Process the 35 minutes

specimen

2.4 Validate and 45 minutes

Release result

TOTAL: *Refer to 1 hr and 30

the minutes
approved
schedule of
fees
Body Fluid Analysis
This provides a rapid gross and microscopic analysis of Body Fluids which plays a critical role in
the diagnosis and prognosis of a disease.

Office/Division: Department of Pathology and Laboratories – Clinical Microscopy

Classification: Simple
Type of Transaction: G2C
Who may avail: All Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Completely filled up laboratory request Attending Physician/Respective Wards
form (name, age/sex, hospital registration
number, date, ward, laboratory
examination desired and attending
physician).
2. Specimen Sample Patient
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit specimen 1. Receive None 5 minutes Laboratory
sample specimen Information
1.1 Inform the Clerk
patient/
representative on
claiming of result

2. Wait for the 2. Record in None 5 minutes Medical

laboratory result receiving logbook Technologist
2.1 Check-in the
specimen to LIS

2.3 Process the 30 minutes

specimen

2.4 Validate and 5 minutes

Release result

TOTAL: *Refer to 45 minutes

the
approved
 schedule of
fees

Fecalysis
Examination of stool specimen to out-patients.
Availability of Service: 6:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Department of Pathology and Laboratories – Clinical Microscopy

Classification: Simple
Type of Transaction: G2C
Who may avail: All Patients - OPD
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Printed Official Request Form JICA LAB Receiving Counters 1 or 2
2. Specimen Sample Patient
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit specimen 1. Receive None 5 minutes Medical
sample specimen Technologist
1.1 Inform the
patient/
representative on
claiming of result

2. Wait for the 2. Record in None 15 minutes Medical

laboratory result receiving logbook Technologist
2.1 Gross
assessment of the
specimen.
2.2 Check-in the
specimen to LIS
and print the
worksheet

2.3 Process the 13 minutes

specimen and
microscopic
examination

2.3 Release result 2 minutes

 TOTAL: *Refer to 35 minutes
the
approved
schedule of
fees

Fecalysis
Examination of stool specimen to in-patients.

Office/Division: Department of Pathology and Laboratories – Clinical Microscopy

Classification: Simple
Type of Transaction: G2C
Who may avail: All Patients - IPD
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Completely filled up laboratory request Attending Physician/Respective Wards
form (name, age/sex, hospital registration
number, date, ward, laboratory
examination desired and attending
physician).
2. Specimen Sample Patient
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit specimen 1. Receive None 5 minutes Laboratory
sample specimen Information
1.1 Inform the Clerk
patient/
representative on
claiming of result

2. Wait for the 2. Record in None 15 minutes Medical

laboratory result receiving logbook Technologist
2.1 Gross
assessment of the
specimen.
2.2 Check-in the
specimen to LIS
and print
worksheet

2.3 Process the 13 minutes

specimen and
 microscopic
examination

2.4 Release result 2 minutes

TOTAL: *Refer to 35 minutes

the
approved
schedule of
fees

Fecal Occult Blood

Detection of occult blood in a stool sample.

Office/Division: Department of Pathology and Laboratories – Clinical Microscopy

Classification: Simple
Type of Transaction: G2C
Who may avail: All Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Completely filled up laboratory request Attending Physician/Respective Wards
form (name, age/sex, hospital registration
number, date, ward, laboratory
examination desired and attending
physician).
2. Specimen Sample Patient
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit specimen 1. Receive None 5 minutes Laboratory
sample specimen Information
1.1 Inform the Clerk
patient/
representative on
claiming of result

2. Wait for the 2. Record in None6. 5 minutes Medical

laboratory result receiving logbook Technologist
2.1 Check-in the
specimen to LIS
and print
worksheet

2.4 Process the 3 minutes

specimen
 2.3 Validate and 2 minutes
Release result

TOTAL: *Refer to 15 minutes

the
approved
schedule of
fees

Filarial Blood Smear

This provides microscopic examination of blood for filaria diagnosis.

Office/Division: Department of Pathology and Laboratories – Clinical Microscopy

Classification: Simple
Type of Transaction: G2C
Who may avail: All Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Completely filled up laboratory request Attending Physician/Respective Wards
form (name, age/sex, hospital registration
number, date, ward, laboratory
examination desired and attending
physician).
2. Specimen Sample Patient
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit specimen 1. Receive None 5 minutes Laboratory
sample specimen Information
1.1 Inform the Clerk
patient/
representative on
claiming of result

2. Wait for the 2. Record in None 5 minutes Medical

laboratory result receiving logbook Technologist
2.1 Check-in the
specimen to LIS

2.3 Process the 45 minutes

specimen
 2.4 Validate and 35 minutes
Release result

TOTAL: *Refer to 1 hr and 30

the minutes
approved
schedule of
fees

Kidney Stone Analysis

Determination of chemical substances on a kidney stone.
Availability of Service: 7:00 am to 4:00 pm, Monday to Friday, except Holidays.

Office/Division: Department of Pathology and Laboratories – Clinical Microscopy

Classification: Simple
Type of Transaction: G2C
Who may avail: All Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Printed Official Request Form JICA LAB Receiving Counters 1 or 2
2. Specimen Sample Patient
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit specimen 1. Receive None 5 minutes Laboratory
sample specimen Information
1.1 Inform the Clerk
patient/
representative on
claiming of result

2. Wait for the 2. Record in None 5 minutes Medical

laboratory result receiving logbook Technologist

2.3 Process the 1 hr 40

specimen minutes

2.4 Validate and 10 minutes

Release result
 TOTAL: *Refer to 2 hrs
the
approved
schedule of
fees

Paragonimus Sputum Smear

Microscopic examination of Paragonimus eggs released by the flukes in the lungs.

Office/Division: Department of Pathology and Laboratories – Clinical Microscopy

Classification: Simple
Type of Transaction: G2C
Who may avail: All Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Completely filled up laboratory request Attending Physician/Respective Wards
form (name, age/sex, hospital registration
number, date, ward, laboratory
examination desired and attending
physician).
2. Specimen Sample Patient
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit specimen 1. Receive None 5 minutes Laboratory
sample specimen Information
1.1 Inform the Clerk
patient/
representative on
claiming of result

2. Wait for the 2. Record in None 5 minutes Medical

laboratory result receiving logbook Technologist
2.1 Check-in the
specimen to LIS
 2.5 Process the 15 minutes
specimen

2.3 Validate and 20 minutes

release result

TOTAL: *Refer to 45 minutes

the
approved
schedule of
fees

Pregnancy Test
Detection of human pregnancy hormone in urine specimen.

Office/Division: Department of Pathology and Laboratories – Clinical Microscopy

Classification: Simple
Type of Transaction: G2C
Who may avail: All Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Completely filled up laboratory request Attending Physician/Respective Wards
form (name, age/sex, hospital registration
number, date, ward, laboratory
examination desired and attending
physician).
2. Specimen Sample Patient
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit specimen 1. Receive None 5 minutes Laboratory
sample specimen Information
1.1 Inform the Clerk
patient/
representative on
claiming of result

2. Wait for the 2. Record in None 5 minutes Medical

laboratory result receiving logbook Technologist
2.1 Check-in the
specimen to LIS
 2.6 Process the 3 minutes
specimen

2.3 Validate and 2 minutes

release result

TOTAL: *Refer to 15 minutes

the
approved
schedule of
fees

Semen Analysis
Measures the quantity and quality of the seminal fluid and evaluates male fertility.

Office/Division: Department of Pathology and Laboratories – Clinical Microscopy

Classification: Simple
Type of Transaction: G2C
Who may avail: All Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Printed Official Request Form JICA LAB Receiving Counters 1 or 2
2. Specimen Sample Patient
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit specimen 1. Receive None 5 minutes Medical
sample specimen Technologist
1.1 Inform the
patient/
representative on
claiming of result

2. Wait for the 2. Record in None 5 minutes Medical

laboratory result receiving logbook Technologist
2.1 Check-in the
specimen to LIS

2.3 Process the 1 hr and 10

specimen minutes
 2.4 Validate and 10 minutes
Release result

TOTAL: *Refer to 1 hr and 30

the minutes
approved
schedule of
fees

Tape Peri-Anal Swab Smear

Detection of human pinworm infections.

Office/Division: Department of Pathology and Laboratories – Clinical Microscopy

Classification: Simple
Type of Transaction: G2C
Who may avail: All Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Completely filled up laboratory request Attending Physician/Respective Wards
form (name, age/sex, hospital registration
number, date, ward, laboratory
examination desired and attending
physician).
2. Specimen Sample Patient
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit specimen 1. Receive None 5 minutes Laboratory
sample specimen Information
1.1 Inform the Clerk
patient/
representative on
claiming of result

2. Wait for the 2. Record in None 5 minutes Medical

laboratory result receiving logbook Technologist
 2.1 Check-in the
specimen to LIS

2.3 Process the 5 minutes

specimen

2.4 Validate and 15 minutes

Release result

TOTAL: *Refer to 30 minutes

the
approved
schedule of
fees

Urinalysis
Examination of urine specimen to out-patients.
Availability of Service: 6:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Department of Pathology and Laboratories – Clinical Microscopy

Classification: Simple
Type of Transaction: G2C
Who may avail: All Patients - OPD
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Printed Official Request Form JICA LAB Receiving Counter 1 or 2
2. Specimen Sample Patient
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit specimen 1. Receive None 5 minutes Medical
sample specimen Technologist
1.1 Inform the
patient/
representative on
claiming of result

2. Wait for the 2. Record in None 15 minutes Medical

laboratory result receiving logbook Technologist
 2.1 Gross
assessment of the
specimen.
2.2 Check-in the
specimen to LIS
and prints the
barcode and
worksheet

2.3 Process the 20 minutes

specimen and
load to machine

2.4 Validate and 10 minutes

Release result

TOTAL: *Refer to 50 minutes

the *per batch of
approved 10 samples
schedule of
fees

Urinalysis
Examination of urine specimen to in-patients.

Office/Division: Department of Pathology and Laboratories – Clinical Microscopy

Classification: Simple
Type of Transaction: G2C
Who may avail: All Patients - IPD
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Completely filled up laboratory request Attending Physician/Respective Wards
form (name, age/sex, hospital registration
number, date, ward, laboratory
examination desired and attending
physician).
2. Specimen Sample Patient
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit specimen 1. Receive None 5 minutes Laboratory
sample specimen Information
1.1 Inform the Clerk
patient/
 representative on
claiming of result

5. Wait for the 2. Record in None 15 minutes Medical

laboratory result receiving logbook Technologist
2.1 Gross
assessment of the
specimen.
2.2 Check-in the
specimen to LIS
and print the
barcode and
worksheet

2.3 Process the 20 minutes

specimen

2.4 Validate and 10 minutes

Release result

TOTAL: *Refer to 50 minutes

the *per batch of
approved 10 samples
schedule of
fees

Urine Glucose, Ketone, Protein, pH and Specific Gravity

Measures the amount of specific chemical substance in urine specimen.

Office/Division: Department of Pathology and Laboratories – Clinical Microscopy

Classification: Simple
Type of Transaction: G2C
Who may avail: All Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Completely filled up laboratory request Attending Physician/Respective Wards
form (name, age/sex, hospital registration
number, date, ward, laboratory
examination desired and attending
physician).
2. Specimen Sample Patient
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit specimen 1. Receive None 5 minutes Laboratory
sample specimen Information
Clerk
 1.1 Inform the
patient/
representative on
claiming of result

2. Wait for the 2. Record in None 5 minutes Medical

laboratory result receiving logbook Technologist
2.1 Check-in the
specimen to LIS

2.2 Process the 3 minutes

specimen

2.3 Validate and 2 minutes

release result

TOTAL: *Refer to 15 minutes

the
approved
schedule of
fees

CLINICAL MICROSCOPY Schedule of Fees

CLINICAL MICROSCOPY
Urinalysis 110.00 APT’s Test 80.00
Urine Glucose 75.00 Body Fluids Cell/Diff Count 100.00
Urine Protein/Albumin 75.00 Fecalysis 60.00
Urine pH 20.00 Fecal Occult Blood 90.00
Urine Specific Gravity 25.00 Filarial Smear 240.00
Urine Ketone 75.00 Malarial Smear (BSMP) 100.00
Urine Bence Jones Protein 200.00 Pregnancy Test 155.00
Kidney Stone Analysis Semen Analysis
300.00 200.00
(Processing Fee)

Internal Services
Acceptance of Deliveries of Supplies and Reagents

Office/Division: Department of Pathology and Laboratories – Clinical Microscopy

Classification: Simple
Type of Transaction: G2B
Who may avail: Suppliers
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Sales Invoice (1 original) Supplier
2. Items or Products Supplier
3. Signed consignment requisition form (1 Medical Technologist Clinical Microscopy Staff
original)
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit all 1. Receive and None 5 minutes Medical
requirements validate Technologist
documents
2. Present the 2. Accept after None 15 minutes Medical
items/products checking, Technologist
validating and
counting of
items/products
2.1 Sign Sale
Invoice

TOTAL: *Refer to 20 minutes

the
approved
schedule of
fees

Affiliation Training (Internship)

Office/Division: Department of Pathology and Laboratories – Clinical Microscopy

Classification: Simple
Type of Transaction: G2B
Who may avail: Medical Technology Interns
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Daily Time Record As accomplished by trainee
2. Monthly completion (as necessary) As accomplished by trainee
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present 1. Verify the None 5 minutes Medical
requirements to submitted Technologist
Medical Technologist requirements are
staff on site complete
 1.2 Pre-orientation 30 minutes Clinical
on Standard Microscopy
Operating Training
Procedures Supervisor
1.3 Post- 30 minutes
orientation Clinical
1.4 Review on Microscopy
SOP Section Head
1.5 Discuss
Policies
2. Report to duty as 2. Facilitate on 2 weeks to 1 Medical
scheduled with training month Technologist
supervision
2.1 Proficiency Medical
assessment Technologist
Section Head
2.2 Authentication MLS
and approval of Coordinator
evaluation report
Chief Medtech
TOTAL: *Refer to 2 weeks to 1
the month
approved
schedule of
fees

Issuance of Laboratory Supplies

Provision of supplies (urine container, etc.) for Satellite Labs (ER, IWNH, CCI and HSSC)

Office/Division: Department of Pathology and Laboratories – Clinical Microscopy

Classification: Simple
Type of Transaction: G2G
Who may avail: Suppliers
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Record Monitoring Logbook Provided by Clinical Microscopy Section
2. Urine Container Provided by Clinical Microscopy Section
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Get supplies 1. Clinical None 5 minutes MTOD Clinical
Microscopy issues Microscopy
requested supply Staff
2. Record supplies 2. Log containers None 5minutes Laboratory Aide
taken taken in or
monitoring Medical
logbook Technologist
2.1 Sign logbook
noting
quantity/date of
request

TOTAL: *Refer to 10 minutes

the
approved
schedule of
fees

LIST OF SERVICES

Classification Type of Transaction

G2C G2B G2G
Highly
Services Simple Complex Gov’t Gov’t Gov’t
Technical
3 days 7 days to to to
20 days
Client Business Gov’t
External Services (in alphabetical order)
1. Collection of Blood samples
 
for different analysis
2. Issuance of Second Copy
 
of Results
3. Processing of MOA for
  
Confirmatory Drug Testing
4. Receiving /Processing and
Releasing of Results for   
Confirmatory Drug Testing
5. Receiving /Processing of
Laboratory Specimen and
 
Releasing of Laboratory
Results
6. Receiving of Urine Sample
for Confirmatory Drug   
Testing
7. Receiving/Processing and
Releasing for Screening  
Drug Testing
8. Scheduling of Drug Testing
for School Affiliates and   
Remote Collection
 Laboratory

HSSC Laboratory and Drug Testing Unit

External Services

Collection of Blood Samples

Collection of Blood samples for different analysis
Availability of Service: 7:00 am to 3:00 pm, Mondays to Fridays, except Holidays

Office/Division: Department of Pathology and Laboratories / HSSC Laboratory

Classification: Highly Technical
Type of Transaction: G2C
Who may avail: 1. Patients (Out-patient and Walk-In patients)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patient Information Card/ Yellow Card Encoder / Information Section
2. Official Receipt for paid transaction Cashier
3. Approved guarantee letter MAIP, LINGAP, OP and other charged
accounts
 CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. 1 Presents yellow 1.1 Receives Laboratory 1 minute Administrative
card to the laboratory yellow card Fees (Refer Aide
section to the /Laboratory
1.2 Verifies test as approved Aide
encoded in the schedule of
Hospital fees) 1 minute
Information
System

1.2 Submits proof of 1.3 Receives

payment and/or official receipt or 1 minute
approved guarantee approved
letter for charge guarantee letter
accounts. for charged
accounts

2 minutes
1.3 Prints
laboratory request
2. Wait to be called by 2.1 Verifies None 1 minutes Medical
Medical Technologists printed laboratory Technologist
on duty request.

2.2 Validate 1 minutes Medical

identification of Technologist
the client/patient.

2.3 Extract blood 5 minutes Medical

sample Technologist

2.4 Provide claim 1 minute

stub and inform Medical
the client when Technologist
the results will be
release
TOTAL: Refer to 13 minutes
approved
schedule
of fees

ISSUANCE OF SECOND COPY OF RESULTS

The purpose of such is to provide copies for lost results or file copy for company or
personal use.
Availability of Service: 7:00 am to 5:00 pm, Mondays to Fridays, except Holidays

Office/Division: Department of Pathology and Laboratories/HSSC Laboratory

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients (Out-patient and Walk-In patients)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patient Information Card/ Yellow Card Encoder / Information Section
2. Official Receipt for paid transaction Cashier
 CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Presents yellow 1.1 Receives 1 minute Administrative
card to the laboratory yellow card and Aide
section and request request for /Laboratory
for second copy of second copy. Clerk
specific results.
1.2 Verifies test
date as encoded
in the Hospital 2 minutes
Information
System

1.3 Issues charge

slip 1 minute
2. Presents Charge 2. Accepts 50.00 10 minutes Cashier
Slip and Pays to the payment and
Cashier issue an official
receipt

3. Presents Official 3.1 Receives 1 minute Administrative

Receipt Official Receipt Aide
/Laboratory
Clerk
3.2 Generates
Result from the 2 minutes Medical
HIS and/or result Technologist
logbook

3.3 Releases the Administrative

result 1 minute Aide/Laboratory
Clerk
TOTAL: 50.00 18 minutes

PROCESSING OF MOA FOR CONFIRMATORY DRUG TESTING

The purpose of such is to provide an agreement between screening and
confirmatory drug testing laboratory.
Availability of Service: 7:00 am to 5:00 pm, Mondays to Fridays, except Holidays

Office/Division: Department of Pathology and Laboratories/Drug Testing Section

Classification: HT
Type of Transaction: G2B; G2G
Who may avail: Accredited Drug Test Screening Laboratory
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
 1. Memorandum of Agreement- at least 3 Confirmatory Drug Testing Lab
sets
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1.Presents 1.1 Receives the NONE 1 minute Chemist
Memorandum of Memorandum of
Agreement Agreement

1.2 Inspects the

completeness
of information
including the 3 minutes
signatories

1.3 Instruct the

client to come
back or 2 minutes
contact the
laboratory
after 10
working days

Note :

Contact # (082)-
227-2731 local
4144
TOTAL: 5 minutes

Receiving/Processing and Releasing of Results for Confirmatory Drug Testing

Receiving/Processing of Urine Sample for Confirmatory Drug Testing for Methamphetamine
(METH/SHABU) and/or Tetrahydrocannabinol (THC/Marijuana) and Releasing Results.
Availability of Service: 7:00 am to 4:00 pm, Mondays to Fridays, except Holidays

Office/Division: Department of Pathology and Laboratories / Drug Testing Section

Classification: Highly Technical
Type of Transaction: G2B, G2G
Who may avail: Screening Drug Testing Laboratory duly accredited by DOH with
existing Memorandum of Agreement (MOA)
 CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Letter of Request IDTOMIS Generated from Screening
Laboratory
2. Custody and Control Form (DT-002D) Referring Screening Laboratory
3. Urine Sample (45-55 ml for single Referring Screening Laboratory
collection or 25-30 for split collection)
4. Official Receipt Cashier
5. Acknowledgement Receipt Confirmatory Drug Testing
6. Charge Slip Confirmatory Drug Testing
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Presents Letter of 1.1 Receives 2 minutes Chemist
Request and CCF - Letter of Request
002D and CCF-002D
and verifies the
completeness of
the information

2. Provides the urine 2.1 Receives the 2 minutes Chemist

Sample for Sample and
Confirmatory testing checks the
Packing and
Specimen
Condition
including the
volume of the
specimen

2.2 Attach a
checklist to the 2 minutes
document and
Designate a code
(YEAR – ###) for
each received
sample.

2.3 Record in the

Receiving 1minute
Logbook

2.4 Provide
Charge Slip for 1 minutes
payment
3. Presents Charge 3. Accepts 1,000.00 10 minutes Cashier
Slip and Pays to the payment and /metabolite
Cashier issue an official
receipt
4. Presents Official 4 Receives 2 minutes Chemist
Receipt Official Receipt
and inform client
on the availability
of results

4.1 Process the 5 working days Chemist

specimen

4.2 Validate and 1 working day Chemist

Interpret results

4.3 Receive and 1 working day Chemist

Release result via
the IDTOMIS
system
TOTAL: 1,000.00/ 7 days and 20
metabolite minutes
Receiving/Processing of Laboratory Specimen and Releasing of Laboratory
Results
Acceptance and processing of different specimen and Releasing of laboratory Results
Availability of Service: Receiving/Processing of Specimen 7:00 am to 4:00 pm, Releasing of
Laboratory Results: 7:00 am to 5:00 pm, Mondays to Fridays, except Holidays

Office/Division: Department of Pathology and Laboratories / HSSC Laboratory

Classification: Complex
Type of Transaction: G2C
Who may avail: Walk In Clients, Out Patient
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patient Information Card/Yellow Card Encoder/Information Section
2. Official Receipt for paid transaction Cashier
3. Approved guarantee letter MAIP, LINGAP, OP and other charged
accounts
4.Specimen/Sample Patient
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1.1 Presents yellow 1.1-2. Receives Refer to the 2 minutes Laboratory
card to the laboratory yellow card official approved Clerk/
section receipt or schedule of Administrative
approved fees Aide
1.2 Submits proof of guarantee letter
payment and/or for charged
approved guarantee accounts
letter for charge
accounts
1.3. Verifies and 2 minutes
prints laboratory
request

2.1 Proceed to Blood 2.1 Extract Blood 5 minutes Medical

Extraction Sample Technologist

2.2 Submits specimen 2.2 Receives 3 minutes Medical

(urine, stool, body specimen Technologist
fluids)

2.3 Accepts claim 2.3 Provide claim 1 minute Medical

stub stub Technologist

2.4 Segregate
sample for 5 minutes Medical
endorsement Technologist

Schedule of
Endorsement

1st – 9:30 am
2nd – 11:00 am
3rd – 1:00 pm
4th – 3:30 pm
Clinical
2.3 Process the Microscopy/
specimen in its Hematology/
respective section Immunology
and Serology:
Routine – 4
hours

Microbiology:
6 working days

Note :
Processing
time indicated
under normal
conditions,
also it may
vary to the
following
 cases for
difficult and
special
examinations
3. Presents claim stub 3. Receives claim None 2 minutes Laboratory
stub and release Clerk/Administr
results ative Aide
TOTAL: Refer to 4 hours and
the 20 minutes
approved
schedule
of fees

Receiving of Urine Sample for Confirmatory Drug Testing

Receiving of Urine Sample for Confirmatory Drug Testing for Methamphetamine (METH/SHABU)
and/or Tetrahydrocannabinol (THC/Marijuana)
Availability of Service: 7:00 am to 4:00 pm, Mondays to Fridays, except Holidays

Office/Division: Department of Pathology and Laboratories / Drug Testing Section

 Classification: Highly Technical
Type of Transaction: G2B; G2G
Who may avail: Screening Drug Testing Laboratory duly accredited by DOH with
existing Memorandum of Agreement (MOA)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Letter of Request IDTOMIS Generated from Screening
Laboratory
2. Custody and Control Form (DT-002D) Referring Screening Laboratory
3. Urine Sample (45-55 ml for single Referring Screening Laboratory
collection or 25-30 for split collection)
4. Official Receipt Cashier
5. Acknowledgement Receipt Confirmatory Drug Testing
6. Charge Slip Confirmatory Drug Testing
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Presents Letter of 1.1 Receives 2 minutes Chemist
Request and CCF - Letter of Request
002D and CCF-002D
and verifies the
completeness of
the information

2. Provides the urine 2.1 Receives the 2 minutes Chemist

Sample for Sample and
Confirmatory testing checks the
Packing and
Specimen
Condition
including the
volume of the
specimen

2.2 Attach a
checklist to the 2 minutes
document and
Designate a code
(YEAR – ###) for
each received
sample.

2.3 Record in the

Receiving 1minute
Logbook

2.4 Provide
Charge Slip for 1 minutes
payment
3. Presents Charge 3. Accepts 1,000.00 10 minutes Cashier
Slip and Pays to the payment and /metabolite
Cashier issue an official
receipt
4. Presents Official 4 Receives 1 minute Chemist
Receipt Official Receipt

4.1 Store sample

in the freezer and 1 minute Chemist
keep until
processed.
TOTAL: 1,000.00/ 20 minutes
metabolite
Receiving/Processing and Releasing of Results for Screening Drug Testing
Receiving/Processing of Urine Samples for Screening Drug Testing for Methamphetamine
(METH/SHABU) and/or Tetrahydrocannabinol (THC/Marijuana) and Releasing of Results.
Availability of Service: 7:00 am to 4:00 pm, Mondays to Fridays, except Holidays
Office/Division: Department of Pathology and Laboratories / Drug Testing Section
Classification: Highly Technical
Type of Transaction: G2C
Who may avail: Walk-in Clients, School Affiliates, Pre-employment Requirement,
Follow-up (After Care Clients)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Identification Card Client
2. Custody and Control Form (CCF) Screening Drug Testing Laboratory
3. Official Receipt Cashier
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Presents 1.1 Receives 1 minute Laboratory
Identification Card Official Receipt Clerk/Administr
and Official Receipt and provides CCF ative Clerk

1.2 Instructs client

to fill all checked 1 minute
items on the CCF

2. Submits CCF for 2.1 Receives CCF 1 minute Laboratory

encoding and instruct client Clerk/Administr
to wait for ative Clerk
encoding

2.2 Encodes
information,
capture photo and 5 minutes
biometric in the
IDTOMIS

2.3 Instruct client

to collect urine 2 minutes
sample

3. Submits for urine 3. 1 Provides 1 minute Authorized

collection specimen Specimen
container and Collector
provide
instructions

3.2 Observed 5 minutes

urine collection
– sample should
be at least 45 ml
4.1 Submits urine 4.1 Receives 2 minutes Laboratory
sample for sealing sample and ask Clerk
client to verify the
correctness of his
sample.
4.2 Acknowledge the 1minute
sample by fixing
his/her signature on
the specimen bottle

4.3 Fills the 4.3 Instruct to 3minutes

corresponding client fill the
number on the necessary
worksheet provided worksheet and
label the sample
with its unique
specimen code (
 YEAR-###), date
and time of
collection

4.4 Provide client 1 minute

4.4 Accepts claim with claim stub
stub and inform when
the results will be
released

4.5 Process 5 minutes Medical

Sample Technologist/Dr
For Negative ug Testing
Results – Analyst
Proceed to
Releasing

For Positive
Results –
Submit sample
to confirmatory
testing

4.6 Tag client data 1 hour

and release result
through the
IDTOMIS system

4.7 Record and

endorse result to 3 minutes
the Laboratory
Clerk

5. Presents Claim 5. Receives claim 2 minutes Laboratory

Stub stub and release Clerk/Administr
result ative Clerk
TOTAL: 2 hrs

Scheduling of Drug Testing for School Affiliates and Remote Collection

This is to facilitate scheduling of clients for drug testing
Availability of Service: 7:00 am to 5:00 pm, Mondays to Fridays, except Holidays
Office/Division: Department of Pathology and Laboratories/ Drug Testing Section
Classification: Simple
Type of Transaction: G2B; G2G
Who may avail: Government Offices; School Affiliates
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Letter of Request Address to the Client
Training Officer - School Affiliates ;
Chief of Hospital – Government Offices
(Remote Collection)
2. Official Receipt for paid transaction Cashier
3. Charge Slip Drug Testing Laboratory
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. 1 Presents Letter of 1.1 Receives 1 minute Administrative
request received and Letter of Request Aide
approved by specified /Laboratory
offices. Aide
1.2 Checks 1 minute
availability of
schedule

1.2 Wait for the 1.3 Provides

approval of the schedule for drug 1 minute
chosen schedule testing

1.4 Provides
charge slip for 1 minute
paid transaction
2. Pays to the Cashier 2. Receives 225.00 5 minutes Cashier
Payment
3. Presents Official 3.1 Receives 1 minute Laboratory
Receipt Official Receipt Clerk/
Administrative
3.2 Blocks the Aide
schedule and 1 minute
provides
instructions
TOTAL: 225.00 13 minutes

LIST OF SERVICES
Classification Type of Transaction
G2C G2B G2G
Highly Gov’t Gov’t Gov’t
Services Simple Complex
Technical
2 hrs. 7 days to to to
20 days
Client Business Gov’t
External Services (in alphabetical order)
1. Clinical Chemistry
[Albumin (serum/body fluids),
ALT, Amylase, AST, BUN,
Calcium Ca++ (Serum/ urine),
Chloride(serum/ urine),
Glucose, Hemoglobin A1c,  
Lactic Dehydrogenase,
Magnesium, Potassium
(serum/urine), Sodium
(serum/urine), Serum Uric
Acid.]
2. Clinical Microscopy
[APTS test, Blood Smear for
Malaria Parasite, Filaria  
Smear, Urinalysis, Fecalysis,
Occult Blood, Pregnancy test]
 3. Hematology
 [ABO & Rh Blood typing,
APTT, Clotting
time/Bleeding time,
 
Complete Blood Count,
Erythrocyte Sedimentation
Rate, Prothrombin Time]

4. Immunology/Serology
 Qualitative tests [ASO, C
Reactive Protein,
C3Dengue Rapid, HBsAg,
H. Pylori, Rheumatoid
 
Factor,
Syphilis]
 Quantitative [CK- MB, C
Reactive Protein, Troponin
I]
5. Peripheral Blood Smear – 

COLLECTION ONLY
Internal Services (in alphabetical order)
1. Acceptance of deliveries of
supplies and reagent (General  
Supplies and Reagents)
2. Acceptance of deliveries of
supplies and reagent
 
(Consignment Reagents and
supplies)
3. Affiliation Training (Internship)
 

4. Test for Processing in

General Laboratory:
 Clinical Chemistry Section
[Lithium, Phosphorus,  
Total Protein (serum/ body
fluids)]

5. Test referral to General

Laboratory:
 Immunology/Serology
Section (Quantitative)
[Beta HCG, Hepatitis  
Profile (Anti-HBs, HBsAg,
Hepatitis A IgG/ IgM,
Hepatitis C), Thyroid
Function Test]
 Laboratory

Emergency Department Laboratory

External Services

Processing of Specimen for Clinical Chemistry (Emergency Department

Satellite Laboratory)
Availability of Service: 6:00 am to 6:00 am (24 hours service), Monday to Sunday.
Office/Division: Department of Pathology and Laboratories – Emergency Dept.
Satellite Laboratory
Classification: Simple
Type of Transaction: G2C
Who may avail: All Patients -Emergency Department
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. HIS Encoded Clinical Chemistry request Attending Physician
2. Small paper with patient’s Health Attending Physician/Nurse
Record Number [HRN]- (If tests are not
EHR encoded)
3. Printed Laboratory Request from HIS Emergency Laboratory Receiving Clerk
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit paper with 1. Print all Clinical None 2minutes E.D. Laboratory
patient’s Health Chemistry test/s receiving clerk
Record Number encoded in HIS
[HRN] Emergency and give to
Laboratory receiving Phlebotomist
clerk
2. Wait for the 2. Collect blood None 25 minutes E.D.
Phlebotomist for blood samples base on Phlebotomist/
sample extraction. printed Clinician’s (*Receiving
HIS encoded clerk)
request.
2.1* Encode in
HIS all requests
with samples.
2.1 Submit urine or 2.1 Received None 5 minutes E.D. Laboratory
body fluid samples for body fluid sample receiving clerk
Clinical Chemistry and encode in the
examination. HIS.
2.2 * Inform the
patient/representa
tive the
schedule/time of
claiming of results
2.3 Processing of None 90 minutes MTOD
specimens for (Emergency
Clinical Laboratory
Chemistry, Clinical Chem.
validate results Section)
and release to
HIS.
3. Claim results. 3. Print the None 3minutes E.D. Laboratory
complete Clinical receiving clerk
Chem. results and
release to patient
or representative.

TOTAL: ** Refer to 2 hours

approved
Schedule
of fees

Emergency Dept. Laboratory: Schedule of Fees

** Payment upon discharge of patient from Emergency Department.
Processing of Specimen for Clinical Microscopy (Emergency Department
Satellite Laboratory)
Availability of Service: 6:00 am to 6:00 am (24 hours service), Monday to Sunday.

Office/Division: Department of Pathology and Laboratories – Emergency Dept.

Satellite Laboratory
Classification: Simple
Type of Transaction: G2C
Who may avail: All Patients -Emergency Department
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. HIS Encoded Clinical Chemistry request Attending Physician/Nurse
2. Small paper patient’s Health Record Attending Physician/Nurse
Number [HRN]- (If tests are not EHR
encoded)
3. Printed Laboratory Request from HIS Emergency Laboratory Receiving Clerk
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Patient/ 1. Print request of None 5 minutes E.D. Laboratory
representative submit Clinical receiving clerk
paper with patient’s Microscopy[e.g.
Health Record BSMP, Filarial
Number [HRN] to smear] in HIS and
Emergency give to
Laboratory receiving Phlebotomist for
clerk collection of blood
sample for smear
preparation
1.1Give the
printedrequest
together with the
specimen
container to the
Patient or
representative of
the following tests:
Fecalysis, Occult
Blood,
Pregnancy test
and Urinalysis
1.2 Instruct patient
or representative
of the proper
collection and
volume of the
specimen.
2. Submit sample 2. Check the None 5 minutes E.D. Laboratory
together with the request and receiving clerk
request sample
(urine/stool),receiv
e if acceptable.
2.1 Check the
volume and label
of body fluid
samples. Check
the correctness
and completeness
of request for the
required data.
2.3 Inform the
patient/representa
tive the
schedule/time of
claiming of results
2.4 Collect the None 20 minutes E.D.
blood sample for Phlebotomist
 blood smear
preparation
2.5 Processing of None 90 minutes MTOD
specimens for (Emergency
Clinical Laboratory
Microscopy, Clinical
validate results Microscopy.
and release Section)
toHIS.
3.Claim results. 3. Print the None 5 minutes E.D. Laboratory
complete Clin. receiving clerk
Microscopy
results and
release to patient
or representative.
TOTAL: ** Refer to 2 hours
approved
Schedule
of fees

Emergency Dept. Laboratory: Schedule of Fees

**payment upon discharge of patient from Emergency Department.
Processing of Specimen for Hematology (Emergency Department Satellite
Laboratory)
Availability of Service: 6:00 am to 6:00 am (24 hours service), Monday to Sunday.

Office/Division: Department of Pathology and Laboratories – Emergency Dept.

Satellite Laboratory
Classification: Simple
Type of Transaction: G2C
Who may avail: All Patients -Emergency Department
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. HIS Encoded Clinical Chemistry request Attending Physician
2. Small paper with patient’s Health Attending Physician/Nurse
Record Number [HRN]- (If tests are not
EHR encoded)
3. Printed Laboratory Request from HIS Emergency Laboratory Receiving Clerk
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit paper with 1. Print all None 2minutes E.D. Laboratory
patient’s Health Hematology test/s receiving clerk
Record Number requests encoded
[HRN] to Emergency in HIS and give to
Laboratory receiving Phlebotomist
clerk
2.Wait for 2.Collect blood None 25 minutes E.D. Laboratory
Phlebotomist for blood samples base on Phlebotomist or
sample extraction. printed Clinician’s (*Receiving
HIS encoded clerk)
request.
2.1* Encode in
HIS all requests
with samples.
2.2 * Inform the
patient/representa
tive the
schedule/time of
claiming of results
2.3 Processing of None 90 minutes MTOD
specimens for (Emergency
Hematology, Laboratory
validate results HematologySec
and release to tion)
HIS.
3.Claim results. 3. Print the None 3minutes E.D. Laboratory
complete receiving clerk
Hematology
results and
release to patient
or representative.
TOTAL: ** Refer to 2 hours
approved
Schedule
of fees

Emergency Dept. Laboratory: Schedule of Fees

**payment upon discharge of patient from Emergency Department.
Processing of Specimen for Immunology/Serology (Emergency Department
Satellite Laboratory)
Availability of Service: 6:00 am to 6:00 am (24 hours service), Monday to Sunday.

Office/Division: Department of Pathology and Laboratories – Emergency Dept.

Satellite Laboratory
Classification: Simple
Type of Transaction: G2C
Who may avail: All Patients -Emergency Department
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. HIS Encoded Clinical Chemistry request Attending Physician
2. Small paper patient’s Health Record Attending Physician/Nurse
Number [HRN]- (If tests are not EHR
encoded)
3. Printed Laboratory Request from HIS Emergency Laboratory Receiving Clerk
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit paper 1. Print all None 2minutes E.D. Laboratory
patient’s Health Hematology test/s receiving clerk
Record Number requests encoded
[HRN] to Emergency in HIS and give to
Laboratory receiving Phlebotomist
clerk
2.Wait for 2.Collect blood None 25 minutes E.D. Laboratory
Phlebotomist for blood samples base on Phlebotomist or
sample extraction. printed Clinician’s (*Receiving
HIS encoded clerk)
request.
2.1* Encode in
HIS all requests
with samples.
2.2 * Inform the
patient/representa
tive the
schedule/time of
claiming of results
2.3 Processing of None 90 minutes MTOD
specimens for (Emergency
Immunology/Serol Laboratory
ogy,validate Immuno/SeroS
results and ection)
release to HIS.
3.Claim results. 3. Print the None 3minutes E.D. Laboratory
complete receiving clerk
Hematology
results and
release to patient
or representative.
TOTAL: ** Refer to 2 hours
approved
Schedule
of fees

Emergency Dept. Laboratory: Schedule of Fees

**payment upon discharge of patient from Emergency Department.
Peripheral Blood Smear- COLLECTION ONLY (Emergency Department
Satellite Laboratory)
Availability of Service: 6:00 am to 6:00 am (24 hours service), Monday to Sunday.

Office/Division: Department of Pathology and Laboratories – E.D. Laboratory

Classification: Simple
Type of Transaction: G2C
Who may avail: All Patients -Emergency Department
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. HIS Encoded request for PBS Attending Physician
2. Complete PBS Referral form with CBC Attending Physician
results
3. Printed PBS / * Manual PBS request Emergency Laboratory Receiving Clerk /
*Attending Physician
AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit paper with 1. Print the PBS None 5minutes E.D. Laboratory
Patient’s HRN request encoded receiving clerk
together with the in HIS then attach
Complete PBS the complete
referral to Emergency referral form and
Laboratory receiving give to
clerk Phlebotomist for
specimen
1.1 Submit Manual collection.
PBS request together 1.1 Receive the
with complete referral Manual PBS
to Emergency request with
Laboratory receiving attached complete
referral form and
give to
Phlebotomist for
specimen
collection.
2. Wait for 2.Collect and None 25 minutes E.D.
Phlebotomist for prepare Phlebotomist
specimen collection. Peripheral Blood
Smear.
2.2 Instruct the
patient’s
representative to
submit the
specimen to
Histopathology
Section (JICA
WINDOW-4)
TOTAL: ** Refer to 30 minutes
approved
Schedule
of fees

Emergency Dept. Laboratory: Schedule of Fees

** Payment upon discharge of patient from Emergency Department.
 Laboratory

Emergency Department Laboratory

Internal Services
Acceptance of Laboratory Supplies and reagents
Receiving of General supplies and reagents for Emergency Department Satellite Laboratory
Office/Division: Department of Pathology and Laboratories – Emergency Dept.
Satellite Laboratory
Classification: Simple
Type of Transaction: G2G
Who may avail: Emergency Satellite Laboratory
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Stockroom Requisition Slip (SPMC-F- Hospital General Requisition Form Printing
LAB-GF-005) Section
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Emergency Dept. 1. General Lab. none 1 hours General
Laboratory Stockroom Laboratory
Stockroom- In- charge custodian receive Stockroom
submits the and prepare the Custodian
requisition slip to requested
General Lab. supplies and
Stockroom custodian reagents
2. Record the 2. Log all the None 30 minutes Emergency
received supplies and received supplies Dept. Lab.
reagents and reagents in Stockroom
their respective Custodian
Supply’s/
Reagent’s
monitoring stock
card.
TOTAL: 1 hour and 30
minutes
Acceptance of Laboratory Supplies and reagents
Receiving of Consignment supplies and reagents for Emergency Department Satellite Laboratory
Office/Division: Department of Pathology and Laboratories – Emergency Dept.
Satellite Laboratory
Classification: Simple
Type of Transaction: G2B
Who may avail: Emergency Satellite Laboratory
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Consignment Reagent Requisition Form Emergency Department Satellite Laboratory
(SPMC-F-LAB-GF-014) Chemistry and Serology Section
2.
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Pick up the 1. Prepare and none 10 minutes Emergency
Consignment Reagent Print Consignment Dept. Lab.
Requisition Form Reagent Clinical Chem.
Requisition Form or immune/Sero
1.1 Print the RIS Senior MTOD
for requested
consignment
reagents and
supplies then
submit to MMS
2. Delivers the 2. Receive and None 60 minutes Emergency
requested record in their Dept. Lab.
consignment reagents respective reagent Clinical Chem.
and supplies log sheet and or immune/Sero
stock card. MTOD

TOTAL: 1 hour and 10

minutes
Affiliation Training (Internship)
Office/Division: Department of Pathology and Laboratories – Emergency Dept.
Laboratory
Classification: Highly Technical
Type of Transaction: G2B
Who may avail: All Bachelor of Medical Laboratory Science/Medical Technology
Interns- Emergency Dept. Laboratory
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Schedule of BLS/Medical Technology Clinical Instructor/Affiliated School
Interns assigned in Emergency Dept. Representative
Laboratory
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit the printed 1. Receives and none 1 week to Emergency
schedule of post the schedule 1 month Dept. Lab.
BLS/Medical of duties of (depends on Section
Technology Interns BLS/Medical the School’s Head/interns
Technology Scheduled coordinator
interns contract)
1.1 Conducts the
orientation of
BLS/Med. Tech.
Interns on the
Emergency Dept.
Laboratory
Protocol and
SOP.
1.2 Let the
affiliates/interns
immerse in their
respective
assignment
section reflected
in the schedule.
2. Submit Individual 2. Evaluate and None 30 minutes Emergency
Intern’s Performance rate individual Dept. Lab.
Evaluation Form intern’s MTOD
performance base
on the given
Evaluation Form
Criteria.
TOTAL: 1 week to
1 month
(depends on
the School’s
Scheduled
contract)
Test for Processing in General Laboratory
Clinical Chemistry Tests (those are not available in Emergency Department Laboratory.)
Availability of Service: 6:00 am to 6:00 am (24 hours service), Monday to Sunday.
Office/Division: Department of Pathology and Laboratories – Emergency Dept.
Laboratory
Classification: Simple
Type of Transaction: G2G
Who may avail: All patients-Emergency Department Laboratory
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. HIS Encoded Clinical Chemistry request Attending Physician
2. Small paper with patient’s Health Attending Physician/Nurse
Record Number [HRN]- (If tests are not
EHR encoded)
3. Printed Laboratory Request from HIS Emergency Laboratory Receiving Clerk
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit paper with 1. Print all Clinical none 2 minutes E.D. Laboratory
Patient’s Health Chemistry test/s receiving clerk
Record Number encoded in HIS
[HRN] to Emergency and give to
Dept. Laboratory Phlebotomist
receiving clerk
2. Wait for the 2. 2. Collect blood None 25 minutes E.D. Laboratory
Phlebotomist for blood sample base on Phlebotomist/
sample extraction. printed Clinician’s (*Receiving
HIS encoded clerk)
request.
2.1* Encode in
HIS all requests
with samples.
2.2 * Inform the
patient/
representative on
the schedule/time
of claiming of
results
2.3 Prepare the None 90 minutes MTOD- Clinical
Specimen to be Chem.
process in Clinical (E.D.
Chem. - General Laboratory-
Laboratory staff)
2.4 Processing of
specimen in
Clinical Chem.
General
Laboratory,
validates and
releases result to
HIS.
3. Claim results. 3. Print the None 3 minutes E.D. Laboratory
Clinical Chem. receiving clerk
results and
release to
patient/representa
tive.
TOTAL: ** Refer to 2 hours
approved
Schedule
of fees
Emergency Dept. Laboratory: Schedule of Fees
** Payment upon discharge of patient from Emergency Department.

Test for Referral to General Laboratory

Immunology/Serology Tests (those are not available in Emergency Department Laboratory)
Availability of Service: 6:00 am to 6:00 am (24 hours service), Monday to Sunday.
Office/Division: Department of Pathology and Laboratories – Emergency Dept.
Laboratory
Classification: Simple
Type of Transaction: G2G
Who may avail: All patients-Emergency Department Laboratory
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. HIS Encoded Immuno/Sero Test/s Attending Physician
request.
2. Small paper with patient’s Health Attending Physician/Nurse
Record Number [HRN]- (If tests are not
EHR encoded)
3. Printed Laboratory Request from HIS Emergency Laboratory Receiving Clerk
4. Two copies of printed Job Immunology/Serology Section-Emergency
orders/Worksheets with the name of the Dept. Laboratory
patient and the Immunology/Serology
test/s for referral to General Laboratory
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit paper with 1. Print all Clinical none 2 minutes E.D. Laboratory
patient’s Health Immuno/Sero receiving clerk
Record Number test/s encoded in
[HRN] to Emergency HIS and give to
Laboratory receiving Phlebotomist
clerk
2. Wait for the 2. 2. Collect blood None 20 minutes E.D. Laboratory
Phlebotomist for blood sample base on Phlebotomist/
sample extraction. printed Clinician’s (*Receiving
HIS encoded clerk)
request.
2.1* Encode in
HIS all requests
with samples.
2.2 * Inform the
patient/
representative on
the schedule/time
of claiming of
results
2.3 Prepare and None 5 minutes MTOD- Clinical
endorse the Chem.
Specimen and the (E.D.
Worksheet of the Laboratory-
test/s for referral staff)
to Immuno/Sero -
General
Laboratory
2.4 Processing of None 4 hours MTOD Immuno/
specimen in Serology-
Immuno/Sero - (General
General Laboratory-
Laboratory, staff)
validates and
releases result to
HIS.
3. Claim Results. 3. Print the None 3 minutes E.D. Laboratory
Immuno/Sero receiving clerk
results of the
 test/s referred to
General
Laboratory and
release to patient
or representative.
TOTAL: ** Refer to 4 hours and
approved 30 minutes
Schedule
of fees

Emergency Dept. Laboratory: Schedule of Fees

** Payment upon discharge of patient from Emergency Department.

LIST OF SERVICES
Classification Type of Transaction
G2C G2B G2G
Highly
Services Simple Complex Gov’t Gov’t Gov’t
Technical
3 days 7 days to to to
20 days
Client Business Gov’t
External Services (in alphabetical order)
1A. Hematology Tests – Out-  
Patient  
ABO, Rh Blood Typing; 
Activated Partial
 
Thromboplastin Time
 
(APTT); APTT Mixing;
 
Bleeding – Clotting Time
(CT/BT);  
Complete Blood Counts  
(CBC);  
Du Variant Typing;  
Erythrocytes Sedimentation  
Rate (ESR);  
Hematocrit, Hemoglobin,
Platelets (HHP)
Hemoglobin, Hematocrit
(HH);
Platelet count;  
Prothrombin Time (PT);
Reticulocytes Count;
Toxic Granules
1B. Hematology Tests – In-Patient  
ABO, Rh Blood Typing;  
Activated Partial 
Thromboplastin Time
 
(APTT); APTT Mixing;
 
Bleeding – Clotting Time
 
(CT/BT);
Complete Blood Counts  
(CBC);  
Du Variant Typing;  
Erythrocytes Sedimentation  
Rate (ESR);  
Hematocrit, Hemoglobin,  
Platelets (HHP)  
Hemoglobin, Hematocrit  
(HH);
Platelet count;
Prothrombin Time (PT);
Reticulocytes Count;  
Serial Hematology Testing;
Toxic Granules;
 White Blood Cells
Differential Smear Staining;

Internal Services (in alphabetical order)

6. Acceptance of deliveries of
 
supplies and reagent
7. Affiliation Process
 
(Internship)
8. Evaluation of Products and
  
Supplies
9. Evaluation of Hematology
 
Equipment
10. Issuance of laboratory
 
supplies to designated units
11. Issuance of Monthly-Annual
 
Report
 Laboratory

Hematology

External Services
1A. Hematology Tests - Out -Patient

ABO, Rh TYPING, ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT),

APTT MIXING, BLEEDING – CLOTTING TIME (CT/BT), COMPLETE BLOOD COUNTS
(CBC), DU VARIANT TYPING, ERYTHROCYTES SEDIMENTATION RATE (ESR),
HEMATOCRIT, HEMOGLOBIN, PLATELETS (HHP), HEMOGLOBIN, HEMATOCRIT(HH),
PLATELETS COUNT, PROTHROMBIN TIME (PT),
RETICULOCYTES COUNT, TOXIC GRANULES

Availability of Service: OPD – 6: 00 AM – 6:00 PM Monday to Friday, except Holidays

Office/Division: Department of Pathology and Laboratories – Hematology Section

Classification: Simple
Type of G2C
Transaction:
Who may avail: All Out - Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Fully accomplished Hematology request Attending Physician
form
2. Appropriately labeled specimen Attending Physician, Phlebotomist
3. Yellow Card (OPD) HIMD
4. Official Receipt for paid laboratory Cashier
procedure
 For claiming of results (official claim Patient/ Authorized Individual
stub)
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Present Yellow 1. Accept and check None 5 minutes Laboratory
card and other requirements Reception Clerk
requirements to 1.1 No payment
JICA-LAB window 1 proceeds to Step 3
1.2 With payment;
Instruct patient or
representative to
settle payment at
the Cashier (Step 2)
2.Settle Hematology 2. Refer to Finance Refer to Refer to Cashier
request payments at Division: approved Finance (Refer to
the cashier. Refer to Accept payment for list of fees Division (10 Finance
Finance division the processing of minutes) Division)
scheme test.
3.Get Priority number 3. Checks official None 5 minutes Laboratory
and claim stub at receipt or other Reception Clerk
JICA-LAB Window 1 documents of proof
of payment
3.1 Print official
request and claim
stub and issue
priority number.
3.2 Instruct client to
proceed to Patient
Extraction Area
4. Blood Collection at 4. Check priority None 15 minutes Phlebotomist
Patient Extraction number and advise
Area client to stay at
waiting area.
4.1 Call client name None 5 minutes Phlebotomist
and verify identity
before blood
collection
4.2 Collect blood
specimen and label
tube sample
4.3 Inform client on
how to claim official
result at JICA LAB -
Window 3
4.3 Generate none 1 hour Medical
barcode and Technologist
endorse sample to
Hematology section
4.4 Process test
request
5. Claim Results 5. Ask for claim stub None 2 minutes Laboratory
and print official Reception Clerk
result (Official
results can be view
at LIS/HIS.)
5.1 Duplicate or
second copy
printing
TOTAL: 1 hour and 42
minutes

HEMATOLOGY- Schedule of Fees

SOCIALIZED NON-SOCIALIZED
ABO, RH Blood Typing 80.00 APTT 400.00
Bleeding & Clotting Time (CT/BT) 50.00 APTT with Mixing 800.00
Complete Blood Count 130.00 Prothrombin Time (PT) 240.00
Du Variant Typing 180.00
Erythrocyte Sedimentation Rate (ESR) 100.00
Hematocrit+Hemoglobin+Platelets 130.00
Hematocrit + Hemoglobin 130.00
Platelets count 130.00
Reticulocyte count 100.00
Toxic Granules 180.00
1B. Hematology Test – In-patient

ABO, Rh TYPING, ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT),

APTT MIXING, BLEEDING – CLOTTING TIME (CT/BT),
COMPLETE BLOOD COUNTS (CBC), DU VARIANT TYPING,
ERYTHROCYTES SEDIMENTATION RATE (ESR), HEMATOCRIT, HEMOGLOBIN,
PLATELETS (HHP), HEMOGLOBIN, HEMATOCRIT (HH), PLATELETS COUNT,
PROTHROMBIN TIME (PT), RETICULOCYTES COUNT,
SERIAL HEMATOLOGY REQUEST (Q12, Q8, Q6), TOXIC GRANULES,
WHITE BLOOD CELLS DIFFERENTIAL SMEAR STAINING

Availability of Service: IPD – 24 hours Daily

Office/Division: Department of Pathology and Laboratories – Hematology Section

Classification: Simple
Type of G2C
Transaction:
Who may avail: Admitted Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Fully accomplished Hematology request Attending Physician
form
2. Appropriately labeled specimen Attending Physician, Phlebotomist
3. PHIC card Billing section
4. Official Receipt for paid laboratory Cashier
procedure

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Present 1. Accept, check None 5 minutes Laboratory
Hematology request requirements and Reception Clerk
form and blood encode request to HIS.
specimen (optional) 1.1 Inform client about
and PHIC card to the test and result
JICA-LAB window 2 procedures
1.2 Receipt of testing
request with
specimen, proceed to
step 1.4
1.2.1Receipt of test
request only endorse
to Phlebotomist for
blood sample
collection.
1.3 Collection of blood 15 minutes Phlebotomist
specimen
1.3.1 Endorsement of
blood specimen tube/s 10 minutes Nurse
collected with request (Refer to Nurse
form to nurse station. Station
1.3.2 Nurse station Protocol)
submit blood specimen
and request forms to
 lab. via Pneumatic
tube system
1.4 Receipt of none 5 minutes Laboratory
specimen in the Reception Clerk
laboratory following the
(Accept/ Reject
Protocol)
1.4.1 Accept endorse
for barcoding

1.5 Processing of 1 hour Medical

barcoded specimen Technologist
with request
1.6 Validation and None 5 minutes Medical
Releasing of test result Technologist
in LIS / HIS

2. Claim Result 2. View result at HIS none Attending

Physician
TOTAL: 1 hour and 40
minutes

HEMATOLOGY- Schedule of Fees

SOCIALIZED NON-SOCIALIZED
ABO, RH Blood Typing 80.00 APTT 400.00
Bleeding & Clotting Time (CT/BT) 50.00 APTT with Mixing 800.00
Complete Blood Count 130.00 Prothrombin Time (PT) 240.00
Du Variant Typing 180.00
Erythrocyte Sedimentation Rate (ESR) 100.00
Hematocrit+Hemoglobin+Platelets 130.00
Hematocrit + Hemoglobin 130.00
Platelets count 130.00
Reticulocyte count 100.00
Serial Q12 (2 takes) 260.00
Serial Q 8 (3 takes) 390.00
Serial Q 6 (4takes) 520.00
Toxic Granules 180.00
WBC Differential Smear count 90.00
WBC Differential Smear Staining 20.00
1A. Hematology Tests - Out -Patient

ABO, Rh TYPING, ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT),

APTT MIXING, BLEEDING – CLOTTING TIME (CT/BT), COMPLETE BLOOD COUNTS
(CBC), DU VARIANT TYPING, ERYTHROCYTES SEDIMENTATION RATE (ESR),
HEMATOCRIT, HEMOGLOBIN, PLATELETS (HHP), HEMOGLOBIN, HEMATOCRIT(HH),
PLATELETS COUNT, PROTHROMBIN TIME (PT),
RETICULOCYTES COUNT, TOXIC GRANULES

Availability of Service: OPD – 6: 00 AM – 6:00 PM Monday to Friday, except Holidays

Office/Division: Department of Pathology and Laboratories – Hematology Section

Classification: Simple
Type of G2C
Transaction:
Who may avail: All Out - Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Fully accomplished Hematology request Attending Physician
form
2. Appropriately labeled specimen Attending Physician, Phlebotomist
3. Yellow Card (OPD) HIMD
4. Official Receipt for paid laboratory Cashier
procedure
 For claiming of results (official claim Patient/ Authorized Individual
stub)
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Present Yellow 1. Accept and check None 5 minutes Laboratory
card and other requirements Reception Clerk
requirements to 1.1 No payment
JICA-LAB window 1 proceeds to Step 3
1.2 With payment;
Instruct patient or
representative to
settle payment at
the Cashier (Step 2)
2.Settle Hematology 2. Refer to Finance Refer to Refer to Cashier
request payments at Division: approved Finance (Refer to
the cashier. Refer to Accept payment for list of fees Division (10 Finance
Finance division the processing of minutes) Division)
scheme test.
3.Get Priority number 3. Checks official None 5 minutes Laboratory
and claim stub at receipt or other Reception Clerk
JICA-LAB Window 1 documents of proof
of payment
3.1 Print official
request and claim
stub and issue
priority number.
 3.2 Instruct client to
proceed to Patient
Extraction Area

4. Blood Collection at 4. Check priority None 15 minutes Phlebotomist

Patient Extraction number and advise
Area client to stay at
waiting area.
4.1 Call client name None 5 minutes Phlebotomist
and verify identity
before blood
collection
4.2 Collect blood
specimen and label
tube sample
4.3 Inform client on
how to claim official
result at JICA LAB -
Window 3
4.3 Generate none 1 hour Medical
barcode and Technologist
endorse sample to
Hematology section
4.4 Process test
request
5. Claim Results 5. Ask for claim stub None 2 minutes Laboratory
and print official Reception Clerk
result (Official
results can be view
at LIS/HIS.)
5.1 Duplicate or
second copy
printing
TOTAL: 1 hour and 42
minutes

HEMATOLOGY- Schedule of Fees

SOCIALIZED NON-SOCIALIZED
ABO, RH Blood Typing 80.00 APTT 400.00
Bleeding & Clotting Time (CT/BT) 50.00 APTT with Mixing 800.00
Complete Blood Count 130.00 Prothrombin Time (PT) 240.00
Du Variant Typing 180.00
Erythrocyte Sedimentation Rate (ESR) 100.00
Hematocrit+Hemoglobin+Platelets 130.00
Hematocrit + Hemoglobin 130.00
Platelets count 130.00
Reticulocyte count 100.00
Toxic Granules 180.00
1B. Hematology Test – In-patient

ABO, Rh TYPING, ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT),

APTT MIXING, BLEEDING – CLOTTING TIME (CT/BT),
COMPLETE BLOOD COUNTS (CBC), DU VARIANT TYPING,
ERYTHROCYTES SEDIMENTATION RATE (ESR), HEMATOCRIT, HEMOGLOBIN,
PLATELETS (HHP), HEMOGLOBIN, HEMATOCRIT (HH), PLATELETS COUNT,
PROTHROMBIN TIME (PT), RETICULOCYTES COUNT,
SERIAL HEMATOLOGY REQUEST (Q12, Q8, Q6), TOXIC GRANULES,
WHITE BLOOD CELLS DIFFERENTIAL SMEAR STAINING

Availability of Service: IPD – 24 hours Daily

Office/Division: Department of Pathology and Laboratories – Hematology Section

Classification: Simple
Type of G2C
Transaction:
Who may avail: Admitted Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Fully accomplished Hematology request Attending Physician
form
2. Appropriately labeled specimen Attending Physician, Phlebotomist
3. PHIC card Billing section
4. Official Receipt for paid laboratory Cashier
procedure

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Present 1. Accept, check None 5 minutes Laboratory
Hematology request requirements and Reception Clerk
form and blood encode request to HIS.
specimen (optional) 1.1 Inform client about
and PHIC card to the test and result
JICA-LAB window 2 procedures
1.2 Receipt of testing
request with
specimen, proceed to
step 1.4
1.2.1Receipt of test
request only endorse
to Phlebotomist for
blood sample
collection.
1.3 Collection of blood 15 minutes Phlebotomist
specimen
1.3.1 Endorsement of
blood specimen tube/s 10 minutes Nurse
 collected with request (Refer to Nurse
form to nurse station. Station
1.3.2 Nurse station Protocol)
submit blood specimen
and request forms to
lab. via Pneumatic
tube system
1.4 Receipt of none 5 minutes Laboratory
specimen in the Reception Clerk
laboratory following the
(Accept/ Reject
Protocol)
1.4.1 Accept endorse
for barcoding

1.5 Processing of 1 hour Medical

barcoded specimen Technologist
with request
1.6 Validation and None 5 minutes Medical
Releasing of test result Technologist
in LIS / HIS

2. Claim Result 2. View result at HIS none Attending

Physician
TOTAL: 1 hour and 40
minutes

HEMATOLOGY- Schedule of Fees

SOCIALIZED NON-SOCIALIZED
ABO, RH Blood Typing 80.00 APTT 400.00
Bleeding & Clotting Time (CT/BT) 50.00 APTT with Mixing 800.00
Complete Blood Count 130.00 Prothrombin Time (PT) 240.00
Du Variant Typing 180.00
Erythrocyte Sedimentation Rate (ESR) 100.00
Hematocrit+Hemoglobin+Platelets 130.00
Hematocrit + Hemoglobin 130.00
Platelets count 130.00
Reticulocyte count 100.00
Serial Q12 (2 takes) 260.00
Serial Q 8 (3 takes) 390.00
Serial Q 6 (4takes) 520.00
Toxic Granules 180.00
WBC Differential Smear count 90.00
WBC Differential Smear Staining 20.00
 Laboratory

Hematology

Internal Services
Acceptance of Deliveries of Supplies and Reagents
Acceptance of deliveries of Consignment supplies and reagents used in processing Hematology
testing
Office/Division: Department of Pathology and Laboratories- Hematology Section
Classification: Simple
Type of G2B
Transaction:
Who may avail: Suppliers
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Requisition Consignment Form Hematology section
2. Delivery Receipts Supplier
3. Items or Products Supplier
4. Requisition and Issue Slip Stockroom custodian
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Receive 1. Hematology staff none 5 minutes MTOD-
Requisition Form make a requisition Hema- Staff
(Consignment) of reagents and
supplies needed for
the testing
1.1 Call the supplier
and submit the
requisition form with
proper signature
and keep a copy for
filing.
2. Present Delivery 2. Check and None 5 minutes MTOD- Hema-
Receipt and validate the items Staff
items/products and the delivery
receipts
2.1 if not
acceptable, return
the item and
delivery receipt
2.2 if acceptable,
receive and sign
receipt with name,
signature, date and
time
2.3 Endorse
delivery receipt to
stockroom Stockroom
custodian and items custodian
for proper storage
 2.4 Requisition and
Issue slip creation
and documentation
TOTAL: 10 minutes

Affiliation Process (Medical Technology Internship Program)

Process of affiliation for Medical Technology Interns rotation in Hematology Section

Office/Division: Department of Pathology and Laboratories- Hematology Section

Classification: Simple
Type of G2B, G2G
Transaction:
Who may avail: Affiliated: School, College, University
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Contract of Affiliation Affiliating School/University/College
2. Letter of Intent
3. List of Interns and Schedule
4. Bio-data of Affiliates
5. Endorsement Letter PETD Office
CLIENT STEPS AGENCY ACTION FEES TO PROCESSIN PERSON
BE PAID G TIME RESPONSI
BLE
1. Submit all 1. Check all the none Refer to PETD
requirements to requirements following PETD Training
PETD in duplicate (accept/ reject criteria) required time coordinator
1.1 Receive and issue billing (1 day) Staff
fees as approval for
affiliation
2. Pay affiliation 2. Refer to Finance Division: 600 per Refer to Cashier
fee at the cashier Accept payment for the affiliates Finance (Refer to
affiliation fee. Division (10 Finance
minutes) Division)

3.Submit official 3. Refer to PETD none Refer to PETD PETD Staff

receipt copy to Receive proof of payment and required time
PETD prepare an endorsement letter 10 minutes
3.1 Return received duplicate
copy of the requirement
papers
4.Submit file copy 4. Receive all the none 5 minutes Laboratory
of all requirements requirements and Training
received from endorsement letter from Coordinator
PETD to PETD
Hematology 4.1 Process and schedule
Training for General Orientation
Coordinator
5. Commence duty 5. Give orientation of the none 1 hour Hematology
Standard Operation Protocol Section
of the section head
 5.1 Schedule affiliates to
Hematology bench work as
to the required number of
days
6. Signing of 6.Evaluate affiliates none 5 minutes Hematology
Clearance performance Section
head
TOTAL: 600/pax 1 day 1 hour
30 minutes

Evaluation of Products and Supplies

Process of evaluation of laboratory products and supplies

Office/Division: Department of Pathology and Laboratories- Hematology Section

Classification: Complex
Type of Transaction: G2B, G2G
Who may avail: Suppliers
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Product Evaluation Form Provided by the Quality Assurance Unit
2.Product / materials for evaluation Supplier
3.Letter of intent Supplier
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit letter of 1. Laboratory none 10 minutes Laboratory
intent and present the office will check Quality
products / supplies for and approve Assurance staff
evaluation to 1. 1 Endorse the
Laboratory office products /
supplies with the
Product
Evaluation form to
the Hematology
section

1.2. Process the None 2-3 days MTOD- Hema-

evaluation of Staff
supplies
according to use.
1.3 Submit report
of Product
Evaluation form to
Quality Assurance
unit
2. Follow – up result 2. Preparation of None 1 day Laboratory
of evaluation the report copy for Quality
the supplier Assurance staff

TOTAL: 4 days 10
minutes
Evaluation of Hematology Equipment
Process of evaluation of equipment before purchase and prior to use in the Hematology section

Office/Division: Department of Pathology and Laboratories- Hematology Section

Classification: Highly Technical
Type of G2B
Transaction:
Who may avail: Suppliers
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Letter of intent Supplier
2.Product / equipment for evaluation Supplier
3.Reagents / Consumables used for evaluation Supplier
CLIENT STEPS AGENCY ACTION FEES TO PROCESSI PERSON
BE PAID NG TIME RESPONSIBLE
1. Submit letter of 1. Chief of hospital office none 10 minutes COH
intent to the Chief of receive and endorse to
Hospital (COH) Laboratory office
1.1 Laboratory office will Laboratory
check and approve Chief Medical
1. 1 Endorse the Technologist
approved letter to the (CMT)
Hematology section head
1.2. Schedule for product none 5 minutes Hematology
demonstration and Section Head
evaluation.
2. Submit the other 2. Process the evaluation None 7 days Hematology
requirements procedures based on Section Head /
needed on the validation protocol and Staffs and
scheduled date for according to its functions. validation- in-
evaluation 2.1 Records the report of charge
Product Evaluation
process
2.2 Create final report for none 2 days Validation- In
documentation charge
2.3 Verify and sign report none 1 day Department
Chairman /
CMT/ Section
head/
Validation- In -
charge
 3. Follow – up result 2. Preparation of the None 5 minutes Hematology
of evaluation report copy for the Section Head
supplier
TOTAL: 10 days 20
minutes

Issuance of Laboratory Supplies to Designated Units

Provision of Laboratory supplies to ward (vacutainer tubes)

Office/Division: Department of Pathology and Laboratories- Hematology Section

Classification: Simple
Type of Transaction: G2G
Who may avail: Operating Room, PACU, Pedia-ICU and Heart Institute - OR
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Requisition paper Provided by the Requesting unit
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present request 1. Hematology none 3 minutes MTOD-
paper to Hematology staff check the Hema- Staff
staff request paper if
included in the list
of who can avail.
1.1 The staff will
approve the
number requested
or write the
number of
supplies to be
release.
2. Log in requisition in 2. Prepares the None 5 minutes
the record book as supplies for MTOD- Hema-
approved or provided release Staff
by the section

3. Get supplies 3. Release None 2 minutes MTOD- Staff

supplies and
validate record
TOTAL: 10 minutes
Issuance of Monthly-Annual Report
Process of a required report monthly or annual census

Office/Division: Department of Pathology and Laboratories- Hematology Section

Classification: Simple
Type of Transaction: G2G
Who may avail: Chief Medical Technologist, Auditor, Accounting, Chief Of Hospital
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Daily worksheet summary Provided by Hematology section
2. Monthly Census Report Provided by Hematology section
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Request report 1. Process the none 15 minutes MTOD-
from Section request document Hema- Staff
as recorded / filed
in the section
1.1 Collate and None 1 hour Hema-Section
verify gathered Head
census
1.2 Summarize None 1 hour
data as requested
to report

2. Collect report 2. Print and None 5 minutes

submit needed
report
TOTAL: None 2 hour 20
minutes

Hematology Schedule of Fees

Arrange the table as necessary.

Procedure Fee
Acceptance Process for Deliveries Free
 Issuance of Laboratory supplies to designated Free
units
Medical Technology Internship Affiliation P 600.00 / affiliate
Process for evaluation of product /supplies Free
Process for evaluation of equipment Free
Process for Issuance of monthly – Annual Free
report

LIST OF SERVICES
Classification Type of Transaction
G2C G2B G2G
Highly
Services Simple Complex Gov’t Gov’t Gov’t
Technical
3 days 7 days to to to
20 days Client Business Gov’t
External Services (in alphabetical order)
6. Autopsy  
7. Biopsy- In Patient  
8. Biopsy – Out Patient  
9. Bone Marrow Aspirate  
10. Borrowing of Slides/Blocks  
11. Cell Block- In Patient  
12. Cell Block- Out Patient 
13. Duplicate of
 
Results/Second Copy
14. Fine Needle Aspirate
 
Biopsy- In Patient
15. Fine Needle Aspirate

Biopsy- Out Patient
16. Flow Cytometry
17. Frozen Section Biopsy  
18. Immuno Histochemical
 
Stains
19. Pap Smear  
20. Peripheral Blood Smear  
21. Rectal Biopsy  
22. Releasing and Receiving of

Cadavers
23. Review of Slides  
24. Sample Adequacy  
Internal Services (in alphabetical order)
12. Acceptance of deliveries of
 
supplies and reagent
13. Affiliation Training
 
(Internship)
14. Issuance of laboratory
supplies to ward (formalin  
etc..)

Laboratory

Histopathology
 External Services

1, Processing of Specimens (Autopsy)

 This is a surgical procedure that consists of a thorough examination of a corpse by dissection to
determine the cause, mode, and manner of death or to evaluate any disease or injury that may be
present
 Availability of Service: 8:00 am to 5:00 pm, Monday to Sunday.
Office/Division: Department of Pathology and Laboratories
Classification: HT
Type of Transaction: G2C
Who may avail: 1. Patients (In-patient)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Three (3) copies of filled up referral form Attending Physician
Certification of Identification and consent for Direct relatives of the victim
autopsy
Pertinent documents which can be submitted Attending Physician
before release of Final Report (clinical
abstract)
Processing Fee Cashier
Professional Fee Cashier
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit filled up 1. Checks None 15 minutes Laboratory
referral form. completeness of receiving clerk
documentary Medical Officer
requirements then III-IV
informs the
(Department of
requesting party on
Pathology
the procedure to be
conducted to Resident-in-
include, if Charge)
necessary, a
histopathological
exam in which case
the requesting party
will be informed that
the final result will
 be released in 30
days.
1.1 Process the None 15 working days Medical Officer
specimen (which III-IV
includes gross (Department of
description, read Laboratories
Resident-
and interpret the
inCharge)
slides.
1.2 Read and None 15 working days Medical Officer
Interpret slides III-IV
(Department of
Laboratories
Resident-
inCharge)
2. Claim Autopsy Releases the None 15 minutes Medical Officer
report laboratory report. III-IV
(Department of
Laboratories
Resident-
inCharge)
TOTAL: None 30 orking
days

2. Processing of Biopsy Specimens (Histopathology – In Patient)

To process the given specimen by preparing thin sections for microscopic examination and
interpretation and provide diagnosis without further re-processing or additional reading before
releasing result.
Office/Division: Department of Pathology and Laboratories – Histopathology Section

Classification: HT
Type of Transaction: G2C
Who may avail: In patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Fully Accomplished Surgical Pathology
Request Form / Doctor’s request form with
Attending Physician, Surgical Pathology Clerk
contact information of the requesting
physician
2. Appropriately labeled and oriented Attending Physician, Surgical Pathology Clerk,
specimen container Operating Room, Wards
FOR CLAIMING OF RESULTS:
Patient/authorized individual must present Window 5 JICA Laboratory
official claim stub of histopathology section
at Window 5.

For lost claim stub, the following document

must be presented:
If the patient is the claimant:
 1. Note signed by the attending
physician of its intent
Patient
2. Photocopy of valid ID
If claimant is not the patient:
1. An authorization letter from the
patient or note signed the attending
physician of its intent
2. Photocopy of one valid ID of the Authorized Person
claimant
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit 1. Check and none 5 minutes Laboratory
requirements to verifies request if Clerk
Window 5 fully accomplished
Medical
Histopathology and if specimen
Technologist
Section container is
properly labeled (Histopathology
and oriented Section)
1.1 Charge biopsy
processing fees
and the type of
billing
1.2 Provide official
claim stub with the
date of release of
biopsy result
1.3 Inventory of none 5 minutes Medical
received samples Technologist
(Histopathology
Section)
1.4 Gross Medical Officer
description of III (Department
specimen of Laboratories
Resident-in-
1.4.1 Small and
Charge)
Medium None 1 working day
specimens
1.4.2 Large, Extra
Large and Bone
specimen None 2 days

1.5 Processing of Medical

grossed specimen Technologist
1.5.1 Small and (Histopathology
None 2 working days
Medium Section)
specimens
1.5.2 Large, Extra
Large and Bone
specimen None 4 working days

1.6 Read and None 4 working days Medical Officer

Interpret slides III-IV / Medical
Specialist II-IV
(Department of
 (Note: For Laboratories
specimens and Resident-in-
cases Charge /
provisionally Consultant-in-
assessed to Charge)
require additional
processing and
reading – contact
number of patient
or authorized
person will be
asked. Pathology
resident will be
the one to contact
the patient for the
availability of
result)
2. Claim results 2. Check for None 30 minutes Laboratory
official claim stub Clerk
(whether the
Medical
patient is still
Technologist
admitted or has
2.1 Present official already been (Histopathology
claim stub at Window discharged) Section)
5

(Note: For
specimens and
cases
provisionally
assessed to
require additional
processing and
reading – contact
number of the
patient or
authorized person
will be asked.
Pathology
resident will be
the one to contact
the patient for the
availability of
result)

2.2 Check
2.2 For lost claim
requirements
stub:
If the patient is the
claimant: 2.3 Release the
result to the
a. Note signed by the
patient /
attending
Authorized person
physician of its
intent
b. Photocopy of valid
ID
If claimant is not the
patient:
 a. An authorization
letter from the
patient or note
signed the
attending
physician of its
intent
b. Photocopy of one
valid ID of the
claimant

TOTAL: Refer to 10 working

approved days
schedule
of fees

Laboratory- Histopathology Section-Schedule of Fees

BIOPSY FEES
Small 800.00
Medium 900.00
Large 1,200.00
Extra Large 1,500.00

3. Processing of Biopsy Specimens (Histopathology – Out Patient)

To process the given specimen by preparing thin sections for microscopic examination and
interpretation and provide diagnosis without further re-processing or additional reading before
releasing result.
Office/Division: Department of Pathology and Laboratories – Histopathology Section
Classification: HT
Type of Transaction: G2C
Who may avail: Patients (Out-patient and Walk-In patients)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Fully Accomplished Surgical Pathology
Request Form / Doctor’s request form with
Attending Physician, Surgical Pathology Clerk
contact information of the requesting
physician
2. Appropriately labeled and oriented Attending Physician, Surgical Pathology Clerk,
specimen container Clinics
3. Yellow Card HIMD
4. Official Receipt for paid biopsy test or Cashier, Payment Assistance Centers
proof of payment from payment assistance
centers
FOR CLAIMING OF RESULT:
Window 5 JICA Laboratory
Patient/authorized individual must present
official claim stub of histopathology section
at Window 5.

For lost claim stub, the following document

must be presented:
If the patient is the claimant: Patient
3. Note signed by the attending
physician of its intent
4. Photocopy of valid ID
If claimant is not the patient:
3. An authorization letter from the
patient or note signed the attending Authorized Person
physician of its intent
4. Photocopy of one valid ID of the
claimant
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit 1. Check request none 5 minutes Laboratory
requirements to if fully Clerk / Medical
Window 5 accomplished and Technologist
Histopathology if specimen
(Histopathology
Section container is
Section)
properly labeled
and oriented
1.1 Verifies
request and
payment in the
system.
1.2 Instruct
patient/watcher to
settle payment at
the cashier or any
payment
assistance
centers
2. Settle the payment 2. Accept Biopsy Fees Refer to Cashier,
for the specimen payment for (Refer to Finance Payment
processing at the biopsy specimen approved Services Assistance
cashier or any processing schedule of Centers
payment assistance fees)
centers

3. Present official 3. Check official None 5 minutes Laboratory

receipt or proof of receipt / proof of Clerk / Medical
payment from payment from Technologist
payment assistance payment
(Histopathology
centers assistance center
Section)
3.1 Record in
Surgical
Pathology
Logbook
 3.2 Provide official
claim stub with the
date of release of
biopsy result
3.3 Inventory of none 5 minutes Medical
received samples Technologist
(Histopathology
Section)
3.4 Gross Medical Officer
description of III (Department
specimen of Laboratories
Resident-in-
3.4.1 Small and
Charge)
Medium None 1 working day
specimens
3.4.2 Large, Extra
Large and Bone
specimen None 2 days

3.5 Processing of Medical

grossed specimen Technologist
3.5.1 Small and (Histopathology
None 2 working days
Medium Section)
specimens
3.5.2 Large, Extra
Large and Bone
specimen None 4 working days

3.6 Read and None 4 working days Medical Officer

Interpret slides III-IV / Medical
Specialist II-IV
(Department of
(Note: For Laboratories
specimens and Resident-in-
cases Charge /
provisionally Consultant-in-
assessed to Charge)
require additional
processing and
reading – contact
number of patient
or authorized
person will be
asked. Pathology
resident will be
the one to contact
the patient for the
availability of
result)
4. Claim results 4. Check for None 30 minutes Laboratory
official claim stub Clerk / Medical
Technologist
(Histopathology
(Note: For
4.1 Present official Section)
specimens and
claim stub at Window
cases
5
provisionally
 assessed to
require additional
processing and
reading – contact
number of the
patient or
authorized person
will be asked.
Pathology
resident will be
the one to contact
the patient for the
availability of
result)

4.2 Check
requirements

4.3 Release the

4.2 For lost claim result to the
stub: patient /
Authorized person
If the patient is the
claimant:
c. Note signed by the
attending
physician of its
intent
d. Photocopy of valid
ID
If claimant is not the
patient:
c. An authorization
letter from the
patient or note
signed the
attending
physician of its
intent
d. Photocopy of one
valid ID of the
claimant

TOTAL: Refer to 10 working

approved days
schedule
of fees

Schedule of Fees
Arrange the table as necessary.
BIOPSY FEES
Small 800.00
Medium 900.00
 Large 1,200.00
Extra Large 1,500.00

4. Bone Marrow Aspirate (BMA) Smears (Histopathology- In and Out Patient)

To process the given specimen by preparing the submitted smears for staining, microscopic
examination and interpretation and provide diagnosis without further re-processing or additional
reading before releasing results.
Office/Division: Department of Pathology and Laboratories- Histopathology Section
Classification: HT
Type of Transaction: G2C
Who may avail: Patients (Out-patient and In-patients)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Fully Accomplished Referral form, Attending Physician, Departmental wards,
Request form and Doctor’s request form Clinics, Nurse’s Station
with contact information of the requesting
physician and completed patient’s history.
2. Appropriate labeled smears (at least six Attending Physician, Departmental wards,
(6) slides) Clinics, Nurse’s Station
3. For Claiming of Result: Patient/ Window 5 – JICA Laboratory (Mondays-Fridays
authorized individual must present official at 7:00 am – 4:00 pm)
claim stub of histopathology section at
Window 5

For lost claim stub, the following document Patient

must be presented:
If the patient is the claimant:
1. Note signed by the attending
physician of its intent
2. Photocopy of valid ID
If claimant is not the patient: Authorized Person
1. An authorization letter from the
patient or note signed by the
attending physician of its intent
2. Photocopy of one valid ID of the
claimant
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit 1. Check and None  5 Laboratory
requirements to verifies request if minutes (if Clerk / Medical
Window 5 fully accomplished smears are Technologist
Histopathology and if submitted appropriate (Histopathology
Section smears are for reading) Section)
properly labeled
and appropriate  1 day (
for PBS and BMA if smears
examination. submitted did
1.1. Encode not passed on
examination the criteria for
processing fees PBS and
and the type of BMA reading,
billing. subject for
1.2. Window 5 repeat
assigned collection.)
personnel will
provide official
claim stub with the
release date of
the PBS and BMA
official result.
2. Processing of PBS 2. Verifies referral None 5 minutes Medical
and BMA smears and request forms Technologist
(must include (Histopathology
CBC result in Section)
every request
form for PBS and
BMA
examination).
2.1. Preparation of 60 minutes Medical
smears for Technologist on
staining duty
2.2 Endorsement 5 minutes Medical
of PBS and BMA Technologist on
Smears to the duty
Pathology office.
2.3. Pre-reading 1 to 3 days Pathology
of pathology residents
residents before
endorsement to
consultants.
2.4. Endorsement 5 to 6 days Consultants
of pre-reading
results of PBS
and BMA to
consultants
3. Claiming of Results 3. Verifies claim None 5 minutes Laboratory
stub then releases Clerk, Medical
official results. Technologist on
duty
TOTAL: Refer to 10 days and
approved 75 minutes
schedule
of fees
Laboratory – Histopathology Section Schedule of Fees

Laboratory Procedure
PBS 400.00
BMA 400.00

5. Borrowing of Slides and Blocks

Borrowing of slides and blocks for referral to other laboratories.
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Department of Laboratory and Pathology- Main

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients (Out-patient and Walk-In patients)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Referral letter for borrowing blocks and Attending Physician
slides
2. Yellow Card HIMD
3. Official Receipt for borrowing slides and Cashier
blocks
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present referral 1. Verify if the Borrowing 5 minutes Laboratory Aide
request to window 5 request is for block and II
receiving counter. review or test slide Fees (Clerk)
outside. (Refer to
2.1 Instruct patient approved
to come back the schedule of
next day. fees)
2. Retrieval of block 2. Retrieve block/s None 15 minutes Laboratory Aide
and slide requested. and slide/s II (clerk),
requested. Medical
Technologist
(Histopathology
Section)

2.1 Proceed to 5 minutes Laboratory Aide

resident on duty to II (clerk),
choose the Medical
specific slide/s Technologist
and block/s (Histopathology
required (if special Section)
test will be done
outside); check
slide/s and block/s
(if request for
second opinion for
diagnosis and
review of slides
will be done
outside)

2.3 Inform Medical

Technologist on 5 minutes Medical
duty to re-cut Technologist
block for save
copy (case to
case basis).

2.4 Stain and 15 minutes Medical

mount slide. Technologist

2.5 Prepare 5 minutes Laboratory Aide

block/s and slide/s II
requested (put in
slide box) and
labeled.

2.6 Double check 5 minutes Laboratory Aide

slide/s and block/s II
prepared by the
resident on duty
prior to release.
3. Return to releasing 3. Verifies request None 5 minutes Laboratory Aide
window 5 counter. then release slide II (clerk)
and block
requested to the
claimant.
TOTAL: Refer to 1 day and 60
approved minutes
schedule
of fees

Laboratory- Borrowing of Slide and Block Schedule of Fees

Deposit of Slide and Block 200.00

6. cell block/cytology SPECIMEN (in-PATIENT)
THIS PROCESS PROVIDES INTERPRETATION AND DIAGNOSIS THROUGH EXAMINATION OF
VARIOUS BODY FLUID SAMPLES.
AVAILABILITY OF SERVICE: MONDAY TO SUNDAY, 24 HOURS.

Office/Division: Department of Pathology and Laboratories

Classification: HT
Type of Transaction: G2C
Who may avail: All Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Fully accomplished Surgical Pathology Attending Physician
request form/ Doctor's request form with
the doctors contact information.
Appropriately labeled specimen container Attending Physician
Yellow Card HIMD
Official Receipt for paid Cell Block/ Cell Cashier
Cytology procedure
FOR CLAIMING OF RESULTS: Patient, Authorized Individual.
 present an official claim stub at
JICA Laboratory Window 5.
FOR LOST CLAIM STUB:
The following document must be
presented at JICALaboratory Window 5. Patient, Authorized Individual.
1. note signed by the attending
physician of it's intent.
2. photocopy of valid ID.
3. Authorization letter from the
patient.
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submitted 1.1 Check and Cell 5 minutes Laboratory
requirements to JICA verifies request Block/Cytol Clerk, Intern, or
Laboratory Window 5. and payment in ogy Fees Medical
the Hospital (Refer to Technologist
Information approved (Histopathology
system schedule of Section)
1.2 check request fees)
if fully
accomplished and
if specimen is
properly labelled.
1.3 for payment Laboratory
A. patient is Clerk
still
admitted,
accept
referral and
specimen
and encode
in the
system as Laboratory
TPL-to pay Clerk
later, PHIC,
Charity,
and others.
B. if patient is
already
advised to
go home or
has already
been
discharged:
instruct
authorized
individual
to settle
payment
for the
processing
fee at the
cashier or
any
payment
assistance
center.
1.4 Accept and re none 5 minutes Laboratory
ord the specimen Clerk, Medical
in the Cell Technologist
Block/Cytology (Histopathology
logbook and store Section)
at proper storage
area.
1.5 Provide official
claim stub to the
patient/authorized
individual with the
date of release of
 the Cell
Block/Cytology
result.
2. Processing of 2.1 inventory of None 10 minutes Intern, Medical
specimen. the received Technologist
specimens.
2.2 undergo Cell
Block/Cytology 1 working day Intern, Medical
processing. Technologist
3. Segregation and 3.1 Segregate and None 1 working day Medical
endorsement of slides insert slides in Technologist
for reading and appropriate slide
interpretation. pockets and
endorse to
resident
pathologist in- 3 working days Resident
charge. Pathologist
3.2 Read and 2 working days
interpret slides. Consultant
3.3 Endorsement Pathologist
to consultant for
final diagnosis
and releasing of
result.
4. Claiming of result: 4.1 check for none 30 minutes Laboratory
present official claim official claim Clerk, Intern,
stub at Jica stub Medical
Laboratory window 5 Technologist
TOTAL: Refer to 7 working
approved days
schedule
of fees

LABORATORY- Cell Block/Cytology: Schedule of Fees

CELL BLOCK/CYTOLOGY 500

7. CELL BLOCK/CYTOLOGY SPECIMEN (WALK-IN AND OUT PATIENT)

THIS PROCESS PROVIDES INTERPRETATION AND DIAGNOSIS THROUGH
EXAMINATION OF VARIOUS BODY FLUID SAMPLES.
AVAILABILITY OF SERVICE: MONDAY TO FRIDAY, 8AM TO 5PM.

Office/Division: Department of Pathology and Laboratories- Histopathology Section

Classification: HT
Type of Transaction: G2C
Who may avail: All Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Fully accomplished Surgical Pathology Attending Physician
request form/ Doctor's request form with
the doctors contact information.
Appropriately labeled specimen container Attending Physician
Yellow Card HIMD
Official Receipt for paid Cell Block/ Cell Cashier
Cytology procedure
FOR CLAIMING OF RESULT: Patient, Authorized Individual.
  present an official claim stub at
Jica Laboratory Window 5.
FOR LOST CLAIM STUB:
The following document must be
presented at Jica Laboratory Window 5. Patient, Authorized Individual.
4. note signed by the attending
physician of it's intent.
5. photocopy of valid ID.
6. Authorization letter from the
patient.
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit 1.1 Check and Cell Block/ 5 minutes Laboratory
requirements to JICA verifies request Cell Clerk, Medical
Laboratory Window 5. and payment in Cytology Technologist
the system. Fees (Refer (Histopathology
1.2 Check request to approved Section)
if fully schedule of
accomplished and fees)
if specimen is
properly labelled.
1.3 Instruct
patient/authorized
individual to settle
billing at the
cashier or any
payment
assistance center.
1.4 Accepts and none 5 minutes Laboratory
record the Clerk,Medical
specimen in the Techologist
cell block/cytology (Histopathology
logbook and store Section)
at proper storage
area.
1.5 provide official
claim stub to the
patient/authorized
individual with the
date of release of
the cell
block/cytology
result.
2. Processing of 2.1 Inventory of None 10 minutes Medical
specimen. the received Technologist
specimens in the
storage
refrigerator. 1 working day Medical
2.2 Perfom cell Technologist
block/cytology
processing.
3. Segregation and 3.1 Segregate and None 1 working day Medical
endorsement of slides insert slides in Technologist
for reading and appropriate slide
interpretation. pockets and
endorse to
resident
pathologist in- 3 working days Resident
charge. Pathologist
3.2 Read and
interpret slides. 2 working days Consultant
3.3 Endorsement Pathologist
to consultant for
final diagnosis
and releasing of
result.
 4. Claiming of result: 4.1 check for none 30 minutes Laboratory
present official claim official claim Clerk, Intern,
stub at Jica stub Medical
Laboratory window 5 Technologist
TOTAL: Refer to 7 working
approved days
schedule
of fees

LABORATORY- CELL BLOCK/ CELL CYTOLOGY: Schedule of Fees

CELL BLOCK/ CELL CYTOLOGY 800

8. Duplicate/Second Copy of Results

This aims to provide additional copies of the surgical pathology results
Availability of Service: 8:00 am to 4:00 pm, Monday to Friday, except Holidays.

Office/Division: Department of Pathology and Laboratories

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients (Out-patient and Walk-In patients)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Original Surgical Pathology Report Requesting Party/ Patient
2. Yellow Card HIMD
If requesting party is the patient but is not
the one doing the transaction:
1. Authorization letter signed by the Patient
patient.
2. Patient`s Valid ID Patient
3. Authorized Representative`s ID Authorized Representative
 CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1.Submit 1.Retrieval of File None 1 working day Histopathology
requirements to Copy of the Clerk
Window 5- JICA Requested (Histopathology
building Surgical Section)
Pathology Report
2.Claim copies of 2.1 Check Refer to the 20 minutes Histopathology
Surgical Pathology Requirements approved Clerk
Result schedule of (Histopathology
2.2 Release the fees Section)
copies of surgical
pathology result to
patient/patients
representative

3. Present official
receipt at the Surgical
Pathology Section

If the person doing the

transaction (claiming
of results)
Is:
3.1 The patient :
Present Valid ID
(Government Issued)
3.2 A patient
representative
Present the following:
1.Authorization letter
signed by the patient.
2. Patient`s valid ID
photocopy.
3.Authorized
representatives ID.

TOTAL: Refer to 2 working

approved days
schedule
of fees

Fine Needle Aspiration BiopsySPECIMEN ( In-PATIENT)

THIS PROCESS PROVIDES INTERPRETATION AND DIAGNOSIS THROUGH EXAMINATION OF
VARIOUS BODY FLUID SAMPLES.
AVAILABILITY OF SERVICE: MONDAY TO SUNDAY, 24 HOURS.

Office/Division: Department of Pathology and Laboratories- Histopathology Section

Classification: HT
Type of Transaction: G2C
Who may avail: All Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Fully accomplished Surgical Pathology Attending Physician
request form/ Doctor's request form with
the doctors contact information.
Appropriately labeled specimen container Attending Physician
Yellow Card HIMD
Official Receipt for paid Fine Needle Cashier
Aspiration Biopsy procedure
FOR CLAIMING OF RESULT: Patient, Authorized Individual.
7. present official claim stub at Jica
Laboratory Window 5.
FOR LOST CLAIM STUB:
The following document must be
presented at Jica Laboratory Window 5. Patient, Authorized Individual.
C. note signed by the attending
physician of it's intent.
D. photocopy of valid ID.
E. Authorization letter from the
patient.
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Requirements 1.1 Check and Fine Neddle 5 minutes Laboratory
submitted to JICA verifies request Aspiration Clerk, Medical
Laboratory Window 5. and payment in Biopsy Fees Technologist
the system. (Refer to (Histopathology
1.2 Check request approved Section)
if fully schedule of
accomplished and fees)
if specimen is
properly labelled.
1.3 For payment
 If patient is Laboratory
still Clerk
admitted,
accept
referral and
specimen
and encode
in the
system as
TPL-to pay Laboratory
later, PHIC, Clerk
Charity,
and others.
 if patient is
already
advised to
go home or
has already
been
discharged:
instruct
authorized
individual
to settle
payment
for the
processing
fee at the
cashier or
any
payment
assistance
center.
1.4 Accept and None 5 minutes Laboratory
record the Clerk, Medical
specimen in the Technologist
Fine Needle (Histopathology
Aspiration Biopsy Section)
logbook and store
at proper storage
area.
1.5 Provide official
claim stub to the
 patient/authorized
individual with the
date of release of
the Fine Neddle
Aspiration Biopsy
result.
2. Processing of 2.1 Inventory of None 10 minutes Medical
specimen. received Technologist
specimens.
2.2 Fine Needle
Aspiration Biopsy 1 working day Medical
processing. Technologist
3. Segregation and 3.1 Segregate and None 1 working day Medical
endorsement of slides insert slides in Technologist
for reading and appropriate slide
interpretation. pockets and
endorse to
resident
pathologist in- 3 working days Pathology
charge. Resident
3.2 Read and
interpret slides. 2 working days Consultant
3.3 Endorsement Pathologist
to consultant for
final diagnosis
and releasing of
result.
4. Claiming of result: 4.1 Check for none 30 minutes Laboratory
present official claim official claim Clerk, Medical
stub at JICA stub Technologist
Laboratory Window 5 (Histopathology
Section)
TOTAL: Refer to 7 working
approved days
schedule
of fees

LABORATORY- FINE NEEDLE ASPIRATION BIOPSY: Schedule of Fees

FINE NEEDLE ASPIRATION BIOPSY 500

Processing of Flow Cytometry Samples (In and Out Patient Department)

To process procedures of the different panels performed in flow cytometry by the medical
technologist staff and with direct participation of the pathologists and consultants.
Office/Division: Department of Pathology and Laboratories- Flow Cytometry Section
Classification: HT
Type of Transaction: G2C
Who may avail: 1. Patients (Out-patient and In-patients)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Fully Accomplished Flow Cytometry Attending Physician, Departmental wards,
Referral form with contact information of Clinics, Nurse’s Station
the requesting physician and completed
patient’s history.
2. Appropriate labeled specimen (at least 2 Attending Physician
mL EDTA tube and/or 3 mL Heparin tube)
3. For Claiming of Result: Patient/ Window 5 – JICA Laboratory (Mondays-Fridays
authorized individual must present official at 7:00 am – 4:00 pm)
claim stub of Flow Cytometry section at
Window 5

For lost claim stub, the following document Patient

must be presented:
If the patient is the claimant:
3. Note signed by the attending
physician of its intent
4. Photocopy of valid ID

If claimant is not the patient: Authorized Person

3. An authorization letter from the
patient or note signed by the
attending physician of its intent
4. Photocopy of one valid ID of the
claimant
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit 1. Check and None 5 minutes Laboratory
requirements to verifies request if Clerk/ Medical
Window 5 fully accomplished Technologist
Histopathology and and if submitted
Flow Cytometry flow cytometry
Section samples are
properly labeled
and appropriate
for examination.
1.1. Encode
requested panel
to process fees
1.2. Window 5
assigned
personnel will
provide official
claim stub with the
release date of
the flow cytometry
official result.
2. Processing of Flow 2. Verifies referral None 5 minutes Medical
Cytometry specimens and request forms Technologist on
duty
2.1. Preparation 2 hours and Medical
and processing of 30 minutes Technologist on
requested Flow duty
Cytometry panels

2.2. Endorsement
of processed Flow 5 minutes Medical
Cytometry Technologist on
procedures to the duty
office of Pathology

2.3. Gating of
acquired data 3 days
from flow Pathology
cytometry residents
samples

2.4. Endorsement
of gated flow 6 days
cytometry
samples to Pathology
pathology residents /
consultants
 Pathology
consultants
3. Claiming of Results 3. Verifies claim None 5 minutes Laboratory
stub then releases Clerk, Medical
official results. Technologist on
duty
TOTAL: Refer to 9 days , 2
approved hours and 45
schedule minutes
of fees

Laboratory – Histopathology and Flow Cytometry Section Schedule of Fees

Laboratory Procedure
Lineage Panel 15,000.00
Comprehensive Panel 19,500.00

Fine Needle Aspiration Biopsy SPECIMEN (walK-in and out-PATIENT)

THIS PROCESS PROVIDES INTERPRETATION AND DIAGNOSIS THROUGH EXAMINATION OF
VARIOUS BODY FLUID SAMPLES.
AVAILABILITY OF SERVICE: MONDAY TO FRIDAY, 8AM TO 5PM.

Office/Division: SURGICAL PATHOLOGY SECTION

Classification: HT
Type of Transaction: G2C
Who may avail: All Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Fully accomplished Surgical Pathology Attending Physician
request form/ Doctor's request form with
the doctors contact information.
Appropriately labeled specimen container Attending Physician
Yellow Card HIMD
Official Receipt for paid Cell Block/ Cell Cashier
Cytology procedure
FOR CLAIMING OF RESULT: Patient, Authorized Individual.
 present an official claim stub at
Jica Laboratory Window 5.
FOR LOST CLAIM STUB:
The following document must be
presented at Jica Laboratory Window 5. Patient, Authorized Individual.
 note signed by the attending
physician of it's intent.
 photocopy of valid ID.
 Authorization letter from the
patient.
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Requirements 1.1 Check and Fine Needle 5 minutes Laboratory
submitted to Jica verifies request Aspiration Clerk, Medical
Laboratory window 5. and payment in Biopsy Fees Technologist
the system. (Refer to (Histopathology
1.2 Check request approved Section)
if fully schedule of
accomplished and fees)
if specimen is
properly labeled.
1.3 Instruct
patient/authorized
individual to settle
payment at the
cashier or any
payment
assistance center.

1.4 Accept and re none 5 minutes Laboratory

ord the specimen Clerk, Medical
in the Fine Needle Technologist
Aspiration Biopsy (Histopathology
logbook and store Section)
at proper storage
area.
1.5 Provide official
claim stub to the
patient/authorized
individual with the
due date for
release of Fine
Needle Aspiration
Biopsy result.
2. Processing of the 2.1 Inventory of None 10 minutes Medical
specimen. the received Technologist
specimens. (Histopathology
2.2 Perform Fine Section)
Needle Aspiration 1 working day
Biopsy
processing.
3. Segregation and 3.1 Segregate and None 1 working day Medical
endorsement of slides insert slides in Technologist
for reading and appropriate slide
interpretation. pockets and
endorse to
resident
3 working days
 pathologist in- Resident
charge. 2 working days Pathologist
3.2 read and
interpret slides. Consultant
3.3 endorsement Pathologist
to consultant for
final diagnosis
and releasing of
result.
4. Claiming of result: 4.1 Check for none 30 minutes Laboratory
present official claim official claim Clerk, Medical
stub at JICA stub Technologist
Laboratory Window 5 (Histopathology
Section)
TOTAL: Refer to 7 working
approved days
schedule
of fees

LABORATORY- FINE NEEDLE ASPIRATION BIOPSY: Schedule of Fees

FINE NEEDLE ASPIRATION BIOPSY 500

Frozen Section Biopsy

 This provides a rapid gross and microscopic analysis of a specimen, which will determine further
conduction of surgical procedure or changes in patient management after operation.
 Availability of Service: 8:00 am to 5:00 pm, Monday to Saturday (Sundays and beyond office
hours for STAT cases only).

Office/Division: Department of Pathology and Laboratories

 Classification: HT
Type of Transaction: G2C
Who may avail: 1. Patients (In-patient)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Three (3) copies of fully accomplished Surgical Attending Physician, Surgical Pathology clerk
Pathology request form/ Doctor’s request form
with the doctor’s contact information
Fresh (unfixed) Specimen Attending Physician, Operating Room, Wards,
Clinics
Processing Fee Cashier
Professional Fee (pay patients) Cashier
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Requirements 1. Accept and check None 10 minutes Laboratory
forwarded to the requirements receiving clerk
Department of Medical Officer
Pathology and 1.1 Charge Refer to the III-IV
Laboratories by processing approved (Department of
requesting fees/reader’s fee schedule of
Pathology
unit/individual through through the MRP fees (Subject
SPMC-authorized *(Charging through to Change) Resident-in-
individuals the MRP runs Charge)
concurrently with
the processing of
the tissue)
1.2 Gross None 5 minutes / slide Medical Officer
description/ tissue III-IV
sampling (Department of
Laboratories
Resident-
inCharge)
1.4 Process None 3 minutes / slide Medical Officer
specimen on III-IV
Cryostat (Department of
Laboratories
Resident-
inCharge)
1.5 Read and None 15 minutes / Medical Officer
Interpret slides; slide III-IV / Medical
relay results Specialist II-IV
(Note: *For (Department of
specimens that will Laboratories
require further Resident-
testing/processing inCharge/Consult
/reading or for ant-in-charge)
which a definitive
specimen will be
subsequently sent
for processing, refer
to Service 1.
(Official paper
results to be
released as part of
results released
with Service 1)
TOTAL: Refer to the 38 minutes /
approved slide
schedule of
fees +
Professional
Fee (if pay
patient)

Processing of Specimens (Immunohistochemical Stains)

To process the given specimen and provide interpretation/reading of the diagnosis that does not
require further re-processing and additional interpretation/reading before releasing result.

Office/Division: Department of Pathology and Laboratories – Histopathology Section

Classification: HT
Type of Transaction: G2C
Who may avail: All patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Fully Accomplished Surgical Pathology
Request Form / Doctor’s request form with
Attending Physician, Clinics
contact information of the requesting
physician
2. Copy of Histopathology results Attending Physician, Clinics, Hospital where
biopsy was done
3. Biopsy Slides, tissue in paraffin block Attending Physician, Clinics, Hospital where
(for biopsies done outside the Hospital) biopsy was done
FOR CLAIMING OF RESULT:
Patient/authorized individual must present Window 5 JICA Laboratory
official claim stub of histopathology section
at Window 5.

For lost claim stub, the following document

must be presented:
If the patient is the claimant:
5. Note signed by the attending Patient
physician of its intent
6. Photocopy of valid ID
If claimant is not the patient:
5. An authorization letter from the
patient or note signed the attending
physician of its intent
6. Photocopy of one valid ID of the Authorized Person
claimant
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit 1. Check request None 5 minutes Laboratory
requirements to if fully Clerk / Medical
Window 5 accomplished: Technologist
Histopathology
Section
1.1 Requirements:
- Doctor’s
Request
- Photocopy of
biopsy result
- Paraffin
block/s and
biopsy slide/s
(if biopsy
was done
outside the
hospital)

Note: If blocks
and slides are
from the Hospital
the clerks or
 Medical
Technologist will
be the one to
retrieve the blocks
and slides for
processing

1.2 Screen none 5 minutes Medical Officer

paraffin block/s III-IV
and biopsy slide/s (Department of
Laboratories
Resident-in-
Charge)

1.3 Instruct patient 5 minutes Laboratory

/ authorized Clerk / Medical
person to settle Technologist
payment for the
processing fee at
the cashier or at
any payment
assistance
centers

1.3.1 For patients

under Z-Package
of PhilHealth,
proceed to Client
step 3. Charged
under PHIC

2. Settle the payment 2. Accept Immunohhis Refer to Cashier,

for the specimen payment for tochemical Finance Payment
processing at the Immunohistochem stains Services Assistance
cashier or any ical staining (Refer to Centers
payment assistance approved
centers schedule of
fees)

3. Present official 3. Check official None 5 minutes Laboratory

receipt or proof of receipt / proof of Clerk / Medical
payment from payment from Technologist
payment assistance payment
centers assistance center

3.1 Get the

contact number of
patient or
authorized person
and note in the
request the date
received

3.2 Provide official

claim stub with the
date of release of
test

3.3 Processing of none 7working days Medical

IHC Technologist

3.4 Read and None 7working days Medical Officer

interpret slides III-IV / Medical
Specialist II-IV
(Department of
Note: For Laboratories
specimens and Resident-in-
cases Charge /
provisionally Consultant-in-
assessed to Charge)
require additional
processing and
reading— contact
number of the
patient or
authorized person
will be asked. The
resident-in-charge
will be the one to
contact for the
availability of
result.

4. Claim results 4. Check for None 30 minutes Laboratory

official claim stub Clerk / Medical
Technologist

Note: For
4.1 Present official
specimens and
claim stub at Window
cases
5
provisionally
assessed to
require additional
processing and
reading — contact
number of the
patient or
authorized person
 will be asked. The
resident-in-charge
will be the one to
contact for the
availability of
result.

4.2 Check
requirements

4.3 Release result

to the patient /
4.2 For lost claim Authorized person
stub:
If the patient is the
claimant: 4.3.1 Return the
paraffin block/s
e. Note signed by the and biopsy slide/s
attending to the patient or
physician of its authorized person
intent (for biopsy done
f. Photocopy of valid outside the
ID hospital)
If claimant is not the
patient:
e. An authorization
letter from the
patient or note
signed the
attending
physician of its
intent
f. Photocopy of one
valid ID of the
claimant

TOTAL: Refer to 14 working

approved days
schedule
(2 weeks)
of fees

Schedule of Fees
 BIOPSY FEES
ER,PR,HER-2 5,500
CD 56 2,000
KAPPA 2,000
LAMBDA 2,000
MYOGENIN 2,000
Pap Smear/ CYP
Cervical / Vaginal Cytology (CYP) / PAP SMEAR for Out Patient
Availability of Service: Monday to Friday, 8:00 AM to 5:00PM.

Office/Division: Department of Pathology and Laboratory – Histopathology Section

Classification: Simple
Type of Transaction: G2C
Who may avail: Patients (Out-patients)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. 1. Fully Accomplished Request Form / Attending Physician
Doctor’s request form with contact
information of the requesting physician
2. Appropriately labeled Specimen Attending Physician, OB-Gyne
3. Yellow Card HIMD
FOR CLAIMING OF RESULT:
Patient/authorized individual must present Window 5 JICA Laboratory
official claim stub of histopathology section
at Window 5.

For lost claim stub, the following document

must be presented:
If the patient is the claimant: Patient
7. Note signed by the attending
physician of its intent
8. Photocopy of valid ID
If claimant is not the patient: Authorized Person
7. An authorization letter from the
patient or note signed the attending
physician of its intent
Photocopy of one valid ID of the claimant
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit Rectal 1.Check the None 5 minutes Laboratory
Biopsy Request at Specimen (Slide) Clerk, Medical
JICA Laboratory for the following: Technologist
Window 5. (Histopathology
1.1 Proper Section)
handling of the
specimen.
Unbroken slide
1.1.2 Adequate
specimen.

2. Pertinent data
on the request,
completely filled
and without
discrepancies.

2. Settle the payment 2. Accept CYP Fees Refer to Cashier,

for the specimen payment for (Refer to Finance Payment
processing at the specimen approved Services Assistance
cashier or any processing schedule of Centers
payment assistance fees)
centers
3. Present official 3. Check official None 5 minutes Laboratory
receipt or proof of receipt / proof of Clerk / Medical
payment from payment from Technologist
payment assistance payment (Histopathology
centers assistance center Section)
3.1 Record in
CYP Receiving
Logbook
 3.2 Provide official
claim stub with the
date of release of
CYP result
4. CYP Processing 2. Performs CYP None 5 minutes Medical
processing Technologist
2.1 Accession 5 minutes (Histopathology
number is affixed Section)
on the Pap smear
slide. Then the
slide is placed in
the slide rack for
staining.
2.3 Staining of 10 minutes
slides.
5.Endorsed to 3.1 Slides are None 2 days Pathology
Pathology Office endorsed to the Resident
resident
pathologist on
deck for
screening.
3.2 Screening of
stained smear.
3.3Preparation of
Result form
3.4 Microscopic
results are
transcribed on the
result form by the
resident
pathologist and
signed.

6. Recording of Official results are None 5 minutes

Results logged in the
cytology record
book and filed
accordingly.

7. Claiming of Results 3. Verifies claim None 5 minutes Clerk/ Medical

stub Technologist
TOTAL: Refer to 2 days and 40
approved minutes
schedule
of fees
LABORATORY- CERVICAL/VAGINAL CYTOLOGY (CYP): Schedule of Fees

CERVICA/VAGINAL CYTOLOGY (CYP) P150.00

Processing of Peripheral Blood Smear (PBS) -In and Out Patient)
To process the given specimen by preparing the submitted smears for staining, microscopic
examination and interpretation and provide diagnosis without further re-processing or additional
reading before releasing results.
Office/Division: Department of Pathology and Laboratories- Histopathology Section
Classification: HT
Type of Transaction: G2C
Who may avail: Patients (Out-patient and In-patients)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Fully Accomplished Referral form, Attending Physician, Departmental wards,
Request form and Doctor’s request form Clinics, Nurse’s Station
with contact information of the requesting
physician and completed patient’s history.
2. Appropriate labeled smears (at least six Attending Physician, Departmental wards,
(6) slides) Clinics, Nurse’s Station
3. For Claiming of Result: Patient/ Window 5 – JICA Laboratory (Mondays-Fridays
authorized individual must present official at 7:00 am – 4:00 pm)
claim stub of histopathology section at
Window 5

For lost claim stub, the following document Patient

must be presented:
If the patient is the claimant:
5. Note signed by the attending
physician of its intent
6. Photocopy of valid ID

If claimant is not the patient: Authorized Person

5. An authorization letter from the
patient or note signed by the
attending physician of its intent
6. Photocopy of one valid ID of the
claimant
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit 1. Check and None  5 Laboratory
requirements to verifies request if minutes (if Clerk / Medical
Window 5 fully accomplished smears are Technologist
Histopathology and if submitted appropriate (Histopathology
Section smears are for reading) Section)
properly labeled
and appropriate  1 day (
for PBS and BMA if smears
examination. submitted did
1.1. Encode not passed on
examination the criteria for
processing fees PBS and
and the type of BMA reading,
billing. subject for
1.2. Window 5 repeat
assigned collection.)
personnel will
provide official
claim stub with the
release date of
the PBS and BMA
official result.
2. Processing of PBS 2. Verifies referral None 5 minutes Medical
and BMA smears and request forms Technologist
 (must include (Histopathology
CBC result in Section)
every request
form for PBS and
BMA
examination).
2.1. Preparation of 60 minutes Medical
smears for Technologist on
staining duty
2.2 Endorsement 5 minutes Medical
of PBS and BMA Technologist on
Smears to the duty
Pathology office.
2.3. Pre-reading 1 to 3 days Pathology
of pathology residents
residents before
endorsement to
consultants.
2.4. Endorsement 5 to 6 days Consultants
of pre-reading
results of PBS
and BMA to
consultants
3. Claiming of Results 3. Verifies claim None 5 minutes Laboratory
stub then releases Clerk, Medical
official results. Technologist on
duty
TOTAL: Refer to 10 days and
approved 75 minutes
schedule
of fees

Laboratory – Histopathology Section Schedule of Fees

Laboratory Procedure
PBS 400.00
BMA 400.00
RECTAL BIOSPY
Rectal Biopsy for Out Patient
Availability of Service: Monday to Friday, 8:00 AM to 5:00PM.

Office/Division: Department of Pathology and Laboratory – Histopathology Section

Classification: Simple
Type of Transaction: G2C
Who may avail: Patients (Out-patients)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. 1. Fully Accomplished Surgical Attending Physician
Pathology Request Form / Doctor’s
request form with contact information of
the requesting physician
2. Appropriately labeled Specimen Attending Physician, Special Laboratory
3. Yellow Card HIMD
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBL
E
1. Submit Rectal 1.Check the None 5 minutes Laboratory
Biopsy Request at Specimen (Slide) Clerk, Medical
JICA Laboratory for the following: Technologist
Window 5. (Histopatholog
1.1 Proper y Section)
handling of the
specimen.
Unbroken slide
1.2 Specimen
Adequacy

2. Receiving of Rectal 2.1 Record in None 5 minutes Laboratory

Biopsy Rectal Biopsy Clerk / Medical
Receiving Technologist
Logbook (Histopatholog
2.2 Instruct patient y Section)
to wait for result
3.Endorse to 3.1 Slides are None 10 minutes Pathology
Pathology Office endorsed to Resident
pathology resident
for reading.
3.2 Final
Diagnosis

4. Encoding of 4.1Encode results None 5 minutes Medical

Results 4.2 Signed by Technologist
Verified by
Pathology
Resident

5. Release Results 5.1 Release None 5 minutes Laboratory

results to patient Clerk / Medical
5.2 Affix patients Technologist
signature upon (Histopatholog
claiming y Section)
TOTAL: Refer to 30 Minutes
approved
schedule
of fees

LABORATORY- CERVICAL/VAGINAL CYTOLOGY (CYP): Schedule of Fees

 RECTAL BIOPSY P300.00

Receiving and Releasing of Cadavers

Applies to all Cadaver endorsed to Department of Pathology and Laboratories Morgue
Availability of Service: 24 hours a day

Office/Division: Department of Pathology and Laboratories- Histopathology Section

Classification: Complex
Type of Transaction: G2C
Who may avail: Patients (In patients)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Death Tag Ward (death of patient recorded)
2. Diagnosis of Death- reflected on death Ward
tag
3. Qualified Claimants Claimant
a. Legal/Husband Wife
b. Child who is at least 18 years old
c. Parents
d. Sibling who is at least 18 years old
e. Watcher who is a 2nd degree relative
(aunt/uncle,2nd cousin).
4.Valid ID`s
Government issued ID`s
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1.Verification of data Check death tag none 5 minutes Morgue
to determine Attendant
deceased identity. (Histopathology
Section)
2. Receiving of Register in none 2 minutes Ward Attendant
cadaver morgue registry
logbook
3. Classification of Verify none 3 minutes Morgue
Cadaver endorsement note Attendant
for cadaver (Histopathology
classification Section)

Classification
Infectious and
Non-infectious
4.Deposit in morgue Non infectious none 30 minutes Morgue
freezer cadavers are Attendant
directly deposited (Histopathology
in freezer. Section)
Cadavers with
dangerous
communicable
diseases must be
place in airtight
bags prior to
placing in morgue
freezer.
5.Retention in Morgue Retention time for none 5 working days Morgue
Freezer Cadavers in Attendant
morgue freezer is (Histopathology
5 working days Section)
upon entry in
morgue registry.
Retention for
infectious
cadavers is twelve
 (12) hours. More
than this allotted
time will be
considered
unclaimed.
6.Release to Verify the identity none 10 minutes Morgue
immediate family of claiming next of Attendant
members/relative kin (Histopathology
Identification of Section)
the body/ cadaver
by the verified
claiming next of
kin.
TOTAL: none 5 days, 50
minutes
REVIEW OF SLIDES
This aims to provide agreement or second opinion on slides that have been previously read/interpreted by
a pathologist.
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Department of Pathology and Laboratories- Histopathology Section

Classification: Simple
Type of Transaction: G2C
Who may avail: All patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Fully accomplished Surgical Pathology Attending Physician
request form/ Doctor’s request form with
the patient and/or doctor’s contact number
2. Previous Histopathology Report Hospital previously admitted
3. Slides and paraffin blocks Hospital previously admitted
4. Processing Fee Cashier
FOR CLAIMING OF RESULT:
Patient/authorized individual must present Window 5 JICA Laboratory
official claim stub of histopathology section
at Window 5.

For lost claim stub, the following document

must be presented:
If the patient is the claimant: Patient
9. Note signed by the attending
physician of its intent
10. Photocopy of valid ID
If claimant is not the patient: Authorized Person
8. An authorization letter from the
patient or note signed the attending
physician of its intent
9. Photocopy of one valid ID of the
claimant
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit 1. Accept, check Refer to the 5 minutes Laboratory
requirements to the and verifies approved Clerk / Medical
Histopathology requirements schedule of Technologist
Section fees.
1.1 Screen None Medical Officer
Paraffin blocks / III-IV
slides (Department of
Laboratories
Resident-in-
Charge)

1.2 Instruct None Laboratory

patient / Clerk / Medical
authorized person Technologist
to settle payment
for the processing
fee to the cashier
2. Settle payment for 2. Accept Refer to the Refer to Cashier
processing at cahier payment for approved Finance
processing schedule of Services
FOR HOUSE CASE: (cashier) fees
Proceed to client step (subject to
3.1 change)

3. Present official 3. Check official None 15 minutes Laboratory

receipt at the receipt Clerk / Medical
Histopathology 3.1 Record in Technologist
Department Review of Slide (Histopathology
Logbook Section)
3.2 Provide official
claim stub with the
date of release of
result
3.3 Re-cut from None 1 day Medical
the paraffin Technologist
block/processing (Histopathology
slides Section)
3.4 Read and None 2 days Medical Officer
interpret slides III-IV / Medical
Specialist II-IV
(Note: For (Department of
specimens and Laboratories
cases Resident-in-
provisionally Charge /
assessed to Consultant-in-
require additional Charge)
processing and
reading – contact
number of patient
or authorized
person will be
asked. Pathology
resident will be
the one to contact
the patient for the
availability of
result)
4. Claim results 4. Check for None 30 minutes Laboratory
official claim stub Clerk / Medical
Technologist
4.1 Present official (Note: For (Histopathology
claim stub at Window specimens and Section)
5 cases
provisionally
assessed to
require additional
processing and
reading – contact
number of the
patient or
authorized person
will be asked.
Pathology
resident will be
the one to contact
the patient for the
availability of
result)

4.2 For lost claim 4.2 Check

stub: requirements
If the patient is the
claimant:
 g. Note signed by the 4.3 Release the
attending result to the
physician of its patient /
intent Authorized person
h. Photocopy of valid
ID
If claimant is not the
patient:
g. An authorization
letter from the
patient or note
signed the
attending
physician of its
intent
h. Photocopy of one
valid ID of the
claimant

Total: Refer to 3 days

approved
schedule
of fees

Schedule of Fees:

REVIEW OF SLIDE
House Case No Outside Biopsy Result
1,000.00
Payment
Processing of Specimens (Adequacy)
 This provides assessment of adequacy (quantity/cellularity) of fine needle aspiration biopsy.
 Availability of Service: 8:00 am to 5:00 pm, Monday to Saturday (Sundays and beyond office hours
for STAT cases only).

Office/Division: Department of Pathology and Laboratories

Classification: HT
Type of Transaction: G2C
Who may avail: All patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Three (3) copies of fully accomplished Surgical Attending Physician, Surgical Pathology clerk
Pathology request form/ Doctor’s request form
with the doctor’s contact information
Slides for staining, tissues for cytology/paraffin Attending Physician, Operating Room, Wards,
block Clinics
Processing Fee Cashier
Professional Fee (pay patients) Cashier
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Requirements 1. Accept and check None 10 minutes Laboratory
forwarded to the requirements receiving clerk
Department of Medical Officer
Pathology and 1.1 Charge Refer to the III-IV
Laboratories by processing approved (Department of
requesting fees/reader’s fee schedule of
Pathology
unit/individual through through the MRP fees (Subject
SPMC-authorized Note: Charging to Change) Resident-in-
individuals through the MRP Charge)
runs concurrently
with the processing
of the tissue
1.2 Gross None 5 minutes / slide Medical Officer
description/ tissue III-IV
sampling (Department of
Laboratories
Resident-
inCharge)
1.4 Process None 3 minutes / slide Medical Officer
specimen on III-IV
Cryostat (Department of
Laboratories
Resident-
inCharge)
1.6 Read and None 15 minutes / Medical Officer
Interpret slides; slide III-IV / Medical
relay results Specialist II-IV
(Note: *For (Department of
specimens that will Laboratories
require further Resident-
testing/processing inCharge/Consult
/reading or for ant-in-charge)
which a definitive
specimen will be
subsequently sent
for processing, refer
to Service 1.
(Official paper
results to be
released as part of
results released
with Service 1)
TOTAL: Refer to the 38 minutes /
approved slide
schedule of
fees +
Professional
Fee (if pay
patient)

Laboratory

Histopathology

Internal Services
1. Acceptance of Delivery of Reagents and Supplies
Acceptance of deliveries of reagents and supplies in processing of laboratory examination.

Office/Division: Department of Pathology and Laboratories- Histopathology Section

Classification: Simple
Type of Transaction: G2G
Who may avail: Histopathology Section Staff
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Requisition Slip (2 copies) Stockroom In charge
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Acceptance of 1. Verifies None 5 minutes Medical
Reagent and Supplies requested Technologist –
supplies and Supply In
reagent charge(Histopat
1.2 Check for hology Section)
expiry details
1.3 Check for
viability of packing

2. Encode in Inventory 2. Update None 10 minutes Medical

of Supplies inventory list Technologist –
2.1 Note first in Supply
first use items Incharge(Histop
2.2 Compiles athology
duplicate Section)
requisition slip

3.Monthly Inventory 3.Submit None 30 minutes Medical

Records inventory of Technologist-
supplies Supply
3.1 Reagents/ Incharge
Supplies (Histopathology
consumed Section)

TOTAL: None 45 minutes

2. Affiliation (Medical Laboratory Science Internship)
Availability of Service: 7:00 am to 4:00 pm,2:00 to 10:00 pm Monday to Fridays

Office/Division: Department of Pathology and Laboratories- Histopathology Section

Classification: Highly Technical
Type of Transaction: G2B
Who may avail: Affiliated Schools
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Letter of Endorsement from School PETD/Training Coordinator
signed by Training Office
2. Schedule of Duties Clinical Instructor
3. Attendance Record Interns Affiliate
4. Evaluation Forms Clinical Instructor
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1.Orientation 1. Verifies list of none 30 minutes Medical
interns and Technologist
duration of Section Head
training. (Histopathology
1.2 Orientation on Section)
Standard
Operating
Procedure
2. Bench Assignments 2. Assign and None Medical
directs to specific Technologist
area of (Histopathology
assignment Section)
2.1 Bench A- 5 working days
Receiving of
Samples
Specimen
Inventory
2.2 Bench B- 5 working days
Releasing of
Results
2.3 Bench C- 5 working days
Assist in Gross
Cutting
Change Reagent
and Stains
Processing of
Biopsy Specimens
FNAB and CYP
processing
Embedding of
tissues
2.4 Bench D- 5 working days
Cell block
processing
 Staining
Mounting
Reagent
Preparation
3. Evaluation 3. Interns None 30 minutes Medical
Evaluation Technologist
Section Head
(Histopathology
Section)
TOTAL: None 20 days, 60
minutes

3. Issuance of Laboratory Supplies to Ward

Provision of reagents for Surgical Pathology processing

Office/Division: Department of Pathology and Laboratories- Histopathology Section

Classification: Simple
Type of Transaction: G2C
Who may avail: Operating Room and Specialized Areas
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Requisition Slip Provided by Histopathology Section
2. Container for specific reagent
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Get Supplies 1. Histopathology none 10 minutes Medical
Section- issues Technologist
requested supply (Histopathology
Section)

2. Record reagents 2. Log reagents None 1 minute Operating

taken taken in Reagent Room Aide
monitoring
logbook
3. Signs logbook 2 minutes
noting
quantity/date and
time of request
3. Record verification 3. Verifies record None 2 minutes Medical
and reagent released and reagent Technologist
checking released (Histopathology
Section)
TOTAL: 15 minutes
 LIST OF SERVICES

Classification Type of Transaction

G2C G2B G2G
Highly
Services Simple Complex Gov’t Gov’t Gov’t
Technical
3 days 7 days to to to
20 days
Client Business Gov’t
External Services (in alphabetical order)
1. Collection of Urine or Stool
 
sample ( In-patientS)
2. Collection of Urine or Stool (
 
OB-ER)
3.Collection of Urine or Stool
sample (OPD Gyne-Onco  
patients)
4. Extraction of blood (In-patients
 
)
5. Extraction of blood ( OB-ER
 
patients)
6. Extraction of blood (OPD Gyne-
 
Onco patients.)
7. Extraction of blood for
 
Expanded Newborn Screening
8. Provision of Training on Blood
 
Collection for Newborn Screening
Internal Services (in alphabetical order)
1. Provision of Monthly Census
reports for Newborn Screening  
blood collection
 Laboratory

IWNH Laboratory

External Services
1. Collection of Urine/Stool
Urine or stool for urinalysis can be collected anytime and collected in the specific urine container
provided.
Availability of Service: 24/7; NO NOON BREAK

Office/Division: IWNH LABORATORY/DEPARTMENT OF LABORATORIES

Classification: SIMPLE
Type of Transaction: G2C
Who may avail: ADMITTED PATIENTS AT WARDS
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
PROPERLY ACCOMPLISHED NURSE STATION
LABORATORY REQUEST FOR
URINALYSIS AND STOOL
EXAMINATION
CLIENT STEPS AGENCY FEES TO BE PROCESSI PERSON
ACTION PAID NG TIME RESPONSIBLE
1.1. Receive the
specimen and Laboratory
1. Watcher or
request and Clerk/
Hospital Staff
instructs them to Medical
present the
write the name of Refer to the 2 minutes Technologist
laboratory
patient on the approved
request
container provided laboratory fees
together with
and logs on the at JICA
the urine
name of patient Laboratory
sample
and hospital
number in the log
book provided
1.2. Checks-in in None 1 minute Laboratory
the SEGHIS Clerk/
Medical
Technologist
2.1.Receive the
specimen and Laboratory
2. Watcher or
request and Refer to the Clerk/
Hospital Staff
instructs them to approved 2 minutes Medical
present the
write the name of laboratory fees Technologist
laboratory
patient on the at JICA
request
container provided Laboratory
together with
and logs on the
the stool
name of patient
sample
and hospital
number in the log
book provided
2.2.Submit all 60 minutes Laboratory
specimens Clerk/
 collected to the (submitted Medical
JICA main ER by batch) Technologist
laboratory
TOTAL: 1 hour and
5 minutes

2. Collection of Urine/Stool
Urine or stool for urinalysis can be collected anytime and collected in the specific urine container
provided.
Availability of Service: 24/7; NO NOON BREAK

Office/Division: IWNH LABORATORY/DEPARTMENT OF LABORATORIES

Classification: SIMPLE
Type of Transaction: G2C
Who may avail: ADMITTED PATIENTS AT OB-ER
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
ENCODED REQUEST IN SEGHIS FROM SEGHIS
OB-ER
CLIENT STEPS AGENCY FEES TO BE PROCESSI PERSON
ACTION PAID NG TIME RESPONSIBLE
2.1.1. Medical
2.1.Patient collects Technologist Medical
urine ( mid stream) assigned in OB- Technologist
in the container ER will collect the Refer to the
provided and label specimen approved 2 minutes
it with her name. submitted at nurse laboratory fees
station and bring at ER
to the laboratory. Laboratory
2.1.2. Checks-in N/A 1 minute Laboratory
in the SEGHIS Clerk/
Medical
Technologist
2.2.1 Medical
2.2.Patient collects Technologist Medical
stool in the assigned in OB- Refer to the Technologist
container provided ER will collect the approved
and label it with specimen laboratory fees 2 minutes
her name. submitted at nurse at ER
station and bring Laboratory
to the laboratory.
2.2.2Checks-in in N/A 1 minute Laboratory
the SEGHIS Clerk/
Medical
Technologist
2.2.3 Submit all 60 minutes Laboratory
specimens (submitted Clerk/
collected to the by batch) Medical
main ER Technologist
laboratory
 TOTAL: 1 hour and
3 minutes

3. Collection of Urine/Stool
Urine or stool for urinalysis can be collected anytime and collected in the specific urine container
provided.
Availability of Service: MONDAY TO FRIDAY (EXCEPT HOLIDAY) 8:00 AM -6:00PM

Office/Division: IWNH LABORATORY/DEPARTMENT OF LABORATORIES

Classification: SIMPLE
Type of G2C
Transaction:
Who may avail: OUT PATIENT (GYNE-ONCO)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
ENCODED REQUEST IN SEGHIS FROM DOCTOR’S CLINIC
GYNE-ONCO
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSI PERSON
PAID NG TIME RESPONSIBL
E
3.1.1. Receive the
3.1.Watcher
specimen and request Laboratory
or patient
and instructs them to Refer to the Clerk/
presents the
write the name of approved Medical
laboratory
patient on the laboratory fees 2 minutes Technologist
request
container provided and at JICA
together with
logs on the name of Laboratory
the urine
patient and hospital
sample
number in the log book
provided
3.1.2. Checks-in in the N/A 1 minute Laboratory
SEGHIS Clerk/
Medical
Technologist
3.2.1.Receive the
3.2.Watcher
specimen and request Laboratory
or Hospital
and instructs them to Refer to the Clerk/
Staff present
write the name of approved 2 minutes Medical
the laboratory
patient on the laboratory fees Technologist
request
container provided and at JICA
together with
logs on the name of Laboratory
the stool
patient and hospital
sample
number in the log book
provided
 3.2.2 Checks-in in the N/A 1 minute Laboratory
SEGHIS Clerk/
Medical
Technologist
3.3.1Submit all 60 minutes Laboratory
specimens collected to (submitted Clerk/
the JICA main by batch) Medical
laboratory Technologist
TOTAL: 1 hour and
3 minutes

4. Blood Extraction (Phlebotomy)

Blood sample is extracted usually from a vein in the arm using a hypodermic needle for the
hematology, serology or chemistry analyses or via finger prick for blood typing or CBC
Availability of Service: 24/7; NO NOON BREAK

Office/Division: IWNH LABORATORY/DEPARTMENT OF LABORATORIES

Classification: SIMPLE
Type of Transaction: G2C
Who may avail: ADMITTED PATIENTS AT THE WARDS
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
PROPERLY ACCOMPLISHED NURSE STATION
LABORATORY REQUEST

CLIENT STEPS AGENCY ACTION FEES TO PROCESSI PERSON

BE PAID NG TIME RESPONSIBLE
4.1.1 Encode the Refer to 2 minutes Laboratory
4.1.Nurse/Watcher laboratory request in approved Clerk/
submit completely the SEGHIS schedule of Medical
accomplished fees Technologist
laboratory request to 4.1.2. Extraction of N/A 5 minutes/ Medical
the IWNH laboratory blood for patient Technologist
Hematology,
Chemistry, Serology
4.1.3. Check in all n/a 2 Laboratory
samples with minutes Clerk/
requests to SEGHIS Medical
Technologist
4.1.4.Submit all 100 Laboratory
specimens collected minutes Clerk/
to the main JICA (submitted Medical
laboratory by batch Technologist
per rounds)
TOTAL: 1 hour and
49 minutes
5. Blood Extraction (Phlebotomy)
Blood sample is extracted usually from a vein in the arm using a hypodermic needle for the
hematology, serology or chemistry analyses or via finger prick for blood typing or CBC
Availability of Service: 24/7; NO NOON BREAK

Office/Division: IWNH LABORATORY/DEPARTMENT OF LABORATORIES

Classification: SIMPLE
Type of Transaction: G2C
Who may avail: ADMITTED PATIENTS AT OB-ER
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
ENCODED REQUEST IN SEGHIS FROM SEGHIS
OB-ER

CLIENT STEPS AGENCY FEES TO BE PROCESSI PERSON

ACTION PAID NG TIME RESPONSIBLE
5.1.1. Laboratory Laboratory
Clerk/Medical N/A 2 minutes Clerk/
technologist will Medical
5.1 Upon encoding of
print the request. Technologist
request, nurse calls
5.1.2. Medical Refer to 3 minutes/ Medical
the laboratory to
Technologist will approved patient Technologist
inform that there will
extract blood and schedule of
be patient for blood
placed in fees at JICA
extraction.
corresponding laboratory
tubes based from
laboratory request
5.1.3.Check-in in N/A 1 minute Laboratory
the SEGHIS Clerk/
Medical
Technologist
5.1.4.Submit all 60 minutes Laboratory
specimens (submitted Clerk/
collected to the by batch Medical
main ER samples/ Technologist
laboratory rounds)
TOTAL: 1 hour and
6 minutes
6. Blood Extraction (Phlebotomy)
Blood sample is extracted usually from a vein in the arm using a hypodermic needle for the
hematology, serology or chemistry analyses or via finger prick for blood typing or CBC
Availability of Service: 24/7; NO NOON BREAK

Office/Division: IWNH LABORATORY/DEPARTMENT OF LABORATORIES

Classification: SIMPLE
Type of Transaction: G2C
Who may avail: GYNE-ONCO OUT PATIENTS
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.ENCODED AND PROPERLY GYNE-ONCO CLINIC (IWNH)
ACCOMPLISHED LABORATORY
REQUEST

CLIENT STEPS AGENCY FEES TO BE PROCESSI PERSON

ACTION PAID NG TIME RESPONSIBLE
6.1.1. Extraction Refer to 2 minutes Laboratory
6.1.Patient submit
of blood for approved Clerk/
encoded and
Hematology, schedule of Medical
completely
Chemistry, fees at JICA Technologist
accomplished
Serology laboratory
laboratory request to
the IWNH laboratory
6.1.2. Check-in in N/A 2 minutes/ Medical
the SEGHIS patient Technologist
6.1.3.Submit all 100 Laboratory
specimens minutes Clerk/
collected to the (submitted Medical
main JICA together Technologist
laboratory with batch
samples/
rounds)
TOTAL: 1 hour and
44 minutes
7. EXPANDED NEWBORN SCREENING BLOOD COLLECTION
Blood is extracted via heel prick and collected onto the special filter cards which can diagnose 29
newborn disorders.

Availability of Service: MONDAYS TO SUNDAYS; 8:00AM TO 5:00PM

Office/Division: IWNH NEWBORN SCREENING UNIT

Classification: SIMPLE
Type of Transaction: G2C
Who may avail: >24 HOUR-BORN BABIES (ADMITTED)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
PROPERLY ACCOMPLISHED SEGHIS
INFORMATION IN THE FILTER CARDS

CLIENT STEPS AGENCY FEES TO BE PROCESSI PERSON

ACTION PAID NG TIME RESPONSIBLE
1.Completely 1.Extraction of Refer to 5 minutes/ Properly DOH
accomplished blood via heel approved baby trained
information of patient prick schedule of Medical
in the Expanded fees in the Technologist
Newborn Screening NBS unit
Filter Card.

TOTAL: Refer to 5 minutes/

approved baby
schedule of
fees
8. TRAINING ON EXPANDED NEWBORN SCREENING BLOOD COLLECTION
Newborn Screening Health Facilities are trained on how to properly collect blood for Expanded
Newborn Screening which is facilitated by Department of Health Region XI.
Availability of Service: Scheduled Training every quarter

Office/Division: IWNH LABORATORY/DEPARTMENT OF LABORATORIES

Classification: SIMPLE
Type of Transaction: G2G
Who may avail: NEWBORN SCREENING FACILITIES ORGANIZED BY
DEPARTMENT OF HEALTH REGION XI
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
APPROVED LETTER FROM THE CHIEF CHIEF MEDICAL TECHNOLOGIST OFFICE
OF HOSPITAL PROPERLY ENDORSED
BY LABORATORY HEAD
CLIENT STEPS AGENCY FEES TO BE PROCESSI PERSON
ACTION PAID NG TIME RESPONSIBLE
1.Conduct training N/A 1 hour Properly trained
on blood Newborn
collection at IWNH Screening In -
Letter of request from
lecture room charge -
Department of Health
Medical
requesting for training
Technologist
on blood collection for
2. Assist in the N/A 2 hours Properly trained
Expanded Newborn
actual training in (whole Newborn
Screening.
Extraction of batch) Screening In -
blood charge -
Medical
Technologist
TOTAL: 3 HOURS
 Laboratory

IWNH Laboratory
 Internal Services

1. PROVISION OF EXPANDED NEWBORN SCREENING MONTHLY REPORT

every 10th day of the following month a report which comprises the total number of screened
babies, their disorders, prematurity status, weight status and feeding status is submitted to
Pediatric Department and Newborn Screening facility of Southern Philippines Medical Center.
Availability of Service: 10th day of the preceding month.

Office/Division: IWNH LABORATORY/DEPARTMENT OF LABORATORIES

Classification: SIMPLE
Type of Transaction: G2G
Who may avail: SPMC Newborn Screening Facility and Pediatric Department
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
IWNH LABORATORY

CLIENT STEPS AGENCY FEES TO BE PROCESSI PERSON

ACTION PAID NG TIME RESPONSIBLE
1.1.1.Encodes N/A 30 minutes Properly trained
Everyday Census Newborn
and Tally all Screening In -
1.1.Availment of
disorders charge -
Expanded Newborn
Medical
Screening Monthly
Technologist
Report with Total
1.1.2.Release N/A 10 minutes Properly trained
Census and Newborn
Monthly report to Newborn
Screening Disorders.
the respective Screening In -
units charge -
Medical
Technologist
TOTAL: 40 minutes
 SUB-NATIONAL Emerging Infectious
LABORATORY Diseases Facility and Local 4315
Laboratory,2nd floor and
EREID-Molecular
Tuberculosis Culture Local 5055
Biology Laboratory
Office Name Address(es) Contact Number(s)
*Include satellite offices, if any

LIST OF SERVICES
Classification Type of Transaction
G2C G2B G2G
Highly
Services Simple Complex Gov’t Gov’t Gov’t
Technical
3 days 7 days to to to
20 days
Client Business Gov’t
External Services (in alphabetical
order)
25. Diagnostic Services

Chikungunya Virus Detection;

Dengue Virus Detection;
Dengue Serotype
Differentiation;  
Hepatitis B Viral Detection;
MERS-Corona Virus
Detection;
SARI Virus Detection;
ZIKA Virus Detection
26. Surveillance Services

a. Surveillance for Dengue,

Chikungunya, Zika Virus
(ZDC)
b. Surveillance for MERS-  
Corona Virus (MERS-CoV);
Surveillance for Severe
Acute Respiratory Infections
(SARI)

27. Tuberculosis Bacterial

 
Detection (TB-PCR)
Internal Services (in alphabetical order)
15. Acceptance of deliveries of
 
supplies and reagent
16. Evaluation of Products and
  
Supplies
17. Evaluation of Equipment  
18. Issuance of Monthly-
 
Annual Report
19. Packing and Storage of
Valuable Biological   
Materials (VBM)

Laboratory
 Sub-National Laboratory EREID-MBL

External Services

1a. Diagnostic Services (Inpatient)

Chikungunya Virus Detection

Dengue Virus Detection
Dengue Serotype Differentiation
Hepatitis B Viral Detection
Severe Acute Respiratory Infection (SARI) Virus Detection
MERS-Corona Virus Detection
ZIKA Virus Detection

Availability of Service: 7:00 am to 4:00 pm, Monday to Friday

Office/Division: Department of Pathology and Laboratories – Sub-National

Laboratory EREID-Molecular Biology
Classification: Complex
Type of Transaction: G2C
Who may avail: Admitted Patients (INPATIENTS)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Fully accomplished laboratory request Attending Physician
form
2. Completely filled up Request Form for Laboratory
Molecular Diagnosis
3. Yellow Card/PHIC Card HIMD/Billing Section
3. Appropriately labeled specimen Operating Room, Wards
4. Official Receipt for paid laboratory Cashier
procedure
● For claiming of results (official claim Patient/ Authorized Individual
stub
● If representative (authorization letter
signed by the patient and authorized
representatives ID)
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Submit Laboratory 1. Accept and check None 5 minutes Laboratory
Request Form and requirements Reception Clerk
present PHIC Card to
1.1 Encode
JICA Laboratory-
laboratory request
Window 2
into Hospital
Information System
(HIS)
1.2 If with excess
charges, advise
client/client
representative to
settle payment at
cashier or to
Patients Assistance
Desk (PAD) for
medical financial
assistance queries.
1.3 If no further
payment is required,
proceed to Step 3.1
2. Settle the payment 2. Accept payment None Refer to Cashier
for processing at the for the processing. Finance
(Refer to
cashier Division (10
Finance
minutes)
Division)
3.Present the official 3. Checks official None 5 minutes Laboratory
receipt at the JICA receipt or other Reception Clerk
Laboratory- Window 2 proof of payment
3.1 Inform the client/
representative on
the schedule of
collection,
processing and
claiming of results
3.2 Endorse
laboratory request to
Phlebotomist-on-
duty
3.3 Phlebotomist will 15 minutes Phlebotomist
collect blood
specimen,
accomplish Request
Form for Molecular
Diagnosis and
endorse sample to
Nurse-On-Duty
(NOD) for sending
to laboratory via
Pneumatic tube
system or hand-
carried by patient
representative
3.4 NOD will submit Refer to Nurse-On-Duty
blood sample with Nursing
(NOD)
accompanying Services
completely filled-up
(5 minutes)
request forms to
laboratory
3.5 Laboratory will 5 minutes Laboratory
receive sample and Reception Clerk
request sent from
ward (following the
Acceptance/
Rejection Criteria)
3.5.1 Check-in
acceptable requests
into the HIS and
endorse sample with
requests forms to
Hematology section
3.5.2 Endorse
rejected request to
Phlebotomist and/or
NOD for correction
or repeat collection,
whichever applies.
3.6 Initial 2-8 days Medical
preparation of Technologist-
(from sample
serum sample at on-Duty
pooling to
Hematology section (MTOD) in
batch testing)
for safekeeping until Hematology
batch testing section
schedule
3.7 Collect batch of Medical
serum samples Technologist-
and bring to EREID- on-Duty
Molecular Biology (MTOD) in
section for PCR EREID-
Testing Molecular
Biology section
3.8 Perform data
registry, nucleic acid
extraction and PCR
testing of submitted
samples
3.9 Validate results Medical
generated by PCR Technologist
testing Supervisor
3.10 Print official MTOD
result
3.11 Verify and sign 1 working day Pathology
report/results Consultant
 None

4. Claim Results 4. Issues official None 5 minutes Laboratory

result Reception Clerk
(Refer to
Present official Claim
requirements)
Stub at the JICA
Laboratory- Window 2
TOTAL: (Refer to 3-9 days 50
minutes
approved
Schedule
of Fees)

1b. Diagnostic Services (Outpatient)

Chikungunya Virus Detection

Dengue Virus Detection
Dengue Serotype Differentiation
Hepatitis B Viral Detection
SARI Virus Detection
MERS-Corona Virus Detection
ZIKA Virus Detection

Availability of Service: 7:00 am to 4:00 pm, Monday to Friday, except Holidays.

Office/Division: Department of Pathology and Laboratories – Sub-National

Laboratory EREID-Molecular Biology
Classification: Complex
Type of Transaction: G2C
Who may avail: SPMC Outpatients and Walk-in patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Fully accomplished laboratory request Attending Physician
form
2. Completely filled up Request Form for Laboratory
Molecular Diagnosis
3. Yellow Card HIMD
3. Appropriately labeled specimen JICA-Laboratory OPD Extraction Area/ HSSC
4. Official Receipt of payment Cashier
● For claiming of results (official claim Patient/ Authorized Individual
stub
● If representative (authorization letter
signed by the patient and authorized
representatives ID)
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Present Yellow 1. Accept and verify None 5 minutes Laboratory
Card at JICA-OPD Lab requirements Reception Clerk
Window 1
1.1 Check encoded
laboratory request in
OR Hospital Information
System (HIS)
at HSSC Lab Window 1.2 If requiring
1 payment, advise to
settle at the cashier
1.3 If no further
payment is required,
proceed to Step 3.1

2. Settle the payment 2. Accept payment None Refer to Cashier

for processing at the for the processing. Finance
(Refer to
cashier Division (10
Finance
minutes)
Division)

3.Present the official 3. Checks official None 5 minutes Laboratory

receipt at the JICA receipt or other Reception Clerk
Laboratory- Window 1 proof of payment
3.1 Provide print out
of laboratory request
3.1.1 For requests
with Samples
collected from
outside laboratory,
proceed to Step 3.5
3.2 Inform the client/
representative to
proceed to Patient
Extraction Area for
blood sample
collection
procedures
 3.3 Endorse
laboratory request to
Phlebotomist-on-
duty
3.4 Collect blood 10 minutes Phlebotomist
specimen and
accomplish Request
Form for Molecular
Diagnosis
3.5 Endorse blood JICA-Lab
sample to Phlebotomist or
Hematology Section HSSC staff
3.6 Initial 2-8 days Medical
preparation of Technologist-
(from sample
serum sample at on-Duty
pooling to
Hematology section (MTOD) in
batch testing)
for safekeeping until Hematology
batch testing section
schedule
3.7 Collect batch of Medical
serum samples Technologist-
and bring to EREID- on-Duty
Molecular Biology (MTOD) in
section for PCR EREID-
Testing Molecular
Biology section
3.8 Perform data
registry, nucleic acid
extraction and PCR
testing of submitted
samples
3.9 Validate results Medical
generated by PCR Technologist
testing Supervisor
3.10 Print official MTOD
result
3.11 Verify and sign 1 working day Pathology
report/ results Consultant

4. Claim Results 4. Issues official None 5 minutes Laboratory

result Reception Clerk
(Refer to
Present official Claim
requirements)
Stub at the JICA
Laboratory- Window 2
TOTAL: (Refer to 3-9 days 35
approved minutes
Schedule
of Fees)
2a. Surveillance Services (Bloodborne)
Surveillance for Dengue, Chikungunya, ZIKA Virus (ZDC)

Availability of Service: 24/7 Daily

Office/Division: Department of Pathology and Laboratories – Sub-National

Laboratory EREID-Molecular Biology
Classification: Complex
Type of Transaction: G2G
Who may avail: Referrals from SPMC-IPCU and RESU, RITM, DOH
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Fully accomplished PIDSR Case Report Attending Physician/Infection Prevention and
Form (CRF) Control Unit (IPCU) Nurse
2. Properly filled-up Serology Request Form Laboratory
2. Appropriately labeled specimen Emergency Complex, Wards
 CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Submits PIDSR 1. Accept and verify None 2 minutes Medical
CRF and/or Serology requirements Technologist
Request form to JICA-
1.1 Endorse CIF to
Laboratory
Phlebotomist for
Hematology Section
specimen collection
1.2 Collects blood 10 minutes Phlebotomist
sample from
patients enrolled in
the surveillance
1.3 Endorse request
forms and collected
blood sample to
Hematology section
and register patient
data on Surveillance
Samples List
1.3 Separate patient 20 minutes Medical
serum in cryogenic Technologist
tube and store in (Hematology
Hematology section Section)
freezer and endorse
along with CIFs to
EREID-MBL staff for
listing, processing
and packing
1.4 Aliquot sample 4 hours Medical
accordingly, process Technologist
200ul for in-house
(EREID-MBL)
PCR testing and the
rest for RITM
referral
1.4.1 Evaluate and
validate PCR testing
results
1.4.2 Coordinate
testing results to
RITM partners
before releasing to
IPCU
1.5 Pack (up to 30 minutes
secondary container
packing only)
referral samples and
its corresponding
documents to be
submitted to RITM
for Quality
Assurance (QA) and
Virus Isolation (VI)
procedures
1.6 Endorse packed
items to RESU
 2. Pick-up Indefinite RESU Staff
secondary packed
samples and its
documents from
laboratory
2.1 Enclose items in
a triple-pack system
before shipment
2.2 Ship package to
RITM using affiliated
courier
2.3 Referred Indefinite RITM Staff
samples will
(Refer to
undergo further
RITM)
virology (VI) and
concordance (QA)
studies
3. Claim Results 3.1 Electronic EREID-
delivery of result via MBL/RITM
SARI surveillance
network
TOTAL: None Indefinite

2b. Surveillance Services (Respiratory)

Surveillance for Severe Acute Respiratory Infections (SARI)

Surveillance for MERS-Corona Virus

Availability of Service: 7:00 am to 4:00 pm, Monday to Friday, except Holidays.

Office/Division: Department of Pathology and Laboratories – Sub-National

Laboratory EREID-Molecular Biology
Classification: Complex
Type of Transaction: G2G
Who may avail: Referrals from SPMC-IPCU and RESU, RITM, DOH
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Fully accomplished Case Information Attending Physician/Infection Prevention and
Form (CIF) Control Unit (IPCU) Nurse
2. Appropriately labeled specimen Emergency Complex, Wards
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Submits CIF to 1. Accept and verify None 5 minutes Medical
JICA-Laboratory Case Information Technologist
Hematology Section Form
1.1 Endorse CIF to
trained NPS/OPS
Collectors for
specimen collection
1.2 Collects 5 minutes Trained Swab
Nasopharyngeal Collectors
swab (NPS)and
Oropharyngeal
swab (OPS) from
patients enrolled in
the surveillance
1.3 Store collected
NPS/OPS in
Hematology section
freezer and endorse
along with CIFs to
EREID-MBL staff for
listing, processing
and packing
1.4 Aliquot sample 4 hours Medical
accordingly, process Technologist
200ul for in-house
PCR testing and
save the rest for
RITM referral
1.4.1 Evaluate and
validate PCR testing
results
1.4.2 Coordinate
testing results to
RITM partners
before releasing to
IPCU
1.5 Pack (up to 30 minutes
secondary container
packing only)
referral samples and
its corresponding
documents to be
transported to RITM
for Quality
Assurance (QA) and
Virus Isolation (VI)
procedures
1.6 Endorse packed
items to RESU
 2. Pick-up Indefinite RESU Staff
secondary packed
samples and its
documents from
laboratory
2.1 Enclose items in
a triple-pack system
before shipment
2.2 Ship package to
RITM using affiliated
courier
2.3 Referred Indefinite RITM Staff
samples will
(Refer to
undergo further
RITM)
virology (VI) and
concordance (QA)
studies
2. Claim Results 3.1 Electronic EREID-
delivery of result via MBL/RITM
SARI surveillance
network
TOTAL: None Indefinite

3. TUBERCULOSIS BACTERIAL DETECTION (TB-PCR)

(TB LABORATORY – In/Out Patient)

Availability of Service: OPD - 8:00 am to 5:00 pm, Monday to Friday, except Holidays.
IPD – 24 Hours daily

Office/Division: Department of Pathology and Laboratories –TB laboratory Section

Classification: Complex
Type of Transaction: G2C
Who may avail: All Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Fully accomplished Microbiology request Attending Physician
form and/or hospital request form if from
outside laboratory
2. Appropriately labeled specimen Attending Physician, All Wards, Clinics
3. a. OPD - Yellow Card HIMD
b. IPD – Microbiology request form Ward

4. a. OPD - Official Receipt for paid Cashier

laboratory procedure
b. IPD – present PHIC card to windows 1
and 2 of JICA laboratory
 For claiming of results ( a text Patient/ Authorized Individual
message will be sent once results
are available)
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Submit 1. Check none 10 minutes Laboratory
requirements to JICA requirements and Clerk and or
laboratory windows 1 encode test MTOD
and 2 1.1 OPD - Instruct
patient/patient’s
representative to
settle payment
1.2 IPD – present
PHIC card upon
encoding of
request
2. Settle the payment 2. Accept payment Refer to Refer to Cashier
for processing at the for the processing. approved Finance (Refer to
cashier list of fees Division (10 Finance
minutes) Division)
3.Presents the official 3. a. OPD - Checks None 5 minutes Laboratory clerk
receipt at JICA official receipt of and or MTOD
laboratory windows 1 payment and
and 2 receive request
and sample
b. IPD – Encode
test and charge to
PHIC funds of
patient. If no PHIC,
ask for LINGAP
and social services
assistance.

3.1 Ask for

patient’s contact
number and Inform
the patient/
representative on
the schedule of
claiming of results
3.2. Processing of None 1 working day MTOD
PCR specimen (TB lab)
3.3 Running, none 1 working day MTOD
interpretation and (TB lab)
validation of results
4. Claim Results (Refer to None 10 minutes MTOD
requirements) (TB lab)
Results will be
claimed at TB
laboratory
TOTAL: Refer to 2 days 35
approved minutes
schedule of
fees
 Laboratory

Sub-National Laboratory EREID-MBL

Internal Services

1. Acceptance of Deliveries of Supplies and Reagents

Acceptance of deliveries of supplies and reagents used in molecular detection
Office/Division: Department of Pathology and Laboratories- EREID-MBL
Classification: Simple
Type of G2B
Transaction:
Who may avail: Suppliers
CHECKLIST OF REQUIREMENTS WHERE TO SECURE

5. Delivery Receipts Supplier

6. Items or Products Supplier
7. Requisition and Issue Slip Stockroom custodian
 CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Submit 1. Receive none 5 minutes EREID-MBL
requirements at requirements and Staff
EREID-MBL check documents
1.1. Check and None 15 minutes EREID-MBL
validate the items Staff
and the delivery
receipts

2.Receive copy of 2. if not acceptable,

signed delivery return the item and
receipts delivery receipt
2.1 if acceptable,
receive and sign
receipt with name,
signature, date and
time
3.Store the supplies 15 minutes EREID-MBL
and reagents Staff
according to storage
requirement.
3.1 Endorse
delivery receipt to
stockroom
custodian for proper
documentation
4. Requisition and 30 minutes Stockroom
Issue slip creation custodian
and documentation
TOTAL: 65 minutes

2. Evaluation of Products and Supplies

Process of evaluation of laboratory products and supplies

Office/Division: Department of Pathology and Laboratories- EREID-MBL

Classification: Complex
Type of Transaction: G2B, G2G
Who may avail: Suppliers
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Product Evaluation Form Provided by the Quality Assurance Unit
2.Product / materials for evaluation Supplier
3.Letter of intent Supplier
 CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit letter of 1. Laboratory none 10 minutes Laboratory
intent and present the office will check Quality
products / supplies for and approve Assurance staff
evaluation to 1. 1 Endorse the
Laboratory office products /
supplies with the
Product
Evaluation form to
the EREID-MBL

1.2. Process the None 2-3 days EREID-MBL

evaluation of Staff
supplies
according to use.
1.3 Submit report
of Product
Evaluation form to
Quality Assurance
unit
2. Follow – up result 2. Preparation of None 1 day Laboratory
of evaluation the report copy for Quality
the supplier Assurance staff

TOTAL: 4 days 10
minutes

3. Evaluation of EREID-MBL Equipment

Process of evaluation of equipment before purchase and prior to use in the Molecular detection

Office/Division: Department of Pathology and Laboratories- EREID-MBL

Classification: Highly Technical
Type of G2B
Transaction:
Who may avail: Suppliers
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Letter of intent Supplier
 2.Product / equipment for evaluation Supplier
3.Reagents / Consumables used for evaluation Supplier
CLIENT STEPS AGENCY ACTION FEES TO PROCESSI PERSON
BE PAID NG TIME RESPONSIBLE
1. Submit letter of 1. Chief of hospital office none 10 minutes COH
intent to the Chief of receive and endorse to
Hospital (COH) Laboratory office
1.1 Laboratory office will Laboratory
check and approve Chief Medical
1. 1 Endorse the Technologist
approved letter to the (CMT)
EREID-MBL section head
1.2. Schedule for product none 5 minutes EREID-MBL
demonstration and Section Head
evaluation.
2. Submit the other 2. Process the evaluation None 7 days EREID-MBL
requirements procedures based on Section Head /
needed on the validation protocol and Staffs and
scheduled date for according to its functions. validation- in-
evaluation 2.1 Records the report of charge
Product Evaluation
process
2.2 Create final report for none 2 days Validation- In
documentation charge
2.3 Verify and sign report none 1 day Department
Chairman /
CMT/ Section
head/
Validation- In -
charge
3. Follow – up result 2. Preparation of the None 5 minutes EREID-MBL
of evaluation report copy for the Section Head
supplier
TOTAL: 10 days 20
minutes

EREID-MBL Schedule of Fees

Procedure Fee
Process for evaluation of equipment Free

4. Issuance of Monthly-Annual Report

Process of a required report monthly or annual census

Office/Division: Department of Pathology and Laboratories- EREID-MBL

Classification: Simple
Type of Transaction: G2G
Who may avail: Chief Medical Technologist, Auditor, Accounting, Chief Of Hospital
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Request Letter of required report Provided by client
 CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present Request 1. Receive and none 15 minutes EREID-MBL-
letter process the head
request document
as recorded / filed
in the section
1.1 Collate and None 1 hour
verify gathered
census
1.2 Summarize None 1 hour
data as requested
to report

2. Collect report 2. Print and None 5 minutes

submit needed
report
TOTAL: None 2 hour 20
minutes

5. Packing of Valuable Biological Materials (VBM)

Provide assistance in the packing of valuable biological materials following the IATA packaging guidelines.

Office/Division: Department of Pathology and Laboratories – Sub-National

Laboratory EREID-Molecular Biology
Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: Walk-in/Admitted Clients, Disease Surveillance Referrals
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Properly labeled specimen with Requesting agency/Wards/Attending
accompanying Request/Case Information Physician/IPCU
Form
2. Leakproof Box Containers Personal/RESU
3. Packing Materials Laboratory
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit samples, 1. Check sample None 5 minutes Certified IATA
accompanying for Infectious Packer/Shipper
documents and Substance
Leakproof Box category
container to EREID- 1.1 For Walk-
MBL in/Admitted
Clients, advise to
settle
corresponding fee
at the cashier
1.2 For
Surveillance
referrals, proceed
to Step 3.1
2. Settle the payment 2. Accept None Refer to Cashier
for processing at the payment for the Finance (Refer to
cashier processing. Division (10 Finance
minutes) Division)
3. Present official 3.Checks official None 30 minutes Certified IATA
receipt to EREID-MBL receipt Packer/Shipper
3.1 Pack samples
using appropriate
IATA Packing
Instruction
3.2 For
Surveillance
referrals, store
package to
Hematology
Section freezer
until pick-up for
shipment by
RESU (then Step
4.1)
3.3 For Walk-
in/Admitted
Clients, proceed
to Step 4.
4. Collect package for 4. Release None 2 minutes Certified IATA
shipment package to client Packer/Shipper
4.1 Pick-up RESU Staff
package from
laboratory
TOTAL: None 37 minutes

Sub-National Laboratory EREID-MBL Schedule of Fees

Procedure Fee
Chikungunya Virus Detection ₱ 4000.00
Dengue Virus Detection ₱ 4000.00
Dengue Serotype Differentiation ₱ 4000.00
Hepatitis B Viral Detection ₱ 4000.00
SARI Virus Detection ₱ 4000.00
MERS-Corona Virus Detection ₱ 4000.00
ZIKA Virus Detection ₱ 4000.00
Surveillance for MERS-Corona Virus Free
Surveillance for Severe Acute Respiratory Free
Infections (SARI)
Surveillance for Dengue, Chikungunya, ZIKA Free
Virus (ZDC)
TB PCR 4,000.00

Acceptance Process for Deliveries Free

Process for evaluation of equipment Free
Process for evaluation of product /supplies Free
Process for Issuance of monthly – Annual report Free
Specimen Packing Fee ₱400.00

LIST OF SERVICES
Classification Type of Transaction
G2C G2B G2G
Highly
Services Simple Complex Gov’t Gov’t Gov’t
Technical
3 days 7 days to to to
20 days Client Business Gov’t
External Services (in alphabetical order)
1. Acid Fast Bacilli Stain (AFB),
 
sputum
2. Acid Fast Bacilli Stain (AFB-O),
 
other than sputum
3. Blood Culture  
4. Culture & sensitivity (Aerobic)
with Gram Stain for body fluids,
exudates, respiratory, urine, stool,  
rectal swab, urethral and
cervicovaginal discharge.
5. Giemsa Stain  
6. Gram Stain  
7. India Ink Stain  
8. Issuance of blood culture vial  
9. KOH preparation  
10. Provision of control strain
 
isolates for research studies
11. Wet Mount  

Internal Services (in alphabetical order)

1. Acceptance of deliveries of
 
supplies and reagent
2-A. Affiliation training (In-service
Registered Med. Tech. and  
Interns)
2-B. Affiliation Training (Medical
 
Technology Interns)
3. Collection and processing of
 
environmental Samples
4. Encoding of ARSP data, and
referral of clinical isolates to  
ARSL-RITM.
5. Issuance of sterile containers to
 
wards
6. Submission of hospital’s
 
antibiogram report
 Laboratory

Clinical Microbiology

External Services

1. Acid Fast Bacilli Stain (AFB), sputum

Availability of Service: Monday to Sunday & Holidays; 24 hours a day.

Office/Division: Department of Pathology & Laboratories (JICA Bldg.) – Microbiology Section

Classification: Complex
Type of Transaction: G2C
Who may avail: All Patients
 CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Fully Accomplished microbiology request Attending Physician
form.
2. Yellow Card HIMD
3. Number of samples required – 2 Sputum
samples
4. Collection time – 1st) Early morning; 2nd) on
spot Collection
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE
1. Submit request to 1.0 Check for none 5 minutes Receiving Clerk/
microbiology laboratory completeness of Lab. Aide
for encoding (JICA Lab data written on the
– window 4) request form, then
encode the test
desired by the
attending physician.

1.1 Give instruction

on the proper
collection of
sputum.

2. Submit laboratory 2.0 Check the free of 5 minutes Receiving Clerk/

request and sputum correctness of data charge Lab. Aide
samples at window 4, written on both
JICA Lab container and the
request form.

2.1 Accept the

request form and
the two sputum
samples.

3. Secure claim stub 3.0 Write on the none 5 minutes Receiving Clerk/
claim stub the name Lab. Aide
of the patient,
sample submitted,
date of submission,
and mark with
“check” the test to
be performed on the
patient sample

3.1 Issue claim stub

3.2 Process sample 2 days Med Tech Staff

(microbiology)
4. Claim result 4.0 Release result none After 2 working Med. Tech. staff
days (Microbiology)

TOTAL: ₱0.00

2. Acid Fast Bacilli Stain (AFB-O), other than sputum

Availability of Service: Monday to Sunday & Holidays; 24 hours a day.

Office/Division: Department of Pathology & Laboratories (JICA Bldg.) – Microbiology Section

Classification: Complex
Type of Transaction: G2C
 Who may avail: All Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Fully Accomplished microbiology request Attending Physician
form.
2. Yellow Card HIMD
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE
1. Submit request to 1.0 Check for none 5 minutes Receiving Clerk/
microbiology laboratory completeness of Lab. Aide
for encoding (JICA Lab data written on the
– Window 4) request form, then
encode the test
desired by the
attending physician.

2. Submit laboratory 2.0 Check the free of 5 minutes Receiving Clerk/

request and sputum correctness of data charge Lab. Aide
samples at window 4, written on both
JICA Lab container and the
request form.

2.1 Accept the

request form and
the sputum
samples.

3. Secure claim stub 3.0 Write on the none 5 minutes Receiving Clerk/
claim stub the name Lab. Aide
of the patient,
sample submitted,
date of submission,
and mark with
“check” the test to
be performed on the
patient sample

3.1 Issue claim stub

3.2 Process sample Within 24 hours Med Tech Staff

(microbiology)

4. Claim result 4.0 Release result none 24 hours upon Med. Tech. staff in
receipt of Microbiology
sample
TOTAL: ₱0.00

3. Processing of Specimen (Microbiology – Blood Culture; In-Patient)

Availability of Service: Monday to Sunday & Holidays; 24 hours a day.

Office/Division: Department of Pathology & Laboratories (JICA Bldg.) – Microbiology Section

Classification: Complex
 Type of Transaction: G2C
Who may avail: All Patients (In-Patient)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Fully Accomplished microbiology request Attending Physician
form.
2. Yellow Card, PHIC HIMD
3. For LINGAP, CMAP, PAD For approval prior to encoding.
4. For PHIC – Bactec vial is provided by the
hospital
5. For non-PHIC a) cash payment
b) LINGAP, CMAP, PAD
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE
1. Submit request to 1.0 Check for none 5 minutes Receiving Clerk/
microbiology laboratory completeness of Lab. Aide
for encoding (JICA Lab data written on the
– Window 4) request form, then
encode the test
desired by the
attending physician.

2.0 Issue blood

culture vial for
PHIC-enrolled
patients.

2. Settle payments Refer to list Cashier

of fees

3. Submit request with 3.0 Check none 5 minutes Receiving Clerk/

the sample at window 4 payments Lab. Aide

3.1 Check the blood

culture vial if it’s
filled with blood
sample and if it’s
labelled correctly

3.1 Accept request

and the sample

4. Secure claim stub 4.0 Write on the none 5 minutes Receiving Clerk/
claim stub the name Lab. Aide
of the patient,
sample submitted,
date of submission,
and mark with
“check” the test to
be performed on the
patient sample

4.1 Issue claim stub

4.2 Process sample 5-8 days Med. Tech. staff

(Microbiology)

5. Claim result 5.0 Release result none After 5-8 days Med. Tech. staff in
Microbiology

TOTAL: ₱1,200.00

4. Processing of Specimen (Culture & Sensitivity Test – Microbiology)

Availability of Service: Monday to Sunday & Holidays; 24 hours a day.
Office/Division: Department of Pathology & Laboratories (JICA Bldg.) – Microbiology
Section
 Classification: Complex
Type of Transaction: G2C
Who may avail: All Patients (Out-Patient)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Fully Accomplished microbiology request Attending Physician
form.
2. Appropriately labelled specimen Attending Physician
3. Yellow card HIMD
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE
1. Submit request to 1.0 Check for none 5 minutes Receiving Clerk/
microbiology laboratory completeness of Lab. Aide
for encoding (JICA Lab data written on the
– Window 4) request form, then
encode the test
desired by the
attending physician

1.1 Encode/Billing none 5 minutes Receiving Clerk/

Lab. Aide

2. Settle payment refer to list of Cashier

fees

3. Present Official 3.0 Check if the none 5 minutes Receiving clerk

Receipt or receipt of container is
payment along with the correctly labelled
laboratory request and and request if
the specimen to the correctly filled-out
receiving clerk at prior to accepting
window 4 the specimen

3.1 Accept Med. Tech. staff

specimen in Microbiology

4. Secure claim stub 4.0 Write on the none 5 minutes Receiving clerk
claim stub the name
of the patient,
sample submitted,
date of submission,
and mark with
“check” the test to
be performed on the
patient sample

4.1 Issue claim stub

2-5 days Med Tech staff
4.2 Process sample (Microbiology)

5. Claim results 5.0 Release result none After 2-5 days Med. Tech. staff
in Microbiology

TOTAL: ₱1,200.00

5. Giemsa Stain
Availability of Service: Monday to Sunday & Holidays; 24 hours a day.
 Office/Division: Department of Pathology & Laboratories (JICA Bldg.) – Microbiology
Section
Classification: Complex
Type of Transaction: G2C
Who may avail: All Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Fully Accomplished microbiology request Attending Physician
form.
2. Yellow Card HIMD

CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON

PAID TIME RESPONSIBLE
1. Submit request to 1.0 Check for none 5 minutes Receiving Clerk/
microbiology laboratory completeness of Lab. Aide
for encoding (JICA Lab data written on the
– Window 4) request form, then
encode the test
desired by the
attending physician

1.1 Encode/Billing none 5 minutes Receiving Clerk/

Lab. Aide

2. Settle payment refer to list of Cashier

fees

3. Present Official 3.0 Check if the none 5 minutes Receiving clerk

Receipt or receipt of container is
payment correctly labelled
and request if
correctly filled-out
prior to accepting
the specimen

3.1 Accept
specimen

4. Secure claim stub 4.0 Write on the none 5 minutes Receiving clerk
claim stub the name
of the patient,
sample submitted,
date of submission,
and mark with
“check” the test to
be performed on the
patient sample

4.1 Issue claim stub

4.2 Process sample Within 24 hours Med. Tech. staff

(Microbiology)
5. Claim result 5.0 Release result none 24 hours upon Med. Tech. staff
receipt of in Microbiology
sample
TOTAL: ₱90.00

6. Gram Stain
Availability of Service: Monday to Sunday & Holidays; 24 hours a day.
Office/Division: Department of Pathology & Laboratories (JICA Bldg.) – Microbiology
Section
Classification: Complex
Type of Transaction: G2C
Who may avail: All Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Fully Accomplished microbiology request Attending Physician
form.
2. Yellow Card HIMD

CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON

PAID TIME RESPONSIBLE
1. Submit request to 1.0 Check for none 5 minutes Receiving Clerk/
microbiology laboratory completeness of Lab. Aide
for encoding (JICA Lab data written on the
– Window 4) request form, then
encode the test
desired by the
attending physician

1.1 Encode/Billing none 5 minutes Receiving Clerk/

Lab. Aide

2. Settle payment refer to list of Cashier

fees

3. Present Official 3.0 Check if the none 5 minutes Receiving clerk

Receipt or receipt of container is
payment correctly labelled
and request if
correctly filled-out
prior to accepting
the specimen

3.1 Accept
specimen

4. Secure claim stub 4.0 Write on the none 5 minutes Receiving clerk
claim stub the name
of the patient,
sample submitted,
date of submission,
and mark with
“check” the test to
be performed on the
patient sample

4.1 Issue claim stub

4.2 Process sample Within 24 hours Med. Tech. staff

(Microbiology)
5. Claim result 5.0 Release result none 24 hours upon Med. Tech. staff
receipt of in Microbiology
sample
TOTAL: ₱165.00

7. India Ink
Availability of Service: Monday to Sunday & Holidays; 24 hours a day.

Office/Division: Department of Pathology & Laboratories (JICA Bldg.) – Microbiology

Section
Classification: Complex
Type of Transaction: G2C
Who may avail: All Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Fully Accomplished microbiology request Attending Physician
form.
2. Yellow Card HIMD

CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON

PAID TIME RESPONSIBLE
1. Submit request to 1.0 Check for none 5 minutes Receiving Clerk/
microbiology laboratory completeness of Lab. Aide
for encoding (JICA Lab data written on the
– Window 4) request form, then
encode the test
desired by the
attending physician

1.1 Encode/Billing none 5 minutes Receiving Clerk/

Lab. Aide

2. Settle payment refer to list of Cashier

fees

3. Present Official 3.0 Check if the none 5 minutes Receiving clerk

Receipt or receipt of container is
payment correctly labelled
and request if
correctly filled-out
prior to accepting
the specimen

3.1 Accept
specimen

4. Secure claim stub 4.0 Write on the none 5 minutes Receiving clerk
claim stub the name
of the patient,
sample submitted,
date of submission,
and mark with
“check” the test to
be performed on the
patient sample

4.1 Issue claim stub

4.2 Process sample Within 24 hours Med. Tech. staff

(Microbiology)
5. Claim result 5.0 Release result none 24 hours upon Med. Tech. staff
receipt of in Microbiology
sample
TOTAL: ₱150.00
8. Issuance of Blood Culture Vials
Availability of Service: Monday to Sunday & Holidays; 24 hours a day.

Office/Division: Department of Pathology & Laboratories (JICA Bldg.) – Microbiology

Section
Classification: Complex
Type of Transaction: G2C
Who may avail: All Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Fully Accomplished microbiology Attending Physician
request form.
2. Yellow Card HIMD

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Submit request to 1.0 Check for 5 minutes Receiving
microbiology completeness of Clerk/ Lab. Aide
laboratory (JICA Lab data written on the
– Window 4) request form.

2. Settle payments 2.0 Issue blood Bactec vial 5 minutes Receiving

culture vial for Adult: Clerk/ Lab. Aide
₱600.00;

Bactec vial
for Pedia:
₱761.00

PHIC
enrolled:
blood
culture vial
is provided
by the
laboratory

TOTAL: ₱600.00 –
for adult;

₱761.00 –
for pedia
9. KOH preparation
Availability of Service: Monday to Sunday & Holidays; 24 hours a day.
Office/Division: Department of Pathology & Laboratories (JICA Bldg.) – Microbiology
Section
Classification: Complex
Type of Transaction: G2C
Who may avail: All Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Fully Accomplished microbiology Attending Physician
request form.
2. Yellow Card HIMD

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Submit request to 1.0 Check for none 5 minutes Receiving Clerk/
microbiology laboratory completeness of Lab. Aide
for encoding (JICA Lab data written on the
– Window 4) request form, then
encode the test
desired by the
attending physician

1.1 Encode/Billing none 5 minutes Receiving Clerk/

Lab. Aide

2. Settle payment refer to list of Cashier

fees

3. Present Official 3.0 Check if the none 5 minutes Receiving clerk

Receipt or receipt of container is
payment correctly labelled
and request if
correctly filled-out
prior to accepting
the specimen

3.1 Accept
specimen

4. Secure claim stub 4.0 Write on the none 5 minutes Receiving clerk
claim stub the name
of the patient,
sample submitted,
date of submission,
and mark with
“check” the test to
be performed on the
patient sample

4.1 Issue claim stub

4.2 Process sample Within 24 hours Med. Tech. staff

(Microbiology)
5. Claim results 5.0 Release result none 24 hours upon Med. Tech. staff
receipt of in Microbiology
sample
TOTAL: ₱165.00
10. Provision of Control Strain Isolates for Research Studies
Availability of Service: Monday to Sunday & Holidays; 24 hours a day.

Office/Division: Department of Pathology & Laboratories (JICA Bldg.) – Microbiology

Section
Classification: Complex
Type of Transaction: G2B
Who may avail: Students taking Allied Medical Courses
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Check the Guidelines posted at
Microbiology Lab.
2. Approved Letter and Photocopy of
Concerned Laboratory’s Protocol in
Handling and Disposal of Isolates
3. Official Receipt for Paid Isolates.
a) Claiming of requested isolates is after
3 days upon receipt of approved letter
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit letter to 1.0 Accept & none 1 – 3 working Med. Tech. staff
Microbiology Section submit letter to days in Microbiology
for approval Department
Chairman for
approval

2. Submit all the 2.0 Check Refer to 5 minutes Med. Tech. staff
requirements to requirements if guidelines in Microbiology
Microbiology Section complete

3. Inquire for the 3.0 Schedule of none 3 minutes Med. Tech. staff
schedule of pick-up of pick-up is in Microbiology
isolates arranged between
Microbiology
Section and
requesting party

3.1 Regrow the none 3 days Med. Tech. staff

isolates and in Microbiology
restreak to
Nutrient Slant
Tube

3.2 Pack the 10 minutes

isolates in Triple
Packaging
System

4. Claim the isolates 4.0 Release the none 2 minutes Med. Tech. staff
after 3 days of packed isolates in Microbiology
preparation

TOTAL: ₱200.00/
isolate
11. Wet Mount
Availability of Service: Monday to Sunday & Holidays; 24 hours a day.
Office/Division: Department of Pathology & Laboratories (JICA Bldg.) – Microbiology
Section
Classification: Complex
Type of Transaction: G2C
Who may avail: All Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Fully Accomplished microbiology Attending Physician
request form.
2. Yellow Card HIMD

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Submit request to 1.0 Check for none 5 minutes Receiving Clerk/
microbiology laboratory completeness of Lab. Aide
for encoding (JICA Lab data written on the
– Window 4) request form, then
encode the test
desired by the
attending physician

1.1 Encode/Billing none 5 minutes Receiving Clerk/

Lab. Aide

2. Settle payment refer to list of Cashier

fees

3. Present Official 3.0 Check if the none 5 minutes Receiving clerk

Receipt or receipt of container is
payment correctly labelled
and request if
correctly filled-out
prior to accepting
the specimen

3.1 Accept
specimen

4. Secure claim stub 4.0 Write on the none 5 minutes Receiving clerk
claim stub the name
of the patient,
sample submitted,
date of submission,
and mark with
“check” the test to
be performed on the
patient sample

4.1 Issue claim stub

4.2 Process sample Within 24 hours Med. Tech. staff

(Microbiology)
5. Claim results 5.0 Release result none Within 24 hours Med. Tech. staff
upon receipt of in Microbiology
sample
TOTAL: ₱150.00
 Laboratory

Clinical Microbiology

Internal Services
1. Acceptance of Deliveries of Supplies and Reagent
Availability of Service: 7:00 AM – 4:00 PM; Monday to Friday

Office/Division: Department of Pathology & Laboratories (JICA Bldg.) – Microbiology

Section
Classification: Complex
Type of Transaction: G2B
Who may avail: Distributors/Suppliers & Laboratory section (End-user)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Delivery Receipt Distributors/Suppliers
Requisition and Issue Slip (RIS) End-user
Stock card End-user
Log book End-user
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE
1. Accept delivery 1.0 Check the items Refer to 5 – 10 minutes Microbiology staff
receipt & items delivered and signed in-charge
correlate with the contract
product description
and the number of
items delivered
printed in the
delivery receipt.

2.0 Check for any

damaged items.

2. Acceptance of the 2.0 Microbiology None 2 minutes Microbiology staff

delivered items staff in-charge sign in-charge
the delivery receipt
above the printed
name to show
acknowledgement
of the items being
delivered.

3. Make requisition and 3.0 Microbiology None 1 minute Microbiology staff

issue slip (RIS) staff in-charge in-charge
make 3 copies of
RIS

4. Sign requisition and 4.0 Section Head of None 10 – 20 minutes Section Head of
issue slip. the microbiology microbiology
checks the data
printed on the
requisition and
issue slip and signs
the same document
to indicate
acknowledgement

5. Submit requisition 5.0 The requisition none 10-20 minutes Laboratory staff
and issue slip to the and issue slip are in-charge
Material & Management submitted to the
Services (MMS) procurement office
Department for documentation
and accounting of
items being
delivered.

TOTAL: ₱0.00
2-A. Affiliation Training (In-service Registered Medical Technologist)
Availability of Service: 7:00 AM – 4:00 PM; Monday to Friday except Holidays

Office/Division: Department of Pathology & Laboratories (JICA Bldg.) – Microbiology

Section
Classification: Highly technical
Type of Transaction: G2B
Who may avail: All registered medical technologist (In-service)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Comply the requirements from the Training Professional Education Training &
Office Development (PETD)
Personal Protective Equipment (PPE) Purchase in any medical supply store

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Submit 1.0 Receive none 3 minutes Section Head of
endorsement paper to endorsement Microbiology
Microbiology Section

2. Orientation before 2.0 Conduct none 5 minutes Section Head of

training orientation Microbiology

3. Follow schedule of 3.0 Provide ₱2,000.00 2 months Section Head of

training necessary training Microbiology

4. Secure certificate of 4.0 PETD release none Refer to PETD PETD staff
training certificate of schedule of
training release

TOTAL: ₱2,000.00
2-B. Affiliation Training (Medical Technology Interns)
Availability of Service: 7:00 AM – 10:00 PM; Monday to Friday; Holidays

Office/Division: Department of Pathology & Laboratories (JICA Bldg.) – Microbiology

Section
Classification: Highly technical
Type of Transaction: G2B
Who may avail: 4th year Medical Technology students from different schools
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
List of students School’s clinical instructor
Schedule of rotation School’s clinical instructor

Time card Book store

Personal Protective Equipment (PPE) Purchase in any medical supply store

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Students undergo 1.0 microbiology none 15 minutes Med. Tech. staff
orientation staff conduct in Microbiology
orientation

2. Students are 2.0 Microbiology Refer to 8 hours per Med. Tech. staff
assigned in 5 staff assigned in a schedule of day in Microbiology
Benches of work Bench gives fees
training to
Benches: students

 A - Processing of
Specimen
 B - Work-up of
Culture Growth
 C - Antimicrobial
Susceptibility Test
and Final Results
of Culture Test.
 D - Media
preparation
 R/R - receiving &
releasing of
results of
specimen

3. Workload are 3.0 Microbiology none Med. Tech. staff

recorded student’s staff signed the in Microbiology
manual or journal. workload

TOTAL:
3. Collection & Processing of Environmental Samples
Availability of Service: 7:00 AM – 10:00 PM; Monday to Friday except Holidays

Office/Division: Department of Pathology & Laboratories (JICA Bldg.) – Microbiology

Section
Classification: Complex
Type of Transaction: G2G
Who may avail: Units & wards designated by Infection & Prevention Control Unit
(IPCU)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Collection schedule IPCU & Microbiology section
Materials needed IPCU & Microbiology section
Assigned microbiology staff IPCU & Microbiology section
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. IPCU inform the 1.0 Microbiology none 3 minutes IPCU staff
microbiology section section set the
of the environmental schedule for
collection plan collection

2.0 Microbiology none 10 minutes IPCU staff

staff assigned
prepares the
materials needed

2. IPCU staff 2.0 Microbiology None 1 hour IPCU &

coordinates with staff assigned microbiology
microbiology staff in collects samples staff
the collection of from the ward/unit
samples of the hospital

2.1 Process None 3 days microbiology

samples staff

3. IPCU request for 3.0 Release None 10 minutes microbiology

official results official results to staff
IPCU

TOTAL: ₱0.00
4. Encoding of ARSP Data, and Referral of Clinical Isolates to ARSL-RITM
Availability of Service: Monday to Sunday & Holidays; 24 hours a day.

Office/Division: Department of Pathology & Laboratories (JICA Bldg.) – Microbiology

Section
Classification: Highly Technical
Type of Transaction: G2G
Who may avail: ARSP Sentinel Site Requirements
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. WHONET Program Downloadable from web
2. Guidelines of referable isolates RITM (ARSL)
3. Culture results Microbiology Lab
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE
1. Install WHONET 1.0 Check for the none Once a year Med. Tech. staff
Program latest version in Microbiology

2. Encode culture 2.0 Check for the none 30 days Med. Tech. staff
results completeness of in Microbiology
encoded data

3. Submit data 3.0 Submit data none 5 minutes Med. Tech. staff
every 25th of the in Microbiology
month

4. Identify possible 4.0 Check none Day 1-7 of the Med. Tech. staff
referable isolates Guidelines of month except in Microbiology
referable isolates for fastidious
and other
important
pathogens
5. Re-test referable 5.0 Manual testing none 3-5 days Med. Tech. staff
isolates of isolates in-charge

6.0 Re-isolate pure 6.0 Prepare the none 1 day

colonies isolates for sending
7.0 Prepare ARSP 7.0 Filling-up the none 2 days Med. Tech. staff
provided forms ARSP forms in-charge

8. Review and 8.0 Isolates are none 1-2 days Med. Tech. staff
verification data checked by other in Microbiology
Senior Med Tech
staff
9. Pack 9.0 Seal the none 1-2 hours Med. Tech. staff
transport tubes in-charge
containing the
isolates and pack
based on the triple
packaging system

10. Submission of 10.0 Submit the none 1 day Med. Tech. staff
isolates referable isolates to in-charge
Research Institute
of Tropical Medicine
(RITM)
TOTAL: ₱0.00
5. Issuance of Sterile Containers to Wards
Availability of Service: 6:00 AM – 10:00 PM; Monday to Sunday & Holidays

Office/Division: Department of Pathology & Laboratories (JICA Bldg.) – Microbiology

Section
Classification: Complex
Type of Transaction: G2G
Who may avail: All clinical departments
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
5 sterile vials per ward/ unit a day
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1.0 Personnel from 1.0 Microbiology None 5 minutes Microbiology
ward go to section prepares staff
microbiology section the sterile vials

1.1 Withdraw sterile 1.1 Release the None 2 minutes Microbiology

vials and signed in the sterile vials to staff
logbook provided ward personnel

2. Ward personnel 2.0 Microbiology None 2 minutes

request for additional staff refer to
supply section head and
release the vials

TOTAL: ₱0.00
6. Submission of Hospital’s Antibiogram Report
Availability of Service: Monday to Sunday & Holidays; 24 hours a day.

Office/Division: Department of Pathology & Laboratories (JICA Bldg.) – Microbiology

Section
Classification: Highly Technical
Type of Transaction: G2G
Who may avail: All patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
WHONET program Downloadable from web
Culture results Microbiology Lab

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Data analysis 1.0 Perform data none 1-2 hours Med. Tech. staff
analysis in in Microbiology
WHONET
according to
category (Age,
location, and data
file) quarterly.

2. Select isolates 2.0 Check for the none 1-2 hours Med. Tech. staff
acceptable in Microbiology
number of isolates
to be included in
antibiogram report

3. Print data analysis 3.0 Printing of none 1 hour Med. Tech. staff
result data analysis in Microbiology

4. Final result 4.0 Reporting into none 1 day Med. Tech. staff
much in Microbiology
comprehensible
format

TOTAL: ₱0.00
 LIST OF SERVICES

Classification Type of Transaction

G2C G2B G2G
Highly
Services Simple Complex Gov’t Gov’t Gov’t
Technical
3 days 7 days to to to
20 days Client Business Gov’t
External Services (in alphabetical order)
1. CD4 count   
2. HIV Screening Test 1   
3. HIV Screening Test 2   
4. HIV Confirmatory Test 3   
5. HIV Pre-test Counseling   
6. HIV Post-Test Counseling   
7. HIV Viral Load  

(Qiagen/GeneXpert)
8. MTb/Rif GeneXpert   
Internal Services (in alphabetical order)
1. Participation in the National
External Quality Assessment 
Scheme (NEQAS)
2. Preparation and submission of
reagents and consumables

utilization and consumption
report
3. Referral of HIV samples for
Genotyping and Phenotyping to  
NRL-RITM
4. Referral of HIV samples for
Confirmatory testing (Geenius,  
PCR) to NRL-SACCL
5. Submission of monthly reports
to CMT, RESU, DOH, PBSP, 
and EB.
 Laboratory

SPMC CrCL (Certified rHIVda Confirmatory Laboratory)

External Services
1. Submission of laboratory request form for CD4 test
Availability of Service: 8:00 am to 5:00 pm, Mondays to Fridays, except Holidays.

Office/Division: Department of Pathology and Laboratories / SPMC CrCL

Classification: Simple
Type of Transaction: G2C – Government to Client, G2G – Government to Government
Who may avail: Clients with request or referral for CD4 test
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Laboratory request form for CD4 count Doctor
2. Yellow Card HIMD
3. Official Receipt Cashier,
4. Proof of Payment / Approved Billing PAD, CMAP, Billing Section, Social Services,
Malasakit Center
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE
1. Presents official 1. Verifies request CD4 2 minutes Medical
receipt, proof of and payment in the 2,200.00 Technologist
payment or approved system.
request for CD4 test to 1.1 Instructs Out-/ 1 minute Medical
laboratory receiving Walk-In patient to Technologist
area. proceed to blood
collection area.
1.2 For In-patient-
Informs watcher
that the blood
collection will be
done in their
respective wards.
1.3 For referrals-
verifies documents
and blood sample,
checks criteria for
acceptability.
1.4 Records 2 minutes Medical
patients name, Technologist
source and CD4
request in the
Receiving Logbook
TOTAL: 2,200.00 5 minutes

1. Undergo Laboratory Procedures

Availability of Service: 8:00 am to 5:00 pm, Mondays to Fridays, except Holidays.

Office/Division: Department of Pathology and Laboratories / SPMC CrCL

Classification: Simple
Type of Transaction: G2C – Government to Client, G2G- Government to Government
Who may avail: Clients with request or referral for CD4 test
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Laboratory Request form for CD4 Doctor
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE
1. Undergo blood collection 1. Prepares materials None 3 minutes Medical
and instructs patient Technologist
on what to do
1.1 Performs blood None 5 minutes Medical
collection Technologist

2. Receive claim stub 2. Provide claim stub None 2 minutes Medical

with scheduled date Technologist
of the releasing of
result
2. Wait for the laboratory 3. Performs laboratory None 460 minutes Medical
procedures. procedures Technologist
3.1 Examines
blood sample
collected for
CD4 test
3.2 Validates test
run
3.3 Encodes
patient’s data
and test result
3.4 Prints official
result
TOTAL: None 470 minutes
2. Claim the Official Laboratory Result
Availability of Service: 8:00 am to 5:00 pm, Mondays to Fridays, except Holidays.

Office/Division: Department of Pathology and Laboratories / SPMC CrCL

Classification: Simple
Type of Transaction: G2C – Government to Client, G2G- Government to Government
Who may avail: Clients with request or referral for CD4 test
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Claim Stub Laboratory
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE
1. Return to the 1.Verifies claim stub None 5 minutes Medical
Laboratory Releasing and releases Technologist
area and presents results.
claim stub. 1.1 Instructs client
to affix his/her
signature over
printed name
with date and
time in the
Releasing
Logbook.
TOTAL: None 5 minutes

SPMC CrCL (Certified rHIVda Confirmatory Laboratory)

Schedule of Fees
CD4 Count 2200.00
HIV Test (HSSC) 500.00
HIV Test (DOH Programs) Free
HIV Viral Load 7000.00
MTB/Rif GeneXpert (DOH Programs) Free
3. Submission of laboratory request form for HIV tests
Availability of Service: 8:00 am to 5:00 pm, Mondays to Fridays, except Holidays.

Office/Division: Department of Pathology and Laboratories / SPMC CrCL

Classification: Simple
Type of Transaction: G2C – Government to Client, G2G – Government to Government
Who may avail: Clients with request or referral for HIV tests
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Request for Laboratory Procedures Doctor
2. Yellow Card HIMD
3. Official Receipt Cashier
4. Proof of Payment / Approved Billing PAD, CMAP, Billing Section, Social Services,
Malasakit Center
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Presents official 1. Verifies request Refer to 5 minutes Medical
receipt, proof of and payment in the schedule of Technologist
payment or approved system. Fees
request for HIV tests to 1.1 Instructs Out-/ Medical
laboratory receiving Walk-In patients to Technologist
area. proceed to blood
collection area.
1.2 For In-patient,
Informs watcher that
the blood collection
will be done in their
respective wards.
1.3 For referrals-
verifies documents
and blood sample,
checks criteria for
acceptability.
1.4 Records patients
name, source and
laboratory requests
in the Receiving
Logbook
TOTAL: Refer to 5 minutes
schedule of
fees

Undergo Laboratory Procedures

Availability of Service: 8:00 am to 5:00 pm, Mondays to Fridays, except Holidays.

Office/Division: Department of Pathology and Laboratories / SPMC CrCL

Classification: Simple
Type of Transaction: G2C – Government to Client, G2G- Government to Government
Who may avail: Clients with request or referral for HIV tests
 CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Laboratory Request form for HIV tests Doctor
2. DOH-EB Form A Trained HIV counselor
4. Annex 1-A HTS Counselling Form Trained HIV counselor

5. Annex 1-B HTS Client Referral Form Doctor

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Undergo Pre-test 1. Conducts HIV None 25 minutes Medical
Counselling for HIV Pre-test Technologist /
tests. Counselling Trained HIV
(Voluntary Counselor
Counselling and
Testing).
2. Undergo blood 2. Prepares materials None 3 minutes Medical
collection and instructs Technologist
patient on what to
do
2.1 Performs Blood None 5 minutes Medical
collection Technologist

3. Receives claim stub 3. Provides claim stub None 2 minutes Medical

with scheduled date Technologist
of the releasing of
result.
4. Wait for the 6. 4. Performs laboratory None 420 minutes Medical
laboratory procedures Technologist
procedures. 4.1 Examines blood
sample collected
for HIV tests
4.2 Validates tests run
4.3 Encodes patient’s
data and test result
4.4 Prints official result
TOTAL: None 455 minutes

Claim the Official Laboratory Result

Availability of Service: 8:00 am to 5:00 pm, Mondays to Fridays, except Holidays.
Office/Division: Department of Pathology and Laboratories / SPMC CrCL
Classification: Simple
Type of Transaction: G2C – Government to Client
Who may avail: Clients with request or referral for HIV tests
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Claim Stub Laboratory
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE
2. Return to the 2.Verifies claim stub None 3 minutes Medical
Laboratory Releasing and releases Technologist
area and presents results.
claim stub 2.1 Conducts HIV None 15 minutes Medical
Post-test Technologist /
Counselling Trained HIV
(Voluntary Counselor
Counselling and
Testing).
2.2 Instructs client None 2 minutes Medical
to affix his/her Technologist
signature over
printed name
with date and
time in the
Releasing
Logbook.
TOTAL: None 20 minutes

SPMC CrCL (Certified rHIVda Confirmatory Laboratory)

Schedule of Fees
 CD4 Count 2200.00
HIV Test (HSSC) 500.00
HIV Test (DOH Programs) Free
HIV Viral Load 7000.00
MTB/Rif GeneXpert (DOH Programs) Free

4. Submission of laboratory request form for HIV viral load

Availability of Service: 8:00 am to 5:00 pm, Mondays to Fridays, except Holidays.

Office/Division: Department of Pathology and Laboratories / SPMC CrCL

Classification: Simple
Type of Transaction: G2C – Government to Client, G2G – Government to Government
Who may avail: Clients with request or referral for HIV viral load
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Laboratory request form for HIV viral load Doctor
2. Yellow Card HIMD
3. Official Receipt Cashier,
4. Proof of Payment / Approved Billing PAD, CMAP, Billing Section, Social Services,
Malasakit Center
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE
1. Presents official 1. Verifies request HIV viral load 5 minutes Medical
receipt, proof of and payment in the 7,000.00 Technologist
payment or approved system.
request for HIV viral 1.1 Instructs Out-/
load to laboratory Walk-In patient to
receiving area. proceed to blood
collection area.
1.2 For In-patient-
Informs watcher
that the blood
collection will be
done in their
respective wards.
1.3 For referrals-
verifies documents
and blood sample,
checks criteria for
acceptability.
1.4 Records
patients name,
source and HIV viral
load request in the
Receiving Logbook
TOTAL: 7,000.00 5 minutes

Undergo Laboratory Procedures

Availability of Service: 8:00 am to 5:00 pm, Mondays to Fridays, except Holidays.

Office/Division: Department of Pathology and Laboratories / SPMC CrCL

Classification: Complex
Type of Transaction: G2C – Government to Client, G2G- Government to Government
Who may avail: Clients with request or referral for HIV viral load
 CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Laboratory Request form for HIV viral load Doctor
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE
1. Undergo blood collection 1. Prepares materials None 3 minutes Medical
and instructs patient Technologist
on what to do
1.1 Performs blood None 5 minutes Medical
collection Technologist

3. Receives claim stub 3. Provides claim stub None 2 minutes Medical

with scheduled date Technologist
of the releasing of
result
3. Wait for the laboratory 3.Performs laboratory None 460 minutes Medical
procedures. procedures (batch Technologist
testing)
3.1 Examines
blood sample
collected for
HIV viral load
3.2 Validates test
run
3.3 Encodes
patient’s data
and test result
3.4 Prints official
result
TOTAL: None 470 minutes

Claim the Official Laboratory Result

Availability of Service: 8:00 am to 5:00 pm, Mondays to Fridays, except Holidays.

Office/Division: Department of Pathology and Laboratories / SPMC CrCL

Classification: Complex
Type of Transaction: G2C – Government to Client, G2G- Government to Government
Who may avail: Clients with request or referral for HIV viral load
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Claim Stub Laboratory
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE
3. Return to the 4.Verifies claim stub None 5 minutes Medical
Laboratory Releasing and releases Technologist
area and presents results.
claim stub. 4.1 Instructs client
to affix his/her
signature over
printed name
with date and
time in the
Releasing
Logbook.
TOTAL: None 5 minutes

SPMC CrCL (Certified rHIVda Confirmatory Laboratory)

Schedule of Fees
CD4 Count 2200.00
HIV Test (HSSC) 500.00
HIV Test (DOH Programs) Free
HIV Viral Load 7000.00
MTB/Rif GeneXpert (DOH Programs) Free
5. SPMC CrCL (Certified rHIVda Confirmatory Laboratory)
Laboratory procedures for MTB/Rif
Availability of Service: 8:00 am to 5:00 pm, Mondays to Fridays, except Holidays.

Office/Division: Department of Pathology and Laboratories / SPMC CrCL

Classification: Simple
Type of Transaction: G2G – Government to Government
Who may avail: Clients with referral for MTB/Rif
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Form 2a. NTP Laboratory request form for Doctor
Xpert MTB/Rif
7. Patient Referral Form Doctor
8. Claim Stub Laboratory
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Presents Form 2a. 1. Verifies laboratory Free 15 minutes Medical
NTP laboratory request request form and Technologist
form for Xpert MTB/Rif referral form.
and Patient Referral 1.1 Checks Annex A:
Form and sputum TB Laboratory
sample to laboratory Specimen Referral
receiving area. 1.2 Receives sputum
samples.
1.3 Affixes signature
over printed name
with date received in
the TB Laboratory
specimen Receiving
Form.
2. Receives claim stub 2. Provides claim stub Free 2 minutes Medical
with scheduled date Technologist
of the releasing of
result
3.Wait for the laboratory 3.Performs laboratory Free 460 minutes Medical
procedures procedures (batch Technologist
testing)
8.1 Examines sputum
sample collected for
MTB/Rif
8.2 Encodes patient’s
data in the
Genexpert machine
8.3 Validates test run
8.4 Print Official result
 8.5 Records necessary
data in the FORM
3a. NTP Laboratory
Register
3.4
9. Return to the 4. Verifies claim stub Free 3 minutes Medical
Laboratory Releasing and releases results. Technologist
area and presents 4.1 Instructs client to
claim stub. affix signature over
printed name with
date time in the Result
Transmittal Form.
TOTAL: Free 480 minutes

SPMC CrCL (Certified rHIVda Confirmatory Laboratory)

Schedule of Fees
CD4 Count 2200.00
HIV Test (HSSC) 500.00
HIV Test (DOH Programs) Free
HIV Viral Load 7000.00
MTB/Rif GeneXpert (DOH Programs) Free

LIST OF SERVICES

Classification Type of Transaction

G2C G2B G2G
Highly
Simple Complex Gov’t Gov’t Gov’t
Services Technical
3 days 7 days to to to
20 days
Client Business Gov’t
External Services (in alphabetical order)
9. Issuance of Second Copy
 
of Results
10. Receiving of in-patients
 
requests/samples.
11. Receiving of out-patients
 
requests.
12. Releasing of laboratory
 
results.
Internal Services(in alphabetical order)
1. Operates pneumatic tube
 
system
2. Requisition / Delivery of
 
Office Supplies
 Laboratory

Reveiving/Releasing

External Services
1. ISSUANCE OF SECOND COPY OF RESULTS
The purpose of such is to provide copies for lost results or file copy for company or
personal use.
Availability of Service: 8:00 am to 5:00 pm, Mondays to Fridays, except Holidays

Office/Division: Department of Pathology and Laboratories/JICA Laboratory

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients (Out-patient and In-patients)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patient Information Card/ Yellow Card HIMD
2. Note form requesting physician Doctor
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Presents yellow 1.1 Receives 1 minute Administrative
card to the laboratory yellow card and Aide
section and request request for /Laboratory
for second copy of second copy. Clerk
specific results.
1.2 Verifies test
date as encoded
in the Hospital 31 minutes
Information
System

1.3 Encode in the

system and 1 minute
instruct to pay.
2. Pays to the Cashier 2. Accepts 20.00 10 minutes Cashier
payment and
issue an official
receipt

3. Presents yellow 3.1 Generates 1 minute Administrative

card Result from the Aide
HIS and/or result /Laboratory
logbook Clerk

2 minutes
 3.2 Releases the
result

TOTAL: 20.00 17 minutes

2. Receiving of in-patients requests/samples

The purpose of such is to provide clients/patients laboratory examinations.
Availability of Service: 24/7

Office/Division: Department of Pathology and Laboratories/JICA Laboratory

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients (In-patients)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Laboratory request form (completely Doctor
filled out)
2. Referral form (if required) Doctor
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Presents laboratory 1.1 Verifies Laboratory 5 minutes Administrative
request form (without request form. fee (refer to Aide
specime/blood 1.2 Encodes approved /Laboratory
samples) laboratory request schedule of Clerk
in the system. fees)
(HIS)
1.3 Instruct client
that the process is
compete.
1.4 Results can
be viewed in the
system. (HIS)
2. Presents laboratory 2.1 Verifies Laboratory 5 minutes Administrative
request and request form and fee (refer to Aide/Laboratory
specimen/blood check approved clerk
sample. specimen/blood schedule of
sample. fee)
2.2 Encodes and
check in
laboratory request
in the system
(HIS)
2.3 Issue claim
stub for
 microbiology and
histopath.
2.4 Instruct client
that the process is
complete.
2.5 Laboratory
results can be
viewed in the
system. (HIS)
TOTAL: Refer to 10 minutes
approved
schedule
of fees

3. Receiving of out-patients requests/samples

The purpose of such is to provide clients/patients laboratory examinations.
Availability of Service: 5:30 am to 5:00 pm except holidays.

Office/Division: Department of Pathology and Laboratories/JICA Laboratory

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients (out-patients)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Yellow card HIMD
2. Laboratory request form (completely Doctor
filled out (for microbiology and histopath)
3. Referral form (if required) Doctor
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present yellow card 1.1 Verifies Laboratory 5 minutes Administrative
(Lingap and maip etc. request and fee (refer to Aide
approved form for payment in the approved /Laboratory
patients availing of system (HIS) and schedule of Clerk
medical assistance schedule and fees)
program) instruct patients
preparation prior
to laboratory
examination.
1.2 Print
laboratory
reaquest and
claim stub for
patients ready for
blood extraction.
1.3 Give priority
number.
1.4 Instruct patient
to proceed to
extraction area.
1,5 Laboratory
results can be
 viewed in the
system/issue
claim stub for
microbiology and
histopath.
2. Present yellow card 2.1 Verifies Laboratory 5 minutes Administrative
(for dengue patients) request and fee (refer to Aide/Laboratory
payment in the approved clerk
system (HIS) schedule of
2.2 Print fee)
laboratory request
and claim stub.
2.3 Instruct patient
to proceed to
extraction area.
2.4 Endorse
printed laboratory
request and claim
stub to
phlebotomist on
duty to prioritized
blood extraction
and processing.
2.5 Instruct patient
to wait for the
results.
TOTAL: Refer to 10 minutes
approved
schedule
of fees
4. Releasing of laboratory results.
The purpose of such is to provide printed results upon the request of client for their
personal file/referral to other clinics/hospitals.
Availability of Service: 8:00 am to 5:00 pm except holidays.

Office/Division: Department of Pathology and Laboratories/JICA Laboratory

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients (out-patients and in-patients)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Yellow card Laboratory extraction area/receiving area
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present claim stub 1.1 Verifies claim none 5 minutes Administrative
stub Aide
1.2 Print /Laboratory
laboratory results Clerk
1.3 Release
laboratory results.
1.4 Instruct to
write and sign in
the logbook.

TOTAL: none 5 minutes

Laboratory
 Internal Services

1. Operates pneumatic tube system

The purpose of such is to send and receive laboratory requests and samples via
pneumatic tube system for wards.
Availability of Service: 24/7

Office/Division: Department of Pathology and Laboratories/JICA Laboratory

Classification: Simple
Type of Transaction: G2G
Who may avail: Nurse Stations
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Laboratory request form (completely Doctor/Nurse
filled out)
2. samples for examination/processing Doctor/Nurse

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Send laboratory 1.Open and check none 10 minutes Administrative
request /samples via pneumatic tube Aide
pneumatic tube for request and /Laboratory
system. samples. Clerk
1.1 Verifies
laboratory request
and check
specimen.
1.3 Encode and
check in
laboratory request
in the system.
(HIS)
1.4 Issue claim
stub for
 microbiology and
histopath.
1.5 Send back
claim stub through
pneumatic tube to
designated
pneumatic station.
TOTAL: none 10 minutes

LIST OF SERVICES

Classification Type of Transaction

G2C G2B G2G
Highly
Services Simple Complex Gov’t Gov’t Gov’t
Technical
3 days 7 days to to to
20 days
Client Business Gov’t
External Services
1. QUANTITATIVE TEST

1. HEPATITIS PROFILE
*Anti-HBS
*Hepatitis B Surface Antigen
*Anti-Hepatitis B Core IgM
*Anti-Hepatitis B Core IgG
*Anti-Hepatitis A Virus IgM
*Anti-Hepatitis A Virus IgG
*Anti-Hepatitis C Virus
2. THYROID PROFILE
*Thyroid Stimulating
Hormone (TSH)
*Free Thyroxine (FT4/FRT4)
*Free Triiodothyronine  
(FT3/FRT3)
*Total Thyroxine (T4)
*Total Triiodothyronine (T3)
3. TUMOR MARKERS
*Prostate Specific Antigen
(PSA/PSA Total)
*Alpha-fetoprotein (AFP)
*Beta Human Chorionic
Gonadotropin
(BHCG)
*Carcinoembryonic Antigen
(CEA)
*Cancer Antigen 125
(CA125)
 4. Other Test
*Serum Ferritin
*Procalcitonin (PCT)
*Neutrophil Gelatinase-
associated lipocalin
(NGAL)
4. CARDIAC PROFILE
*Troponin I
*CKMB

B. QUALITATIVE TEST

*Hepatitis B Surface Antigen

*Anti-Hepatitis C Virus
*C-Reactive Protein (CRP)
*Anti-Streptolysin O (ASO)
*Rheumatoid Factor (RF)
 
*Salmonella Typhi
*Syphilis
*Dengue Rapid Test
*NS1 Antigen
*Helicobacter Pylori
*C3

Internal Services
1. Acceptance of reagents and
 
stocks delivery
2. Clinical Internship Training
 
Program
3. Monthly Reports of Census and
 
Billing
4. Consultative meeting report  

Laboratory
 Serology and Immunology

External Services

1. Serology and Immunology (Inpatient)

Tests vailable for admitted patients;

Hepatitis Profile: Anti-HBs, HbsAg (Qualitative/Quantitative), Anti-Hepatitis B Core IgM,
Anti-Hepatitis B Core IgG, Anti-Hepatitis A Virus IgM, Anti-Hepatitis A Virus IgG,
Anti-Hepatitis C Virus (Qualitative/Quantitative)
Thyroid Profile: Thyroid Stimulating (TSH), Free Thyroxine (FT4/FRT4), Free
Triiodothyroxine (FT3/FRT3), Total Thyroxine (T4), Total Triiodothyronine (T3)
Tumor Markers: Prostate Specific Antigen (PSA/PSA Total), Alpha Fetoprotein (AFP),
Carcinoembryonic Antigen (CEA), Cancer Antigen 125 (CA 125), Cancer Antigen 19-9,
(CA19-9), Cancer Antigen 15-3 (CA 15-3)
Cardiac Markers: Troponin I, CK-MB
Other Tests: Qualitative: C-Reactive Protein (CRP), Anti-Streptolysin O (ASO),
Rheumatoid Factor (RF), Salmonella Typhi, Syphilis, Rapid Dengue Test, NS1 Antigen,
H. Pylori, C3; Beta Human Chorionic Gonadoprotein (B-HCG), Ferritin, PCT, NGAL

Availability of Service: 24/7 Daily

Office/Division: Department of Pathology and Laboratories (Serology and

Immunology) - Main
Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients (Inpatient)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Request for Serology and Immunology Doctor
Nurse
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present request to 1. Encodes Serology 2 minutes Administrative
receiving counter. request to Request Officer/Aide
Hospital Fees (Refer Laboratory
Information to approved Clerk
System (HIS) schedule of
fees)
2. Go back to ward 2. Collects blood None 20 minutes Phlebotomist
station and wait for requests from
Phlebotomist to receiving area and
collect blood from sorts them
patient. according to
patient location.

2.1. Proceeds to None 20 minutes Phlebotomist

wards and locates
patient. Identifies
patient and
prepares for blood
collection.

2.2 Explains None 5 minutes Phlebotomist

procedure to
patient/watcher.

2.3 Collects blood None 5 minutes Phlebotomist

sample from the

patient and labels

sample.

2.4 Sends sample None 5 minutes Phlebotomist

and request to
laboratory via
Pneumatic Tube
System or manual
transport the
sample by
Phlebotomist.

2.5 Receives and None 5 minutes Administrative

verifies sample Officer/Aide
with request; Laboratory
Checks-in sample Clerk
to HIS.

2.6 Barcodes None 20 minutes Medical

blood samples Technologist
and proceeds to
deliver sample
with request to
Serology Section.

2.7 Verifies test None 30 minutes Medical

request and Technologist
centrifuge
samples.

2.8 Checks serum None 20 minutes Medical

Integrity and loads Technologist
blood samples to
Serology Analyzer

2.9 Waits for None 1 hour, Medical

analyzer to finish 10 minutes Technologist
processing;
checks and
 validates results
generated by the
analyzer.

2.10 Releases None Medical

result through LIS. 5 minutes Technologist

Refer to
TOTAL: approved 3 hours,
schedule 39 inutes
of fees

1. Serology and Immunology (Outpatient)

Tests available for outpatients;

Hepatitis Profile: Anti-HBs, HbsAg (Qualitative/Quantitative), Anti-Hepatitis B Core IgM,
Anti-Hepatitis B Core IgG, Anti-Hepatitis A Virus IgM, Anti-Hepatitis A Virus IgG,
Anti-Hepatitis C Virus (Qualitative/Quantitative)
Thyroid Profile: Thyroid Stimulating (TSH), Free Thyroxine (FT4/FRT4), Free
Triiodothyroxine (FT3/FRT3), Total Thyroxine (T4), Total Triiodothyronine (T3)
Tumor Markers: Prostate Specific Antigen (PSA/PSA Total), Alpha Fetoprotein (AFP),
Carcinoembryonic Antigen (CEA), Cancer Antigen 125 (CA 125), Cancer Antigen 19-9,
(CA19-9), Cancer Antigen 15-3 (CA 15-3)
Cardiac Markers: Troponin I, CK-MB
Other Tests: Qualitative: C-Reactive Protein (CRP), Anti-Streptolysin O (ASO),
Rheumatoid Factor (RF), Salmonella Typhi, Syphilis, Rapid Dengue Test, NS1 Antigen,
H. Pylori, C3; Beta Human Chorionic Gonadoprotein (B-HCG), Ferritin, PCT, NGAL

Availability of Service: 5:30 AM – 5:00 PM, Monday to Friday, except holidays

Office/Division: Department of Pathology and Laboratories (Serology and

Immunology) - Main
Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients (Outpatient and Walk-In patient)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Request for Serology and Immunology Doctor
2. Yellow Card HIMD
3. Official Receipt for paid serology request Cashier
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present yellow card 1. Verifies request Serology 5 minutes Administrative
and official receipt to and payment in Request Officer/Aide
receiving Clerk the system. Fees (Refer Laboratory
1.2 Gives priority to approved Clerk
number, prints schedule of
request and fees)
Instructs patient to
proceed to blood
extraction area.

2. Proceed to Blood 2. Calls patient None 2 minutes Phlebotomist

extraction area for and collects the
blood sample priority number.
collection
2.1 Verifies None 3 minutes Phlebotomist
Patient Identity
with the blood
request form.

2.2 Explains None 3 minutes Phlebotomist

procedure to
patient

2.3 Collects blood None 5 minutes Phlebotomist

sample from the
patient and labels
sample.

2.4 Gives claim None 1 minute Phlebotomist

stub to patient and
instructs them to
claim result at
window 3 after 3-4
hours.

2.5 Barcodes None 15 minutes Medical

blood samples Technologist
and proceeds to
deliver sample
with request to
Serology Section.

2.6 Verifies test None 30 minutes Medical

request and Technologist
centrifuge
samples.

2.7 Checks serum None 20 minutes Medical

Integrity and loads Technologist
blood samples to
Serology Analyzer

2.8 Waits for None 1 hour, 10 Medical

analyzer to finish minutes Technologist
processing;
checks and
validates results
generated by the
analyzer.

None
 2.9 Releases and 5 minutes Medical
Validates result Technologist
through LIS.

3. Present Claim stub 3. Collects claim None 3 minutes Administrative

to window 3. stub, prints and Officer/
releases results. Administrative
Aide
Refer to
TOTAL: approved 2 hours,
schedule 7 minutes
of fees

Serology and Immunology Section Schedule of Fees

TEST FEES

Hepatitis Profile
Anti-HBs 500.00
Anti-HCV 1,000.00
Anti-HBc IgM 760.00
Anti-HBc IgG 600.00
Anti-HBc Total 760.00
Anti-HAV IgM 600.00
Anti-HAV IgG 600.00
HbsAg (Qualitative) 220.00
HbsAg (Quantitative) 300.00
HCV (Quantitative) 1,000.00
Thyroid Profile
TSH 505.00
FT4 560.00
FT3 560.00
T3 280.00
T4 280.00
T3 + T4 520.00
Tumor Markers
AFP 775.00
B-HCG 700.00
CEA 750.00
CA – 125 800.00
CA 19 – 9 800.00
CA 15 – 3 800.00
PSA (Total) 900.00
Cardiac Markers
Troponin I 1,200.00
CK – MB 780.00
Others
ASO (Qualitative) 350.00
C3 (Qualitative) 480.00
C – Reactive Protein (Qualitative) 250.00
Dengue Rapid Test Qualitative 680.00
Ferritin 680.00
H. Pylori 720.00
Rheumatoid Factor 360.00
Syphilis 180.00
Typhidot 750.00
PCT 1,250.00
NGAL 2,500.00
 LIST OF SERVICES

Classification Type of Transaction

G2C G2B G2G
Highly
Services Simple Complex Gov’t Gov’t Gov’t
Technical
3 days 7 days to to to
20 days
Client Business Gov’t
External Services (in alphabetical order)
1. Bacteriological Tests
1.1 E. Coli
1.2 HPC    
1.3 Pseudomonas
1.4 Total Coliform
2. Physico-chemical Tests
2.1 Acidity
2.2 Alkalinity
2.3 Calcium
  
2.4 Chloride
2.5 Color
2.6 Fluoride
2.7 Iron
 2.8 Magnesium
2.9 Odor
2.10 pH
2.11 Residual Chlorine
2.12 Sulfate
2.13 Total Hardness
2.14 Turbidity
Internal Services (in alphabetical order)
1. Bacteriological Tests
1.1 E. Coli
1.2 HPC    
1.3 Pseudomonas
1.4 Total Coliform
 Laboratory

Water Analysis

External Services

1. Processing of Water Samples for Physico-Chemical Analysis

Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Department of Laboratories – Water Analysis Section

Classification: Complex
Type of Transaction: G2C, G2B, G2G
Who may avail: All clients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Charge slip Water Analysis Laboratory
2. Water analysis request form Water Analysis Laboratory
3. Payment/ Official Receipt Cashier
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Request for the 1. Issue charge None 10 minutes Laboratory
schedule of the date of slip and ask client Personnel
analysis (Water analysis to pay fees (Water Analysis
lab window) Section)
2. Settle the payment 2. Accept the Refer to 30 minutes Cashier
for processing at the payment and issue approved
cashier a receipt list of
fees
3. Present proof of 3. Receive, check None 5 minutes Laboratory
payment at the water proof of payment, Personnel
analysis section and write schedule (Water Analysis
(Payment is required to in the logbook Section)
secure date of
schedule)

4. Present the water 4. Check and None 5 minutes Laboratory Aide

analysis request form, receive the (Water Analysis
charge slip, and submit request form, Section)
sample charge slip, and
sample
(Submit sample only
during pre-arranged 4.1 Inform the
schedule. Refer to client on the
previous step) schedule of
claiming of the
results

4.2 Process the None 5 days Chemist

requested test (Water Analysis
Section)
4.3 Prepare the None 1 day Laboratory Aide
word file ready for (Water Analysis
the encoding of Section)
results

4.4 Interpret and None 1 day Chemist

encode the result (Water Analysis
Section)

5. Claim the result 5. Issue the result None 5 minutes Laboratory

Personnel
(Water Analysis
Section)
TOTAL: Refer to 7 days 55
approve minutes
d
schedule
of fees

WATER ANALYSIS Schedule of Fees

PHYSICO-CHEMICAL
pH
Odor
Turbidity
Color
Acidity
Alkalinity
Total Hardness 1000.00
Calcium
Magnesium
Iron
Sulfate
Chloride
Fluoride
Residual Chlorine 200.00
2. Processing of Water Samples for Bacteriological Analysis
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Department of Laboratories – Water Analysis Section

Classification: Complex
Type of Transaction: G2C, G2B, G2G
Who may avail: All clients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Charge slip Water Analysis Laboratory
2. Water analysis request form Water Analysis Laboratory
3. Payment/ Official Receipt Cashier
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Request for the 1. Issue charge None 10 minutes Laboratory
schedule of the date of slip and ask client Personnel
analysis (Water analysis to pay fees (Water Analysis
lab window) Section)
2. Settle the payment 2. Accept the Refer to 30 minutes Cashier
for processing at the payment and issue approved
cashier a receipt list of
fees
3. Present proof of 3. Receive, check None 5 minutes Laboratory
payment at the water proof of payment, Personnel
analysis section and write schedule (Water Analysis
(Payment is required to in the logbook Section)
secure date of
schedule)
4. Present the water 4. Check and None 5 minutes Laboratory Aide
analysis request form, receive the (Water Analysis
charge slip, and submit request form, Section)
sample charge slip, and
sample
(Submit sample only
during pre-arranged 4.1 Inform the
schedule. Refer to client on the
previous step) schedule of
claiming of the
results

4.2 Process the None 5 days Medical

requested test Technologist
(Water Analysis
Section)
4.3 Prepare the None 1 day Laboratory Aide
word file ready for (Water Analysis
the encoding of Section)
results

4.4 Interpret and None 1 day Medical

encode the result Technologist
(Water Analysis
Section)

5. Claim the result 5. Issue the result None 5 minutes Laboratory

Personnel
(Water Analysis
Section)
TOTAL: Refer to 7 days 55
approve minutes
d
schedule
of fees

WATER ANALYSIS Schedule of Fees

BACTERIOLOGICAL
Total Coliform
E. Coli 450.00
HPC
Pseudomonas 200.00

LIST OF SERVICES
 Classification Type of Transaction
G2C G2B G2G
Highly
Services Simple Complex Gov’t Gov’t Gov’t
Technical
3 days 7 days to to to
20 days
Client Business Gov’t
External Services (in alphabetical order)
1. Bacteriological Tests
1.1 E. Coli
1.2 HPC    
1.3 Pseudomonas
1.4 Total Coliform
2. Physico-chemical Tests
2.1 Acidity
2.2 Alkalinity
2.3 Calcium
2.4 Chloride
2.5 Color
2.6 Fluoride
2.7 Iron   
2.8 Magnesium
2.9 Odor
2.10 pH
2.11 Residual Chlorine
2.12 Sulfate
2.13 Total Hardness
2.14 Turbidity
Internal Services (in alphabetical order)
1. Bacteriological Tests
1.1 E. Coli
1.2 HPC    
1.3 Pseudomonas
1.4 Total Coliform
 Heart Institute

West Wing

External Services

1. ADMISSION OF PATIENTS TO HI- WESTWING WARD

Heart Institute West wing ward cater service cardio patients. The unit serve both adult/pedia, male
and female, pre- and post- operative who needs medical or surgical interventions.

Availability of Service: 24 hours a day, 7 days a week

Office/Division: Heart Institute Westwing Ward
Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Male, female, and pediatric patients
2. Patients who are pre- operative and post- operative
3. Patients who needs medical and/ or surgical intervention
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
 1. Admission form Heart Institute Medical Record
2. Admitting order Doctor
3. Referral form Doctor
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Arrive at 1. Ask for None 10-20 minutes Nurse on duty
nurses’ station admitting
on the day of orders and
admission consent for
admission

2. Present 2.1. Receives None 10-20 minutes Nurse on duty

admitting and verifies
orders from orders
attending 2.2. Accompany 15-30 minutes Nurse on duty
physician patient to
assigned
room, perform
history, orient
patient and
watchers, and
take initial
vital signs
2.3. Orient patient 10-15 minutes Nursing
and watcher attendant on
to unit policies duty
including
necessary
safety
precautions.
TOTAL: None 1.5 hour

2. TRANS-IN/TRANS-OUT OF PATIENTS TO HI- WESTWING WARD

Trans-in of patients from one service unit to another

Availability of Service: 24 hours a day, 7 days a week

Office/Division: Heart Institute Westwing Ward
Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Male, female, and pediatric patients
2. Patients who are pre- operative and post- operative
3. Patients who needs medical and/ or surgical intervention
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
 Trans-out/Trans-in order Doctor
Complete pertinent documents Nurse on duty
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Receive order 1. Verify doctor’s none 30 minutes Nurse on duty
transfer of patients order
from one unit to 1.1 complete
another required
documents for
transfer
2. Await transfer from 2. Endorse the none 5 minutes Nurse on duty
one service area to patient via
another telephone
2.1 transport the 10 minutes Nursing
patient from attendant on
one unit to duty
another
3. Transfer from one 3. Receive the none 20 minutes Nurse on duty
service area to patient and
another assist to
room/bed
assignment
3.1 perform history 20 minutes Nurse on duty
taking and
take initial vital
signs
3.2 Orient patient 10-15 minutes Nurse on duty/
and watcher Nursing
to unit policies attendant on
including duty
necessary
safety
precautions.
TOTAL: None 1.5 hour

3. DISCHARGE OF PATIENTS FROM HI- WESTWING WARD

Discharge of patients from one service unit to another

Availability of Service: 24 hours a day, 7 days a week

Office/Division: Heart Institute Westwing Ward
Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Male, female, and pediatric patients
2. Patients who are pre- operative and post- operative
3. Patients who needs medical and/ or surgical intervention
 CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Discharge order Doctor
Complete discharge documents (CF4) Nurse on duty
Discharge instructions Doctor
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Received request 1.1 Explain none 5-10 minutes Nurse on duty
for notice of process of
discharge discharge

2. Chart evaluation by 2.1 Send chart to none 30 min – Nursing

PHIC evaluator PHIC 1hour attendant
evaluator.
Await call from
PHIC
evaluator if
okay for billing.
3. Secure clearance 3.1 Instruct client None 5 minutes Nurse on duty
from billing and to secure
social service. clearance form
billing and
social service
4. Present the bill with 4.1 Verify for None 5 minutes Nurse on duty
clearance completeness
4.2 Provide 10 minutes Nurse on duty
discharge
instructions
including
follow-up
check-up,
photocopied
laboratory
results,
medicine
prescription
and other
special
instructions
4.3 Escort to the 10 minutes Nurse attendant
lobby per on duty
wheelchair
TOTAL: None 1.5 hour

4. FACILITATION OF PRESCRIBED LABORATORY EXAMINATIONS

Facilitation of prescribed laboratory examinations

Availability of Service: 24 hours a day, 7 days a week

Office/Division: Heart Institute Westwing Ward
Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Male, female, and pediatric patients
2. Patients who are pre- operative and post- operative
3. Patients who needs medical and/ or surgical intervention
 CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Written order from the physician Doctor
Filled- up request form Doctor
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Receive orders for 1. Verify the order none 10 minutes Nurse on duty
laboratory and the
examinations completeness
of the filled- up
request form

2. Permit collection of 2. Collect the None 10 minutes Nurse on duty

specimen requested
specimen
2.1 Complete the 3 minutes
label of the
specimen
container
2.2 Submit the 1 minute
specimen to
the laboratory
TOTAL: None 14 minutes

5. FACILITATION OF REQUESTED DIAGNOSTIC PROCEDURES

Facilitation of requested diagnostic procedure for service ward

Availability of Service: 24 hours a day, 7 days a week

Office/Division: Heart Institute Westwing Ward
Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Male, female, and pediatric patients
2. Patients who are pre- operative and post- operative
3. Patients who needs medical and/ or surgical intervention
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Written order from the physician Doctor
Filled- up request form Doctor
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Receive physician 1.Verify the order none 10 minutes Nurse on duty
orders for diagnostic and the
procedure completeness of
the filled- up
request form

2.give the request 2.schedule the None 20 minutes Nurse on duty

form to the nursing diagnostic
attendant for procedure
scheduling
3.Undergo scheduled 3.ensure timely None 30 minutes Nurse on duty
diagnostic procedure sending of patient
to scheduled
diagnostic
procedure
together with the
request and chart
and perform
proper preparation
if necessary
TOTAL: None 60 minutes
 Heart Institute

Operating Room

External Services

1. Receiving of Request for Surgery

Request for surgery of Heart Institute patients.
Availability of Service: Must follow the memo no. 153 “Guidelines for Resumption of Elective and
Expansion of Emergency surgeries”

Office/Division: Heart Institute- Operating Room (HI OR)

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients (Out-patient and Walk-In patients)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Request for Surgery Doctor
 2. Accounting Clearance Billing
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present order of 1. Verifies None 10 minutes Nurse/Nursing
Request for surgery completeness of Attendant
and Accounting request.
clearance with
complete details to
Heart Institute
Operating Room.
TOTAL: NONE 10 MINUTES

2. Admission of OPD Patient Scheduled for Surgery.

Admission of OPD patients who are scheduled for surgery at the Heart Institute.
Availability of Service: : Must follow the memo no. 153 “Guidelines for Resumption of Elective and
Expansion of Emergency surgeries”

Office/Division: Heart Institute- Operating Room (HI OR)

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients (Out-patient and Walk-In patients)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Order for Surgery Doctor
 2. Filled in Patient’s Information form Nurse on Duty
3. Accounting Clearance Billing
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present order for 1. Verifies None 1 hour Nurse on Duty
surgery (prescription request.
form or referral form)
to Heart Institute 1.1 Instructs client Nurse on Duty/
Operating Room. to properly fill in Medical
the patient’s Records In
information form charge
and submit to
Medical Records
In charge.

1.2 Admits Medical

patient. Records In
charge
1.3 Instruct to go
to the billing office Nurse/Billing In
to secure Charge
accounting
clearance.

TOTAL: NONE 1 HOUR

3. Perioperative Visit (Health Teaching about the Perioperative Process)

Nursing Procedure
Availability of Service: 7:00 am to 11:00 pm, Monday to Friday, on call during weekends and
holidays.
Office/Division: Heart Institute- Operating Room (HI OR)
Classification: Simple
Type of Transaction: G2C
Who may avail: Patients and their watchers
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Request for Surgery Doctor
 CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submits request for 1. Receives NONE Perioperative
sugery to HI OR. request for Nurse
sugery, 1 hour and 30 HI OR/ Unit
Doctor’s order minutes ward nurse and
and consent. Nursing
attendant
1.1 Perioperative
Teaching
TOTAL: NONE 1 hour and 30
minutes

4. Endorsement of Patient
Nursing Procedure
Availability of Service: 7:00 am to 11:00 pm, Monday to Friday, on call during weekends and
holidays.
Office/Division: Heart Institute- Operating Room
Classification: Simple
Type of Transaction: G2C
Who may avail: Patients and their watchers
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
 1. Schedule of OR (Pre-op)/ Post operative Doctor
Order
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Receives 1. Verifies order NONE Attending
endorsement from from attending Physician/Perio
unit ward or physician (to fetch 1 hour perative Nurse
endorsement of post the patient)/post
operative patients. op order Unit Nurse on
Duty

TOTAL: NONE
1 hour

5. Operating Room Procedures

Minor OR Major OR
1. IJ insertion 1. Coronary Artery Bypass Graft
2. CTT insertion 2. Valvular Surgery
3. AVF creation 3. Septal Defect Surgery
4. Porta Cathether Insertion 4. Repair of Aneurysym
5. Pericardiostomy 5. Blalock Taussig Shunting
6. PDA Transection
 7. TOF Correction
8. Aortic Switch Operation
Availability of Service: 7:00 am to 11:00 pm, Monday to Friday, on call during weekends and
holidays.
Office/Division: Heart Institute- Operating Room
Classification: Simple
Type of Transaction: G2C
Who may avail: Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Request for Surgery Doctor
2. Accounting Clearance Billing
3. Supplies and Instruments HI OR CSSD AND Sterile Room
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. On scheduled date 1. Receives To be 30 minutes Unit Nurse/HI-
of surgery/procedure, endorsement from determined OR Nurse and
patient is transported unit NOD. Verifies by billing Nursing
by HI OR nurse and request for incharge attendant
nursing attendant. sugery, (Accounting
Accounting Clearance)
Clearance,
Doctor’s order and
consent.

1.1 Prepares 1-2 hours Attending

patient for Physician
surgery/ Nurse/Nursing
procedure. Attendant
HI OR

1.2 Conducts Minor OR Doctor/Nurse/

procedure. 1. IJ insertion Nursing
(1 hour) Attendant
2. CTT HI OR
insertion
(1 hour)
3. AVF
creation
(2 hours)
4. Porta
Cathether
Insertion
(1 hour)
5. Pericardio
stomy
(4 hours)

Major OR

1.Coronary
Artery Bypass
Graft
(10 hours)

2.Valvular
Surgery
(8 hours)

3. Septal
Defect Surgery
(6 hours)

4. Repair of
Aneurysym
 (6 hours)

5.Blalock
Taussig
Shunting
(6 hours)

6.PDA
Transection
(4 hours)

7. TOF
Correction
(6 hours)

8. Aortic
Switch
Operation
(8 hours)

1.3 Transfers 30 Minutes Doctor/Nurse/

patient to RR for Nursing s
post-op Attendant e
monitoring. HI OR c
t
n

Depending on NONE Depending on

the type of case the type of
case
 Heart Institute

PICU

External Services

1. Providing Close and Specialized Nursing Care to Patients Recovering from

the Effects of Anesthesia and Operation
This procedure covers activities from receipt of handover from Recovery Room nurse/
anesthesiologist up to providing post-operative care.
 Office/Division: Heart Institute- Pediatric Intensive Care Unit
Classification: Simple
Type of Transaction: G2C
Who may avail: Post-operative patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
O.R. documents (Intraoperative Record, OR Nurse
O.R. Technique, Verification Checklist, Surgeon/ Anesthesiologist
Instruments and Sponge Count, Recovery Room Nurse
Anesthesia Record) Physician’s post-
operative orders, Patient’s chart
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE

1. Transfer to PICU 1. Receive None 60 minutes Nurse on Duty

from RR for post- handover from the
operative care O.R. Nurse/ RR
nurse

1.1 Review of
patient’s chart for
treatment plan

1.2 Perform
immediate
postoperative
nursing care

TOTAL: NONE
60 minutes

2. Transfer In of Patient from Other Units

This procedure covers activities of admission of patients from the Emergency Room Department
and other clinical units
Office/Division: Heart Institute- Pediatric Intensive Care Unit
Classification: Simple
Type of Transaction: G2C
Who may avail: All patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Trans-in orders Attending Physician
Completepatient’s chart and other Nurse on duty
pertinent documents
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Receive order 1. Verify the None 10 minutes Nurse on Duty
transfer of patient orders
from one service area Attending
to another Physician

3. Transfer from one 3. Receive the None 10 minutes

service area to patient and Nurse on Duty
another transfer to bed Nursing
assignment Attendant

3.1 Perform None 20 minutes Nurse on Duty

history taking and
take initial vital Attending
signs Physician

3.2 Orient patient None 20 minutes Nurse on Duty

(and watcher) to
unit/facility rules
and policies
including patient
safety precautions

TOTAL: NONE 60 minutes

3. Transfer out of Patient to Pay/ Service Wards

Office/Division: Heart Institute- Pediatric Intensive Care Unit

Classification: Simple
Type of Transaction: G2C
Who may avail: All patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Trans-out orders Attending Physician
Complete pertinent documents Nurse on duty
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE

1. Receive order 1. Verify the None 20 minutes Nurse on Duty

transfer of patient orders
from one service area Attending
to another 1.1 Complete Physician
required
documents for
transfer

2. Await transfer from 2. Endorse the None 10 minutes Nurse on Duty

one service area to patient via
another telephone

3. Transfer patient 3. Transport the None 10 minutes Nurse On Duty

patient from one
unit to another Attending
Physician as
needed

3.1 Endorse 10 minutes

patient and the Nurse on Duty
documents to
receiving nurse

3.2 Place patient

comfortably in bed

3.4 Document the

transfer

TOTAL: NONE 50 minutes

Heart Institute

Recovery Room

External Services
1. Providing Close and Specialized Nursing Care to Patients Recovering from
the Effects of Anesthesia and Operation
This procedure covers activities from receipt of handover from OR nurse/ anesthesiologist up to
providing post-operative care.
Office/Division: Heart Institute- Recovery Room
Classification: Simple
Type of Transaction: G2C
Who may avail: Post-operative patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
O.R. documents (Intraoperative Record, OR Nurse
O.R. Technique, Verification Checklist,
Instruments and Sponge Count,
Anesthesia Record) Physician’s post-
operative orders Surgeon/ Anesthesiologist

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE

1. Transfer to PACU 1. Receive None 4 hours Nurse on Duty

from OR for post- handover from the
operative care O.R. Nurse/ Recovery Room
Anesthesiologist

1.1 Review of
patient’s chart for
treatment plan

1.2 Perform
immediate
postoperative
nursing care

TOTAL:
4 hours
2. Transferring-out of Patient to Clinical/Critical Units
This procedure covers activities from securing of Doctor’s order for transferring of postoperative
patient.
Office/Division: Heart Institute- Recovery Room
Classification: Simple
Type of Transaction: G2C / G2G
Who may avail: Post-operative patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Admitting orders Primary Service
Allocated bed Clinical / Critical Units
Anesthesia Clearance Anesthesiologist on duty
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Transfer out to 1. Transfer from None 2 hours Nurse on Duty
ward/ room/ Critical Recovery Room Recovery Room
care unit to Ward/Room /
Critical Care Unit:
Secure
disposition/order
from
Anesthesiologist/
Surgeon and
Cardiologist

1.1 Document None 1 hour Nurse on Duty

nursing care Recovery Room
rendered and
endorse patient to
respective clinical/
critical care unit

1.2 Transfer
patient to the: None 45 minutes Nurse on Duty
General Ward Nursing
Attendant on
Duty
Recovery Room
Critical Care
Unit None 1 hour Nurse on Duty/
Attendant on
Duty
Recovery Room
Resident in
charge

TOTAL: None General

Wards: 3
hours 45
minutes;
Critical Care
Unit: 4hours
Heart Institute

SICU

External Services
1. Transfer In of Patient from other Units
This procedure covers activities of trans-in of post operative patients from the Recovery Room.
Office/Division: Heart Institute- Surgical Intensive Care Unit
Classification: Simple
Type of Transaction: G2C
Who may avail: All patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Trans-in orders Attending Physician
Complete pertinent documents Nurse on duty
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Receive order 1. Verify the None 10 minutes Nurse on Duty
transfer of patient orders
from one service area Attending
to another Physician

3. Transfer from one 3. Receive the None 10 minutes

service area to patient and Nurse on Duty
another transfer to bed Nursing
assignment Attendant

3.1 Perform None 20 minutes Nurse on Duty

history taking and
take initial vital Attending
signs Physician

3.2 Orient patient None 20 minutes Nurse on Duty

(and watcher) to
unit/facility rules
and policies
including patient
safety precautions

TOTAL: NONE 60 minutes

2. Providing Close and Specialized Nursing Care to Patients Recovering from
the Effects of Anesthesia and Operation
This procedure covers activities from receipt of handover from Recovery Room nurse/
anesthesiologist up to providing post-operative care.
Office/Division: Heart Institute- Surgical Intensive Care Unit
Classification: Simple
Type of Transaction: G2C
Who may avail: Post-operative patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
O.R. documents (Intraoperative Record, OR Nurse
O.R. Technique, Verification Checklist,
Instruments and Sponge Count,
Anesthesia Record) Physician’s post-
operative orders Surgeon/ Anesthesiologist

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE

1. Transfer to SICU 1. Receive None 60 minutes Nurse on Duty

from RR for post- handover from the
operative care Recovery Room SICU Nurse
Nurse/Operating
Room Nurse

1.1 Review of
patient’s chart for
treatment plan

1.2 Perform
immediate
postoperative
nursing care

TOTAL: NONE
60 minutes
3. Transfer out of Patient to Pay/ Service Ward

Office/Division: Heart Institute- Surgical Intensive Care Unit

Classification: Simple
Type of Transaction: G2C
Who may avail: All patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Trans-out orders Attending Physician
Complete pertinent documents Nurse on duty
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE

1. Receive order 1. Verify the None 20 minutes Nurse on Duty

transfer of patient orders
from one service area Attending
to another 1.1 Complete Physician
required
documents for
transfer

2. Await transfer from 2. Endorse the None 10 minutes Nurse on Duty

one service area to patient via
another telephone

3. Transfer patient 3. Transport the None 10 minutes Nurse On Duty

patient from one
unit to another Attending
Physician
3.1 Accompany
patient to ward

3.2 Endorse 10 minutes Nurse on Duty

patient and the
documents to
receiving nurse

3.3 Place patient

comfortably in bed

3.4 Document the

transfer

TOTAL: NONE 50 minutes

Heart Institute

Heart Station

External Services
1. HI- 2DECHO - SCHEDULING
Availability of Service: 7:00 am to 3:00 pm, Monday to Friday, except Regular Holidays
7:00 am to 3:00 pm, Saturday

Office/Division: Heart Station and Echocardiographic Laboratories Section - Heart

Institute
Classification: Complex
Type of Transaction: G2C
Who may avail: IN- patients only
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. 2DEcho Request DOCTOR
ADULT
-Signed by 3RD year IM resident with
complete cardiac diagnosis or any
consultants.
PEDIA
–Signed by any SPMC pediatric resident
or consultants.
-With pediatric cardiac impression

CLIENT STEPS AGENCY FEES TO BE PROCE PERSON

ACTION PAID SSING RESPONSIBLE
TIME
1. Present official 1. Verifies Machine fees 10 mins. Unit Head
request to Heart requests
station receiving for line up/ Echocardiography
area. priority. Charity
2. Check if Machine fee:
MACHINE FEE 1,250.00
can be charged Professional fee:
using the PHIC 750.00
insurance, if not,
instructs the client
to pay for the
procedure.
3. Explain to client
about the patient’s
schedule.
4. Informs the
Nurse-on –Duty of
the ward where
the client’s patient
is admitted about
the schedule of
the procedure and
preparation prior
to schedule.
2. 2DECHO PROCEDURE
Availability of Service: 7:00 am to 3:00 pm, Monday to Friday, except Regular Holidays
7:00 am to 3:00 pm, Saturday

Office/Division: Heart Station and Echocardiographic Laboratories Section - Heart

Institute
Classification: Complex
Type of Transaction: G2C
Who may avail: In patients only
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. 1. Official request to Heart Station Doctor
receiving area
2. Official receipt CASHIER for cash basis.
3. Approved guarantee letter, if with LINGAP,MAIP,OP,DSWD AND PCSO
medical assistance
CLIENT STEPS AGENCY FEES TO BE PROCE PERSON
ACTION PAID SSING RESPONSIBLE
TIME
1. Present the official 1. Verifies request None 10 mins. Unit Head
HI-2DECHO and nature of
Request payment.
form with the official
receipt if paid in 2. Prepare and 5mins Cardiovascular
cash or approved explain to the Technician
guarantee letter patient the
from the medical procedure and
assistance program how long will it
office. take.
1 hour Cardiovascular
3. Instruct patient Technician
to wear the
mask properly 5 mins
during the Cardiovascular
procedure Technician

3.1 Perform /
Conduct
procedure.

3.2 provide claim

stub and
instruct client to
call heart station
on or after 14
working days for
the verification
of the release of
result.
3. 2DECHO – RELEASING of results
Availability of Service: 7:00 am to 3:00 pm, Monday to Friday, except Regular Holidays and
Sunday
7:00 am to 3:00 pm, Saturday

Office/Division: Heart Institute – Heart Station and Echocardiographic Laboratories

Section
Classification: Complex
Type of Transaction: G2C
Who may avail: In – patients only
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. CLAIM STUB ADMIN. CLERK/TECHNICIAN

CLIENT STEPS AGENCY FEES TO BE PROCESS PERSON

RESPONSIBLE
ACTION PAID ING TIME
1. Submit claim stub 1. Verifies request None 5 mins CLERK OR
to heart station then releases TECHNICIAN
counter on scheduled results.
day of release.

TOTAL: NONE
 Heart Institute

Cardiac Catheterization Laboratory (Cardiac CathLab)

External Services
Cardiovascular Catheterization Laboratory
Diagnostic and Intervention Procedures for Admitted Patients
Availability of Service: Elective Procedures: 8:00 am to 5:00 pm, Monday to Saturdays, except
Holidays and Sundays.

Office/Division: SPMC Heart Institute/ Nursing Division

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients (In -patients)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Request for Surgery/ Procedure , Ward Nurse
Accounting Clearance
2. Information Sheet HIMD
3. Official Receipt for paid procedure Cashier
4.Approval of Accounting Clearance Billing Section
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Verifies request
of physician. Ward Nurse III
None 5 minutes Nurse III
2.Submit request HIMD
for procedure and
accounting
clearance
2. Receives the Refer to 5 minutes Nurse III
official receipt and Cathlab Cashier
approved Fees Billing Section
accounting approved
clearance. fees)
1. Consent for the 3.0. Verify Ward Nurse III
procedure. consent for the Nurse III
procedure. None 3 minutes

3.1. Identifies
client through
verbal chart.

4.0. One on one None 5 minutes Nurse III

endorsement of
client.

4.1. Check pre

procedure
checklist.

2.Undergo Cathlab 5.0.Instructs None Estimated Interventional

Procedures patient on what to time2 hours & Cardiologist/
do. 30 minutes Radiologist
Electrophysiologist
Nurse III
MedtechIII
RadTechIII

5.1. Prepares
client technical
supplies,
medications and
functioning
equipment for
client use
.
 5.2. Instructs
patient on what to
do.

5.3 Prepares
client for the
procedure
including skin
preparation on the
catheter puncture
site.

5.4 Conducts
procedure.

3.Client post 6.0. Endorses None 15 minutes Nurse III

procedure client to recovery
room/CCU.

6.1.Receives the
endorsement of
Cath Lab post
procedural client
and documents.

TOTAL: Refer to 3 hours & 3

Cathlab minutes
approved
fees
Cardiovascular Catheterization Laboratory
Diagnostic Procedures (Out-Patient)
Availability of Service: Elective Procedures: 8:00 am to 5:00 pm, Monday to Saturdays, except
Holidays and Sundays.

Office/Division: SPMC Heart Institute/ Nursing Division

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients ( Out –patients )
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Request for Surgery/ Procedure Cathlab Nurse
Accounting Clearance
2. Information Sheet HIMD
3. Official Receipt for paid procedure Cashier
4.Approval of Accounting Clearance Billing Section
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Receives the 1. Verifies request
request for the of physician.
procedures None 5 minutes Nurse III
2. Instruct relative HIMD
to fill up
information data
sheet
2.Present the official 2.Receives the Refer to 5 minutes Nurse III
receipt and approved official receipt and Cathlab Cashier
accounting clearance approved Fees Billing Section
accounting approved
clearance. fees)
3.Sign consent for the 3. Counter check None 5 minutes Nurse III
procedure the consent for
the procedure.
4.Undergo Cathlab 4.1. Check pre None Estimated Nurse III
Procedures procedure time1 hour 30 Interventional
checklist. minutes Cardiologist/Radi
ologist
4.2. Instructs Electrophysiologis
patient on what to t
do. Nurse III
MedtechIII
4.3. Prepares RadTechIII
client technical
supplies,
medications and
functioning
equipment for
client use.

4.4. Instructs
patient on what to
do.

4.5. Conducts
procedure.
5.Client post 5.0. Refer client to None 15 minutes Billing Section
procedure billing section to In charge
settle bills and Cashier
transaction.

5.1. Endorses
client to
designated
hospital.

5.2. Give
discharge health
instructions to
client and
significant others.

5.3. Receives the

endorsement of
Cath Lab post
procedural client
and documents
including results.

TOTAL: Refer to 2 hours

Cathlab
approved
fees
Institute of Psychiatry and Behavioral Medicine

Ward Administrator’s Office

External Services
1. Attending to Inquiries
Dealing with Inquiries pertaining to hospital procedures and policies, location and direction of
department/office/unit
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Institute of Psychiatry & Behavioral Medicine – Ward Administrator’s

office
Classification: Simple
Type of Transaction: G2G
Who may avail: General Public
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Detailed Concern Requesting Agency/Individual
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Visit IPBM-Ward 1. Receive Inquiry None 50 minutes Ward
Administrator’s Office and analyze Administrator
providing details of client’s inquiry
the inquiry Administrative
1.1 Provide Staff
appropriate action
and give precise
instruction/explan
ation based on
current policies
and procedures
and/or give
specific directions

TOTAL: 50 minutes
2. Handling of letters, correspondence received thru email/ courier/ personal
services
Giving action upon receipt of document up to sending a reply/response through letter
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Institute of Psychiatry & Behavioral Medicine – Ward Administrator’s

office
Classification: Simple
Type of Transaction: G2C, G2B, G2G
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Letter/correspondence Requesting Agency/office/Individual
Receiving copy, checklist/ record/ proof of Requesting Agency/office/Individual
receipt
Contact details of the sender/sender’s
authorized representative (as deemed
necessary)
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
A. Email: 1. Open/Check None Urgent: Ward’s
email. 1 Day Administrator’s
1.Send Acknowledge/forw Assistant
letter/correspondence ard refer to and Non-urgent:
to: coordinate with 2 Days
davaomental_hospital offices/persons
@yahoo.com concerned for
appropriate action
(following flow of

B. Courier/Personal
Delivery:

1. Handover the letter/ 2.Examine/screen None Urgent: Ward

correspondence along /receive the 1 Day Administrator’s
with the letter/corresponde Assistant
checklist/record/receiv nce and Non-urgent:
ing copy forward/refer to or 2 Days
coordinate with
offices/persons
concerned for
appropriate action
(following the
process of
handling
communications)

2. Confirm/ 2. Provide the None Urgent: Ward

Acknowledge client with the 1 Day Administrator’s
response to name of office, Non-urgent: Assistant
letter/correspondence/ contract 1 Day
email number/person
and other details
related to the
letter/
correspondence.
TOTAL: None A. Email:
Urgent:
1 Day
Non-urgent:
2 Days

B.
Courier/Perso
nal Delivery:
Urgent:
2 Days
Non-urgent:
3 Day
3. Granting/denying permission to use IPBM conference rooms/gym
Granting access to use IPBM conference rooms/gym
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Institute of Psychiatry & Behavioral Medicine – Ward Administrator’s

office
Classification: Simple
Type of Transaction: G2C, G2B, G2G
Who may avail: General Public, SPMC employee
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Letter of request Requesting Agency/office/Individual
Receiving copy Requesting Agency/office/Individual
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit letter 1. Receive the None 20 minutes Ward
stating the purpose of letter Administrator’s
the request Assistant
1.2 Indicate the
date of receive

1.3 Forward to
Ward
Administrator’s
office

2. Receive the second 2. Advise the None 1 Day Ward

copy client to make a Administrator’s
follow about the Assistant
request

TOTAL: None 1 day and 20

minutes
4. Providing Assistance
This process provides assistance to patients and their watchers/ authorized representatives based
on existing hospital policies and procedures (e.g. hospital bill, consult schedule, new patients)
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Institute of Psychiatry & Behavioral Medicine – Ward Administrator’s

office
Classification: Simple
Type of Transaction: G2C, G2B, G2G
Who may avail: General Public, SPMC employee
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Detailed information of the concern Requesting Individual
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Go to IPBM and 1. Accept request None 20 minutes Ward
deliver the letter of for assistance Administrator’s
request for assistance Assistant
1.1Evaluate the Representative
nature of the
request

1.2 Determine the

type of service

1.3 Ascertain the

nature of
assistance based
on existing
policies and
procedure

1.4 Provide
feedback to client
relative to his
request

TOTAL: None 30 minutes

Institute of Psychiatry and Behavioral Medicine

Ward Administrator’s Office

Internal Services
1. All Administrative Concerns Requiring Appropriate Action/s

Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Institute of Psychiatry & Behavioral Medicine – Ward Administrator’s

office
Classification: Simple
Type of Transaction: G2G
Who may avail: Public and Administrative Personnel
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Verbal or Written Comment or Complaint Client, staff and other stakeholders
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Report a complain 1. Receive and None 15 minutes Administrative
thru verbal or via assess nature of Personnel
written document complaint

1.1 Endorse to None 5 minutes Administrative

unit head Personnel
concerned for
initial action for
initial resolution

1.2 Investigate the None 2 hours Ward

incident and talks Administrator/
to the concerned Unit Heads
staff, client and
unit head
concerned

1.3 If problem is None 5 minutes Ward

unresolved, Administrator/
elevate to next Unit Heads
higher Supervisor

1.4 Submit None 1 day Administrative

summary report in Personnel
relation to the
reported complain

1.4 Forward None 1 day Ward

complaint or Administrator
Summary Report
to Chief
Administrative
Officer (CAO), if
problem complaint
is still not resolved
TOTAL: 2 days, 2
hours & 25
minutes
2. Assessment, Signing and Endorsement of Daily Time Record, Pass Slip and
Application for leaves
Assess, Signs Record of Attendance, Pass Slip and Application for leaves for endorsement
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Institute of Psychiatry & Behavioral Medicine – Ward Administrator’s

office
Classification: Simple
Type of Transaction: G2G
Who may avail: All Administrative Personnel
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Daily Time Record Administrative Staff
Pass Slip PACD, Ward Administrator’s Assistant
Application for Leave Ward Administrator’s Assistant/Administrative
Staff
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Accomplish and 1. Ensure that the None 5 minutes Administrative
signed the document. document is Personnel
completely filled-
out

1.1 Facilitate the

document by the
staff and have it
signed by the
Ward
Administrator
TOTAL: 5 minutes
3. Attending to meetings/conference of the Execom, Admin Section Heads
Attendance to Monthly meeting by the Ward Administrator
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Institute of Psychiatry & Behavioral Medicine – Ward Administrator’s

office
Classification: Simple
Type of Transaction: G2G
Who may avail: Section Heads
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Notice of the Meeting Medical Center Chief’s office
Chief Administrative Officer’s office
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Facilitate notice of 1. Receive and None 10 minutes Administrative
the meeting document the Personnel
date of the
meeting

1.1 Return the

received copy

1.2 Align the

schedule of the
Ward
Administrator

1.3 Inform the

Ward
Administrator
about the
schedule of the
meeting

TOTAL: 10 minutes
4. Handling of documents, memorandums, orders, circulars for appropriate
action
Attendance to Monthly meeting by the Ward Administrator
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Institute of Psychiatry & Behavioral Medicine – Ward Administrator’s

office
Classification: Simple
Type of Transaction: G2G
Who may avail: Medical Center Chief, Section Heads, Coordinators and
Administrative Personnel under the Executive Offices; Heads of
Units and their staff under the Medical Center Chief’s office
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Papers/documents for appropriate action/ Executive offices, Units under the office of the
signing/approval of the Medical Center Medical Center Chief
Chief
Record/Receiving copy Executive offices, Units under the office of the
Medical Center Chief
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present the 1. Check the None Per Administrative
paper/document paper/ document paper/docume Staff
together with the and its nt: 5 minutes
checklist/record/ completeness/
receiving copy correctness
against the
checklist/record/
receiving copy

1.1 Return the

received copy

2. Leave the paper/ 2. Label/mark/tag None Per page: Ward

document in the office the page/s of the 1 Minute Administrator
Note: May follow up paper/ document Administrative
by phone or request to be acted upon/ Staff
DO staff to call office signed/ approved
once acted upon/ by the Medical
signed by the Medical Center Chief
Center Chief
2.1 Disseminate
the information to
the IPBM
Personnel
TOTAL: 6 minutes
5. Handling request reservation of function room
Request of availability of the room
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Institute of Psychiatry & Behavioral Medicine – Ward Administrator’s

office
Classification: Simple
Type of Transaction: G2G
Who may avail: IPBM Personnel
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Request Letter Requesting Employee/Individual
Record/Receiving copy Requesting Employee/Individual
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit the letter 1. Receive the None 5 minutes Administrative
requesting for the letter and indicate Staff
availability of the the date of receive
function room
1.1 Confirms the
availability of the
room

1.1 Return the

received copy

TOTAL: 5 minutes
6. Monitoring of Attendance of Administrative Personnel
Monitors the attendance reliability of the Administrative Personnel
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Institute of Psychiatry & Behavioral Medicine – Ward Administrator’s

office
Classification: Simple
Type of Transaction: G2G
Who may avail: IPBM Administrative Personnel
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Logbook of Attendance Admin Lobby
Daily Time Record Administrative Staff
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit a copy of 1. Monitor None 30 minutes Administrative
the Unit Staff attendance Staff
Schedule to the Ward reliability of
Administrator’s Office, Administrative
and report absences Personnel
of staff
TOTAL: 30 minutes
7. Performance evaluation of Job Order (JO) personnel, regular admin staff
Evaluates the performance of the Administrative Personnel
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Institute of Psychiatry & Behavioral Medicine – Ward Administrator’s

office
Classification: Simple
Type of Transaction: G2G
Who may avail: IPBM Administrative Personnel
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Monthly Performance Output Report Concerned Employee
(MPOR)
Individual Performance Commitment and Concerned Employee
Review
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit the duly 1. Evaluate the None Per document: Administrative
accomplished copy to submitted 2 minutes Staff
Ward Administrator’s document
Office and/or
Administrative 1.2 Indicate the
Assistant date of receive
and return the
second to the
concerned
TOTAL: None 30 minutes
8. Performance/task supervision over out-sourced security services
Evaluates the performance of the Administrative Personnel
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Institute of Psychiatry & Behavioral Medicine – Ward Administrator’s

office
Classification: Simple
Type of Transaction: G2G
Who may avail: Office of the Ward Administrator, Office of the Custodial Services
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Performance Evaluation Sheet (PES) Initernal Audit Office
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Send the PES to 1. Check/ Screen/ None 5 minutes Administrative
the Medical Center Receive the PES Staff
Chief’s office and/or
Chief Administrative
Officer’s Office

2. Receive the 2. Accomplish the None 3 days Administrative

accomplished PES PES for security Assistant or
personnel Executive
assigned at the Assistant
Medical Center
Chief’s office, sign
and send back to
the office
concerned
TOTAL: None 3 days and 5
minutes
9. Processing of letter/documents/reports/transmittal for submission to
concerned offices
Process letters/documents/reports for transmittal to concerned offices
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Institute of Psychiatry & Behavioral Medicine – Ward Administrator’s

office
Classification: Simple
Type of Transaction: G2G
Who may avail: Office of the Ward Administrator, IPBM Personnel/Offices
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Documents of any kind Concerned offices
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Prepare the 1. Check the None 5 minutes Administrative
documents for completeness of Staff
transmittal the documents

1.1 Prepare the

transmittal form

1.2 Facilitate the

signature of the
Ward
Administrator

1.3 Ready for

transmittal

TOTAL: None 5 minutes

Institute of Psychiatry and Behavioral Medicine

Billing Unit

External Services
1. Provides Statement of Account for MGH patients
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: IPBM-Billing
Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: 1.In-Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Claim Stub Nurse on Duty

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Present claim stub 1. Verifies billing None 6 minutes Billing Clerk
to billing clerk. statement in the
system.

1.2. Prints the

Final Billing in 3
copies.
2. Proceed to Social 2. Refer watcher None 1 minute Billing Clerk
Services for financial to social services.
assistance.
TOTAL: 7 minutes
2. Assist patients with Philhealth
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: IPBM-Billing
Classification: Complex
Type of Transaction: G2C, G2G
Who may avail: 1.In-Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Member Data Form (MDR) Philhealth
2. Claim Signature Form (CSF) Billing Clerk
3. Birth Certificate PSA or LCR
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present needed 1. Verifies the None 5 minutes Billing Clerk
requirements for documents in the
Philhealth processing. SureClaims.

1.2. Verifies the

documents and
encodes the
necessary
information in the
system.
2. Sign the documents 2. Prints the PBEF None 5 minutes Billing Clerk
required for Philhealth and let the
processing. member sign the
necessary form.

2.1. Files the

documents for
transmittal.

2.2. Ensures CF4 6 days

are completely
filled up before
transmitting to
Billing Main
Processing Unit
within allowable
period of 60days.
TOTAL: 6 days &
10minutes
Institute of Psychiatry and Behavioral Medicine

Crisis Intervention Unit

External Services
1. Admission of Patients
This procedure covers all patients that requires psychiatric admission.
Availability of Service: 24/7

Office/Division: Crisis Intervention Unit - IPBM

Classification: Simple
Type of Transaction: G2C
Who may avail: Patients who are requiring psychiatric evaluation and management
as deemed.
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Doctor’s Order Patient’s chart
2. Referral from other institution Previous institution

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Arrive at 1. Call patient name None 1 hour Nurse on duty
IPBM,OPD triage area 1.1 Conduct ,Nursing
Psychiatric Attendant,
interview and Clerks/Interns,
physical
Resident
examination
on duty
1.2 Explain the
findings and
management to the
patient
1.3.Signing of
consent of
admission by the
significant others
and patient.
1.4. Give
prescription and/or
laboratory requests
as needed

2.ENTERS CIU 2,Give instructions None 3 minutes Nurse on duty

WARD on hospital stay. Nursing
2.1.Instruct to attendant
wear hospital
uniform through
out the stay.
2.2.Inform
visitation time
between 3:30pm
to 6:30pm daily.
2.3.Daily
evaluation by the
RIC.
2.4.Orientation of
hospital rules and
regulations.
TOTAL: 1 hour and 3
mins
2. Discharge Planning and Home Instructions
Processing of patient discharge with home instructions.

Office/Division: Institute of Psychiatry and behavioral Medicine (IPBM)- Wards

Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: In- patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Discharge orders Physician in-charge
2. Accomplished Discharge Against Advice Nurse on-duty
form Completion of discharge
requirements
3. Statement of account Billing section
4. Discharge instructions Nurse on-duty
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Receive notice of 1.Explain process None 5 minutes Nurse on-duty
discharge. of discharge

Ensure that the

If patient requests to patient/significant
go home against other has signed
medical advice the waiver.
(HAMA), inform nurse
on-duty of desire to go
home.
2. Secure statement 2. Completion of None 10 minutes Guard on-duty
of account from the hospital bill
billing section. clearance

For PHIC
patients: Instruct
to present the
claim stub for
issuance of the
statement of
account.

For Non- PHIC

patients: The
Nurse on-duty/
Nurse Attendant
will acquire the
statement of
account for the
patient.
3. Ask for approved 3. Validates and None 15 minutes Nurse on-duty
statement of account signs statement of
account.
4. Request for 4.Instruct to None 5 minutes Nurse on-duty
pertinent laboratory photocopy such
results, clinical forms.
summary form,
medical abstract and
operation related
documents if
applicable
5. Ask for discharge 5.Provide None 15 minutes Nurse on-duty
instructions and home instructions for
medication home medications
prescriptions. and follow-up
check-up
schedule.
5.1Return unused
medicines and
supplies bought
outside.
TOTAL: 50 minutes
3. Facilitation of Issuance of Certificate of Confinement/ Medical Abstract per
request
Facilitation of Issuance of Certificate of Confinement/ Medical Abstract per request
Availability of Service: Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except
Holidays.

Office/Division: Institute of Psychiatry and behavioral Medicine (IPBM)- Wards

Classification: Simple
Type of Transaction: G2C
Who may avail: Patients/Authorized representatives who needs: 1. Medical
Certificate 2. Medical Certificate for medico-legal purposes (service
patients only). 3. Copy/certified true copies of medical record for
SSS, GSIS, Insurance Claims, PHILHEALTH and other legitimate
purposes.

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

1. Discharge orders Physician in-charge
2. Completion of discharge requirements Nurse on-duty
3. Statement of account Billing
4. Discharge instructions Nurse on-duty
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Get request for Provide requested None 15 minutes HIMD staff
certificate of form
confinement

2. Present the Fill-up the None 15 minutes Nurse on- duty

requested form requested form
at the Nurse
Station

3. Receive Give back the None Nurse on- duty

requested form requested form

30 minutes
TOTAL:
4.Handling of Patient’s Visitation
Handling of Patient’s Visitation
Availability of Service: 3:30 PM to 5:00 PM on Monday to Friday, except Holidays
8:00 AM to 5:00 PM on Saturday to Sundays and Holidays

Office/Division: Institute of Psychiatry and behavioral Medicine (IPBM)- Wards

Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: Family or Authorized representative of In- patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Visitor’s ID Guard On-duty
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present visitor’s ID 1. Usher the None 10 minutes Nursing
visitor to the Attendant
visitation area
1.2. Cell-out the
patient and usher
to the visitation
area

TOTAL: 10 minutes
5. Outpatient General Consultation- CIU (after 5pm,weekends and holidays)
This procedure covers activities from receiving patients after 5pm,weekends and holidays)
Availability of Service:

Office/Division: CRISIS INTERVENTION UNIT- IPBM

Classification: Simple
Type of Transaction: G2C,G2G
Who may avail: Patients who are requiring psychiatric evaluation and management
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Referrals From previous institution

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Arrive at IPBM- 1. Conduct and None 30 minutes Resident’s on
OPD interview duty,Intern”s
1.1.Proper filling and clerks,
up of patient’s Nurse on duty
data OPD form. OPD Nursing
1.2.Conduct a Attendant
mental status
examination.
1.3.Discuss
management to
the patient.
1.4.Give
prescription
and/or laboratory
requests as
needed.
2.Discharge 2.1.Home
medications
instructed.
2.2.Advised for
follow up check up
on scheduled
date.
TOTAL: 30MINUTES
Institute of Psychiatry and Behavioral Medicine

ECG Unit

External Services
1. Electrocardiogram (ECG) Services for IPBM Patients
Availability of Service: 8:00 am to 4:00 pm, Monday to Friday, except Holidays.

Office/Division: ECG Unit - IPBM

Classification: Simple
Type of Transaction: G2C
Who may avail: Out-patient, Walk-In patients, Inpatients, PHS patients.
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Request for ECG Doctor
2. Yellow Card HIMD
3. Official Receipt for paid ECG procedure Cashier
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present ECG 1. Receives and For 3 minutes Respiratory
request and yellow verifies request outpatients: Therapist
card to be verified and payment ECG Fee
through SEGHIS Php 320.00
Respiratory
If the patient is Therapist
able to present For In-
himself/herself for patients:
the procedure; charged to
proceed in patient’s
conducting ECG hospital bill
service. Respiratory
1B. if the patient is Therapist
not able proceed
with procedure
manually by
removing the
clothes of the
patient.
1.2 Instructs
patient to perform
necessary actions
by taking off any
silver accessories
he/she is wearing.
2. As per instruction, 2. Enter patient’s None 1 minute Respiratory
enter the ECG room hospital number, Therapist
and lie down on bed complete name
for the procedure and gender on the
ECG machine.

2.1 Instruct patient 1 minutes Respiratory

or watcher for the Therapist
 patient to bare
anterior chest of
ECG electrodes.

2.2 Covers the 1 minutes Respiratory

chest after placing Therapist
the electrodes.

2.3 Runs ECG 2 minutes Respiratory

machine to record Therapist
12-Lead ECG
(Adult) or 15-Lead
ECG (Pedia)
tracing.
3. Wait for final 3. Transmits result None 1 minute Respiratory
instructions on the to Hospital Therapist
result of the ECG. Information
Upon instruction, shall System
return on the
scheduled check-up 1 minute Respiratory
indicated by the Therapist
requesting doctor. 3.1 Collect ECG
request and log
the patient’s
complete name,
age, gender,
ward, type of
payment and its
amount in the
computer.
TOTAL: 320.00 10 minutes

*NOTE: Printed ECG result will be provided upon indication of the requesting doctor.

ELECTROCARDIOGRAM (ECG) PROCEDURE

PAY P 450.00
SERVICE P 320.00
Institute of Psychiatry and Behavioral Medicine

Laboratory

External Services
Collection of Specimen: Urine/Stool
Submission of urine or stool samples collected by the requesting IPBM ward or OPD to IPBM
Laboratory.
Availability of Service: 5:30 AM – 1:30 PM; No Noon Break

Office/Division: Laboratory – IPBM

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Admitted and OPD patients at IPBM
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Duly accomplished laboratory request Resident-in-charge, Nurse-on-duty
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Watcher or Nursing 1. Receives the Refer to the 1 hour Laboratory
attendant endorses request and approved Clerk/Medical
the request/specimen instructs them to schedule of Technologist
IPBM Laboratory
write the name of fees at JICA
the patient on the laboratory
container provided
and logs on the
name of patient
and hospital
number in the log
book provided

1.2 Encodes the 3 minutes Laboratory

request in the Clerk/Medical
system Technologist
IPBM Laboratory
Laboratory
1.3 Submits all __ minutes? Clerk/Medical
specimens Technologist
collected to JICA IPBM Laboratory
main ER
laboratory
Total: Refer to the 30 minutes
approved
schedule of
fees

Clinical Microscopy
Urinalysis 110.00
Fecalysis 60.00
 Pregnancy Test 155.00

Blood Extraction (Phlebotomy)

Extraction of blood for IPBM admitted and OPD patients.
Availability of Service: 5:30 AM – 1:30 PM; No Noon Break

Office/Division: Laboratory – IPBM

Classification: Simple
Type of Transaction: G2G
Who may avail: 1. Admitted Patients at the wards, seldom for Outpatients (Old
patients, No walk-in) referred by Resident @ IPBM-OPD.

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

1. Duly accomplished laboratory request Resident-in-charge, Nurse-on-duty
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Nurse/Watcher 1. Encode the None 1 hour Laboratory
submit completely request in the Clerk/Medical
filled-out request to system Technologist
the IPBM laboratory
1.2 Extraction of Refer to the 49 minutes/
blood for approved per patient
Hematology, schedule of
Chemistry, fees
Serology
processing

1.3 Ensure all

request/s encoded
in the system:
SEGHIS

1.4 Submit all

specimen/s
collected to the
JICA laboratory
Total: Refer to the 1 hour and 49
approved minutes/ per
schedule of patient
fees

LABORATORY Schedule of Fees

Hematology Chemistry
Complete Blood Count w/ Platelet 130.00 Fasting Blood Sugar 120.00
Blood typing 80.00 HbA1C 440.00
Prothrombin Time (PT) 240.00 Uric Acid 160.00
Activated Partial Thromboplastin Time Creatinine
400.00 200.00
(APT)
Serology Albumin 155.00
Troponin I 1,200.00 Bilirubin Profile 500.00
CK-MB 780.00 Sodium 250.00
Anti-HBS 500.00 Potassium 250.00
Anti-HCN 1,000.00 Calcium 220.00
Anti-HBC IgM 760.00 Magnesium 282.00
Anti-HAV IgG 600.00 SGPT 185.00
Anti-HAV IgM 600.00 SGOT 180.00
HBsAg (Qualitative) 220.00 Lipid Profile 600.00
HBsAg (Quantitative) 300.00 Lithium 400.00

Institute of Psychiatry and Behavioral Medicine

Male and Female Wards

External Services
1. Discharge Planning and Home Instructions
Processing of patient discharge with health teachings and medicine instructions.

Office/Division: Institute of Psychiatry and behavioral Medicine (IPBM)- Wards

Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: In- patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Discharge orders Physician in-charge
2. Accomplished Discharge Against Advice Nurse on-duty
form Completion of discharge
requirements
3. Statement of account Billing section
4. Discharge instructions Nurse on-duty
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Receive notice of 1.Explain process None 5 minutes Nurse on-duty
discharge. of discharge

If patient requests to Ensure that the

go home against patient/significant
medical advice other has signed
(HAMA), inform nurse the waiver.
on-duty of desire to go
home.

2. Secure statement 2. Completion of None 10 minutes Guard on-duty

of account from the hospital bill
billing section. clearance

For PHIC
patients: Instruct
to present the
claim stub for
issuance of the
statement of
account.
 For Non- PHIC
patients: The
Nurse on-duty/
Nurse Attendant
will acquire the
statement of
account for the
patient.
3. Ask for approved 3. Validates and None 15 minutes Nurse on-duty
statement of account signs statement of
account.
4. Request for 4.Instruct to None 5 minutes Nurse on-duty
pertinent laboratory photocopy such
results, clinical forms.
summary form,
medical abstract and
operation related
documents if
applicable
5. Ask for discharge 5.Provide None 15 minutes Nurse on-duty
instructions and home instructions for
medication home medications
prescriptions. and follow-up
check-up
schedule.
5.1Return unused
medicines and
supplies bought
outside.
TOTAL: 50 minutes
2. Facilitation of Issuance of Certificate of Confinement/ Medical Abstract
per request
Facilitation of Issuance of Certificate of Confinement/ Medical Abstract per request
Availability of Service: Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except
Holidays.

Office/Division: Institute of Psychiatry and behavioral Medicine (IPBM)- Wards

Classification: Simple
Type of Transaction: G2C
Who may avail: Patients/Authorized representatives who needs: 1. Medical
Certificate 2. Medical Certificate for medico-legal purposes (service
patients only). 3. Copy/certified true copies of medical record for
SSS, GSIS, Insurance Claims, PHILHEALTH and other legitimate
purposes.

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

1. Discharge orders Physician in-charge
2. Completion of discharge requirements Nurse on-duty
3. Statement of account Billing
4. Discharge instructions Nurse on-duty
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
4. Get request for Provide requested None 15 minutes HIMD staff
certificate of form
confinement

5. Present the Fill-up the None 15 minutes Nurse on- duty

requested form requested form
at the Nurse
Station

6. Receive Give back the None Nurse on- duty

requested form requested form

30 minutes
TOTAL:
3. Handling of Patient’s Visitation / Corroborative Interview
Assisting of visitors during visitation or corroborative interview.
Availability of Service: 3:30 PM to 5:00 PM on Monday to Friday, except Holidays
8:00 AM to 5:00 PM on Saturday to Sundays and Holidays

Office/Division: Institute of Psychiatry and behavioral Medicine (IPBM)- Wards

Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: Family or Authorized representative of In- patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Visitor’s ID Guard On-duty
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present visitor’s/ 1.1 Usher the None 10 minutes Nursing
significant others ID visitor to the Attendant
visitation area

If for corroborative 1.2 Inform the

interview Resident In-
Charge

1.3 Cell-out the

patient and usher
to the visitation/
evaluation area

TOTAL: 10 minutes
4. Facilitation of Student Affiliates’ Psychiatric Exposure
Assisting Nursing Student Affiliates’ on their activities for their Psychiatric Exposure
of Service: 7:00 AM to 4:00 PM on Monday to Friday, except Holidays

Office/Division: Institute of Psychiatry and behavioral Medicine (IPBM)- Wards

Classification: Highly Technical
Type of Transaction: G2B
Who may avail: Nursing Student Affiliates
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Schedule Slip PETD
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present schedule 1.Check and None 10 minutes Head Nurse/
slip validate the Nurse on-duty
schedule list

2.Attend orientation 2.Orient the None 2 hours Supervisor/

on unit policies Affiliates on unit Head Nurse/
policies on the Nurse on-duty
first day of
exposure

3.Receive list of 3.Provide list of None 30 minutes Head Nurse/

patients for student patients for SI Nurse on-duty
interaction (SI)

4.Cell-out patients for 4.Facilitate cell- None 10 minutes Nursing

SI out of patients for Attendant On-
SI duty

5.Cell-in patients 5.Facilitate cell-in None 10 minutes Nursing

of patients Attendant On-
duty
TOTAL: 2 hours
Institute of Psychiatry and Behavioral Medicine

Medical Unit

External Services
1. Acceptance for Residency Training Program
This procedure covers activities from receipt of application requirements up to sending of decision
letter about the application.

Office/Division: Institute of Psychiatry and Behavioral Medicine

Classification: Highly Technical
Type of Transaction: G2C
Who may avail: All applicants for Residency and Fellowship Program
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Letter of Intent addressed to the Applicant
Department Chairman
2. Curriculum Vitae
3. Autobiography
4. Credentials (Transcript, Diploma, Class Graduate School
Standing)
5. Credentials (Medical Board Rating, Philippine Regulatory Commission (PRC)
Transcript)
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit copy of the 1. Give instruction None 1 day Residency
requirements above to on the schedule of Training Officer
the Department interview and Chief
Resident
Department of
Psychiatry

2. Attend pre- 2. Schedule None 5 Residency

residency activities applicant Training Officer
interviews with and Chief
consultants Resident
2.1. Schedule Department of
Psychiatry rotation Psychiatry
 (four (4) weeks
rotation)

3. Receive 3. Deliberate and None 7 Residency

acceptance/rejection send acceptance/ Training
letter. rejection letter Committee
3.1. Submit Department
accepted
applicants to
PACD
TOTAL: None 13 days
2. Consultation and Management of Outpatients
This procedure covers activities from receiving patient in the clinic up to endorsement for follow-up
scheduling and referrals
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Institute of Psychiatry and Behavioral Medicine

Classification: Simple
Type of Transaction: G2C
Who may avail: Patients requiring psychiatric evaluation and management
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Yellow card SPMC-IPBM Cashier
2. Patient chart OPD Records section
3. Queue Number SPMC-IPBM Guard house
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present self to the 1. Secure and None 2 minutes Resident
doctor review chart of the Physician
patient OPD Psych
Clinic

2. Cooperate with the 2. Conduct None 3 hours Resident

assessment process Psychiatric Physician
by answering Interview and OPD Psych
questions and by Physical Clinic
following steps during Examination
physical examination 2.1. Explain the 30 minutes
findings and
management to the
patient
2.2 Give 15 minutes
prescription and/or
laboratory requests
as needed
2.3 Schedule the 5 minutes
patient’s follow-up
and give
appointment slip
2.4 Send the
10 minutes
patient to the
nurses for follow-
up instructions
and giving of
medications as
needed
TOTAL: None 4 hours and 2
minutes
3. Consultation and Management of Emergency Patients
This procedure covers activities from patient assessment up to endorsement of plan of care.
Availability of Service: 24 hours

Office/Division: Institute of Psychiatry and Behavioral Medicine

Classification: Simple
Type of Transaction: G2C
Who may avail: Patients requiring emergency psychiatric evaluation and
management
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patient chart Resident-on-duty
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present self to the 1. Secure and None 10 minutes Resident-on-
doctor review chart of the duty
patient Department

2. Cooperate with the 2. Conduct None 1 hour Resident

assessment process psychiatric Physician
by answering interview and OPD Psych
questions and by physical Clinic
following steps during examination
physical examination 2.1. Write 30 minutes
psychiatric
findings and plan
on patient chart
2.3. Write 15 minutes
laboratory and
diagnostic
requests and
prescription for
patient
2.4. Write on chart 15 minutes
the patient’s
disposition (if to
be admitted or as
OPD)
2.5. Endorse plan
of care, laboratory 10 minutes
and prescriptions
to nurse-in-charge

TOTAL: None 2 hours and

20 minutes
4. Consultation and Management of Outpatients in the Community Setting
This procedure covers activities from patient assessment up to endorsement of plan of care.
Availability of Service: Every first Wednesday of the month (except Holidays)

Office/Division: Institute of Psychiatry and Behavioral Medicine

Classification: Simple
Type of Transaction: G2C
Who may avail: Patients requiring psychiatric evaluation and management
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patient chart OPD Records Section
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present self to the 1. Secure and None 10 minutes Resident
doctor review patient Physician
chart Department

2. Cooperate with the 2. Conduct None 1 hour Resident

assessment process psychiatric Physician
by answering interview and Department
questions and by physical
following steps during examination
physical examination 2.1. Write 20 minutes
psychiatric
findings and plan
on patient chart
2.2. Write 5 minutes
laboratory and
diagnostic
requests and
prescription for
patient
2.3. Endorse plan 2 minutes
of care, laboratory
and prescriptions
to nurse-in-charge

TOTAL: None 1 hour and 37

minutes
5. Consultation and Management of Outpatients in Anxiety Clinic
This procedure covers activities from receiving patient in the clinic up to endorsement for follow-up
scheduling and referrals
Availability of Service: 1:00 pm to 5:00 pm, Tuesday, except Holidays at Department of Family
and Community Medicine OPD Clinic

Office/Division: Institute of Psychiatry and Behavioral Medicine

Classification: Simple
Type of Transaction: G2C
Who may avail: Patients requiring psychiatric evaluation and management
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Yellow card SPMC Cashier/Triage
2. Patient chart Family Medicine OPD Nurses’ Station
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present self to the 1. List name and None 2 minutes Resident
doctor arrange their Physician
charts Department

2. Cooperate with the 2. Conduct None 1 hour 30 Resident

assessment process psychiatric minutes Physician
by answering interview and OPD Psych
questions and by physical Clinic
following steps during examination
physical examination 2.1. Write 20 minutes
psychiatric
findings and plan
on patient chart
2.2. Write 5 minutes
laboratory and
diagnostic
requests and
prescription for
patient
2.3. Endorse plan 5 minutes
of care, laboratory
and prescriptions
to nurse-in-charge

TOTAL: None 2 hours and 2

minutes
6. Evaluation of Forensic Cases, Including Drug Dependency Examination
This procedure covers activities from receiving patient in the clinic up to endorsement for follow-up
scheduling and referrals
Availability of Service:
Forensic cases: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.
Drug Dependency Examination: 8:00 am to 5:00 pm, every Wednesday, except Holidays

Office/Division: Institute of Psychiatry and Behavioral Medicine

Classification: Simple
Type of Transaction: G2C
Who may avail: Patients requiring psychiatric evaluation for forensic purposes and
client’s for Drug Dependency Examination
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Yellow card SPMC-IPBM Cashier
2. Patient chart OPD Records section
3. Queue Number SPMC-IPBM Guard house
4. Referral letter/Court order Referring agency
5. Assignment of Attending Physician SPMC-IPBM Social Service section
6. Drug Test result (for DDE only) Drug test kit at SPMC pharmacy
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present self to the 1. Secure and None 2 minutes Resident
doctor review chart of the Physician
patient OPD Psych
Clinic

2. Cooperate with the 2. Conduct None 3 hours Resident-in-

assessment process Psychiatric charge
by answering evaluation OPD Psych
questions and by 2.1. Give follow- 30 minutes Clinic
following steps during up schedule
physical examination (Note:
Evaluation may
take a minimum of
three (3) to five (5)
meetings for
forensic evaluation
except Drug
Dependency
Examination)
2.2 Refer to 15 minutes
appropriate
sections for
additional
psychological
tests, if indicated
(i.e.
Neuropsychologica
l test)

TOTAL: None 3 hours and

47 minutes
7. Issuance of Medical Abstract and Medical Certificate
This procedure covers activities from patient assessment up to endorsement of plan of care.
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Institute of Psychiatry and Behavioral Medicine

Classification: Simple
Type of Transaction: G2C; G2G
Who may avail: Patients who had undergone psychiatric evaluation and
management in SPMC-IPBM; including court cases
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patient chart OPD Records Section
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Ask for issuance of 1. Secure and None 2 minutes Resident
medical certificate or review patient Physician
medical abstract chart Department

2. Wait for name to be 2. Input data for None 15 minutes Resident

called medical certificate Physician
and medical Department
abstract in the
Hospital
Information
System
2.1. Print medical 10 minutes
certificate and
affix signature
2.2. Endorse to 5 minutes
the medical record
clerk for issuance
to the client

TOTAL: None 25 minutes

8. Psychiatric Evaluation for Employees of Other Institution
This procedure covers activities from patient assessment up to endorsement of plan of care.
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays

Office/Division: Institute of Psychiatry and Behavioral Medicine

Classification: Simple
Type of Transaction: G2C
Who may avail: Employees of other institution who needs psychiatric evaluation for
employment purposes.
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Neuropsychological test result Psychological section of IPBM or SPMC
Industrial Clinic
2. Schedule for psychological evaluation IPBM secretary (Text message to be sent)
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present self to the 1. Secure and None 2 minutes Consultant or
doctor review chart of the Junior
patient Consultant
IPBM

2. Cooperate with the 2. Conduct None 1 hour Consultant or

assessment process Psychiatric Junior
by answering evaluation Consultant
questions and by IPBM
following steps during
physical examination
TOTAL: None 1 hour and 2
minutes
1. Consultation and Management of Emergency Cases referred to
Consultation-Liaison Psychiatry
This procedure covers activities from patient assessment up to documentation of psychiatric
findings and plan on patient chart
Availability of Service: 24 hours

Office/Division: Institute of Psychiatry and Behavioral Medicine

Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: Patients who are requiring psychiatric evaluation and management
as deemed by their attending physicians.
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Phone referral by attending physician Attending physician
2. Written referral on ward chart by Patient chart
attending physician
1. Referral letter by the attending Attending physician
physician
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present self to the 1. Secure and None 15 minutes Resident-on-
doctor review patient duty
chart IPBM

2. Cooperate with the 2. Conduct None 1 hour Resident-on-

assessment process psychiatric Duty
by answering interview and IPBM
questions and by physical
following steps during examination
physical examination 2.1. Write 30 minutes
psychiatric
findings and plan
on patient chart

TOTAL: None 1 hours and

45 minutes
2. Consultation and Management of Non-Emergency Cases referred to
Consultation-Liaison Psychiatry
This procedure covers activities from patient assessment up to documentation of psychiatric
findings and plan on patient chart
Availability of Service: 8:00 AM to 12:00 noon (referrals to be dropped at WCPU) Mondays to
Fridays except Holidays

Office/Division: Institute of Psychiatry and Behavioral Medicine

Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: Patients who are requiring psychiatric evaluation and management
as deemed by their attending physicians.
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Written referral on patient chart by Attending physician
attending physician
2. Submitted complete referral form by Attending physician
intern or attending physician to WCPU
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present self to the 1. Secure and None 30 minutes Resident-in-
doctor review patient charge
chart IPBM

2. Cooperate with the 2. Conduct None 1 hour Resident-in-

assessment process psychiatric charge
by answering interview and IPBM
questions and by physical
following steps during examination
physical examination 2.1. Write 30 minutes
psychiatric
findings and plan
on patient chart

TOTAL: None 2 hours

3. Issuance of Certificate of Confinement, Discharge Summary, and Medical
Abstract
This procedure covers activities from patient assessment up to endorsement of plan of care.
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Institute of Psychiatry and Behavioral Medicine

Classification: Simple
Type of Transaction: G2C
Who may avail: Patients who had undergone psychiatric evaluation and
management in SPMC-IPBM
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patient chart Ward Nurses’ Station
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Ask for issuance of 1. Secure and None 2 minutes Resident-in-
medical certificate or review patient charge
medical abstract chart Ward

2. Wait for name to be 2. Input data for None 30 minutes Resident-in-

called medical abstract charge
in the Hospital Ward
Information
System or write
the discharge
summary in the
appropriate form
2.1. Print medical 10 minutes
certificate and
affix signature
2.2. Endorse to 5 minutes
the medical record
clerk or nurse-on-
duty for issuance
to the client

TOTAL: None 47 minutes

4. Management of Inpatients
This procedure covers activities from patient assessment up to endorsement of plan of care.
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday
Office/Division: Institute of Psychiatry and Behavioral Medicine
Classification: Simple
Type of Transaction: G2C
Who may avail: Patients who are admitted at SPMC-IPBM
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patient chart Ward Nurses’ Station
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present self to the 1. Secure and None 2 minutes Resident-in-
doctor review patient charge
chart Ward

2. Wait for name to be 2. Conduct None 1 hour Resident-in-

called psychiatric charge
interview and Ward
physical
examination
2.1. Write 10 minutes
psychiatric
findings and plan
on patient chart
2.2. Endorse plan 5 minutes
of care, laboratory
and prescriptions
to nurse-in-charge

TOTAL: None 1 hour 17

minutes
5. Psychiatric Evaluation for SPMC Employees
This procedure covers activities from patient assessment up to endorsement of plan of care.
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays

Office/Division: Institute of Psychiatry and Behavioral Medicine

Classification: Simple
Type of Transaction: G2G
Who may avail: SPMC Employees who need psychological evaluation.
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Neuropsychological test result SPMC Industrial Clinic
2. Schedule for psychological IPBM secretary (Text message to be sent)
evaluation
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present self to the 1. Secure and None 2 minutes Consultant or
doctor review chart of the Junior
patient Consultant
IPBM

2. Cooperate with the 2. Conduct None 1 hour Consultant or

assessment process Psychiatric Junior
by answering evaluation Consultant
questions IPBM

TOTAL: None 1 hour and 2

minutes
Institute of Psychiatry and Behavioral Medicine

Medical Unit

Internal Services
Consultation and Management of Outpatients in Anxiety Clinic for SPMC Staff
This procedure covers activities from receiving patient in the clinic up to endorsement for follow-up
scheduling and referrals
Availability of Service: 1:00 pm to 5:00 pm, Tuesday, except Holidays at Department of Family
and Community Medicine OPD Clinic

Office/Division: Institute of Psychiatry and Behavioral Medicine

Classification: Simple
Type of Transaction: G2C
Who may avail: SPMC Employees requiring psychiatric evaluation and management
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Yellow card PHS
2. Patient chart Family Medicine OPD Nurses’ Station
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present self to the 1. Secure and None 2 minutes Resident
doctor review patient Physician
chart Department

2. Cooperate with the 2. Conduct None 1 hour 30 Resident

assessment process psychiatric minutes Physician
by answering interview and Department
questions and by physical
following steps during examination
physical examination 2.1. Write 20 minutes
psychiatric
findings and plan
on patient chart
2.2. Write 5 minutes
laboratory and
diagnostic
requests and
prescription for
patient
2.3. Input 5 minutes
laboratory
requests to the
Hospital
Information
System
2.4. Endorse plan 2 minutes
of care, laboratory
and prescriptions
to nurse-in-charge

TOTAL: None 2 hours and 4

minutes
Institute of Psychiatry and Behavioral Medicine

Occupational Therapy

External Services
Conduct of Initial Evaluation (Outpatient, Inpatient)
Identification of chief complaint, goals for Occupational Therapy, assessment of occupation,
performance skills and client factors to Outpatients and In-patients
Availability of service: Monday, 9:00AM - 4:00PM, except holidays

Institute of Psychiatry and Behavioral Medicine, Occupational Therapy

Office/Division:
Unit
Classification: Simple
Type of Transaction: G2G
Those with referral for Occupational Therapy (OT) service of initial
Who may avail:
evaluation/ standardized assessment
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
None
FEES TO PROCESSING PERSON
CLIENT STEPS AGENCY ACTION
BE PAID TIME RESPONSIBLE
1. Patient attends 1. Conduct of OT None 45 minutes OT-in-charge
the scheduled initial initial evaluation
evaluation session
2. Patient go back 2.1 Endorse the None 10 minutes OT-in-charge
to corresponding patient back to ward
ward
2.2 Note findings in
the patient’s chart

2.3 If amenable for

OT, schedule
patient for session.
If not, inform
RIC/NOD and note
it in the patient’s
chart
TOTAL: None 55 minutes
Conduct of Treatment (Outpatient, Inpatient)
Perform Occupational Therapy intervention techniques to improve participation or performance in
occupations to Outpatient and In-patients
Availability of service: Tuesday to Thursday at 9:00-11:00AM and 1:00-3:00PM, Friday at 9:00-
11:00am, except holidays

Institute of Psychiatry and Behavioral Medicine, Occupational Therapy

Office or Division:
Unit
Classification: Complex
Type of Transaction: G2G
Those with referral for Occupational Therapy (OT) service of therapy
Who may avail:
sessions
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
None
FEES TO PROCESSING PERSON
CLIENT STEPS AGENCY ACTION
BE PAID TIME RESPONSIBLE
1. Patient attend 1.1 OT Staff-in- None 10 minutes OT-in-charge
the scheduled charge bring patient
treatment session to the OT activity
area

1.2 Conduct of OT None 1 hour

treatment
2. Patient returns 2.1 OT Staff-in- None 10 minutes OT-in-charge
back to charge bring patient
corresponding ward back to respective
ward
1 hour 20
TOTAL: None
minutes
Conduct of Re-Evaluation (Outpatient, In-patient)
Identification of chief complaint, goals for Occupational Therapy, assessment of occupational
performance skills and client factors to Outpatients and In-patients after three (3) months of OT
intervention

Institute of Psychiatry and Behavioral Medicine, Occupational Therapy

Office or Division:
Unit
Classification: Simple
Type of Transaction: G2G
Those with schedule for Occupational Therapy (OT) service of re-
Who may avail:
evaluation
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
None
AGENCY FEES TO PROCESSING PERSON
CLIENT STEPS
ACTION BE PAID TIME RESPONSIBLE
1.1 Schedule None 5 minutes OT-in-charge
patient for re-
evaluation
2. Patient attend the 2.1 Conduct OT None 45 minutes OT-in-charge
scheduled date for re- re-evaluation
evaluation
3. Patient go back to 3.1 Endorse the None 10 minutes OT-in-charge
corresponding ward patient back to
ward

3.2 Note findings

in the patient’s
chart
TOTAL: None 1 hour
Scheduling of Initial-Evaluation (Outpatient, Inpatient)
Availability of service: Monday to Friday, 8:00-5:00PM, except holidays

Institute of Psychiatry and Behavioral Medicine, Occupational Therapy

Office or Division:
Unit
Classification: Simple
Type of Transaction: G2G
Those with schedule for Occupational Therapy (OT) service of re-
Who may avail:
evaluation
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Male Ward
Occupational Therapy Referral Form Female Ward
(SPMC-F-OT-PSY-01) – 1 original, 1 CIU
received copy Office of the Occupational Therapy Unit, 2nd floor,
Room ____
AGENCY FEES TO PROCESSING PERSON
CLIENT STEPS
ACTION BE PAID TIME RESPONSIBLE
1. Submit/Forward 1.1 RIC/NOD to None 5 minutes Resident-in-
referral for OT service prepare OT charge/NOD
referral form

1.2 NOD/NAOD
submits referral
form to OT
2.1 OT to accept None 5 minutes OT-in-charge
referral form

2.2 Review the

need for OT
service
3. Get received copy 3.1 Sign and give None 5 minutes OT-in-charge
of the submitted back the copy of
referral form the referral form
to the
NOD/NAOD

3.2 Schedule the

referred patient
for initial
evaluation
TOTAL: None 15 minutes
Institute of Psychiatry and Behavioral Medicine

OPD

External Services
1. Emergency Room Referral (As Primary Service: Preparation for Admission
to Psychiatry Ward-CIU)
This procedure covers activities from patient assessment up to endorsement of plan of care.

Office/Division: Out Patient Department- IPBM

Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: Patients who are requiring psychiatric evaluation and management
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
 Yellow card HIMD
 Referral note from social worker with Patient’s chart
case study, Barangay
 If forensic, Court order
 Completed necessary diagnostic and
laboratory tests
 Written medical clearance by Referring Doctor
appropriate co-managing services
 Admitting Orders Resident-on-duty
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Arrive at IPBM- 1. Assess patients None 20 minutes OPD Psych
OPD for triaging and mental status and Nurse on duty
assessment behavior OPD Nursing
Attendant
Resident in
charge
2. Proceed to 2. Usher and assist None 30 minutes OPD Psych
interview cubicle once patient for interview Nurse on duty
name is called 2.1 Secure and Resident on
review patient chart. duty
2.1 If referred from
other departments,
ensure diagnostic
and laboratory tests
are complete and
clearance by
appropriate co-
managing services
are written and
acceptable
3. Cooperate with the 3. Conduct None 1 hour Clerks/ Interns
assessment process psychiatric interview Resident on
by answering and physical duty
questions and by examination. OPD Psych
following steps during Nurse on duty
physical and mental
examination
3.1 Write on chart None 15minutes Resident on
current patient duty
findings and
indicate that he/she
may be admitted to
Psychiatry ward
3.2 Write admitting None 15 minutes Resident on
orders duty
4. Watcher will 4.1 Carry out None 10 minutes OPD Psych
process the admission Doctor’s order, Nurse on duty
requirements Facilitate the
admission process
and consent for
admission and
gives instruction on
admission policy.
4.2 Performs stat None 20 minutes OPD Psych
procedures and Nurse on duty
management
4.3 Endorse to CIU None 20 minutes OPD Psych
Nurse-on-duty. Nurse on duty
Usher patient to OPD Nursing
CIU ward. attendant
CIU Nurse-in-
charge
TOTAL: 3 hours, 10
minutes
2. Outpatient Department Depot Clinic
This procedure covers activities from receiving patient for depot in the clinic up to endorsement for
follow-up scheduling and referrals
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Out Patient Department- IPBM

Classification: Simple
Type of Transaction: G2C
Who may avail: Patients who are on scheduled every 2 weeks or monthly Depot
injection
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Yellow Card HIMD
2. Patients chart IPBM Medical Records
3. Official Receipt for Depot injection Cashier
4. Pink Depot card Nurse station
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Once name is 1. Call patient name None 10 minutes Nursing
called, proceed to 1.1 Check patient’s Attendant
Nurse Station Depot chart and pink OPD Psych
injection area depot card if due for Nurse on duty
injection
1.2 Prepare the
medication
1.3 Administer
Depot injection
1.4 Give instruction
on next schedule
check-up and depot
injection, give
instructions on
compliance to
medication and its
side effects.
TOTAL: 10 minutes
3. Outpatient Department Consultations (General Consultation)
This procedure covers activities from receiving patient in the clinic up to endorsement for follow-up
scheduling and referrals
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Out Patient Department- IPBM

Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: Patients who are requiring psychiatric evaluation and management
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Yellow Card HIMD
2. Referral from Primary services Referring agency, IPBM Medical Records
3. Official Receipt for consultation Cashier
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Once name is For new clients: None 2 hours and 30 Nursing
called, proceed to minutes Attendant
cubicle assignment for For follow up Clerks/Interns
interview clients: 45 minutes Resident on
1. Call patient name
duty
1.1 Conduct
Psychiatric
interview and
physical
examination
1.2 Explain the
findings and
management to the
patient
1.3 Give
prescription and/or
laboratory requests
as needed
1.4 Send Patient to
nurse for follow-up
scheduling and
referrals to other
services
2. Proceed to Nurse 2. If with stat None 10minutes OPD Psych
Station Depot/oral Nurse on duty
(For clients with stat medications,
Depot/oral facilitate the
medications and NPT administration of
medication.
scheduling)
2.1 For NPT None 20minutes Nursing
scheduling, usher Attendant
patient to
Psychological
Service
3. Present 3. Give instructions None 5 minutes OPD Psych
appointment slip to on prescriptions, Nurse on duty
the OPD Psych Nurse laboratory exams,
on duty diagnostic exams,
follow-up schedule
with Psychiatry, or
referral to other co-
managing services
3.1 Instruct to sign
the OPD
acknowledgement
receipt of instruction
form
TOTAL: New client- 3 hours, 5
minutes

Follow up 1 hour, 20
Client minutes
4. OPD Client Orientation and Psychoeducation
This procedure covers orientation on OPD policies and lectures for patients and watchers
Availability of Service: 8:00 am to 10:00 am, Monday to Friday, except Holidays.

Office/Division: Out Patient Department- IPBM

Classification: Simple
Type of Transaction: G2C
Who may avail: Patients who are requiring psychiatric evaluation and management
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Psychoeducation Flip Chart OPD Waiting area
2. OPD Psychoeducation logbook Nurse Station
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Attend lecture at 1. Conduct OPD None 30 minutes OPD Psych
IPMB-OPD waiting policy orientation Nurse on duty
area and lecture Clerks/Interns
1.1 Ask the
patient/watcher to
sign the logbook
TOTAL: 30 minutes
Institute of Psychiatry and Behavioral Medicine

Nutrition and Dietetics

External Services
1. Conduct of Food Donations for Inpatients
Availability of Service: 8:00 am to 5:00 pm, Monday to Sunday.

Office/Division: Dietary Department - IPBM

Classification: Simple
Type of Transaction: G2C, G2B, G2G
Who may avail: Patients at CIU, Female Ward and Male Ward
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Letter of Notification Dietary Department
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit letter of 1. Receive the None 2 minutes Admin
notification letter of Supervisor
notification. Dietary

1.1 Submit the None 2 minutes Admin

letter of Supervisor
notification to the Dietary
Head Dietitian for
approval.

1.2 Approve of None 2 minutes Head Dietitian

request. Dietary
TOTAL: 6 minutes
2. Conduct of Nutrition Education to Outpatients and Watchers
Availability of Service: 10:00 am to 11:00 am, Monday to Friday, except Holidays.

Office/Division: Dietary Department - IPBM

Classification: Simple
Type of Transaction: G2C
Who may avail: Outpatients and Watchers
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Lecture materials Outpatient Department (OPD) waiting area
2. OPD Nutrition Counseling Conforme
Sheet
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Wait for the 1. Prepares the None 3 minutes Dietitian in-
Dietitian in charge at materials needed charge
the OPD waiting area for the lecture. Dietary

2. Listen to the lecture 2. Conducts None 20 minutes Dietitian in-

lecture: Healthy charge
Lifestyle Dietary
Prescription and
Pinggang Pinoy.

2.1 Give nutrition None 2 minutes Administrative

hand-out. Staff
Dietary
3. Write name on the 3. Assist patient or None 5 minutes Administrative
OPD Nutrition watcher in writing Staff
Counseling conforme name on the Dietary
sheet conforme sheet.
TOTAL: 30 minutes
3. Processing of Daily Acceptance and Inspection Reports (DAIRs):
Foodstuffs
Availability of Service: 6:00 am to 8:00 am, Monday to Friday, except Holidays.

Office/Division: Dietary Department - IPBM

Classification: Simple
Type of Transaction: G2C, G2B
Who may avail: Suppliers of Foodstuffs
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Invoices of Items delivered Suppliers
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Deliver foodstuffs 1. Receive None 30 minutes Procurement
and submit foodstuffs and Dietitian and
corresponding corresponding Admin
invoices invoices. Supervisor
Dietary
1.1 Check None 30 minutes Staff Auditor
accuracy and
completeness of
submitted invoice
(Representative
from IASSS (paused-lock)
attests inspection
of deliveries in the
invoices)

1.2 Endorse None 10 minutes Storeroom

received Keeper
foodstuffs. Dietary

1.3 Prepare the None 15 minutes Procurement

Daily Acceptance Dietitian and
and Inspection Admin
Report (DAIR). Supervisor
Dietary
1.4 Review and None 10 minutes
submit DAIR for
verification.

1.4 Approve and None 10 minutes Head Dietitian

endorse DAIR. Dietary
TOTAL: 1 hour and
45 minutes
4. Processing of Statement of Accounts (SOA) and Disbursement Vouchers
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Dietary Department - IPBM

Classification: Simple
Type of Transaction: G2B, G2G
Who may avail: Suppliers of Foodstuffs
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Statement of Account with DAIRs and Suppliers
Invoices copies of Purchase Order
2. Approved Purchase Request Purchasing Office
3. BUR/OBR BAC Office
4. Notice of Award
5. Performance Bond
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit SOA with 1. Receive SOA None 5 minutes Procurement
Disbursement with all required Dietitian
Voucher and all attachments (once Dietary
required attachments every delivery
week).

1.1 Check None 30 minutes Procurement

accuracy of Dietitian
submitted SOA. Dietary

1.2 Compute None 60 minutes Accounting

taxes to be Clerk
deducted from
payables; prepare
disbursement
vouchers

1.3 Review and None 60 minutes Procurement

submit SOA with Dietitian and
disbursement Admin
vouchers (once a Supervisor
week). Dietary

1.4 Approve and None 10 minutes Head Dietitian

endorse SOA. Dietary
TOTAL: 2 hours and
45 minutes
5. Provision of Meals and Snacks for Inpatients
Availability of Service: 2:30 pm to 3:30 pm, Monday to Sunday.

Office/Division: Dietary Department - IPBM

Classification: Simple
Type of Transaction: G2G
Who may avail: Patients at CIU, Female Ward and Male Ward
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Duly accomplished diet list Dietary Department
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit diet list 1. Receive diet None 2 minutes Dietitian and
list. Admin
Supervisor on-
1.1 Summarize None 10 minutes duty
the diet list; from Dietary
full diet and
therapeutic diet.

1.2 Endorse None 2 minutes

census.

1.3 Dish out food. None 30 minutes Foodservice

Worker
Dietary
2. Receive and load 2. Endorse food. None 30 minutes Foodservice
food of patients Worker
Dietary
TOTAL: 1 hour and
14 minutes
6. Provision of Meals to Referred Outpatients or Watchers
Availability of Service: 8:00 am to 5:00 pm, Monday to Sunday.

Office/Division: Dietary Department - IPBM

Classification: Simple
Type of Transaction: G2C
Who may avail: Outpatients and Watchers
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Meal Ticket or Meal Chit Outpatient Department (OPD) waiting area
2. 2 copies of Inter-Agency Referral Slip
(Social Work Referral)
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present meal ticket 1. Check meal None 1 minute Dietitian on-
to the Dietitian or ticket. duty
Administrative Staff Dietary
on-duty
1.1 Give back the None 2 minutes Dietitian or
meal ticket Admin
together with the Supervisor on-
photocopy of duty
referral form to the Dietary
patient or watcher
with a signature of
the Dietitian or
Administrative
Staff on-duty.

1.2 Dish out meal. None 2 minutes Admin

Supervisor on-
duty
Dietary
2. Receive and load 2. Endorse food. None 2 minutes Administrative
food of patient or Staff
watcher Dietary
TOTAL: 7 minutes
7. Provision of Nutrition Care to Referred Therapeutic Inpatients
Availability of Service: 10:00 am to 6:00 pm, Monday to Sunday, except Holidays.

Office/Division: Dietary Department - IPBM

Classification: Simple
Type of Transaction: G2G
Who may avail: Patients at CIU, Female Ward and Male Ward
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Doctor’s Referral CIU
2. Medical Chart Female Ward
3. Nutritional Assessment Form Male Ward
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Referral from 1. Receives None 2 minutes Staff on duty
attending Physician; referral form. Dietary
can be done through
endorsement by the
nurse on duty
2. Wait for the 2. Attend to None 15 minutes Clinical Dietitian
Dietitian in charge referral; read Dietary
through the chart
and start the
Nutrition Care
Process.
3. Undergo Nutritional 3. Assesses the None 20 minutes Clinical Dietitian
Assessment Nutritional status Dietary
of the client which
includes:
Anthropometric,
Biochemical and
Dietary
Assessment.
4. Receive 4. Provide None 30 minutes Clinical Dietitian
appropriate nutrition nutrition Dietary
intervention and intervention, diet
instructional materials modification and
provision of
dietary
counseling.
TOTAL: 1 hour and 7
minutes
Institute of Psychiatry and Behavioral Medicine

Nutrition and Dietetics

Internal Services
1. Provision of Nutrition Counseling to Referred Personnel
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Dietary Department - IPBM

Classification: Simple
Type of Transaction: G2G
Who may avail: All SPMC - IPBM Personnel
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Doctor’s Referral PHS Clinic
2. Laboratory Results
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Personnel presents 1. Receives None 3 minutes Dietitian in-
referral from attending referral form and charge
Physician with checks the Dietary
laboratory results laboratory results.
2. Clients undergo 2. Starts None 10 minutes Dietitian in-
Nutritional interviewing the charge
Assessment client. Dietary

2.1 Assesses the None 20 minutes

Nutritional status
of the client which
includes:
Anthropometric,
Biochemical and
Dietary
Assessment.
3. Listen to diet 3. Conducts diet None 30 minutes Dietitian in-
counseling counseling. charge
Dietary
4. Receive the 4. Give nutrition None 5 minutes Dietitian in-
nutrition hand-outs to hand-out and charge
be shown to client’s provide a meal Dietary
attending Physician plan pattern.
5. Write name on the 5. Assist client in None 2 minutes Dietitian in-
Referred Patient writing name on charge
Logbook the logbook. Dietary
TOTAL: 1 hour and 5
minutes
Institute of Psychiatry and Behavioral Medicine

Pharmacy

External Services
1. Provision and Replacement of Emergency Drugs for Service Wards (Charge
Transaction- Admitted Patients)
Provision of available needs of paying patients
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Institute of Psychiatry and Behavioral Medicine – Inpatient Dept.

Classification: Simple
Type of Transaction: G2C
Who may avail: All patients admitted at wards,(CIU, Male Ward and Female Ward),
Requesting ward through the Nurse on Duty
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Accomplished Medicine Issue Slip 1.Requesting ward
(with duplicate) duly signed by the
requesting nurse on duty and the
resident physician of the ward
2. Supporting prescriptions of the 2.Resident physician of the ward
medicines used by individual
patients that need to be replaced
3. Accomplished Monitoring Sheet for 3.Requesting ward
Dangerous Drug preparation
replacement

CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1.For initial request, 1. Receive the None 1 minute Pharmacist
submit accomplished required
medicine issue slip documents and
form and Requisition check if all fields
for Dangerous Drug are completely
1.1For replacement of accomplished.
used emergency 1.1 Inform the
drugs, submit nurse that they
medicine issue slip will receive a call
together with if request is ready
supporting for pick up
prescription of the 1.2 Process and 10 minutes Pharmacist
medicines used by fill the request,
individual patient. and sign over
1.2 For replacement printed name on
of dangerous drugs, the space
submit accomplished designated for
requisition form pharmacist
together with the filled 1.3 Call the ward
monitoring sheet from that emergency
previous/initial request medicines/danger
of the consumed ous drugs with
dangerous drug. monitoring sheet
are ready for pick
up
2. Proceed to 2.Dispense None Pharmacist
pharmacy and receive processed 10 seconds
the requested drugs, medicines/drugs,
monitoring sheet (for monitoring sheet
dangerous drug) and and duplicate
duplicate copy of MIS copy of the MIS
(Medicine Issue Slip) 2.1 Encode/
charge the 45 minutes
served medicines
through the
supporting
prescription given,
to patient’s PHIC
or Hospital bill
(whichever is
applicable)
2.2 File the
requisition form
and monitoring
sheet of the
dangerous drug
requested
TOTAL: 56 minutes
and 10
seconds
2. Provision of All Available Drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Charge Transaction- Admitted Patients)
Provision of available needs of paying patients
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Institute of Psychiatry and Behavioral Medicine – Inpatient Dept.

Classification: Simple
Type of Transaction: G2C
Who may avail: All admitted patient at Wards(CIU, Male Ward and Female Ward)
through the request of the Nurse on Duty
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Accomplished Medicine Issue Slip 1.Requesting ward
(with duplicate) duly signed by the
requesting nurse on duty and the
resident physician of the ward
2. Supporting prescriptions of the 2.Resident physician of the ward
requested medicines for admitted
patients
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit medicines 1. Receive the None 1 minute Pharmacist
and issue slip to the medicine issue
pharmacy together slip with the
with the supporting prescriptions from
prescriptions. the nurse and
process the MIS
by checking the
availability of the
requested
medicines
1.1 Prepare the 10 minutes Pharmacist
available
medicines
requested and
sign over printed
name designated
for pharmacist
1.2 Call/inform the 10 seconds Pharmacist
nurse on duty of
the requesting
ward that the
requested
medicines are
ready for pick-up
1.3 encode/ 45 minutes Pharmacist
charge the served
medicines through
the prescription
given, to patient’s
PHIC or Hospital
bill (whichever is
applicable)
2. Proceed to 2.Dispenses the None 10 seconds Pharmacist
pharmacy and receive medicines to the
the requested requesting Nurse
 medicines and
duplicate copy of MIS

TOTAL: 56 minutes
and 20
seconds

3. Provision of All Available Drugs/Medicines/Medical Supplies and Other

Pharmaceuticals (cash Transaction – Regular Client)
Provision of available needs of paying patients
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Institute of Psychiatry and Behavioral Medicine – Outpatient Dept.

Classification: Simple
Type of Transaction: G2C
Who may avail: Outpatient IPBM Clients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
All Clients:
1. Prescription Physician of OPD where client seek
consultation
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present 1. Verifies the None 1 minute Pharmacist
prescription/s to prescription/s
pharmacist for classifies the
availability of prescribed
medicines. medicine as
Regular stock or
Consignment
stock then prices
the meds
2.1. For Socialized 2.1. Interviews None 5 minutes Social Worker
meds (Regular and classifies
stocks), Senior Citizen patient then gives
or with discount to
disability(PWD) prescribed
medicines

2.2 For non- 2.2 Explains to None 5 minutes Social Worker

socialized meds client why
(Consignment stocks) medicines cannot
be discounted.

3. Provide payment 3. Receives Please refer 2 minutes Cashier

for the items being payment and to the
purchased at the issues official approved
cashier’s window. receipt. schedule of
fees
(subject to
change)
4. Proceed to 4. Receives the None 1 minute Pharmacist
Pharmacy and prescription/s and
present prescription Official Receipt.
and official receipt.

5. Receive purchased 5. Dispenses None 1 minute Pharmacist

item/s and receipt and medicine/s to the
client.
 other documents
presented
TOTAL: 15 minutes

4. Provision of All Available Drugs/Medicines/Medical Supplies and Other

Pharmaceuticals (cash Transaction – Regular Client)
Provision of available needs of paying patients
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Institute of Psychiatry and Behavioral Medicine – Outpatient Dept.

Classification: Simple
Type of Transaction: G2C
Who may avail: Walk-in Outpatient Clients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE

1. Prescription Physician of clinic where client seek

consultation.
If senior citizen or PWD:
2. ID of senior citizen or PWD Local Government Unit
OSCA or PWD Medicine booklet
(original).
2.1 Authorization letter with present Person being represented
date (original) if representative only.
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present 1. Verifies the None 1 minute Pharmacist
prescription/s to prescription/s
pharmacist for classifies the
availability of prescribed
medicines. medicine as
Regular stock or
Consignment
stock, then prices
the meds
2. For Senior Citizen
or patient with
disability(PWD)

2.1 Present client 2.1 Accept None 5 minutes Pharmacist

prescription and other prescription and
pertinent documents check
to pharmacist to avail completeness of
discount and for required
validation information,
validity and
requirements
2.2 Process
transaction and
inform client the
total amount to be
paid
3. Provide payment 3. Receives Please refer 2 minutes Cashier
for the items being payment and to the
purchased at the issues official approved
cashier’s window. receipt. schedule of
fees
(subject to
change)
4. Proceed to 4. Receives the None 1 minute Pharmacist
Pharmacy and prescription/s and
present official Official Receipt.
receipt.

5. Receive purchased 5. Dispenses None 1 minute Pharmacist

item/s and receipt. medicine/s to the
client.

TOTAL: 15 minutes
5. Provision of All Available Drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Charge to Donor with Government Funds)
Provision of available needs of paying patients
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Institute of Psychiatry and Behavioral Medicine – Outpatient Dept.

Classification: Simple
Type of Transaction: G2C
Who may avail: SPMC-IPBM Outpatients with Donor from Government funds
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Updated Prescription/s
Physician of OPD where client seek
consultation

CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Present 1. Verifies the None 1 minute Pharmacist
prescription/s to prescription/s
pharmacist for classifies the
availability of prescribed
medicines( Good for 1 medicine as
month only) Regular stock
(stamped with
murang gamot) or
Consignment
(stamped with
consignment
stock) then prices
the medicines
2. Receive priced and None None
stamped
prescription/s and
proceed to office
where government
fund is sought such as
(OP, CMAP, DSWD,
LINGAP, PCSO etc. )

3. Return to IPBM 3. Accept and None 1 minute Pharmacist

Pharmacy and check
present the approved completeness of
prescription/s with the required
complete information,
requirements needed. validity and
requirements.

3.1 Request
additional
payment if total
 amount of item
exceeds the
approved fund

3.2 Endorse to
cashier to produce
charge slip and
receipt if with
additional
payment
4. Return to pharmacy 4. Check None 1 minute Pharmacist
and present duly prescription and
approved prescription documents, and
with proper ask
documents patient/watcher to
sign over printed
name on the
prescription to
acknowledge
receipt.

5. Sign over printed 5. Dispenses None 1 minute Pharmacist

name of the approved medicine/s to the
prescription/s to client.
acknowledge receipt
6. Receive the item 6. Receive signed None 10 sec. Pharmacist
prescription/s with
the required
documents
TOTAL: 4 minutes
and 10 sec.

Medicine Prices as of January 2020 (Subject to change without prior notice)

MEDICINES SELLING SENIOR CHARGE CHARITY (C3)
(Murang Gamot) PRICE PRICE PRICE
Aripiprazole 10mg tablet 278.00 253.00 354.00 139.00
Aripiprazole 15mg tblet 278.00 253.00 354.00 139.00
Biperiden 2mg tablet 10.00 7.00 11.00 5.00
Carbamazepine 200mg tablet 10.00 7.00 11.00 5.00
Chlorpromazine 200mg tablet 8.00 6.00 10.00 4.00
Clonazepam 2mg tablet 12.00 10.50 13.00 6.00
Clozapine 100mg tablet 20.00 15.00 30.00 10.00
Diphenhydramine 50mg/ml 150.00 135.00 200.00 75.00
ampule
Divalproex sodium 500mg tablet 32.00 16.00 25.00 16.00
Escitalopram 10mg tablet 18.00 12.00 20.00 9.00
Fluoxetine 20mg capsule 10.00 9.00 12.00 5.00
Flupentixol dec. ampule 20mg/ml 385.00 335.00 415.00 200.00
Fluphenazine dec. ampule 160.00 145.00 170.00 80.00
25mg/ml
Haloperidol 5mg tablet 10.00 5.00 25.00 5.00
Haloperidol 20mg tablet 30.00 24.00 35.00 15.00
Haloperidol 5mg/ml ampule 500.00 478.00 610.00 250.00
Lithium Carbonate 450mg tablet 7.00 5.00 8.00 4.00
Olanzapine 10mg tablet 50.00 40.00 65.00 25.00
Olanzapine ODT 10mg 50.00 36.00 65.00 10.00
Phenytoin 100mg capsule 23.00 22.00 26.00 12.00
Quetiapine 25mg tablet 42.00 25.00 30.00 21.00
Quetiapine 100mg tablet 40.00 35.00 50.00 20.00
Quetiapine 200mg tablet 77.00 70.00 90.00 39.00
Quetiapine 300mg tablet 60.00 50.00 84.00 30.00
Risperidone 2mg tablet (sizodon) 30.00 20.00 40.00 15.00
Risperidone 2mg tablet (rispedin- 20.00 18.00 30.00 10.00
2)
Risperidone ODT 2mg 50.00 45.00 65.00 25.00
Sertraline 50mg tablet 18.00 16.00 21.00 9.00

MEDICINES SELLING SENIOR CHARGE

CONSIGNMENT PRICE PRICE PRICE
Clozapine 100mg (SIZOPIN) 54.00 52.00 67.00
Escitalopram 10mg (NEXITO) 43.00 40.00 50.00
Olanzapine 10mg (OLEANZ ODT) 154.00 147.00 191.00
Quetiapine 25mg (SEROTIA) 29.00 27.00 35.00
Quetiapine 100mg (SEROTIA) 70.00 64.00 90.00
Quetiapine 300mg (SEROTIA) 108.00 102.00 133.00
Sod.Valproate + Valproic Acid 500mg 17.00 16.00 20.00
(ENCORATE)
Olanzapine 10mg (OLAVEX) 44.00 42.00 52.00
Biperiden 2mg (APIDEN) 13.00 12.00 16.00
Fluphenazine dec 25mg/ml (FLENAZINE) 195.00 185.00 245.00
Risperidone 2mg (DYPERIDONE) 30.00 25.00 35.00
Olanzapine 10mg tablet (OLANDUS) 55.00 50.00 70.00
Risperidone 2mg tablet (RISPONZ) 25.00 20.00 30.00
Institute of Psychiatry and Behavioral Medicine

Social Service

External Services
Accept and Document Donations
Received and record donations.

Availability of Service: Mondays to Fridays 8:00 am – 5:00 pm, except Holidays.

Office/ Division: Social Services

Classification: Simple
Type of Transaction: G2C, G2B, G2G
Who may avail: 1. Walk-In Clients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
none none

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Donors will 1.1 Conduct None
proceed to Social Interview to Medical Social
Service Office of donor and 30 minutes Worker
IPBM itemises
donations
1.2 Record 10 minutes Medical Social
donated items Worker
affixing donor’s
signature
1.3 Issue
acknowledgem Medical Social
ent receipt to 5 minutes Worker
the donor.
1.4 Endorse Medical Social
30 minutes
donations to Worker and Supply
supply officer Staff

Total 1hour and 15

minutes
Assessment and Classification
Conduct patient’s psycho-social assessment and classification.

Availability of Service: Mondays to Fridays 8:00 am – 5:00 pm, except Holidays.

Office/ Division: Social Services
Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients (Out-Patient and In-Patient)
2. Walk-In and Referred Clients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Gate Pass 1. Guard House
2. Yellow Card 2. OPD HIMD

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Present gate 1.1 Conduct None 20 minutes
pass and intake Medical Social Worker
patient’s card interview and
psycho-social
assessment
using DAR
form, MSW
Assessment
tool and
classify
patient.
2. Client signs 2.1 Orient None 2 minutes
in Watcher client on the
Interaction log social services Medical Social Worker
book. offered by the
hospital.

Total 22 minutes
Family Tracing
Facilitate networking and linkages for patients with tracing status.

Availability of Service: Mondays to Fridays 8:00 am – 5:00 pm, except Holidays.

Office/ Division: Social Services
Classification: Highly Technical
Type of Transaction: G2G
Who may avail: 1. In-patient
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Referral from the Resident Psychiatrist and Social 1. Male Ward/ Female
Worker’s Assessment Ward/CIU/ OPD/ Social Service

CLIENT STEPS AGENCY FEES TO PROCES PERSON

ACTION BE PAID SING RESPONSIBLE
TIME
1. Receive referral from 1.1 Interview None 15 Medical Social
CIU and Wards patient and minutes Worker
gather
information
1.2 10 Medical Social
Coordinate, minutes Worker
LGU’s, Local
Social Welfare
office (CSWD,
CSSDO,
MSWDO,
PSWDO)
1.3 Fill-up
5 minutes
progress
Medical Social
notes for
Worker
documentation
1.4 Provide
2 hours Medical Social
update to the
Worker
team by
attending case
conference
and team
evaluation.

2 hours
Total and 30
minutes
Social Work Counselling
Provide Counselling to watchers/families needing emotional and social support

Availability of Service: Mondays to Fridays 8:00 am – 5:00 pm, except Holidays.

Office/ Division: Social Services
Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: 1. Watcher/Families of Patient (In-Patient and Out-Patient)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Referral from the Resident Psychiatrist and Social 1. Male Ward/ Female Ward/
Worker’s Assessment OPD/ Social Service

CLIENT STEPS AGENCY FEES TO BE PROCESSING PERSON

ACTION PAID TIME RESPONSIBLE
1.1 Present issues 1.1 Conduct None 5 minutes Medical Social
and concern intake Worker
interview to
client or
family
member
1.2 Assess 10 minutes Medical Social
the problem Worker
expressed by
the client,
planning and
provide
intervention

Total 15 minutes
Referrals
Referral to OP/Lingap/DSWD/PAD for patients needing medical Assistance for medicines and
Hospital Bill

Availability of Service: Mondays to Fridays 8:00 am – 5:00 pm, except Holidays.

Office/ Division: Social Services
Classification: Simple
Type of Transaction: G2G
Who may avail: 1. Out-patient and In-patient
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Prescription 1. OPD
2. Hospital Bill 2. Billing Unit
3. Referral Letter 3. Social Service

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Present prescription/Hospital 1.1 Advise None 3 minutes Medical Social
Bill client to avail Worker
assistance to
Lingap, Office
of the
President and
Department of
Social Welfare
and
Development
and Patient’s
Assistance
Desk.
1.2 Issue 5 minutes Medical Social
referral letter Worker
to client for
PAD
assistance

Total 8 minutes
Pre- discharge planning
Facilitate discharge planning for “May go home” patients
Availability of Service: Mondays to Fridays 8:00 am – 5:00 pm, except Holidays.
Office/ Division: Social Services
Classification: Highly Technical
Type of Transaction: G2G
Who may avail: 1. Family/Watcher of patient (In-Patient)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Referral from the Resident Psychiatrist and 1. Male Ward/ Female Ward/CIU/
Social Worker’s Assessment Social Service

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Received 1.1 Conduct None 3 hours Medical Social
referrals from CIU ward rounds Worker
and Wards and patient
interaction
1.2 Conduct 5 minutes Medical Social
interview to Worker
patient’s family
1.3 Coordinate
LGU, CSWD, 30 minutes Medical Social
MSWDO for Worker
validation
1.4 Provide Medical Social
5 minutes
update to the Worker
team

Total 3 hours and

40 minutes
Home Conduction
Facilitate discharge of patient through Home Conduction
Availability of Service: Mondays to Fridays 8:00 am – 5:00 pm, except Holidays.
Office/ Division: Social Services
Classification: Highly Technical
Type of Transaction: G2C, G2G
Who may avail: 1. In-Patient
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Social Worker’s Assessment 1. Social Service

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Receive referrals 1.1 If patient is None 5 minutes Medical Social
from CIU and Wards “overstaying” Worker
for “May Go Home” recommend for
patients home conduction
1.2 Conduct
ward rounds and 2 hours Medical Social
gather additional Worker
information from
the patient and
contact family if
there is available
phone number.
1.3 Coordinate
1 hour
LGU, MSWDO, Medical Social
CSSDO, for Worker
validation
especially if
contact number
of patient’s family
or relative is
unavailable.

Total 3 hours and 5

minutes
Temporary Shelter
Facilitate placement of patient with no identified family or relatives.
Availability of Service: Mondays to Fridays 8:00 am – 5:00 pm, except Holidays.
Office/ Division: Social Services
Classification: Highly Technical
Type of Transaction: G2B, G2G
Who may avail 1. In-Patient
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Referral from the Resident Psychiatrist and 1. Male Ward/ Female Ward/CIU/
Social Worker’s Assessment Social Service
2. Social Case Summary Report 2. Social Service
3. Clinical Summary 3. Male Ward/ Female Ward/CIU
4. Discharge Instruction Sheet 4. Nurse Station

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Receives 1.1 Conduct None 1 hour Medical Social
referral from CIU ward rounds Worker
and Wards and intake
interview to
patient for social
case summary
report. Refer to
chart if patient is
unresponsive
and unable to
provide
pertinent
information.
1.2 Identify 5 days Medical Social
possible Worker
agencies (NGO,
GO) for
temporary
placement
1.3 Prepare
documents and Medical Social
2 days
other Worker
requirements for
placement.
 Total 7 days and 1
hour

Institute of Psychiatry and Behavioral Medicine

Psychological Service

External Services
1. Administer Neuropsychological Test for referred patients
Referred patients for NPT to ascertain the cognitive and socioemotional functioning.
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Psychological Services – IPBM

Classification: Simple
Type of Transaction: G2G
Who may avail: 1. Admitted Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Psychological Services Referral Form Female Ward/Resident-In-Charge
2. Patient’s Chart Male Ward/Resident-In-Charge
Crisis Intervention Unit (CIU)/Resident-In-
Charge
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. The Ward 1. Receives the Please refer 5 minutes Psychologist
Attendant will patient and to the Ward Attendant
accompany the assess the approved
patient to the patient’s schedule of
Psychological testing amenability before fees
room. conducting the
request.

1.1A Once the 4 hours

patient is
amenable
proceed in
conducting the
test

1.1B If the patient

is not amenable
the Psychologist
will reschedule the
test.

1.2 refer back the

patient to the
corresponding
ward
2. Usher the patient 2. The None 5 minutes Psychologist
back to the ward Psychologist in Ward Attendant
 charge will
endorse back the
patient to the
corresponding
ward

Total: Please 4 hours and 5

refer to the minutes
approved
schedule
of fees

2. Conduct Counseling Session per referral (Psychoeducation, Insight

Counseling)
Counseling sessions are conducted as referred by the Resident in charge for patients suffering
from psychological disorders.
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Psychological Services – IPBM

Classification: Simple
Type of Transaction: G2C, G2B, G2G
Who may avail: 1. Clients (OPD, Court Cases, School, SSS and GSIS requirements)
2. Admitted Patients

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

1. Psychological Services Referral form Psychiatrist-in-charge
2. Appointment slip Psychologist
3. Charge slip
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Proceed to IPBM – 1. Receive referral None 5 minutes Psychologist
Psychological and confirms
Services Section. appointment

1.2 Issue a charge

slip for the
session

2. Go to cashier to 2. Accept paid Please refer 5 minutes Cashier

pay before proceeding charge slip to the
to the counseling approved
room and give charge schedule of
slip to the attending fees
personnel
3. Proceed to 3. Assess None 1 hour Psychologist
counseling room patient’s
amenability and
proceed to
conduct the
session

3.A. Ward
Attendant/Personnel
 brings patient to
Psychologist’s
Interview/Counseling
room
Total: Please 1 hour and 10
refer to the minutes
approved
schedule
of fees

3. Full Psychological Assessment Report

Full assessment report of clients seen by the psychological services unit
Office/Division: Psychological Services – IPBM
Classification: Simple
Type of Transaction: G2C, G2B, G2G
Who may avail: Clients who already undergone Neuropsychological Test

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

1. Authorization Letter Requesting agency
2. Photocopy of at least two (2) valid IDs Authorized person, Referring Person
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Clients may inquire 1. Staff in charge None Psychological
their availability of will inform the Services
their result through client regarding Personnel
the official contact the availability of
numbers. the result.

2. Submit the signed 2. Verifies the None 30 minutes Psychologist

authorization letter client’s name and Psychological
with attached date of exam. Services
photocopies of IDs of Personnel
the concerned. 2.1 Should there
be any
clarifications
regarding the
result the
Psychologist in
charge will
conduct interview
with the client

2.2 release the

result in a sealed
envelope
Total: None 30 minutes

Notes:
1. Government Agencies who may require their applicants to undergo Neuropsychiatric
Evaluation. The Neuropsychological Test Results will be forwarded to the Neuropsychiatric
Evaluation Staff in charge.

2. Outpatient and In-patient’s Neuropsychological Test result attached to chart

4. Providing NPT for Referred Clients

Includes psychological testing/assessment for referred clients.
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Psychological Services – IPBM

Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: 1. Public Attorneys, Department Heads, Unit Supervisors, DEPED
Personnel, LGU Personnel who are applying for Original Positions,
Transfer and for Appointment/Renewal
2. Regular employees applying for promotion
3. Applicants for non-medical regular positions
4. Applicants for Job Order positions
5. OPD, Court Cases, School, SSS and GSIS requirements
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Referral Form/Endorsement Letter Requesting Agency
2. Appointment Slip with reminders for Psychological Services Personnel
NPT takers
3. Filled-out Personal Data Sheet/From
(Green)
4. Paid Charge Slip IPBM Cashier
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. The client proceeds 1. Receives the Please refer 10 minutes Cashier
to cashier for payment payment and to the
of NPT exam. validate client’s approved
schedule as schedule of
reflected on the fees
appointment slip.

2. Takes the 2. Prepares test None 4 hours Psychometrician

Neuropsychological materials for
test. administration of
NPT for
scheduled clients

Note: Clients who 2.1 Reschedules 3 minutes

come in after 15 the client on the
 minutes on the earliest possible
prescribed date and date
time shall be
rescheduled on the
earliest possible date
2.2 Analysis and
Evaluation of test
protocols 15 days
Total: Please 15 days, 4
refer to the hours and 13
approved minutes
schedule
of fees

Note:
1. Psychological Assessment (Refer to Schedule of fees for detailed charges)

2. For Court Case Client’s payment for charity

5. Scheduling of Neuropsychological Test

Clients in psychological services are provided with date of Neuropsychological Test
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Psychological Services – IPBM

Classification: Simple
Type of Transaction: G2G
Who may avail: 1. Public Attorneys, Department Heads, Unit Supervisors, DEPED
Personnel, LGU Personnel who are applying for Original Positions,
Transfer and for Appointment/Renewal
2. Regular employees applying for promotion
3. Applicants for non-medical regular positions
4. Applicants for Job Order positions
5. OPD, Court Case, School, SSS and GSIS requirements
6. CIU, Male and Female Wards
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Referral form/Endorsement letter Requesting agency
2. Appointment slip with reminders for NPT Psychological Services Personnel
takers
3. Charge slip
4. Personal Data Sheet/Form (Green)
5. Patient’s Chart IPBM OPD Records
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. For Neuro- 1. Schedules NPT None 5 minutes Psychologists
Psychological for applicant. Psychometricians
Testing (NPT)
Schedule: Proceed to 1.1 Prepares
IPBM – Psychological Appointment slip,
Services Section. Charge slip and
Personal Data
Sheet to be
appended along
with the referral
form/endorsement
letter.
 1.2 Indicate the
schedule on the
client’s/patient’s
chart

Total: None 5 minutes

6. Facilitates NPT for referred SPMC Personnel

Includes psychological testing/assessment for SPMC employee.
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Psychological Services – IPBM

Classification: Highly Technical
Type of Transaction: G2G
Who may avail: 1. SPMC Employee

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

1. Referral Form/Endorsement Letter Requesting Agency
2. Filled-out Personal Data Sheet/From Psychological Services Personnel
(Green)
3. Paid Charge Slip IPBM Cashier
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. The client proceeds 1. Receives the Please refer 10 minutes Cashier
IPBM cashier for payment and to the
payment of NPT validate client’s approved
exam. schedule as schedule of
reflected on the fees
appointment slip.

2. Takes the 2. Prepares test None 4 hours Psychometrician

Neuropsychological materials for
test. administration of
NPT for
scheduled clients

2.1 Reschedules 3 minutes

the client on the
earliest possible
Note: Clients who date
come in after 15
minutes on the
prescribed date and
time shall be 2.2 Analysis and 15 days
rescheduled on the Evaluation of test
earliest possible date productions
Total: Please 15 days, 4
refer to the hours and 13
approved minutes
schedule
of fees

PSYCHOLOGICAL SERVICES Schedule of Service Fees

Psychiatric Evaluation
nd
2 Level 1,500.00
1st Level 1,000.00

Neuro-Psychological Test
1. Psychological
Assessment/Diagnostic Test 600.00
2. Employment
a. Abroad 600.00
b. Local 600.00
3. Scholarship
a. Abroad 1,000.00
b. Local 600.00
4. Hospital Training 300.00
5. Promotion 600.00
6. Naturalization 3,500.00
7. Adoption, Custody, Child
1,500.00/applicant
Support
8. IQ Test 300.00
9. VISA Purposes 1,000.00
10. Counseling Fee/Session 50.00
11. Declaration of Nullity of
Marriage, Annulment of
Marriage

a. Psychiatric Services 9,000.00

b. Psychological Services 6,500.00
c. Contesting Party 5,000.00
**Hospital Memorandum No. 82 s. 2016
Institute for Women and Newborn Health (IWNH)

AICU
 External Services

Submission of Patient’s Kit for AICU Patients

Each patient is required to have their own kits with the necessary hygiene and eating materials
they will need.
Availability of Service: 24 hours a day, 7 days a week

Office/Division: Antenatal Intensive Care Unit (AICU) – IWNH

Classification: Simple
Type of Transaction: G2C
Who may avail: AICU Patient’s Watchers
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Mga gamit na kinahanglan sa pasyente Nurse or Midwife on Duty
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Procure and submit 1. Receives None 5 minutes Nurse
the kit to AICU nurse patient’s kit. Midwife
station. AICU
TOTAL: None 5 minutes

Mga gamit kinahanglan sa pasyente sa AICU

1. 1 gallon tubig inumun
2. Kutsara ug Tinidor na dili plastic
3. Baso or mug
4. Toothbrush ug toothpaste
5. Sabon / Soap
6. Shampoo
7. Alcohol
8. 3 rolls a tissue
9. Sudlay
10. Biscuit or cracker
11. Deodorant
 12. Panty / Diaper
13. Gatas
Pahinumdom
 Kung maghatud og pagkaon ibutang sa balunan dili pwede sa plastic.
 Mamalihug isulod sa isa ka sudlanan na han-ay og maigo tanan gamitunon sa pasyente.

OB Ultrasound Services at AICU

Pre-natal test to check on fetal well-being
Availability of Service: 24 hours a day, 7 days a week

Office/Division: Antenatal Intensive Care Unit (AICU) – IWNH

Classification: Simple
Type of Transaction: G2C
Who may avail: AICU Patient’s Watchers
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Charge Slip Nurse on Duty
2. Official receipt of paid professional fee Cashier
for procedure
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Presents charge 1. Checks the Refer to 5 minutes Nurse/
slip and official receipt request for approved Midwife
for paid professional payment of schedule of AICU
fee for procedure. professional fee fees

1.1 Charges the 5 minutes Nurse/

procedure in the Midwife
HIS. AICU
2. Undergo the 2. Prepares None 5 minutes Nurse/
ultrasound procedure materials and Midwife
instructs patient AICU
what to do.

2.1 Conducts the 30 minutes Fellow/

procedure Consultant/
Resident
 OB-Gyne

2.2 Encodes and 12 minutes Fellow/

prints final results. Consultant/
Resident
OB-Gyne

2.4 Attaches 3 minutes Nurse

result in the AICU
patient’s chart.
TOTAL: Refer to 1 hour
approved
schedule
of fees

OB ULTRASOUND SCHEDULE OF FEES

OB ULTRASOUND HF PF TOTAL
Transvaginal Ultrasound 350 150 500
(TVS)
Pregnancy Evaluation 300 150 450
(TAS/TVS) Single
Pregnancy Evaluation 300 300 600
+ Extra Procedures
Placenta Localization
Cervical Length measurement
CS scar / lower uterine
segment thickness
Pregnancy Evaluation 500 250 750
(TAS / TVS) Twin
Biophysical Scoring 500 250 750
(BPS) Twin
Biophysical Scoring 450 150 600
(BPS) Single
Biophysical Scoring 500 250 750
(BPS) Twin
DOPPLER VELOCIMETRY
OB 1,100 700 1,800
Gyn 1,100 700 1,800
Targeted Anomaly Scan 1,100 700 1,800
SPECIAL PROCEDURES:
ULTRASOUND 3,000 2,000 5,000
GUIDED (OB/Gyn)
3D / 4D Scan (OB/Gyn) 3,000 2,000 5,000
Institute for Women and Newborn Health (IWNH)
 Onco Tropho Ward

External Services

1. Chemotherapy Treatment and Management for Admitted patients with

Gynecologic Malignancies and Gestational Trophoblastic
Availability of Service: 24/7

Office/Division: Institute of Women and Newborn Health

ONCOLOGY-TROPHOBLASTIC UNIT
Classification: Complex
Type of Transaction: G2C
Who may avail: 1. Patients (Admitted)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Admitting Orders Doctor
2. Yellow Card HIMD
3. Payment Billing & Cashier
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. OB-ER for Doctor’s 1. Receives patients
Order for Admission and verifies None 15 minutes Nurse
Doctor’s order from
the Chart versus
Endorsement
Logbook

2. Print
Chemotherapy
Protocol

2. Preparation of 1. Receives
Chemotherapy Chemotherapy None 3 minutes Nurse
Medicines Medicines from the
Patient/Watcher
 2. Review
Chemotherapy 2 minutes Nurse
Protocol

3. Prepares Patient
and the Medicine 20 Minutes Doctor

3. Chemotherapy 3. Verify patient None 8 hours Doctor

Infusion versus name tag Nurse
TOTAL: If with 8 hours and
PHIC: 40 minutes
None

If without
PHIC:
Php 1,200
 Institute for Women and Newborn Health (IWNH)

Center for Maternal Fetal Medicine (CMFM)

External Services

1. HIGH RISK PREGNANCY PRENATAL CONSULTATION

Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays, Saturdays, and
Sundays.
Office/Division: CENTER FOR MATERNAL FETAL MEDICINE
Classification:
Type of transaction:
Who May Avail: 1. Patients (Out-Patient and Walk-in)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Triage Triage Nurse
2. Yellow CArd HIMD
3. Official Receipt for consultation fee Cashier
CLIENT STEPS AGENCY ACTION FEES TO PROCESSI PERSON
BE PAID NG TIME RESPONSIB
LE
1. TeleMedi 1. ROD will take the None 10 minutes Medical
cine call of patient via officer on
online or by Duty
telephone and
answer clients
inquiries. Make a
 scheduled visit by
the client.

2. Present 2. Triage nurse call Pays 5 minutes Nurse

Card to on the patients correspondi Cashier
Triage chief complaint ng
Nurse and directs her consultation
respective clinic fee at
Cashier
3. Triaging 3. Medical officer will None 5 minutes Medical
of patient auscultate patient officer on
by for clearance from duty
medical any COVID19
officer signs and
symptoms

4. Medical Record None 10 minutes Medical

4. Go to pull out patients records staff
Clinic and chart and delivers
wait for it to clinic 3 minutes Nurse
her Name 3.1 Recieving Midwife
to be Clerk or Nurse
called Recieves patients
chart and records
it to daily census
logbook returns
yellow card and
reciept to patient
5. Taking of 5. Nurse/midwife None 3 minutes Nurse
Patients takes patients vital Midwife
vital signs signs and guide
patient to
consultation room

6. Consult chief 6. Doctor None 10 minutes Medical

complaint to assesses Officer
doctor patients chief
complaint and
provide Procedure 5 mins
management correspondi
care ng fee paid
6.1 If to the 15 mins
ultrasound/ Cashier Cashier
NST is Procedure
needed for is done to
patient client
6.2
Medical
Procedure Officer
done by
ROD
7. Discharge 6. Nurse/Midwife carry None 1 minute Nurse
Instructio out Doctors order Midwife
ns 6.1 Nurse/Midwife gives 2 minutes
discharge instructions to Nurse
patient and schedules Midwife
next appointment of 10 minutes
consult.
6.2 Return Patients
record to record section
Nurse
 Midwife
TOTAL: 79 minutes
 Institute for Women and Newborn Health (IWNH)

Newborn Screening

External Services

1. Newborn Screening
Collection of Blood Sample for Newborn Screening
Availability of Service: 8:00 am to 4:00 pm, Daily (Monday to Sunday)

Office/Division: IWNH- NEWBORN SCREENING

Classification: SIMPLE (RELEASING OF NEWBORN SCREENING RESULT)
Type of Transaction: G2C
Who may avail: MOTHER, FATHER, NEAREST KIN
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.NEWBORN SCREENING CLAIM STUB 1. GIVEN TO MOTHER AFTER BABY’S
BLOOD EXTRACTION.
2. IF BABY AT NICU, YOU CAN ASK FROM
NURSE ON DUTY.

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Present the claim 1. Staff will find None 10 minutes Staff Nurse
stub to the newborn the result.
screening staff on
duty.
For negative results:
2. Receives NBS
result
 For positive results: 2. Give health None 10 minutes Staff Nurse
2. Receives Health teaching/
teachings Instruction
depending on the
case and refer to
appropriate
agency/institution.
TOTAL: 20 minutes

2. Newborn Screening
Collection of Blood Sample for Newborn Screening
Availability of Service: 8:00 am to 4:00 pm, Daily (Monday to Sunday)

Office/Division: IWNH- NEWBORN SCREENING

Classification: SIMPLE (REPEAT NEWBORN SCREENING FOR POSITIVE
BABIES)

(CAH – congenital adrenal hyperplasia, CH – congenital

hypothyroidism, MSUD – maple syrup urine disorder, PKU –
phenylketonuria, AMINO ACIDS DISORDER, FATTY ACIDS,
CYSTIC FIBROSIS, ORGANIC ACID AND BIOTINIDASE)
Type of Transaction: G2C
Who may avail: 1. MOTHER, FATHER, NEAREST KIN
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Positive Newborn Screening result Newborn Screening Unit

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
 1. Receives note of 1. Contacts None 5 minutes Staff Nurse
NBS positive result parents of the
baby
2. Returns to NBS- 2. Extracts blood None 5 minutes Staff Nurse
IWNH for confirmatory
test

3. Receives claim 3. Issues claim None 10 minutes Staff Nurse

stub stub & give health
teachings
depending on the
case.
TOTAL: 20 minutes

3. Newborn Screening
Collection of Blood Sample for Newborn Screening
Availability of Service: 8:00 am to 4:00 pm, Daily (Monday to Sunday)

Office/Division: IWNH- NEWBORN SCREENING

Classification: REPEAT NEWBORN SCREENING FOR LESS THAN 37 WEEKS
AOG AND LESS THAN 2KILOS BABIES
Type of Transaction: G2C
Who may avail: MOTHER, FATHER, NEAREST KIN
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. NEWBORN SCREENING TEST 1. NEWBORN SCREENING UNIT
2. OFFICIAL RECEIPT FOR PAID NBS 2. CASHIER
CHARGE SLIP

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Present the official 1. Verifies request 1,750 3 minutes Staff Nurse
receipt to the staff & & payment
charge slip
2. Undergoes blood 2. Extracts blood None 10 minutes Staff Nurse
extraction
3. Receives claim 3. Releases claim None 1 minutes Staff Nurse
stub stub & instruct to
claim the result
after 2 weeks
TOTAL: 14 minutes
 Outpatient Department (OPD Main)

External Services

1. OPD ONLINE TRAGING

Location: SPMC Virtual Consultation
Availability of Service: 7:00 am to 3:00 pm, Monday to Friday, except Holidays.

Office/Division: Outpatient Department - Admin

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients (Out-patient and Walk-In patients)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Internet access Facebook page
2. Valid Identification Card to be sent online on Facebook page
3. Picture or camera take of patient to be send on Facebook page
 CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Opens the 1. Provides tha None 1 minute Triage Nurse
Facebook page of facebook page,
SPMC Virtual SPMC virtual
Consultantion. consultation to
patient.

2. Check the online 2. Asks the None 2 minutes Triage Nurse

consent: “Yes” consent of patient
for consultation
online.
3. Fills up the online Provides online None 5 minutes Triage Nurse
patient personal patient’s
information consultation online

4. Send his picture Valid ID checked None 2 minutes Triage Nurse

and show his/her valid for security
ID online purposes

Gives and None 5 minutes Triage Nurse

instructs patient to
download the
website (Cisco
Access) for the
attending
physician.

5. Received queries Interviews the None 30 minutes SPMC Attending

about his/her physical patient concerning Physician on the
complaints or medical his/her physical line.
requests online complaints or
concerns
Asks the patient to None 30 minutes SPMC Attending
hold ont he Physician on the
line.access fo line.
verification and
availability of
Doctors

6. Downloads the Fact to Fact with None 10 minutes SPMC Attending

website (CISCO the patients online Physician on the
Access) of the for consultation line.
attending physician

End

TOTAL:
2. OPD TELECONSULTATION
Location:SPMC Teleconsultation
Availability of Service: 7:00 am to 3:00 pm, Monday to Friday, except Holidays.

Office/Division: Outpatient Department

Classification: Simple
Type of Transaction: G2C
Who may avail: All patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Internet access Facebook page
2. Valid Identification Card to be sent online on Facebook page
3. Picture or camera take of patient to be send on Facebook page
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Downloads the Open Webex None 10 minutes SPMC Attending
website (CISCO meeting and wait for physician.
access) to the patent to come in.
attending physician.

2. Receives interviews Interview and None 3 minutes SPMC Attending

and queries about encodes patient’s physician.
personal information. data in google
spreadsheet.

Open HIS and PACS None 5 minutes SPMC Attending

if patient has physician.
previous records

3. Online consultation. Online Face to None 20-30 minutes SPMC Attending

face consultation physician.

None 5 minutes SPMC Attending

physician.

None 5 minutes SPMC Attending

physician.

End

TOTAL: 48minutes
 Dental Clinic

External Services

Dental Consultation
Consultation for dental evaluation and assessment.
Availability of services: Monday to Fridays except Holidays (8:00 am-5:00 pm)

Office/Division: Department of Dental Medicine

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients (Out-patient and Walk-In patients)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Undergone OPD triaging
2. Yellow card HIMD
3. Official Receipt for paid dental Cashier
consultation.
4. Appointment Slip Electronic Consultation,
5. PCR Test Result Laboratory Testing
6. Medical Clearance
 7. Informed consent Dental Triage
8. Waiver Form Dental Triage
9. Temperature, Pulse Oximeter
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Proceed to Dental 1. Confirm patient none 5 minutes Clinic
Clinic window of schedule Receptionist
reception area and 1.1 Prepare the Department of
inform of their chart. Dental Medicine
appointed schedule 1.2 Calls patient
and time and wait for name.
their name to be 1.3 Return yellow
called. card and receipt
to the patient
1.4 Instruct patient
to proceed at
dental triage.

2.. Proceed to Dental 2. Confirm patient

Triage area and schedule
present appointed slip 2.1 Prepare the
and wait for their informed consent
name to be called. and waiver.
2.2 Calls patient
name.
2.3 Instruct patient
for vital signs and
screening for
CoVID-19
3. Submit for vital 3. Call patient’s None 5 minutes Nurse
signs (temperature, name and take Department of
oximeter and blood vital signs and Dental Medicine
pressure) and record at the
screening for CoVID- patient’s chart.
19. 3.1 Check 10 minutes Dental Staff
temperature and (Dental
conduct screening Residents)
guided by CoVID- Department of
19 screening Dental Medicine
questionnaire
3.2 Explain and
obtain informed
consent and
waiver.

4. Present medical 4. Check for 10 minutes Dental Staff

clearance and PCR medical (Dental
test result clearances and its Residents)
validity as well as Department of
PCR test result Dental Medicine
and date taken.
4.1 Instructs
patient to wait for
name to be called
for dental
consultation.
4.2 Instruct patient
of the following:
hand hygiene, foot
bath and
respiratory
etiquette and wear
of face mask prior
to entry in dental
clinic.
 5. Wear appropriate 5. Direct patient 5 minutes Dental assistant
PPE at donning area inside the dental Department of
for patient clinic for donning Dental Medicine
of PPE.

4. Undergoes dental 4.Assesses and None 20 minutes Dentist

consultation. identifies chief Department of
complaint of the Dental Medicine
patient.
4.1 Conducts oral
examination and
dental charting.
4.2 Advises
patient for:
A. Dental
procedure
4.2A –Prescribes
materials
eg.dental
cartridge, suturing
materials and
hemostatic agent.
B. Referrals
4.2B- Refer to
medical and other
services
TOTAL: none 55 minutes

DENTAL CONSULTATION: Schedule of Fees

Consultation 50.00 php

Dental Procedures
Dental procedures include: Tooth restoration, tooth extraction, preventive
Availability of services: Monday to Fridays except Holidays (8:00 am-5:00 pm)

Office/Division: Department of Dental Medicine

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients (Out-patient and Walk-In patients)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Yellow card HIMD
Official Receipt for paid dental procedure Cashier
Local Anesthesia Pharmacy
Suturing Materials Pharmacy
Surgical blade Pharmacy
Hemostatic agent Pharmacy
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Waits for name to 1. Calls clients none 5 minutes Nurse
be called. name.
 Department of
Dental Medicine
1.1 Prepares
dental equipment, Dental
and materials Assistant
needed for the Department of
procedure. Dental Medicine

2. Undergoes 2. Assesses None 10 minutes Dentist

assessment. medical history of Department of
the patient Dental Medicine
2.1 Checks
materials for
dental procedure.
2.2. Informs
patient of the
tooth /teeth
indicated for
procedure.
3. Undergoes dental 3. Performs dental None 30 minutes Dentist
procedure. procedure Department of
indicated for the Dental Medicine
tooth/teeth.
3.1 Releases
post-op
instructions and
prescribed
medications if
indicated.
3.2 Instructs
patient to return to
Dental Clinic, if
necessary.
3.3 Discharges
patient.
TOTAL: none 45 minutes

DENTAL PROCEDURES: Schedule of Fees

Oral Prophylaxis
Restoration: (Non-aerosol Generating Procedure)
GI restoration
Rubber Dam Assembly
SDF
ART
Pit and Fissure Sealant
Fluoride Treatment
Restoration: (Aerosol Generating Procedure)
Tooth Extraction
Odontectomy
 Derma Clinic

External Services

1. Teledermatology
Online consultation for existing and new patients with dermatologic complaints.
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Department of Dermatology

Classification: Complex
Type of Transaction:
Who may avail: 1. Patients within any part of the Philippines with dermatologic
concerns
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Written informed consent Teledermatology doctor on duty
2. Demographic data Patient information
CLIENT STEPS AGENCY FEES TO PROCESSI PERSON
ACTION BE PAID NG TIME RESPONSIBLE
1. The patient visits 1.1. Doctor on No fees 5 minutes Teledermatology
the official FB page of duty instructs resident on duty
SPMC patient or legal
Teledermatology and guardian to fill-out
sends a message a written informed
consent (both
adult and pedia)
before proper
consultation takes
place
1.2 Doctor on duty
instructs the
patient or legal
guardian to give
out demographic
details of the
patient (e.g.
name, age,
birthday,etc.)
2. The patient sends 2.1 Doctor on duty None 10 minutes Teledermatology
pictures of the skin examines clarity resident on duty
lesion/s and adequacy of
the pictures sent.
2.2 Doctor on duty 5 minutes Teledermatology
asks patient to resident on duty
send more
pictures for
adequate
assessment, if Teledermatology
needed resident on duty
2.3 Doctor on duty 10 minutes
examines images,
confers with the
teledermatology Teledermatology
consultant on duty resident on duty
about the case
and provides 5 minutes
diagnosis and
other possible
differentials.
2.4 Doctor on duty
sends out online 5 minutes
prescriptions Teledermatology
and/or necessary resident on duty
lab work-up
2.5 Doctor on duty
explains online
prescription
and/or necessary
lab work-up as
well as addresses
other clarifications
the patient might
ask regarding
consult
3. Return to 3.1 Doctor on duty None 35 minutes Teledermatology
teledermatology asesses the resident on duty
platform at the date of condition of the
follow-up patient previously
seen, whether
improved,
maintained, or not
improved. If
further treatment
is needed, doctor
on duty repeats
 process as in
number 2.
TOTAL: N/A 75 mins

DERMATOLOGY – TELEDERMATOLOGY CONSULTATION Schedule of Fees

 THERE ARE NO FEES OR ANY OTHER CHARGES

2. Dispensing of MDT medications to HD patients

Releasing of medications to Hansen’s disease patients as part of their Multi-drug Therapy regimen
(MDT).
Availability of Service: 8:00 am to 10:00 am, Thursday and Friday, except Holidays.

Office/Division: Department of Dermatology

Classification: Complex
Type of Transaction:
Who may avail: 1. Diagnosed Hansen’s Disease patients who are on MDT
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Identification Card Patient
2. Patient’s chart Medical records
3. Central HD Logbook Department of Dermatology
4. MDT Department of Dermatology
CLIENT STEPS AGENCY FEES TO PROCESSIN PERSON
ACTION BE PAID G TIME RESPONSIBLE
1. Patient visits the 1.1. Doctor on 5 minutes Teledermatology
official FB page of duty instructs the resident on duty
SPMC patient out a
Teledermatology and written informed
makes an online consent (both
consultation as well adult and pedia)
as sets an before proper
appointment for consultation takes
retrieval of MDT place

1.2 . Doctor on 10 minutes Teledermatology

duty interviews resident on duty
the patient and
assesses for
improvement or
any new lesions
or untoward
reactions. Referral
of the case to the
consultant on duty 4 minutes Teledermatology
is done. resident on duty

1.3 . Doctor on
duty requests for
laboratory
examinations
(sends out lab
requests by 1 minute Teledermatology
teleconsult) resident on duty

1.4 . Doctor on
duty sets an
agreed upon date
of appointment for
dispensing of the
patient’s MDT
2. The patient goes to 2.1 Doctor on duty None 1 minute Teledermatology
the designated area at examines the resident on duty
the hospital where identification card
dispensing of MDT is of the patient
done at the
appointment date 2.2 Doctor on duty 1 minute Teledermatology
previously agreed dispenses MDT resident on duty
upon as indicated

2.3 Doctor on duty 1 minute Teledermatology

takes note of the resident on duty
number of MDTs
given at the
Central HD
logbook.

2.4 Doctor on duty 1 minute Teledermatology

instructs patient resident on duty
regarding next
follow-up
consultations via
Teledermatology
3. Returns to 3.1 Doctor on duty None 20 minutes Teledermatology
teledermatology repeats same resident on duty
platform at the date of process as in
scheduled follow-up number 1.
 for regular
consultation and
appointment for
dispensing of next
MDT
TOTAL: N/A 45 mins

3. Receiving inpatient referrals

Accepting inpatient referrals from other services either for evaluation or co-management
Availability of Service: 8:00 am to 5:00 pm, Monday to Sunday

Office/Division: Department of Dermatology

Classification: Complex
Type of Transaction:
Who may avail: Admitted patients at Southern Philippines Medical Center (including
patients at the ER, Charity wards, and Pay wards)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Official Referral Form Referring physician/resident
2. Signed informed Consent (either for Patient, Guardian (for minors and those
photographs, biopsy or other procedures) physically or mentally incapacitated)
3. Negative swab test results (if the c/o the referring Primary service
patient’s condition is considered as
“emergent” or life-threatening, no need to
wait for test results)
CLIENT STEPS AGENCY FEES TO PROCESSIN PERSON
ACTION BE PAID G TIME RESPONSIBLE
1. Patient is referred 1.1. The None 5 minutes Ward resident
by the primary service ward/receiving
to our department team assesses
either for evaluation or the referral and
co-management of a triages the case
dermatologic as either
complaint/concern emergent, urgent,
or routine.

* For non-COVID
referrals classified
as urgent or
routine referrals,
the ward team
answers to the
referral within 24
hours.

* For non-COVID
referrals classified
as emergent, the
ward team
answers to the
referral
immediately.

* For referrals
from COVID
positives or
COVID suspects
classified as
urgent or routine,
the ward team
coordinates with
the referring RIC
in managing the
case through
teledermatology.

* For referrals
from COVID
positives or
COVID suspects
classified as
“emergent” and/or
those needing
biopsy to establish
the diagnosis, the
ward answers to
the referral
immediately.
2. The patient or 2.1 The ward None 10 minutes or Ward resident
guardian participates team examines less
with the interview and interviews the
and/or physical patient. For
examination done by COVID referrals,
the ward team. this part is done
 through
teledermatology

2.2 The ward

team performs a
complete
dermatologic
physical
examination. For
COVID referrals,
close coordination
with the primary
service is done to
obtain clear
pictures of the
patient’s lesion/s.

2.3 The ward

team refers the
case to the ward
consultant and
comes up with a
working diagnosis.

2.4 If further
testing is needed,
the ward team
requests for
additional
laboratory work-
up or biopsy as
needed.
3. The patient signs 3.1 The ward None 3 minutes or Ward resident
an informed consent team performs less
for any photographs biopsy and any
taken or before any other necessary
procedure is tests. For COVID
performed. patients or
suspects, should
a biopsy be
deemed
necessary, the
ward team suits
up with the
required PPE as
mandated by the
DOH and WHO
and observe the
necessary
precautions in
dealing with such
patients.

4. The patient follows 4.1. The ward None 5 minutes Ward resident
strictly the advises team will make
given by the ward rounds as
team and/or take the necessary and will
medications update, revise or
prescribed thereof. continue the
management of
the patient based
on the status of
the patient’s
dermatologic
complaint/concern
 .For COVID
referrals,
management of
the patient’s case
will be done
through
teledermatology
with close
coordination with
the primary
service unless the
patient’s case
necessitates the
strict guidance
and care that can
only be done by a
dermatologist.

5. The patient is 5.1. The ward None 5 minutes Teledermatology

discharged from the team advises the resident on duty
hospital. patient to follow-
up through SPMC
Teledermatology
for continuation of
care.
TOTAL: N/A 28 minutes
mins
 Family Medicine Clinic

External Services

1. General Family and Community Medicine OPD Consultation for Scheduled

Appointment
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Department of Family and Community Medicine

Classification: Simple
 Type of Transaction: G2C
Who may avail: Patients with scheduled appointment from Family Medicine Doctor
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Yellow Card HIMD
2. Patient’s Chart OPD Medical Record
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE
1. Patient cleared for 1. Screening for None 1 hour DFCM Nurse
possible COVID19 from COVID19 and Nurse
triage/screening area 1.1Calls patient Attendant
goes to Family Medicine for vital signs
waiting area taking
1.2 Instructs
patient to wait for
consultation
2. Consultation 2. Takes Medical Consultation Total time of Family and
History Fee for Non consultation: Community
2.1 Performs Senior 40min Medicine Doctor
physical Citizens (Medical Officer
examination III/IV, Medical
2.2 Interpret Specialist II/III)
available
laboratory and
diagnostic results
2.3 Request of
necessary
laboratory and
diagnostic work-
up as needed
2.4 Referral to
other departments
for further
evaluation, co-
management,
and/or transfer of
service as needed
3. Discharge 3. Gives None 20 minutes Family and
discharge Community
instruction Medicine Doctor
3.1 Issues (Medical Officer
medical certificate III/IV, Medical
Specialist II/III)
TOTAL: 2 hours

Fees

Yellow Card Replacement (non

50.00
Senior Citizen)
Consultation Fee (non Senior
50.00
Citizen)

2. General Family and Community Medicine OPD Teleconsultation (WEBEX

Meeting for Audio-Visual Consultation)
Availability of Service: 7:00 am to 3:00 pm, Monday to Friday, except Holidays.

Office/Division: Department of Family and Community Medicine

 Classification: Simple
Type of Transaction: G2C
Who may avail: All patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Facebook account Internet
2. Virtual Consent Nurse-Moderator at FB Page
3. WEBEX app Internet
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE
1. Waits for the URL Sends URL-link to None 15 minutes SPMC Nurse-
link sent by the nurse- patient’s FB Moderator
moderator at FB messenger
messenger (SPMC
Virtual Consultation
page)
2. Waits for the doctor 2. Takes Medical None Total time of Family and
to admit him/her to History consultation: Community
WEBEX Meetings for 2.2 Virtual 40min Medicine Doctor
Audio-Visual physical (Medical Officer
Consultation examination if III/IV, Medical
necessary Specialist II/III)
2.3 Interpret
available
laboratory and
diagnostic results
2.4 Request of
necessary
laboratory and
diagnostic work-
up as needed
2.5 Advised
referral to other
departments for
further evaluation,
co-management,
and/or transfer of
service as needed
2.6 Advised for
physical consult if
necessary
3. Discharge Gives discharge None 5 minutes Family and
instruction Community
Medicine Doctor
(Medical Officer
III/IV, Medical
Specialist II/III)
TOTAL: 1 hour

3. General Family and Community Medicine OPD Teleconsultation (Phone

Call)
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.
 Office/Division: Department of Family and Community Medicine
Classification: Simple
Type of Transaction: G2C
Who may avail: All patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Facebook account Internet
2. Virtual Consent Nurse-Moderator in FB Page
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE
1. Waits for the 1. Takes Medical None Total time of Family and
assigned doctor to call History consultation: Community
1.1 Interpret 40min Medicine Doctor
available (Medical Officer
laboratory and III/IV, Medical
diagnostic results Specialist II/III)
1.2 Request of
necessary
laboratory and
diagnostic work-
up as needed
1.3 Advised
referral to other
departments for
further evaluation,
co-management,
and/or transfer of
service as needed
1.4 Advised for
physical consult if
necessary
2. Discharge Gives discharge None 10 minutes Family and
instruction Community
Medicine Doctor
(Medical Officer
III/IV, Medical
Specialist II/III)
TOTAL: 50 minutes

4. Referral of DFCM OPD Patients to other Departments/Services via

Teleconsultation
Availability of Service: 7:00 am to 3:00 pm, Monday to Friday,except Holidays.
 Office/Division: Department of Family and Community Medicine
Classification: Simple
Type of Transaction: G2C
Who may avail: All DFCM patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Facebook account Internet
2. Virtual Consent Nurse-Moderator at FB Page
3. WEBEX app Internet
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE
1. After 1. Instructs patient none 30 minutes Nurse-
teleconsultation with to wait for Moderator
FM doctor, patient will teleconsultation of
wait for nurse- medical doctor
moderator for further from other
instruction department
1.1 FM doctor to
send to nurse- Family and
moderator via Community
WEBEX Teams Medicine Doctor
the referral form (Medical Officer
III/IV, Medical
Specialist II/III)
TOTAL: 30 minutes

5. Issuance of Medical Certificate to OPD Patients (Same Day Consultation)

Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.
 Office/Division: Department of Family and Community Medicine
Classification: Simple
Type of Transaction: G2C
Who may avail: DFCM Patients (Out-patient)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Yellow Card HIMD
2. Patient’s Chart OPD Medical Record
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. After the 1. Prints two Medical 10 minutes Medical Record
consultation, patient copies of medical Certificate Personnel
goes to window 12 for certificate Fee
printing of medical 1.1 Gives to the
certificate patient the copies
of the medical
certificate
2. Returns to the 2. Signs the none 10 minutes Family and
doctor with printed medical certificate Community
medical certificate for 2.1 Indicates the Medicine
signature number of days of Doctor
rest (Medical Officer
2.2 Indicates if III/IV, Medical
patient is fit to Specialist II/III)
work/ return to
work
3. Return to window Seals the medical none 30 minutes Medical Record
12 certificate Personnel
TOTAL: 30 minutes

Fees

Medical Certificate Fee 50.00

6. Intramuscular Injection of Medications

Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.
Office/Division: Department of Family and Community Medicine
Classification: Simple
Type of Transaction: G2C
Who may avail: DFCM patients advised for IM injection of medication
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Yellow Card HIMD
2. Physician’s order of IM injection of Written order in the Patient’s chart
medicine
3. Medicine Hospital Pharmacy or Outside Pharmacy
4. Receipt of injection fee Cashier
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Give the following 1. Retrieves Injection 10 minutes DFCM OPD
to DFCM nurse: patient’s medical Fee Nurse
-Medicine record
-Yellow card 1.1 Instructs
-Injection fee receipt patient to wait at
DFCM OPD area
2. Wait name to be 2. Verifies the none 25 minutes DFCM OPD
called doctor’s order Nurse/Nurse
2.1 Calls the Attendant
patient
3. Give consent to 3. Explain to the none 1 hour DFCM OPD
planned management patient the Nurse
procedure
3.1 Let the patient
sign the consent
form
3.2 Prepare and
give the
medication
intramuscularly as
ordered in the
patient’s chart
3.3 Instruct patient
to stay at the OPD
for monitoring of
possible adverse
effect
4. Discharge from the Gives discharge none 5 minutes Family and
OPD slip Community
Medicine
Doctor
(Medical Officer
III/IV, Medical
Specialist II/III)
&
DFCM OPD
Nurse
TOTAL: 1 hour and 30
minutes
Fees

Injection Fee 50.00

7. Referral of patients to National Tuberculosis Program (SPMC TB DOTS) for

procurement of anti-TB meds
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Department of Family and Community Medicine

Classification: Simple
Type of Transaction: G2C
Who may avail: DFCM patients diagnosed with Tuberculosis (already cleared from
COVID19)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Yellow Card HIMD
2. Filled Out Referral Form Referring Doctor
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. After consultation 1. Makes referral none 15 Family and
patient will be advised form to TB-DOTS minutes Community
to go SPMC TB- Medicine
DOTS area Doctor
(Medical Officer
III/IV, Medical
Specialist II/III)

2. Discharge 3. Gives None 15 minutes Family and

discharge Community
instruction Medicine
Doctor
(Medical Officer
III/IV, Medical
Specialist II/III)
TOTAL: 30 minutes

8. Residency and Fellowship Training - Application

Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.
Office/Division: Department of Family and Community Medicine
Classification: Complex
Type of Transaction: G2C
Who may avail: All applicants for Residency and Fellowship Program
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Letter of intent From the applicant
2. 2x2 picture
3. Certificate of class rank Graduate School
4. Photocopies of the following: Graduate School
- Transcript of Records (TOR) Medical School
- Medical Diploma Medical School
- PRC Board Rating Philippine Regulatory Commission (PRC)
- Certificate of Internship Training Hospital

5. For Fellowship Training: Training Hospital

- Certificate of Residency Training Philippine Academy of Family Physicians
- Diplomate Certificate
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1.Submit application 1. Accept None 1 day Administrative
form and complete Residents and staff
requirements to the Fellowship
Department Training
Application
1.1 Schedule for None 7 days
an online panel Administrative
interview staff

2.Appear during Interview proper via None 1 hour Department

scheduled online online platform Chairman,
interview Training Officer
and Consultants
3.Schedule for Secure schedule for None As soon as Administrative
adjunctship training adjunctship training applicant is staff
available for
adjunctship
training
4.Sign MOA for Send MOA of None 1 hour Administrative
adjunctship training adjunctship to staff
PETD
5.Start Adjunctship Assess and None 2 weeks Department
training deliberate the (SPMC Consultants and
trainee Interns) Senior Residents

1 month
(non-SPMC
Interns)
6.Receive 6.Deliberate and None 7 days Residency
acceptance/rejection send acceptance/ Training
letter rejection letter Committee
6.1 Submit DFCM
accepted applicants
to HRMO
TOTAL: 2 months and
2 days

9. Palliative Care Ward Interdepartmental Referral for COVID-19 Patients

COVID-19 confirmed patients from other departments that need referral to Palliative Care
Services for Family Care and Support may undergo an interdepartmental referral.
Availability of Service: 8:00 AM – 5:00 PM
[
Office or Division: Department of Family and Community
Medicine (DFCM) Section of Palliative
and Hospice Care
Classification: Simple
Type of Transaction: G2G
Who may avail: 1. Departments who are handling COVID-
19 patients that need referral to
Palliative Care Services for Family
Care and Support
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Chart entry/Order for referral from Referring Physician
referring department, with indication
and updated working diagnosis
relevant for purpose of referral
2. Two (2) copies of referral form with COVID-19 Designated Ward
patient’s data, relevant and updated
working diagnosis, relevant history and
physical exam findings, relevant
diagnostics, reason for referral
3. Phone Referral through text and/or call Referring Physician
4. Completed work up Laboratory, Imaging, Chart entry
CLIENT AGENCY ACTION FEES TO PROCESSING PERSON
STEPS BE PAID TIME RESPONSIBLE
1. Sending 1. Order referral in None 1 hour Physician from
the Referral the chart, inform the Referring
Palliative Care Department
fellow through text
and/or call, and
prepare referral
form
1.1 Carry out Physician from
referral and send the Referring
to Section of Department
Palliative and
Hospice Care
1.2 Nurse to check Nurse in charge
if referral was sent
2. Receiving 2. Receive two None 30 minutes Palliative Care
the Referral copies of the fellow in charge/
referral form from Secretary
the referring
department
2.1 Fill out Section None Palliative Care
of Palliative and fellow in
Hospice Care charge/Secretary
logbook (as
necessary) and
have the
Secretary/Palliative
Care fellow sign
the second copy of
the referral form
2.2 Attach signed None Physician from
second copy of Referring
referral form to Department
patient’s chart
TOTAL: 1 hour, 30
minutes
10. Receiving of OPD patients to National Tuberculosis Program (SPMC TB
DOTS) for DSSM and Sputum GeneXpert
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: SPMC TB DOTS Center

Classification: Simple
Type of Transaction: G2C
Who may avail: All TB Referrals cleared from COVID19 infection
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Yellow Card HIMD
2. Filled Out Referral Form with Referring Physician
inclusion of COVID19 Clearance
3. Chest XRAY result Facility where XRAY was done
4. rRT-PCR result Laboratory where rRT-PCR was done
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Patient goes to 1. Receives the none 1 minute NTP Nurse
SPMC TB-DOTS area referral form after
encoded to NTP

1.1 Encode 1 minute

Hospital TB
Referral Logbook

1.2 Fill-out 1 minute

Laboratory
Request Form
and provide
specimen
container with
label

1.3 Instruct hand 30 seconds

washing and
mouth rinsing

1.4 Teach/coach/ 30 minutes

supervise
watcher-patient
sputum collection
procedure and
instruct how to
lock cover and
pack specimen
tightly with plastic
cellophane

1.5 Instructs 30 seconds

patient when to
follow-up

1.6 Discharge the 5 minutes

patient
TOTAL: 40 minutes
11. Receiving of OPD patients to National Tuberculosis Program (SPMC TB
DOTS) for procurement of anti-TB meds
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Department of Family and Community Medicine -TB DOTS Center

Classification: Simple
Type of Transaction: G2C
Who may avail: All TB Referrals cleared from COVID19 infection
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Yellow Card HIMD
2. Filled Out Referral Form with inclusion Referring Physician
of COVID19 clearance
3. Chest XRAY (Partial/Official Facility where XRAY was done
Reading)
4. rRT-PCR result Laboratory where rRT-PCR was done
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Go to SPMC TB- Out-Patient None 30 minutes NTP Nurse
DOTS Center 1. Receives the
referral form
1.1 Calls/Informs
triage to
retrieve/print
patient’s medical
record and
encode to
Hospital TB
Referral Logbook

In-Patient
1.1 Encode in the
Hospital TB
Referral Logbook

2. Go to SPMC 2.1. Gets the none 1 hour NTP Program

TB-DOTS referral form from Resident
consultation the patient Physician
room once 2.2 Evaluates
name is called patient &
2.3 Explains
disease condition NTP Nurse
and treatment
plan with proper
TB Education of
patient and
treatment partner
3. Enrollment to A. E 1 hour & 30 NTP Program
the Program n minutes Resident
(Catchment/Pat r Physician
ient o
Preference) ll &
p
a NTP Nurse
ti
e
n
t
t
o
N
T
P
3.1 Enrolls patient
if within catchment
area or patient’s
preference to be
treated in this
facility if outside
the catchment
area
3.2. Fill-out the
NTP and ID Card
3.3 Register in the
TB Registery and
monitor daily
treatment until
completed
3.4 Update
Hospital TB
referral Logbook
3.5 Allocates and
Dispenses anti-TB
medicines for
admitted patients
 if with available
stocks
3.6 Prescribes
anti-TB medicines
if without available
stock (for financial
assistance)
3.7 Requests
additional
laboratory/
diagnostic tests if
necessary
3.8 Instructs when
to follow up
3.9 Discharges
the patient

B. Refer patients
to Local Health
Center (outside
catchment area)
by providing
properly filled-out
NTP Referral
Form with
attachment of
diagnostic tests
and
corresponding
instructions to
report to
Community Health
Worker

Note:
Ensure that the
patient has final
disposition of TB
Disease from
consultant/NTP
Medical
Coordinator prior
to enrollment
and/referral to
Local Health
Center

TOTAL: 3 hours
Fees

Yellow Card Replacement (non

50.00
Senior Citizen)
Consultation Fee (non Senior
50.00
Citizen)
 Family Medicine Clinic

Personnel Health Services (PHS)

External Services
Referral of DFCM PHS OPD Patients to other Departments/Services via
Teleconsultation
Availability of Service: 7:00 am to 3:00 pm, Monday to Friday, except Holidays.

Office/Division: Department of Family and Community Medicine

Classification: Simple
Type of Transaction: G2C
Who may avail: SPMC personnel
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Facebook account Internet
2. Virtual Consent Nurse-Moderator at FB Page
3. WEBEX app Internet
CLIENT STEPS AGENCY FEES TO BE PROCESSIN PERSON
ACTION PAID G TIME RESPONSIBLE
1. After 1. Instructs patient none 30 minutes Nurse-
teleconsultation with to wait for Moderator
FM doctor, patient will teleconsultation of
wait for nurse- medical doctor
moderator for further from other
instruction department

1.2 FM doctor to Family and

send to nurse- Community
moderator via Medicine Doctor
CISCO Teams the (Medical Officer
referral form III/IV, Medical
Specialist II/III)
TOTAL: 30 minutes
PHS OPD Teleconsultation (WEBEX Meeting for Audio-Visual Consultation)
Availability of Service: 7:00 am to 3:00 pm, Monday to Friday, except Holidays.

Office/Division: Department of Family and Community Medicine

Classification: Simple
Type of Transaction: G2C
Who may avail: SPMC personnel
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Facebook account Internet
2. Virtual Consent Nurse-Moderator at FB Page
3. WEBEX app Internet
CLIENT STEPS AGENCY FEES TO BE PROCESSIN PERSON
ACTION PAID G TIME RESPONSIBLE
1. Waits for the URL 1. Sends URL-link None 15 minutes SPMC Nurse-
link sent by the nurse- to patient’s FB Moderator
moderator at FB messenger
messenger (SPMC
Virtual Consultation
page)
2. Waits for the doctor 2. Takes Medical None Total time of Family and
to admit him/her to History consultation: Community
WEBEX Meetings for 2.1 Virtual 40min Medicine Doctor
Audio-Visual physical (Medical Officer
Consultation examination if III/IV, Medical
necessary Specialist II/III)
2.2 Interpret
available
laboratory and
diagnostic results
2.3 Request of
necessary
laboratory and
diagnostic work-
up as needed
2.4 Advised
referral to other
departments for
further evaluation,
co-management,
and/or transfer of
service as needed
2.5 Advised for
physical consult if
necessary
3. Discharge 3. Gives None 5 minutes Family and
discharge Community
instruction Medicine Doctor
(Medical Officer
III/IV, Medical
Specialist II/III)
TOTAL: 1 hour
PHS OPD Teleconsultation (phone call)
Availability of Service: 7:00 am to 3:00 pm, Monday to Friday, except Holidays.

Office/Division: Department of Family and Community Medicine

Classification: Simple
Type of Transaction: G2C
Who may avail: SPMC personnel
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Facebook account Internet
2. Virtual Consent Nurse-Moderator at FB Page
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE
1. Waits for the 2. Takes Medical None Total time of Family and
assigned doctor to call History consultation: Community
2.1 Interpret 40min Medicine Doctor
available (Medical Officer
laboratory and III/IV, Medical
diagnostic results Specialist II/III)
2.2 Request of
necessary
laboratory and
diagnostic work-
up as needed
2.3 Advised
referral to other
departments for
further evaluation,
co-management,
and/or transfer of
service as needed
2.4 Advised for
physical consult if
necessary
2. Discharge 3. Gives None 10 minutes Family and
discharge Community
instruction Medicine Doctor
(Medical Officer
III/IV, Medical
Specialist II/III)
TOTAL: 50 minutes
Scheduled Immunization among Personnel
Availability of Service: 8 am to 11am, Monday to Friday, except Holidays.

Office/Division: Department of Family and Community Medicine (PHS)

Classification: Simple
Type of Transaction: G2C
Who may avail: Personnel
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Yellow Card HIMD
2. Health declaration form List name at the chosen schedule date near the
Biometrics area, OPD JICA
3.Consent forms PHS
4.DOH forms PHS
5.Logbook PHS
6.Vaccination schedule List name at the chosen schedule date near the
Biometrics area, OPD JICA
7. Available vaccine Hospital Pharmacy or Outside Pharmacy
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Patient lists his/her 1.Nurse gets the none 10 minutes Nurse
name at his/her list posted near
preferred date of the biometric
vaccination. List can machine at JICA
be found on the OPD
biometrics area at
JICA OPD.
Vaccination is done
daily in the morning,
Monday to Fridays
except holidays

2. Patient shows up 2.Nurse let the none 10 minutes Nurse

on the scheduled date patient fill in the
of vaccination. signed health
Presents her yellow declaration form,
card to the nurse triages the patient
if asymptomatic
and endorse to
HIMD clerk for
registration and
chart retrieval
3.Patient’s waits for 3. Doctor calls the None 30 minutes Doctor
his/her name to be name of the
called by the doctor. patient and
verifies it with the
retrieved patient’s
chart.
3.1Patient is
asked pertinent
history like
allergies to
chicken and egg,
allergy to previous
vaccinations, any
contraindications,
co-morbidities and
other pertinent
medical history
and physical
examination.
Patient advised
for the possible
 development of
fever and slight
pain and possible
swelling at
injection site.

3.2Orders for
vaccination or not
(deferred) at the
chart

4.Patient proceeds to For those for None 30minutes Nurse

vaccination proper vaccination
4. Explain to the
patient the
procedure and
vaccine he/she
will receive.
4.1 Let the patient
sign the consent
form, fill in DOH
forms and sign
logbook
4.2 Prepare and
give the
medication
intramuscularly as
ordered in the
patient’s chart.
4.3 Instruct patient
to stay at the OPD
for 15 to 30min for
monitoring of
possible adverse
effects

5. Patient is 5.Gives discharge none 5 minutes Nurse

discharged from the slip
OPD

TOTAL: 1 hour and 25

minutes
Issuance of Medical Certificate to Physical Consult at PHS (Same Day
Consultation)
Availability of Service: 7:30 am to 3:00 pm, Monday to Friday, except Holidays.

Office/Division: Department of Family and Community Medicine

Classification: Simple
Type of Transaction: G2C
Who may avail: SPMC personnel
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Yellow Card HIMD
2. Patient’s Chart OPD Medical Record
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. After the 1 Doctor gives none 10 minutes HIMD or
consultation, patient medical certificate Medical Record
requests for a medical draft to PHS clerk
certificate to his dedicated HIMD
attending physician clerk for printing of
medical
certificate. Prints
two copies of
medical certificate
1.1 Gives to the
doctor the copies
of the medical
certificate
1.2Doctor signs
the medical
certificate
1.3Indicates the
number of days of
rest
1.4 Indicates if
patient is fit to
work/ return to
work

2. Patient waits for 2.Returns to the none 10 minutes HIMD clerk

his/her medical patient the signed
certificate medical certificate
2.1 Instruct patient
to proceed to
WINDOW 12
3. Return to window 5. Seals the none 20 minutes HIMD clerk
12 of Medical Records medical certificate
TOTAL: 40 minutes
PHS OPD Consultation for Scheduled Appointment
Availability of Service: 7:00 am to 3:00 pm, Monday to Friday, except Holidays.

Office/Division: Department of Family and Community Medicine

Classification: Simple
Type of Transaction:
G2C
Who may avail: SPMC personnel with scheduled appointment from Family Medicine
Doctor
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Yellow Card HIMD
2. Patient’s Chart PHS OPD Medical Record
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE
1. Patient from 1. Calls patient for None 1 hour DFCM Nurse
triage/screening area vital signs taking and Nurse
goes to PHS Family and Yellow card is Attendant
Medicine waiting area returned to patient
1.2 Instructs
patient to wait for
consultation
2. Consultation 2. Takes Medical None Total time of Family and
History consultation: Community
2.1 Performs 40min Medicine Doctor
physical (Medical Officer
examination III/IV, Medical
2.2 Interpret Specialist II/III)
available
laboratory and
diagnostic results
2.3 Request of
necessary
laboratory and
diagnostic work-
up as needed
2.4 Referral to
other departments
for further
evaluation, co-
management,
and/or transfer of
service as needed
3. Discharge 3. Gives None 20 minutes Family and
discharge Community
instruction Medicine Doctor
3.1 Issues (Medical Officer
medical certificate III/IV, Medical
Specialist II/III)
TOTAL: 2 hours
Health Insurance Medical Evaluation Section (HIMES)

Internal Services
1. Evaluation of PHIC Charts – HIMES Main
Evaluation of patient’s chart with PHIC.
Availability of Service: 8:00 am to 5:00 pm, Monday to Sundays.

Office/Division: Health Insurance Medical Evaluation Section – Main

Classification: Simple
Type of Transaction: G2G
Who may avail: 1. SPMC Departments
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patient Health Record with PHIC slip Ward Units
2. Patient Health Record with routing slip Ward Units

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Present Patient 1. Registers None 10 minutes Administrative
Health Record name/s of Patient Officer I
schedule for billing. Health Record at HIMES
logbook.
2. Evaluation of 2.1.a Checks None 5 minutes Administrative
Patient Health Record complete entries Officer I
on all required HIMES
clinical
attachments Administrative
2.1.b Evaluate None 5minutes Officer I
CF4/CF3. HIMES

2.1.c attaches None 5 minutes Administrative

routing slips as Officer I
needed. HIMES
2.2a Codes the None 5 minutes Medical Officer
final diagnosis IV
with ICD-10 and HIMES
PHIC ICD
modifications
2.2b Evaluates None 3 minutes Medical Officer
patient’s case and IV
final diagnosis for HIMES
assignment of first
and second case
rate.
2.2c Determines None 2 minutes Medical Officer
clinical IV
attachments HIMES
required by PHIC
2.2d Attach None 1 minute Medical Officer
routing slips as IV
needed. HIMES
3. Endorse and None 10 minutes Administrative
counter sign to Officer I
billing received HIMES
Patient Health
Record cover
sheets with
attachments at
logbook.
4. Receives Patient 4.a Counter signs None 10 minutes Administrative
Health Record from received Patient Officer I
HIMES. Health Record. HIMES
 4.b Instructs ward
assistants to
endorse charts to
composite team
after
bill/discharge.
TOTAL: None 56 minutes

2. Evaluation of PHIC Charts – HIMES IWNH

Evaluation of patient’s chart with PHIC.
Availability of Service: 8:00 am to 5:00 pm, Monday to Sundays.

Office/Division: Health Insurance Medical Evaluation Section – IWNH

Classification: Simple
Type of Transaction: G2G
Who may avail: 1. SPMC Departments
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patient Health Record with PHIC slip Ward Units
2. Patient Health Record with routing slip Ward Units

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Present Patient 1. Registers None 10 minutes Administrative
Health Record/s name/s of Patient Officer I
schedule for billing. Health Record at HIMES
logbook.
2. Evaluation of 2.1.a Checks None 5 minutes Administrative
Patient Health complete entries Officer I
Record/s on all required HIMES
clinical
attachments Administrative
2.1.b Evaluate 5minutes Officer I
CF4/CF3. HIMES

2.1.c attaches 5 minutes Administrative

routing slips as Officer I
needed. HIMES
2.2a Codes the 5 minutes Medical Officer
final diagnosis IV
with ICD-10 and HIMES
PHIC ICD
modifications
2.2b Evaluates 3 minutes Medical Officer
patient’s case and IV
final diagnosis for HIMES
assignment of first
and second case
rate.
2.2c Determines 2 minutes Medical Officer
clinical IV
attachments HIMES
required by PHIC
2.2d Attach 1 minute Medical Officer
routing slips as IV
needed. HIMES

3. Endorse and None 10 minutes Administrative

counter sign to Officer I
billing received HIMES
Patient Health
Record cover
sheets with
attachments at
logbook.
 3. Receives patient’s 3.a Counter signs None 10 minutes Administrative
charts from HIMES. received charts. Officer I
3.b Instructs ward HIMES
assistants to
endorse charts to
composite team
after
bill/discharge.
TOTAL: None 56 minutes

3. Evaluation of PHIC Charts – HIMES ASU

Evaluation of patient’s chart with PHIC.
Availability of Service: 9:00 am to 5:00 pm, Monday to Sundays.

Office/Division: Health Insurance Medical Evaluation Section – ASU

Classification: Simple
Type of Transaction: G2G
Who may avail: 1. SPMC Departments
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patient Health Record with PHIC slip ASU
2. Patient Health Record with routing slip ASU

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Present Patient 1. Registers None 1 minute Medical Officer
Health Record for name/s of patient IV
billing. health record HIMES
using MS Access
Database.
2. Evaluation of 2.1a Evaluate None 4 minutes Medical Officer
Patient Health CF4. IV
Record. 2.1b Attaches None 1 minute HIMES
routing slips as
needed.

2.2 Check None 1 minute Medical Officer

correctness of IV
entries in clinical HIMES
attachments

2.3a Codes the None 1 minute Medical Officer

final diagnosis IV
with ICD-10 and HIMES
PHIC ICD
modifications
2.3b Evaluates None 1 minute
patient’s case and
final diagnosis for
assignment of first
and second case
rate.

3. Record and None 1 minute Medical Officer

returns evaluated IV
patient record to HIMES
biller.

TOTAL: None 10 minutes

4. Evaluation of PHIC-Covid 19 Cases
Evaluation of patient’s chart with PHIC.
Availability of Service: 8:00 am to 5:00 pm, Monday to Sundays.

Office/Division: Health Insurance Medical Evaluation Section – Main

Classification: Simple
Type of Transaction: G2G
Who may avail: 1. SPMC Departments
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patient Health Record with PHIC slip Ward Units
2. Patient Health Record with routing slip Ward Units

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Present Electronic 1. Registers None 5 minutes Administrative
Health Record of name/s of Patient Officer I
patient scheduled for Health Record at HIMES
billing. logbook.
2. Evaluation of 2.1.a Checks None 5 minutes Administrative
Electronic Health complete entries Officer I
Record on all required HIMES
clinical
attachments thru
phone call
interview.
2.1.b Evaluate None 5minutes Administrative
final diagnosis on Officer I
CF4. HIMES

2.2a Codes the None 5 minutes HIMES

final diagnosis Medical Officer
with ICD-10 and IV
PHIC ICD HIMES
modifications
2.2b Evaluates None 3 minutes
patient’s case and Medical Officer
final diagnosis for IV
assignment of first HIMES
and second case
rate.
2.2c Determines None 2 minutes
clinical Medical Officer
attachments IV
required by PHIC HIMES

3. Endorse and None 10 minutes Medical Officer

counter sign to IV
billing received HIMES
Patient Health Administrative
Record cover Officer I
sheets with HIMES
attachments at
logbook.
 TOTAL: None 35 minutes

Operating Room Nursing Services

Internal Services
1. Submission of Request for Surgery
Availability of Service: Daily, 24 hours a day.

Office/Division: Nursing – Main Operating Room

Classification: Simple
Type of Transaction: G2G
Who may avail: 1. Nursing Staff with admitted patient with a surgical plan
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Request for Surgery Nurse on Duty (from Resident in Charge)
2. Informed Consent and Clearances, for Nurse on Duty (from Resident in Charge)
elective surgery
3. Accounting Clearance, for Pay elective Nurse on Duty (from Billing Department)
surgery
FEES TO PROCESS PERSON
CLIENT STEPS AGENCY ACTION
BE PAID ING TIME RESPONSIBLE
1. Present the 1. Verify None 5 minutes Charge Nurse
Request for Surgery completeness of the (Perioperative
to the OR Charge Request for Surgery Nurse if
Nurse (Perioperative (and attachments, if elective)
Nurse if elective elective surgery).
surgery).
1.1 Receive the None 3 minutes Charge Nurse
request form by (Perioperative
indicating name, Nurse if
signature, with date elective)
and time of receipt.
2. Retrieve the signed 2. Return a copy of None 10 minutes Charge Nurse
Request for Surgery. the Request for (Perioperative
Surgery to the ward Nurse if
nursing staff. elective)

2.1 Retain and file a None 3 minutes Charge Nurse

copy of the Request (Perioperative
for Surgery. Nurse if
elective)

2.2 Document the None 3 minutes Charge Nurse

information in the OR (Perioperative
logbook. Nurse if
elective)
TOTAL: None 30
minutes
2. Processing of Death Records
Availability of Service: Daily, 24 hours a day.

Office/Division: Nursing – Main Operating Room

Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: 1. Hospital Staff involved in the care of the expired patient
2. Family/Claimant
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Identification Card and one photocopy of ID Family/Claimant
card
2. Death Certificate (4 copies) Resident in Charge
3. HIMES Routing Slip Health Insurance and Medical Evaluation
Section (HIMES)
4. Temporary Bill Billing Department
FEES TO PROCESS PERSON
CLIENT STEPS AGENCY ACTION
BE PAID ING TIME RESPONSIBLE
1. Process the 1. Prepare the None 5 minutes Perioperative
Cadaver Clearance Record of Department
Slip. Death/Cadaver Head / Staff
Clearance Slip. Nurse

1.1 Physician-in- None 20 minutes Physician-in-

Charge and Nurse on Charge and
Duty sign the slip. Staff Nurse

1.2 Verify and retrieve None 5 minutes Staff Nurse

a photocopy of the ID
card of the claimant.
1.3 Instruct claimant None 5 minutes Staff Nurse
to proceed to the
Pathology
Department.
1.4 Release the None 5 minutes Staff Nurse
Cadaver Clearance
Slip to the claimant.
2. Process the death 2. Complete the None 1 hour Physician-in-
records of the expired Clinical Cover Sheet Charge
patient. documentation.
2.1 Prepare 4 copies None 1 hour Physician-in-
of the Certificate of Charge
Death.
2.2 Accomplish the None 3 hours Physician-in-
Doctor’s Dashboard Charge
and/or CF4
Dashboard.
2.3 Review and None 1 hour Staff Nurse
complete the nursing
documentation of the
surgical block.
None 30 minutes
2.4 Submit the Staff Nurse/
completed patient Nursing
health record to the Attendant
HIMES for evaluation. None 30 minutes
2.5 Submit the patient Staff Nurse/
health record to the Nursing
Health Information Attendant
Management
Department (HIMD)
once the temporary
bill is available.
7 hours,
TOTAL: None 40
minutes

Housekeeping

Internal Services
1. Request for Supplies and Materials
Submission of requests for housekeeping supplies and materials.
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays

Office/Division: Housekeeping
Classification: Simple
Type of Transaction: G2G
Who may avail: All SPMC Departments/Wards/Offices/Sections
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Request slip Housekeeping Section
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present request 1. Verifies request None 5 minutes Administrative
slip. and checks Assistant I
availability of Housekeeping
requested
supplies/
materials.
1.1 Prepares 30 minutes Storekeeper/
Materials Office staff
Housekeeping
2. Receives supplies/ 2. Releases None 5 minutes Storekeeper/
materials. requested Office staff
supplies/ Housekeeping
materials.
TOTAL: None 40 minutes
2. Request for Emergency General Cleaning
Submission of requests for emergency general cleaning.
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays

Office/Division: Housekeeping
Classification: Simple
Type of Transaction: G2G
Who may avail: All SPMC Departments/Wards/Offices/Sections
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Request slip, or Housekeeping Section
2. Letter of request Requesting office
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present request slip 1. Verifies request None 5 minutes Administrative
or letter of request. and checks Assistant I
availability of Housekeeping
manpower.
1.1 Schedules
general cleaning.
TOTAL: None 5 minutes
 Security

External Services
1. Request for CCTV Footage Viewing and Copy
Viewing of CCTV footage and filing of request for CCTV footage copy.
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays

Office/Division: Security Section

Classification: Simple
Type of Transaction: G2C, G2G
1. Watchers, Patients, Visitors
Who may avail: 2. SPMC Personnel
3. Other government agencies
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. None
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Proceed to CCTV 1. Ask client to None 5 minutes CCTV Operator
Office to request for sign in the visitors’ Security
viewing of footage. logbook. Section
1.1 Interview 10 minutes
client about the
details of the
incident.
1.2 Review 3 hours
footage together
with the client.
1.3 Advice client 3 minutes
to client to report
the incident to the
police station and
secure a police
blotter as needed.
Optional, if copy of 2. Provides None 3 minutes CCTV Operator
CCTV footage is request form and Security
needed: instructs client to Section
2. Files for request for attach Police
CCTV footage copy.
blotter to request
form, upon
completion, and to
submit it to Chief
Admin Office.
TOTAL: None 3 hours and
21 minutes
2. Release of Requested Copy of CCTV Footage
CCTV footage reviewing and releasing.
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Security Section

Classification: Simple
Type of Transaction: G2C, G2G
1. Watchers, Patients, Visitors
Who may avail: 2. SPMC Personnel
3. Other government agencies
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Filled up Footage request form Security Section
2. Police Blotter Police Station
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submits Footage 1. Receives None 1 day Admin Staff
Request form with request form and CAO Office
attached Police advises client to
Blotter to Chief Admin return after on the
Officer. following working
day.
1.1 Approves Chief Admin.
request and Officer
attaches CAO Office
signature.
2. Submits approved 2. Checks form None 30 minutes CCTV Operator
request form to CCTV then prepares and Head
Office. releases footage Security
Section
TOTAL: None 1 day, 30
minutes
3. Issuance of Watcher’s ID
Releasing of Watcher’s ID to watchers of admitted patients.
Availability of Service: 24 hours a day, 7 days a week.

Office/Division: Security Section, Admin Division

Classification: Simple
Type of Transaction: G2C
Who may avail: Admitted Patient’s Watcher
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Referral Form Nurse Station
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Client present a 1. Records the None 5 minutes Guard on duty
referral form from patient’s details in Security
ward nurse station the logbook. Section
address to the guard 1.1 Issues 5 minutes
on duty. watcher’s ID to
client.
TOTAL: None 10 minutes
4. Replacement of Lost Watcher’s ID
Releasing of Watcher’s ID to watchers of admitted patients.
Availability of Service: 24 hours a day, 7 days a week.

Office/Division: Security Section, Admin Division

Classification: Simple
Type of Transaction: G2C
Who may avail: Admitted Patient’s Watcher
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Referral Form Ward Nurse Station
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Receives referral 1. Records None 5 minutes Guard on duty
form issued from the patient’s and Security
nurse on duty. watcher’s details Section
in the logbook
1.1 Issues charge 5 minutes
slip and instructs
client to pay for
the lost ID to the
Cashier.
2. Pays for the lost 2. Receives Php 50.00 10 minutes Cashier on Duty
watcher’s ID at the payment and Cashier
Cashier. issues an official
receipt.
3. Submits official 3. Checks receipt None 10 minutes Guard on duty
receipt to Guard on then issues Security
duty. replacement Section
watcher’s ID.
TOTAL: Php 50.00 30 minutes
5. Incident Investigation
Investigation of any untoward incident.
Availability of Service: 8:00am to 5:00pm Monday to Friday.

Office/Division: Security Section

Classification: Complex
Type of Transaction: G2C, G2G
Who may avail: 1. Watchers, Patients, Visitors, Clients
2. SPMC Personnel/Offices
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Present any of the following:
Memorandum/order Admin Office
Letter request for investigation Requesting Person or unit
Verbal request or complaint Victim/complainant
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Forward 1. Record and None 30 Minutes Security Officer
Memo/Investigation verify reported Security
request or verbal untoward incident. Section
instruction address to
security section and
state the details of the
untoward incident.
2.Give 2. Conduct ocular None 2 days Security Officer
statements/details or inspection and Security
Facts of the incident. proper Section
investigation with Police
2.1 Interview Investigator
persons involved:
Complainant,
suspect or
witnesses if
available.
2.2 Gather
Evidences.
2.3 Evaluate None 5 days Security Officer
evidences based Security
on the generated Section
facts and finding with Police
with Investigator
corresponding
recommendation/s
2.4 Submit
Investigation (IR)
 to Chief Admin for
proper disposition.
TOTAL: None 7 days,30
minutes

6. Screening and Interview of Private Security Guard Applicants

Screening and interview of Private Security guard applicants.
Availability of Service: 8:00am to 5:00pm Monday to Friday.

Office/Division: Security Section

Classification: Simple
Type of Transaction: G2C,G2B
Who may avail: Agency security guard applicant
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Referral/Duty Detailed Order Security Agency
2. Complete 201 File;
Complete Resume / BIODATA Security personnel
National/local clearances NBI, Police Barangay
Security guard’s License to exercise PNP-SOSIA
Profession / Provisional permit
SBR / OP Landbank of the Philippines (LBP)
Neuro psychiatric and Drug test result PNP Accredited Neuro and Drug testing Center
Training Certificate PNP Accredited Security guards training center
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit all required 1. Verify None 30 minutes Administrative
documents. completeness of Officer/Security
documents Officer
submitted.
2. Undergoes 2. Interview on None 1 hour Administrative
interview. basic security Officer/Security
training and other Officer
relevant
information.

If applicant
passed the
interview:
2.1 Provide
schedule for
orientation
pertaining to
Hospital security
policy.
TOTAL: None 1 hour, 30
minutes
7. Orientation and OJT of Private Security Guard Applicants
Orientation and OJT for Private Security guard applicants.
Availability of Service: 8:00am to 5:00pm Monday to Friday.

Office/Division: Security Section

Classification: Simple
Type of Transaction: G2C,G2B
Who may avail: Agency security guard applicant
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Must have undergone the initial screening Personal
and interview by SPMC Security Office
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Proceeds to 1. Conduct None 1 day Administrative
Security Office for orientation of Officer/Security
orientation. basic security Officer
guard’s duties
responsibilities
and hospital
security policy.
2. Undergoes On- 2. Supervises None 1 day Administrative
The-Job Training applicant’s OJT Officer/Security
anvaluation. and assesses and Officer
evaluates his/her
capability and
knowledge on
basic duties and
responsibilities.

If applicant
passed the OJT:
4.1 Deploys guard
to his/her area of
assignment.
TOTAL: None 2 days
8. Issuance of PPE’S to All Security Guards
Secure the PPE’s of all guards on duty assigned/posted at identified covid areas
Availability of Service: 24 hours a day Monday to sunday

Office/Division: Security Section

Classification: Simple
Type of Transaction: G2C
Who may avail: Agency security guard
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Physical Appearance of security guards CCTV/SECURITY OFFICE
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Proceed to Security 1. Issues PPE None 5 minute CCTV Operator
Office to ask for PPE. then logs the
issuance on the
inventory sheet.
TOTAL: None 5 minutes
 Special Care Areas

HIV-AIDS Care Team (HACT) CLINIC

External Services
1. HIV Counseling and Testing for Outpatients
Due to ongoing Covid-19 situation, these services are for special cases only. The clients that will be
catered for HIV Screening are the following:
a. Partner of infected client
b. Children of infected Mother
c. Client for Confirmatory Test
Availability of Service: 8:00 am to 4:00 pm, Monday to Friday, except Holidays

Office/Division: HIV / AIDS Core Team (HACT)

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Out-patient
2. Walk-in patient and referred patient from other hospitals/clinics)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Identification Card (ID) Patient
2. Information sheet, filled out, for new Admin Aide I (Clerk)
clients
3. Yellow Card HIMD
4. Referral form Doctor
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Presents yellow 1. Verifies and None 5 minutes Clerk
card, referral form and encode client’s HACT
client’s information information.
sheet. 1.1 Instructs None 10 minutes Clerk
patient to wait to HACT
be called by the
counselor.
2. Undergoes Pre- 2. Provides None 15 minutes Counselor
testing and lecture on HACT
Counseling. HIV/AIDS.
2.1 Conducts None 20 minutes Counselor
counseling and HACT
assessment.
2.2 Provides None 5 minutes Counselor
schedule of the HACT
release of results.
3. Undergoes blood 3. Prepares None 15 minutes MedTech
extraction. materials and HACT
 prepare the
patient for blood
extraction
3.1 receives the None 5 minutes MedTech
laboratory request HACT
forms.
3.2 Verifies the
names of the None 5 minutes MedTech
patient. HACT
3.3. Goes to the
assigned wards of None 15 minutes MedTech
the patients HACT

4. Undergo Post Test 4. Explains the None 15 minutes Counselor

and Counseling result of HIV HACT
screening and
emphasize the
importance of the
test
4.1 Assesses the None 15 minutes Counselor
understanding of HACT
the client about
HIV test.
None 1 hour and 40
TOTAL: minutes

2. HIV Counseling and Testing for Admitted Patients

Availability of Service: 8:00 am to 3:00 pm, Monday to Friday, except Holidays

Office/Division: HIV / AIDS Core Team (HACT)

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. In-patient
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Referral form Doctor
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Undergoes pre- 1. Provides None 15 minutes Counselor
testing and counseling lecture on HACT
through phone call HIV/AIDS.
2.1 Conducts None 20 minutes Counselor
counseling and HACT
assessment.
2.2 Provides None 5 minutes Counselor
schedule of the HACT
release of results.
2. Undergoes blood 3. Prepares None 10 minutes MedTech
extraction. materials and HACT
prepare the
patient for blood
extraction
3.1 receives the None 5 minutes MedTech
laboratory request HACT
forms.
3.2 Verifies the None 5 minutes MedTech
names of the HACT
patient
3.3 Goes to the None 20 minutes MedTech
assigned wards of HACT
the patients
3. Awaiting for the HIV 2. Provides HIV None 5 minutes Resident on
result result Duty
HACT
 2.1 Explains the None 15 minutes Resident on
result of HIV Duty
screening and HACT
emphasize the
importance of the
test
None 1 hour and 40
TOTAL: minutes

3. HACT Consultation
Due to Covid-19 situation the clinic will only cater 15 patients a day for consultation. The criteria
for consultation are the following:
a. Newly diagnosed
b. Lost to follow-up
c. Have major complaints
d. Follow-up check up for discharged patients
Availability of Service: Monday to Friday 10:00 – 12:00 am (except holidays)

Office/Division: HIV / AIDS Core Team (HACT)

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients (out-patient, referred patient and walk-in patient)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Yellow Card HIMD
2. Referral form Doctor
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Presents yellow 1. Verifies None 5 minutes Clerk
card and referral form. patient’s record HACT
and retrieves
chart.
1.2 Checks the None 5 minutes Clerk
Philhealth HACT
eligibility
1.3 Instructs None 10 minutes Clerk
patient to wait to HACT
be called by the
doctor.
2. Clients undergo 2. Assesses the None 20 minutes Dietitian
Nutritional nutritional status HACT
Assessment of client which
includes:
Anthropometric
(DBW & BMI),
Biochemical (Lab
 results) and
Dietary
assessment.
2.1 Conducts diet None 20 minutes Dietitian
counseling and HACT
provision of take
home meal plan.
3. Undergoes 2. Explains None 35 minutes Junior
consultation. current health Consultant
status and Doctor
reminds treatment HACT
adherence.
2.1 Prescribes None 5 minutes Junior
medicines and Consultant
make laboratory Doctor
request. HACT
2.2 Refers to sub- None 5 minutes Junior
specialty clinic if Consultant
warranted. Doctor
HACT
3. Proceeds to nurse 3. Provides health None 20 minutes Nurse
for further instructions. teaching and HACT
treatment
adherence.
3.1 Gives None 5 minutes Nurse
instructions for HACT
procedures of
referrals and
laboratory
requests.
3.2 validate the None 10 minutes Nurse
prescriptions to HACT
the chart
3.3 updates None 10 minutes Nurse
medication sheet HACT
and nurses notes
4. Proceeds to 4. Receives form None 5 minutes Pharmacist
Dispensing room BC and HACT
prescriptions
4.1 Assesses None 5 minutes Pharmacist
client’s knowledge HACT
about his/her
regimen.
4.2 Assist client in None 5 minutes Pharmacist
signifying HRN HACT
number on the
Logbook.
4.3 Adherence None 30 minutes Case
Counseling. Manager/Nurse
HACT
None 3 hours and
TOTAL: 15 minutes
4 Tele-Consultation
Tele-consultation process for HACT patients. (09555145191/09325601960/0823217061)
Availability of Service: Monday to Friday 09:00 – 03:00 pm (except holidays)

Office/Division: HIV / AIDS Core Team (HACT)

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Yellow Card of patient HIMD/Patient
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Provide yellow card 1. Verifies None 20 minutes Clerk
number through call patient’s record HACT
or text. and retrieves
chart.
2. Clients undergo 2. Asks patients None 20 minutes Junior
Tele-consultation what are the Consultant
health concerns Doctor
HACT
2.1 Explains None 10 minutes Junior
current health Consultant
status and Doctor
reminds treatment HACT
adherence.
2.1 Prescribes None 10 minutes Junior
medicines and Consultant
make laboratory Doctor
request through HACT
messenger
2.2 Refers to sub- None 10 minutes Junior
specialty clinic if Consultant
warranted (referral Doctor
is through HACT
messenger)
 None 1 hour and 10
TOTAL: minutes

5. Dispensing of Medicine
Dispensing of medicine to HACT enrolled patients.
Due to covid-19 situation, patients who don’t need consultation can have ARV medicine without
prescriptions (as per advised).
Availability of Service: Monday to Friday - 8:00 am to 4 pm, except holidays

Office/Division: HIV / AIDS Core Team (HACT)

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients (out-patient, referred patient and walk-in patient)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Yellow Card HIMD
2. Prescription Doctor
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Presents yellow 1. Verifies None 5 minutes Clerk
card and prescription. patient’s record HACT
and retrieved
chart.
1.2 Checks the None 5 minutes Clerk
Philhealth HACT
eligibility.
1.3 Instructs None 5 minutes Clerk
patient to wait to HACT
be called by the
nurse.
2. Proceeds to nurse 2. Validates the None 35 minutes Doctor
station when called. prescription from HACT
the chart.
2.1 Monitors the None 5 minutes Doctor
treatment HACT
adherence.
2.2 Updates the None 5 minutes Doctor
medication sheet HACT
and nurses notes.
3. Proceeds to 3. Receives form None 5 minutes Pharmacist/
dispensing room. BC and Case
prescriptions Manager/Nurse
HACT
3.1 Assist client in None 5 minutes Pharmacist/
signifying HRN Case
number on the Manager/Nurse
Logbook HACT
3.2 Monitors None 10 minutes Pharmacist/
adherence Case
checklist and Manager/Nurse
explains the HACT
dosage of
medicines given.
3.3 Emphasizes None 5 minutes Pharmacist/
the benefits of Case
antiretroviral drug Manager/Nurse
in the body. HACT
4. Clients receives 4. Review client’s None 5 minutes Case Manager/
adherence counseling understanding of Nurse
(new patients & lost to HIV/AIDS HACT
follow-up) 4.1 Assesses the None 10 minutes Case Manager/
barriers to Nurse
adherence in HACT
taking
antiretroviral
4.2 Provides None 10 minutes Case Manager/
coaching styles Nurse
and techniques in HACT
taking
antiretroviral drug
4.1. Conducts None 10 minutes Case Manager/
adherence Nurse
counseling. HACT
TOTAL: None 2 hours
6. Fulfillment of Laboratory Requests
Blood extraction for laboratory tests of HACT patients.
Availability of Service: 8:00 am to 10:am, Monday to Friday, except Holidays

Office/Division: HIV / AIDS Core Team (HACT)

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Clients (Out-patient, In-patient , Walk-in patient and referred
patient from other hospitals/clinics)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Identification Card Patient
2. Information sheet (new client) Admin Aide I (Clerk)
3. Yellow Card HIMD
4. Referral form Doctor
CLIENT STEPS AGENCY FEES TO BE PROCESSIN PERSON
ACTION PAID G TIME RESPONSIBLE
1. Presents yellow 1. Verifies and None 5 minutes Administrative
card, referral form and encode client’s Aide I
client’s information information. HACT
sheet 1.2 Check the None 10 minutes Administrative
philhealth Aide I
eligibility. HACT
1.3 Instructs None 10 minutes Administrative
patient to wait to Aide I
be called by the HACT
nurse.
2. Proceeds to Nurse 2. Validates the None 5 minutes Nurse
Station when called. request laboratory HACT
to the chart.
2.1 Checks the None 5 minutes Nurse
qualification of the HACT
patient for
laboratories.
None 5 minutes Nurse
 2.3 Make a HACT
laboratory
request. None 5 minutes Nurse
2.4 Prepares HACT
documents for
laboratories. None 15 minutes Nurse
2.5 Explains the HACT
importance of
monitoring of their
laboratories and
the effectiveness
of the
antiretroviral drug
to their immune
system.
3. Proceeds to blood 3. Prepares None 10 minutes MedTech
extraction room materials and HACT
prepare the
patient for blood
extraction
3.1 Receives the None 10 minutes MedTech
laboratory request HACT
forms and verifies
the name of the
patient.
4. For Medical 4. Gets the Refer to 20 minutes Social Worker
Assistance (patient’s pertinent approved HACT
seeking assistance). information and scheduled of
assesses the fees (fees
financial capacity may vary
of the patient. according to
4.1 Provides their 10 minutes Social Worker
discounts and free classification) HACT
of charges.
4.2 Provides 5 minutes Social Worker
referrals to PAD HACT
and Lingap for
further assistance.
Refer to 1 Hour and
TOTAL: approved 45 minutes
scheduled of
fees (fees
may vary
according to
their
classificatio
n)

LABORATORY SCHEDULE OF FEES

LABORATORIES FEES
CD4 2,200.00
VIRAL LOAD 7,700.00
ANTI-HBS 500.00
ANTI-HCV 1,000.00
HBSAG (Qualitative) 220.00
SYPHILIS 180.00
FASTING BLOOD SUGAR 120.00
(FBS)
CREATININE 200.00
ALT(SGPT) 185.00
LIPID PROFILE 600.00
COMPLETE BLOOD COUNT 130.00
W/PLT
 Special Care Areas

Cardio-Pulmonary Services (CPS)

External Services
 1. ARTERIAL BLOOD GAS (ABG) EXTRACTION PROCEDURE
Availability of Service: 24/7
Office/Division: CARDIO-PULMONARY SERVICES/MEDICAL-ANCILLARY
Classification: Simple
Type of Transaction: G2C
Who may avail: 1. IN PATIENTS
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Request for ABG/Telephone Order Doctor

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
IN-PATIENT with CPS ABG Request Form
1. Submits ABG 1. Receives, ABG Fee 3 minutes CPS Clerk/
Request and waits as Verifies and (Refer to Respiratory
request is being verified charges ABG approved Therapist
procedure through schedule of
SEGHIS fees)
1.1 Instructs 2 minutes
watcher to wait at
their respective
room/ward

2. Waits at room/ward 2. Proceeds to ward None 1 hour Respiratory

for procedure to be and conducts Therapist
done procedure
1. 3. Receives ABG 2. 3.Receives and None 10 mins Respiratory
sample and submits to processes ABG Therapist
CPS sample
4. Receives ABG result 4. Releases ABG None 5 minutes Respiratory
result Therapist
TOTAL: Refer to 1 hour, 20
approved minutes
schedule of
fees
TELEPHONE ORDER
 ARTERIAL BLOOD GAS (ABG) PROCEDURE
ABG: SERVICE Patient with PHIC P 525.00
Classified Service Patient without PHIC P 130.00
1. Client is informed of 1. Receives ABG Fee 3 minutes CPS Clerk/
procedure to be telephone order (Refer to Respiratory
done from approved Therapist
ward/special schedule of
units fees)
1.2 Verifies and
charges ABG
procedure through
SEGHIS

2. Waits at room/ward 2. Proceeds to ward None 1 hour Respiratory

for procedure to be and conducts Therapist
done procedure
3.Receives service 3. Processes ABG None 5 minutes Respiratory
rendered sample at CPS unit Therapist
2.1 Relays ABG
Result To NOD 2 minutes Respiratory
2.2 Releases ABG Therapist
Result to Within 8 hrs
ward/special Respiratory
unit within the Therapist
shift
TOTAL: Refer to Within 8 hrs
approved
schedule of
fees

CARDIO-PULMONARY SERVICES Schedule of Fees

2. ARTERIAL BLOOD GAS (ABG) PROCESSING PROCEDURE
Availability of Service: 24/7
Office/Division: Cardio-Pulmonary Services
Classification: Simple
Type of Transaction: G2C
Who may avail: 1. IN PATIENT
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Request for ABG Doctor
4. ABG Sample Patient
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
IN-PATIENT: SERVICE Patient
1. Submits ABG 1. Receives ABG ABG Fee CPS Clerk/
Request and ABG request and ABG (Refer to Respiratory
sample to CPS sample approved Therapist
1.1 Verifies request schedule of
and charges ABG fees) 5 minutes
procedure through
SEGHIS
1.2 Instructs
watcher to wait for
the result

2. Waits for the result to 2. Processes ABG None 10 minutes Respiratory

be released sample Therapist
3. Receives ABG official 3.Releases ABG None 5 minutes Respiratory
result result Therapist
TOTAL: Refer to 20 minutes
approved
schedule of
fees

CARDIO-PULMONARY SERVICES Schedule of Fees

ARTERIAL BLOOD GAS (ABG) PROCEDURE

3. ABG: SERVICE Patient with PHIC P 525.00
Classified Service Patient without PHIC P 130.00
ELECTROCARDIOGRAM (ECG) PROCEDURE
Availability of Service: 24/7
Office/Division: CARDIO-PULMONARY SERVICES/MEDICAL-ANCILLARY
Classification: Complex
Type of Transaction: G2C
Who may avail: 1. ADMITTED PATIENTS
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Request for ECG/Telephone Order Doctor
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
IN-PATIENT with CPS Request Form
1. Submits ECG request 1. Receives, verifies ECG Fee 5 minutes CPS Clerk
and waits as request is and charges (Refer to
being verified request through approved
SEGHIS schedule of
1.1 Instructs fees)
watcher to wait at
their respective
room/ward
2. Waits at room/ward 2. Proceeds to ward None 2 hours Respiratory
for procedure to be and conducts ECG Therapist
done procedure
3. Receives Service 3. Transmits result None 15 minutes Respiratory
Rendered to Hospital Therapist
Information System
(For Digital ECG)/
Releases mounted
ECG strip (Manual
ECG)
ELECTROCARDIOGRAM (ECG) PROCEDURE
TOTAL: Refer to 2 Hours, 20
approved minutes
schedule of
fees
TELEPHONE ORDER:
2. Client is informed of 3. Receives ECG Fee 3 minutes CPS Clerk/
procedure to be done telephone order (Refer to Respiratory
from approved Therapist
ward/special schedule of
units fees)
1.2 Verifies and 2 minutes CPS Clerk/
charges ECG Respiratory
procedure through Therapist
SEGHIS

2. Waits at room/ward for 2. Proceeds to None 2 hours Respiratory

procedure to be done ward and conducts Therapist
procedure

3.Receives service 3. Transmits result None 15 minutes Respiratory

rendered to Hospital Therapist
Information System
(For Digital ECG)/
Releases mounted
ECG strip (Manual
ECG)

TOTAL: Refer to 2 Hours, 20

approved minutes
schedule of
fees

CARDIO-PULMONARY SERVICES- Schedule of Fees

ECG Procedure: SERVICE Ward P 320.00

4. MECHANICAL VENTILATOR TRANSPORT
Availability of Service: 24/7

Office/Division: CARDIO-PULMONARY SERVICES/MEDICAL - ANCILLARY

Classification: Complex
Type of Transaction: G2C
Who may avail: 1. Admitted Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Telephone Order Doctor
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
4. Client is informed of 1.Receives and None 3 minutes CPS Clerk/
procedure to be verifies telephone Respiratory
done order from Therapist
ward/special units

2. Waits at room/ward 2. RT on duty None 1 hour Respiratory

for procedure to be prepares transport Therapist
done ventilator and
proceeds to ward
3. Receives service 3. Explains to None 3 minutes Respiratory
rendered watcher/patient and Therapist
 hooks patient to
transport ventilator
3.1 Accompanies None 2 hours Respiratory
and assists in Therapist
transport of patient
for procedures
within and outside
the hospital

TOTAL: 3 hours and 6

minutes

5. SETTLEMENT OF VENTILATOR DAILY USAGE CHARGE

Availability of Service: 24/7
Office/Division: CARDIO-PULMONARY SERVICES/MEDICAL - ANCILLARY
Classification: Complex
Type of Transaction: G2C
Who may avail: 1. ADMITTED PATIENTS
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Ventilator Charge Slip CPS Unit
1. Official Receipt for paid ventilator usage/ Cashier
transmittal from PAD/LINGAP LINGAP office
PAD office
CLIENT STEPS AGENCY FEES TO BE PROCESSIN PERSON
ACTION PAID G TIME RESPONSIBLE
1. Proceeds to CPS and 1. Issues ventilator None 5 minutes CPS Clerk or RT
receives ventilator daily daily usage charge staff
usage charge slip slip
1.1 Instructs
watcher to settle
ventilator usage
charge through
cashier or ask
 assistance through
LINGAP or PAD
Office
2. Pays ventilator daily 2. Receives Ventilator 30 minutes Cashier
usage charge at the payment for Usage (Refer Personnel
cashier or processes ventilator daily to approved
charge slip for financial usage charge schedule of PAD/LINGAP
assistance at LINGAP 2.1 Processes fees) Personnel
or PAD office clients’ ventilator 24 hrs
daily usage charge
for LINGAP/PAD
office approval
3.Submits 3. Receives and none 3 minutes CPS Clerk/
paid/approved LINGAP, verifies Respiratory
PAD transmittal paid/approved Therapist
ventilator daily usage LINGAP, PAD
charge slip transmittal ventilator
daily usage charge
slip
OTAL: Refer to 24 Hours &
approved 38 minutes
schedule of
fees

CARDIO-PULMONARY SERVICES Schedule of Fees

MECHANICAL VENTILATOR DAILY USAGE
Ventilator Usage Pay Ward/Special Units: 1,500.00
Service Wards: 1,000.00

6. MECHANICAL VENTILATOR HOOKING PROCEDURE

Availability of Service: 24/7

Office/Division: CARDIO-PULMONARY SERVICES/MEDICAL - ANCILLARY

Classification: Complex
Type of Transaction: G2C
Who may avail: 1. ADMITTED PATIENTS
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Telephone Order & Ventilator Set-up Doctor
3. Ventilator Consumables Pharmacy
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
IN-PATIENT WITH PHIC
5. Client is informed of 1.Receives and Ventilator 3 minutes CPS Clerk/
procedure to be verifies telephone Usage Fee Respiratory
done order from (Refer to Therapist
ward/special units approved
a. Verifies patient schedule of
data and fees) CPS Clerk/
charges 2 minute
 Ventilator Respiratory
Usage and Therapist
consumables
through
SEGHIS
2. Waits at room/ward 2. RT on duty None 1 hour Respiratory
for procedure to be prepares ventilator Therapist
done for hooking and
transport at the
ward to perform the
procedure
3. Receives service 3. Explains to None 15 minutes RT Staff
rendered watcher/patient and
hooks patient to
mechanical
ventilator

TOTAL: Refer to 1 hour and 20

approved minutes
schedule of
fees
IN-PATIENT WITHOUT PHIC
1.Client is informed of 1.Receives and Ventilator 3 minutes CPS Clerk/
procedure to be done verifies telephone Usage Fee Respiratory
order from (Refer to Therapist
ward/special units approved
1.1Verifies patient schedule of 2 minutes
data through fees)
SEGHIS

2. Waits at room/ward 2. RT on duty None 1 hour Respiratory

for procedure to be prepares ventilator Therapist
done for hooking (using
buffer
consumables) and
transport at the
ward to perform the
procedure
3. Receives service 3. Explains to None 15 minutes Respiratory
rendered watcher/patient and Therapist
hooks patient to
mechanical
ventilator

2. Receives request for 2. Issues request Ventilator 5 minutes Respiratory

ventilator consumables for ventilator Circuit Fee Therapist
consumables and HME
2.1 Instructs (Refer to
watcher to secure approved
the items from schedule of
pharmacy and fees)
replace
consumables at
CPS
3. Proceeds to 3. Receives and Ventilator 45 minutes Pharmacist
pharmacy and submits encodes request Circuit Fee
request for ventilator 3.1 Releases and HME
consumables ventilator
consumables to
watcher
4. Submits ventilator 4. Receives None 3 minutes RT Staff
consumables to CPS ventilator
consumables

TOTAL: Refer to 2 Hours & 13

approved minutes
schedule of
fees
 CARDIO-PILMONARY SERVICES Schedule of Fees

MECHANICAL VENTILATOR HOOKING PROCEDURE

Ventilator Circuit 1,100.00
HME 400.00
Ventilator Usage Pay Ward/Special Units: 1,500.00
Service Wards: 1,000.00
 Special Care Areas

Peritoneal Dialysis Unit

External Services

1. APPLICATION FOR PD Z PACKAGE

Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Peritoneal Dialysis (PD) Unit - Nursing

Classification: SIMPLE
Type of Transaction: G2C
Who may avail: 1. All PD Patients who are PHIC eligible
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Member Data Record (MDR) Philippine Health Insurance Corporation (PHIC)
2. Confinement Journal Philippine Health Insurance Corporation (PHIC)
3. Proof of Contribution Philippine Health Insurance Corporation (PHIC)
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submits MDR, 1. Verifies PHIC None 5 minutes PD Z Nurse
Confinement Journal eligibility. Navigator
and proof of paid PD Unit office
contribution (must
 have 9 months of paid
contribution prior to
application).
2. Fills out CSF. 2. Provides form None 5 minutes PD Z Nurse
and assists Client Navigator
in filling out CSF. PD Unit office
3. Fills out the 3. Orients and None 30 minutes PD Z Nurse
following application assists patient in Navigator
requirements: filling out the PD Unit office
Philhealth Dialysis application
Database, Pre- requirements.
authorization Request 3.1. Instructs the
and Member client to proceed
Empowerment Form. to his
Nephrologist for
the necessary
signature in the
forms provided.
TOTAL: 40 minutes

2. PROCESSING OF PD Z PACKAGE BILL

Co-pay is determined according to the patient’s service category. It includes doctors professional
fee and the number of PD bags not covered by Philhealth.
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Peritoneal Dialysis (PD) Unit - Nursing

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. All Patients (Out-patient) with approved pre-authorization request
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. PD Z package statement of account PD Z Navigator
(SOA)
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Secures PD Z 1. Provides PD Z 10 minutes PD Z Nurse
package bill. Statement of Package Navigator
 Account (SOA) to Fees (Refer PD Unit office
the client which is to approved
obtained from the schedule of
RDU billing. fees)
(Note: SOA is pre-
billed 7 days prior
to the scheduled
releasing day.)
1.1 Instructs the PD Z Nurse
client to settle the Navigator
SOA to the PD Unit office
cashier or to seek
for medical
assistance.
TOTAL: Refer to 10 minutes
approved
schedule
of fees

PD Z Package Approved Schedule of Fees

PD Z package Co-pay
Private Case 1,755.00
House Case/ Service Patients 1,035.00
No Balance Billing (NBB) 0.00

3. CLAIMING OF PD SOLUTIONS
Mandatory services for all PD patients under PD First Z Benefits.
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Peritoneal Dialysis (PD) Unit - Nursing

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. All Patients (Out-patient) with approved pre-authorization request
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Tranche Requirement Checklist (Annex PD Nurse Navigator and Nephrologist
E- PD First)
2. Checklist of Services Provided (Annex PD Nurse Navigator and Nephrologist
C-PD First)
3. PD Z passport PD Nurse Navigator
4. PD Z package Statement of Account RDU Billing
(SOA)
5. Official Receipt for paid SOA Cashier
6. Proof of Life (for patient’s Client
representative)
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Proceed at RDU 1. Check the 15 minutes Nurse I/II
Triage for Health client’s body RDU Triage
Screening Procedure temperature and Nurse
let the client filled
up the Health
Declaration Form

2. Presents SOA with 2. Receives SOA, PD Z 15 minutes Administrative

OR or approved and verifies official package Aide III
medical assistance, receipt (OR) or Co-pay RDU Billing
and PD Z passport. approved medical (Refer to
assistance. approved
2.1 Submits Tranche 2.1 Instructs client schedule of 15 minutes PD Nurse Z
Requirement to sign in the fees) Navigator
Checklist (Annex E- releasing logbook PD Unit Office
PD First), and and in the PD Z
Checklist of Services passport (patient
Provided (Annex C- and unit’s copy).
PD First)

For patient’s For patient’s

representative only: representative
2.2 Presents proof of only:
life (patient’s picture 2.2 Verifies the 5 minutes PD Nurse Z
holding a newspaper patient’s proof of Navigator
with the current date life PD Unit Office
same as of the date of
claim). 2.3 Instructs the 5 minutes PD Nurse Z
client to proceed Navigator
to the pharmacy PD Unit Office
to claim for the PD
solutions.
TOTAL: Refer to 55 minutes
approved
schedule
of fees

PD Z Package Approved Schedule of Fees

PD Z package Co-pay
Private Case 1,755.00
House Case/ Service Patients 1,035.00
No Balance Billing (NBB) 0.00
4. CHANGE OF EXTENSION CATHETER
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Peritoneal Dialysis (PD) Unit - Nursing

Classification: SIMPLE
Type of Transaction: G2C
Who may avail: 1. All PD Patients under Z package
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Checklist of Services Provided (Annex PD Nurse Navigator
C- PD First)
2. Yellow Card From the patient / HIMD
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Presents Annex C 1. Verifies None 5 minutes PD Z Nurse
for request on change patient’s Navigator
of extension catheter information PD Unit Office
through Patient’s
files c/o PD unit.
2. Presents yellow 2. Assist the client None 5 minutes PD Z Nurse
card for the in procuring Navigator and
encounter. OPPCCCR for the Administrative
encounter. Officer V
HIMD-RDU

2.1 Assist the None 15 minutes PD Z Nurse

client in seeking Navigator and
prescription for Medical Officer
extension catheter IV
and instructs the Renal Dialysis
watcher to wait at Unit
the dialysis
waiting area while
the PD nurse
facilitates the
process.

2.2 Secures None 30 minutes PD Nurse Z

approval from the Navigator
Z benefits PD Unit Office,
coordinator and Administrative
claims the Officer V
extension catheter Main Billing and
from the Pharmacy
pharmacy.
3. Receives the 3. Performs the None 30 minutes PD Nurse
extension catheter procedure and PD Unit Office
change of
dressing.
TOTAL: 1 hour and 20
minutes
 Special Care Areas

Hemodialysis Unit

External Services

HEMODIALYSIS TREATMENT FOR IN-PATIENTS

Availability of Service: 24 hours

Office/Division: SPMC Dialysis Unit - Annex

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. In-patients from Wards and ICUs
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Settled Statement of Account (SOA) Dialysis Unit (DU) Billing Clerk
 CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Proceeds to 1.1 Processes None 5 minutes Dialysis Unit
Dialysis Unit – patient’s Billing Clerk
Main and asks for statement of
Statement of account
Account (SOA)/ bill 1.2 Issues SOA
from billing clerk. to client and
instructs client
to pay for the
bill, if without
PHIC.
2. for patients 2. Receives Refer to 2 minutes Cashier
WITHOUT PHIC: payment and approved
Pays for the bill issues official schedule of
receipt fees
3. Proceeds to 3. Receives None 2 minutes Dialysis Unit
Dialysis Unit – SOA and Charge Nurse
Annex and schedules
submits SOA and patient’s
official receipt hemodialysis
according to
urgency.
Instructs
clients to wait
for scheduled
dialysis,
based on
urgency.
4. On scheduled 4.1. Prepares None 4 to 8 hours, Dialysis
hemodialysis: machine and depending on Technician
Undergoes supplies to be Doctor’s order
hemodialysis used.

4.2. Notifies the Dialysis Unit

unit to Charge Nurse
transport
patients.

4.3. Takes initial Dialysis Nurse

vital signs.

4.4. Assesses the Dialysis Nurse

patient’s
access and
prepares
patient for
treatment.

4.5. Initiates Dialysis Nurse

hemodialysis
treatment.

4.6. Monitors Dialysis Nurse

patient’s
blood
pressure,
heart rate and
other data
reflected on
the machine.

4.7. Report any Dialysis Nurse

significant
findings to
 Resident-in-
charge
5. Follow nurses’ 5.1. Terminates None 1 hour Dialysis Nurse
discharged treatment
instructions then advises
patient to rest
for 15
minutes.

5.2. Monitors Dialysis Nurse

patient’s BP,
heart rate and
weight.

5.3. Provides Dialysis Nurse

discharge
instructions.

5.4. Notifies the Dialysis Nurse

unit to
transport back
the patient.
TOTAL: Refer to 5 hours & 9
approved mins – 9
schedule hours & 9
of fees mins

SPMC – DU Schedule of Fees (for In-Patient):

Non-PHIC Member PHIC Member

New Dialyzer (4hrs treatment) Php 3, 500.00 Charged to PHIC
New Dialyzer (6hrs treatment) Php 4, 160.00
Reuse Dialyzer (4hrs treatment) Php 2, 350.00
Reuse Dialyzer (6hrs treatment) Php 3, 010.00

OUT-PATIENT HEMODIALYSIS TREATMENT

Availability of Service: 5:00am – 2:00am the following day (21 hours); Monday to Saturday

Office/Division: Dialysis Unit – Main and Dialysis Unit - Annex

Classification: Simple
Type of Transaction: G2C
Who may avail: Enrolled out-patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Hemodialysis Charge Bill Dialysis Unit (DU) Billing Clerk
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present settled 1. Encode None 5 minutes Dialysis Unit
Hemodialysis Charge patient for Medical Record
Bill to DU Satellite hemodialysis Clerk
Medical Record treatment.
Section
2. Present settled 2. Verify None 5 minutes Dialysis Unit
Hemodialysis Charge approved Billing Clerk
Bill to DU Satellite hemodialysis
Billing Section charge bill.
3. Submit approved 3.1. Verify None 3 minutes Dialysis Nurse
Hemodialysis Charge approved
Bill to nurse station hemodialysis
charge bill
and schedule.

3.2. Instruct the

client to wait Dialysis Nurse
for the name
to be called
4. Undergo 4.1. Prepare the None 7 hours Dialysis
hemodialysis machine and Technician
treatment supplies to be
used.

4.2. Weigh Dialysis Nurse

patient before
dialysis.

4.3. Take the Dialysis Nurse

patient’s pre-
HD vital
signs.

4.4. Assess the Dialysis Nurse

patient’s
condition and
vascular
access.

4.4 Initiate Dialysis Nurse

hemodialysis
treatment.

4.5 Monitor Dialysis Nurse

patient’s
blood
pressure,
heart rate and
other
parameters
reflected on
the machine.

4.6 Report any Dialysis Nurse

significant
findings to
 Nephro Junior
Consultant.

4.7. Terminate Dialysis Nurse

hemodialysis
treatment.

4.8. Perform Dialysis Nurse

post-
hemodialysis
care and give
discharged
instruction.
5. Follow nurses’ 5.1. Weigh 5 minutes Dialysis Nurse
discharged patient post-
instructions dialysis

5.2. Discharged Dialysis Nurse

patient
TOTAL Refer to 7 hours 18
approved minutes
schedule
of fees

SPMC – DU Schedule of Fees (for In-Patient):

PHIC Member Non- PHIC Member

Once a week Dialysis PHP 695.00 First Hemodialysis treatment PHP 3,500.00
(New Dialyzer)
Twice a week Dialysis PHP 795.00 Succeeding Hemodialysis PHP 2, 350.00
treatment ( Reused Dialyzer)
Thrice a week Dialysis PHP 1,245.00

OUT-PATIENT HEMODIALYSIS TREATMENT ENROLLMENT

Availability of Service: 7:00am – 3:00pm (8 hours); Monday to Friday

Office/Division: Dialysis Unit – Main and Dialysis Unit - Annex

Classification: Simple
Type of Transaction: G2C
Who may avail: ESRD Patients for maintenance hemodialysis with intended slot
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Hemodialysis Referral Letter Attending Physician
Laboratory results: Laboratory where test was taken
- CBC, Blood Typing (at least 1 month)
- Serum Creatinine, Sodium, Calcium,
Potassium (at least 1 month)
- Hepatitis Profile : HbsAg, Anti-HCV,
Anti-Hbs (within 6 months)
- Ultrasound of the kidney (within 1
year)
- Chest X-Ray (within 1 year)
Clinical Summary Attending Physician
PHIC Requirement
SENIOR CITIZEN
- PDD Dialysis Unit Billing Clerk
- MDR- Latest Copy PHIC Office
- Updated certification of PHIC PHIC Office
availment
- Hospital bill (all hospital admission Hospital where patient was admitted
for the whole year)
- Confinement Journal PHIC Office
EMPLOYED
- PDD
Dialysis Unit Billing Clerk
- MDR- Latest Copy
PHIC Office
- Updated certification of PHIC
availment PHIC Office
- Hospital bill (all hospital admission Hospital where patient was admitted
for the whole year)
- Payment receipt from PHIC Employer/PHIC
/certificate of payment contribution
- Confinement Journal PHIC Office
SELF- EMPLOYED
- PDD Dialysis Unit Billing Clerk
- MDR- Latest Copy PHIC Office
- Updated certification of PHIC PHIC Office
availment Hospital where patient was admitted
- Hospital bill (all hospital admission
for the whole year) PHIC Office
- Payment receipt from PHIC
PHIC Office
- Confinement Journal

INDIGENT/SPONSORED/4Ps/POS
- PDD
- MDR- Latest Copy Dialysis Unit Billing Clerk
- Updated certification of PHIC PHIC Office
availment PHIC Office
- Hospital bill ( all hospital admission Hospital where patient was admitted
for the whole year)
- Certification- (POS/POC) Social Service
- Confinement Journal PHIC Office

CLIENT STEPS AGENCY FEES TO PROCESSI PERSON

ACTION BE PAID NG TIME RESPONSIBLE
1. Present 1.1. Check None 1 hour Dialysis Unit
hemodialysis schedule of and 30 Manager/ OIC
requirements to the patient for minutes
dialysis nurse dialysis.
 1.2. Review Dialysis Unit
requirements Manager/ OIC
for dialysis.

1.3. Orient on the Dialysis Unit

unit policies Manager/ OIC
and provide
health
teaching.
2. Present billing 2.1. Verify billing None 1 hour DU Billing Clerk
requirements to billing requirements.
clerk
2.2. Orient on DU Billing Clerk
billing policies.
Refer to 2 hours and
TOTAL: approved 30 minutes
schedule of
fees

SPMC – DU Schedule of Fees (for In-Patient):

Non-PHIC Member PHIC Member

New Dialyzer (4hrs treatment) Php 3, 500.00 Charged to PHIC
New Dialyzer (6hrs treatment) Php 4, 160.00
Reuse Dialyzer (4hrs treatment) Php 2, 350.00
Reuse Dialyzer (6hrs treatment) Php 3, 010.00
 Health Information Management Department

Admitting Section

External Services

Admission of Patient from Emergency Department

This service is intended for emergency room patients who are ordered admission by the consulting
doctor.
Availability of Service: 24 Hours, 7 Days, including Holidays.

Office/Division: HIMD-Admitting Section (Main)

Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: 1. Patients (Emergency Cases and Referrals), Parents of Patient,
Siblings, Legal Guardian, Authorized Representative
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Admission Slip Doctor
2. Consent for Admission Doctor

*If patient is for Charity/Service Ward

admission, may proceed to Step 1a.

*If patient is for PAY ADMISSION,

admission slip must have PAY stamp with
room number, name of consultant, either
HOUSECASE or PRIVATE, and signature
of BILLING PAYWARD CLERK, otherwise
redirect client to Payward Room
Reservation In-Charge for confirmation of
Room.

*If patient is classified as Covid-19

Suspect, Nurse on Duty from
corresponding ward must make a call for
admission and remote printing (refer to
client steps with ** )

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Present Admission 1. Check None 4 Minutes Client/Nurse/
Slip with Consent for completeness of Doctor
Admission. Admission Slip
(must contain Administrative
patient HRN, Office III
name, diagnosis, Admitting Clerk
name and
signature of
consulting doctor).

1.1 Instruct client

to fill out and sign
admission
consent.

** Calls admitting ** Asks NOD if **5 minutes **Nurse

section for registration patient is already Administrative
and admission of at the ward. Asks Office III
Covid 19 suspect. for information of Admitting Clerk
the patient for
checking of
record.

** Registers
patient under ER
consultation then
prints Clinical
Cover Sheet
remotely.
2. Fills out and signs 2. Receives None 8 minutes Client/Nurse/
admission consent consent and Doctor
then returns it to the check for
admitting clerk and accuracy and Administrative
waits for printing. completeness. Office III
 Admitting Clerk
2.1 Access patient
record in the HIS
and encodes
admission details
then save and
prints out Clinical
Cover Sheet.

** Provides admitting **Access patient **5 minutes **Nurse

diagnosis and record and Administrative
admitting doctor’s encodes Office III
name for admission admission details Admitting Clerk
then save and
prints out clinical
cover sheet
remotely.
3. Reviews the 3. Instructs client None 3 Minutes Client/Nurse/
demographic data to review the Doctor
appeared on the details. Affix their
clinical cover sheet. name and Administrative
signature on the Office III
lower left portion Admitting Clerk
of the clinical
cover sheet.

3.1 Attaches
Clinical Cover
Sheet and
Admission
Consent and
gives it back to
the client.

3.2Inform client
that the patient is
already admitted
then instruct client
to go to the
corresponding
area:
For
Charity/Service
Ward – Philhealth
Table 23 or Main
Billing Philhealth

For Pay
Admission–
Billing Payward.
TOTAL: None 15 Minutes
**10 Minutes

Admission of Well-babies with Late Onset Complications

Well-babies are babies who do not have any complications right after birth. These babies’ records
were created by the Birth Registration Unit. Some well-babies develop complications when they are
Roomed-In or after Room-In with the mother. This service is intended for admission of well-babies
who are ordered admission by the attending physician for late onset of complications.
Availability of Service: 24 Hours, 7 Days, including Holidays.

Office/Division: HIMD-Admitting Section (IWNH)

Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: Parents of the Newborn, Relative, Authorized Representative
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Newborn Clinical Cover Sheet Doctor
Admission Consent Doctor
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Presents Newborn 1. Receives None 5 minutes
Clinical Cover Sheet Newborn Clinical
with Admission Cover Sheet with
Consent. Admission
Consent. Instruct
client to fill out
admission
consent.
Administrative
1.1 Access patient 10 Minutes Officer III
record and Registration
encode admitting Clerk
diagnosis as
provided and
written at the
Newborn Clinical
Cover Sheet.

1.3 Prints out

Admission Clinical
Cover Sheet.

1.4 Instruct client

to write name and
signature at the
designated area.

1.5 Attach
Admission Clinical
Cover Sheet to
the Admission
Consent.

1.6 Gives
Admission Clinical
Cover Sheet with
Admission
Consent to client
and instruct client
to surrender it to
Ward NOD.
TOTAL: None 15 Minutes

Changing or Updating of Admitted Patient’s Personal Information

This service is intended for changing and/or updating of patient’s hospital record (Admitted Patients
only) whose information was erroneously provided and encoded in the system during registration.

Location: HIMD- Admitting Section(IWNH, Main)

Availability of Service: 24 Hours, 7 Days, including Holidays.

Office/Division: HIMD-Admitting Section (Main and IWNH)

Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: 1. Patients (Admitted patients both In-patient from ER and Direct
Admission), Parents of Patient, Siblings, Legal Guardian, Authorized
Representative
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Routing Slip for Correction Philhealth Table, Social Service

*No routing slip needed in cases where:

- request for update is from
Lingap/Malasakit
- the patient does not use PHIC but
requests for update of information
2.Birth Certificate Personal, Philippine Statistics Authority (PSA)
3.Marriage Certificate Personal, Philippine Statistics Authority (PSA),
National Commission on Muslim Filipinos (for
Muslim Marriage)
4. Valid ID’s
- Voter’s ID or Certificate Personal, Commission on Election (Comelec)
- SSS ID or Personal, SSS
- TIN ID Personal, Bureau of Internal Revenue (BIR)
- UMID Personal, GSIS, SSS
- PRC ID (Not Expired) Personal, PRC Office
- Driver’s License (Not Expired) Personal, LTO
- Passport (Not Expired) Personal, Department of Foreign Affairs (DFA)
- Company ID Personal, Company (if Employed)
- Senior ID Personal, Office of the Senior Citizen Affairs
(OSCA)
*for request to update patient’s address,
only VOTER’s ID/CERTIFICATE and/or
BILLING STATEMENT, whose name
appears on the bill, will be accepted*
5. Affidavit from Lawyer For Special Power of Attorney/ Notarized
Authorization Letter:
*This requirement may only be asked for in Legal Office, SPMC (ICU Bldg, Ground Floor)
cases where 2 different documents or IDs Public Attorney’s Office
were presented but does not match or Private Practice Lawyer’s Offices
coincide or if the patient does not have any
other documents to present (ex. Negative
birth certificate)*

**For patients who are admitted for the

first time, present at least 1 of the above-
mentioned requirements.

**For patients who have been

previously admitted, present at least 2 of
the above-mentioned requirements.

***The information to be updated must be

seen on the document or ID being
presented, otherwise legal intervention
shall apply***
6. Clinical Cover Sheet Doctor, Nurse Station, Admitting Section
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Informs clerk for 1. Asks for routing None 2 minutes
errors in patient slip for correction.
record and asks for 1.1Checks patient
requirements. status in the Administrative
system if patient is Officer III
still admitted in Admitting Clerk
the ward or if
records were
already forwarded
to HIMD (Medical
Records).
1.1.a In the event
that the patient
record is already
in the HIMD
(Medical
Records), instruct
client to continue
transaction at the
HIMD Window 6.

1.2 Ask for the

availability of the
requirements
listed above.
2. Provide 2. Checks None 3 minutes
requirements asked requirements and
by the clerk. record to identify
errors.
Administrative
2.1 Once error Officer III
has been cited, Admitting Clerk
instruct client to
secure (2) two
photocopies of the
document
presented.

3. Photocopies 3.1 Issues routing None 2 Minutes

document and slip for borrowing Administrative
borrows patient record of patient’s health Officer III
from Nurses’ Station. record from the Admitting Clerk
Nurses’ Station of
the ward where
the patient is
located.
4. Present 4. Receive None 7 minutes
photocopied documents and
documents and checks its Administrative
patient’s health record accuracy and Officer III
and wait for completeness. Admitting Clerk
instructions.
4.1 Update
patient’s
information in the
system and on the
Clinical Cover
Sheet then attach
1 of each
supporting
document
requested. Attach
routing slip from
PHIC to the other
copy of the
documents.
 4.2 Instructs client
to write their name
and affix their
signature on the
other copy of the
supporting
documents then
keep the copy.

4.3 Instructs client

to write their name
and affix their
signature on the
designated area
and countersigns
beside the
information being
corrected.
5. Sign documents 5. Informs client None 1 Minute
and waits for final that patient’s Administrative
instruction. information has Officer III
been updated and Admitting Clerk
instruct them to
return the
borrowed health
record to the
nurses’ station
and they can now
go back to Billing
PHIC for pending
transactions.
TOTAL: None 15 Minutes
Changing or Updating of Patient’s Classification from Charity/Service Ward to
Pay Ward, Pay Ward to Charity/Service Ward
This service is for changing of classification of accommodation of patients admitted from the
Charity/Service Ward to Pay Ward and from Pay Ward to Charity/Service ward.

Availability of Service: 24 Hours, 7 Days, including Holidays.

Office/Division: HIMD-Admitting Section (Main)

Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: 1. Patients (Emergency Cases and Direct Admissions), Parents of
Patient, Siblings, Legal Guardian, Authorized Representative
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Routing Slip Changing of Patient Billing Pay Ward (7am – 7pm only)
Classification ER Billing Section (7pm – 7am only)

*Routing Slip must specify name of patient

and Pay Room Number and signature of
Pay Clerk In-charge*
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present Routing 1. Receives None 10 Minutes
Slip from Billing and routing slip and
waits for instruction. checks
completeness.

1.1 Checks Administrative

patient record in Officer III
the data base for Admitting Clerk
confirmation of
current
accommodation.

1.2 Access patient

record and
change
classification and
accommodation
according to
specified room
assigned by Pay
Clerk In-charge.

1.3 Keeps routing

slip and instruct
client to go back
to Billing Payward
for further
instructions.
TOTAL: None 10 Minutes
Changing or Updating of Patient’s Personal Information at the Emergency
Department
This service is intended for changing and/or updating of patient’s hospital record, with records that
are still at the Emergency Complex, whose information was erroneously provided and encoded in
the system.

Availability of Service: 24 Hours, 7 Days, including Holidays.

Office/Division: HIMD-Admitting Section – Registration Area (Main)

Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: 1. Patients (Emergency Cases and Referrals), Parents of Patient,
Siblings, Legal Guardian, Authorized Representative
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Birth Certificate Personal, Philippine Statistics Authority (PSA)
2.Marriage Certificate Personal, Philippine Statistics Authority (PSA),
National Commission on Muslim Filipinos (for
Muslim Marriage)
3. Valid ID’s
- Voter’s ID Personal, Commission on Election (Comelec)
- SSS Personal, SSS
- TIN ID Personal, Bureau of Internal Revenue (BIR)
- UMID Personal, GSIS, SSS
- PRC ID (Not Expired) Personal, PRC Office
- Driver’s License (Not Expired) Personal, LTO
- Passport (Not Expired) Personal, Department of Foreign Affairs (DFA)
- Company ID Personal, Place of Employment (If employed)
- School ID (current school-year only) Personal, School
- Senior ID Personal, Office of the Senior Citizen Affairs
(OSCA)
*for request to update patient’s address,
only VOTER’s ID/CERTIFICATE and/or
BILLING STATEMENT, whose name
appears on the bill, will be accepted*
4. Affidavit from Lawyer For Notarized Authorization Letter:
Legal Office, SPMC (ICU Bldg, Ground Floor)
*This requirement may only be asked for in Public Attorney’s Office
cases where 2 different documents or IDs Private Practice Lawyer’s Offices
were presented but does not match or
coincide or if the patient does not have any
other documents to present (ex. Negative
birth certificate)*

**For patients who have not been

previously admitted, present at least 1 of
the above-mentioned requirements.

**For patients who have been

previously admitted, present at least 2 of
the above-mentioned requirements.

***The information to be updated must be

seen on the document or ID being
presented, otherwise, legal intervention
shall apply.***
5. Clinical Cover Sheet Doctor, Nurse Station, Admitting Section
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Informs clerk for 1. Checks None 2 minutes Administrative
errors in patient’s patient’s record on Officer III
record and ask for HIS. Registration
requirements. For patients with Clerk
new records/first
transaction only:
No necessary
requirements
 needed. May
proceed to Step
3.1.

For patients with

old record and/or
multiple
transactions:
Ask for one of the
requirements
listed above.
2. Provide 2. Check None 3 minutes
requirements. requirements and Administrative
record to identify Officer III
errors. Registration
Clerk
2.1 Once error
has been cited,
instruct client to
secure 2
photocopies of the
document
presented.
3. Photocopies 3.1 Prepares None 2 Minutes Administrative
document. routing slip for Officer III
borrowing of ER Registration
Clinical Cover Clerk
Sheet.
4. Presents 4. Receives None 3 minutes
photocopied document.
document. Administrative
4.1 Gives routing Officer III
slip to client and Registration
instruct client to Clerk
present routing
slip to Consulting
Table to borrow
ER Clinical Form.

4.1.1 If Clinical
Cover Sheet was
already submitted
to
PACD/Triage/Adm
itting Section,
routing slip must
be addressed to
corresponding
area.
5. Goes back to 5. Receives ER None 7 Minutes
Registration Table Clinical Cover Administrative
and gives Clinical Sheet. Access Officer III
Cover Sheet. patient information Registration
from the system. Clerk

5.1 Update patient

information in the
system based on
the supporting
document
presented as well
as on the Cover
Sheet.

5.2 Instruct patient

to sign Clinical
 Cover sheet with
name and
signature beside
the corrected
information.
6. Signs ER Clinical 6. Attach None 1 Minute Administrative
Cover Sheet and wait photocopy of the Officer III
for final instruction of document to the Registration
the clerk on duty. Clinical cover Clerk
sheet.

6.1 Inform client

that patient
information has
already been
updated.

6.2 Instructs client

to return borrowed
Clinical Cover
sheet.
TOTAL: None 18 Minutes
Direct Admission of Patients from Out-Patient Department and Referrals
This service is intended for patients from OPD who are scheduled by the doctor for admission.

Availability of Service: 24 Hours, 7 Days, including Holidays.

Office/Division: HIMD-Admitting Section (Main)

Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: 1. Patients (Out-Patient and Referrals), Parents of Patient, Siblings,
Legal Guardian, Authorized Representative
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Patient Data Form – Elective Admission Doctor

*If patient is for Charity/Service Ward

direct admission, PDF must be signed by
the nurse on duty at the assigned ward for
the patient to confirm bed accommodation,
then proceed to Step 1.

*If patient is for PAY DIRECT

ADMISSION, PDF must have PAY stamp
with room number, name of consultant,
either HOUSECASE or PRIVATE, and
signature of BILLING PAYWARD CLERK,
otherwise redirect client to Payward Room
Reservation In-Charge for confirmation of
Room.
2. Consent on Admission Doctor
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Presents Patient 1. Checks for None 4 Minute
Data Form – Elective completeness of
Admission with Patient Data Form Administrative
Consent for – Elective Office III
Admission. Admission. Ask Admitting Clerk
client to fill out
lacking details, if
any.

1.1 Instructs client

to fill out and sign
Consent on
Admission.
2. Fills out and signs 2. Receives None 8 minutes
Consent on Consent on Administrative
Admission then Admission and Office III
returns it to the check for Admitting Clerk
admitting clerk and accuracy and
waits for printing. completeness.

2.1 Access
patient’s record in
the HIS and
encode admission
details then save
and prints out
Clinical Cover
Sheet.
3. Reviews the 3. Instructs client None 3 Minutes Administrative
demographic data to review the Office III
appeared on the details. Affix their Admitting Clerk
clinical cover sheet. name and
signature on the
lower left portion
of the Clinical
Cover Sheet.

3.1 Attaches
Clinical Cover
Sheet, PDF and
Consent on
Admission and
gives it back to
the client.

3.2 Inform client

that the patient is
already admitted
then instruct client
to go to the
corresponding
area:
For
Charity/Service
Ward – Philhealth
Table 23 or Main
Billing Philhealth

For Pay
Admission–
Billing Payward.
TOTAL: 15 Minutes
Issuance of Medical Certificate for Emergency Department Consultation
This service is intended for patients who requests for Medical Certificate for Legal, Work, Medical
Assistance and/or school requirement after consultation.

Availability of Service: 24 Hours, 7 Days, including Holidays.

Office/Division: HIMD-Admitting Section – Registration Area (Main)

Classification: Simple
Type of Transaction: G2C – Government to Citizen;
G2G – Government to Government
Who may avail: 1. Patients (Emergency Cases and Referrals), Parents of Patient,
Legal Guardian, Duly Authorized Representative
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
A. Patient, or Parent of minor, or Legal
Guardian (with Certificate of
Guardianship)
1. Any valid identification cards of patient
and/or authorized representative.(Original
and Photocopy)
- Voter’s ID Personal, Commission on Election (COMELEC)
- SSS Personal, SSS
- TIN ID Personal, Bureau of Internal Revenue (BIR)
- UMID Personal, GSIS, SSS
- Driver’s License (Not Expired) Personal, LTO
- Passport (Not Expired) Personal, Department of Foreign Affairs (DFA)
- Senior ID Personal, Office of the Senior Citizen Affairs
(OSCA)
-Company ID Personal, Place of Employment (If Employed)
-School ID (Present School-Year Only) Personal, School
2. Birth Certificate, if necessary Personal, Philippine Statistics Authority (PSA)
3.Certificate of Guardianship, if necessary Legal Office, SPMC (ICU Bldg, Ground Floor)
Public Attorney’s Office
Private Practice Lawyer’s Offices
4.Billing Statement ER Billing Section
5. Proof of Payment/Official Receipt Cashier

B. Other Authorized Requesting Party

1. Special Power of Attorney or Affidavit of Legal Office, SPMC (ICU Bldg, Ground Floor)
Authorization Public Attorney’s Office
Private Practice Lawyer’s Offices
2. 1. Any valid identification cards of
patient and/or authorized
representative.(Original and Photocopy)
- Voter’s ID Personal, Commission on Election (COMELEC)
- SSS Personal, SSS
- TIN ID Personal, Bureau of Internal Revenue (BIR)
- UMID Personal, GSIS, SSS
- Driver’s License (Not Expired) Personal, LTO
- Passport (Not Expired) Personal, Department of Foreign Affairs (DFA)
- Senior ID Personal, Office of the Senior Citizen Affairs
(OSCA)
-Company ID Personal, Place of Employment (If Employed)
-School ID (Present School-Year Only) Personal, School
3. Birth Certificate, if necessary Personal, Philippine Statistics Authority (PSA)
4.Billing Statement ER Billing Section
5. Proof of Payment/Official Receipt Cashier

8. Clinical Cover Sheet Doctor, Nurse, Admitting Clerk

*for patients who went to the nurses’

station with billing statement which
includes medical certificate, may proceed
to Step 4*
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Inquire for 1. Identify if client 3 minutes
requirements in is the actual
securing Medical patient, parent,
Certificate. sibling, or
authorized
representative.

1.1 Verify status

of patient in
the HIS if Still Administrative
In or Officer III
Discharged to Registration
identify Clerk
availability of
patient’s
record for
retrieval.
1.1.1 In the event
that the
patient’s
record has
already
been
submitted
to the
HIMD,
instruct
patient to
continue
transaction
at the
HIMD
Window 12.

1.2 Determine and

inform client
necessary
requirements
based on the
relationship of
client to
patient.
2. Wait for instructions 2. Instructs client P50.00 3 minutes
of the clerk on duty. to pay for medical
certificate at the
cashier.

2.1. If billing
statement already
include medical
certificate, asks
for official receipt.
3. Process 3. Receive 5 minutes
requirements and requirements and
present completed determines the Administrative
requirements to clerk. completeness and Officer III
accuracy of Registration
requirements Clerk
presented.

3.1 Instruct client

to borrow patient’s
 ER clinical cover
sheet from the
consulting doctor
for encoding.

3.1.1 In the
event that clinical
cover sheet was
already endorsed
to Nurses’ Station
or Admitting
Section, specify
area on the
routing slip.
4a. Proceeds to 4. Receives 5 minutes
Doctor’s table and Clinical cover
states the request sheet then access Nurse VI
then goes back to the patient data from Nurse on Duty
Registration Table the HIS.
accompanied by the Administrative
nurse in-charge with 4.1 Encodes Officer III
the borrowed necessary details, Registration
document. including Final Clerk
Diagnosis and
4b. Proceeds to Doctor’s name.
designated area
specified on the 4.2 Prints out 2
routing slip and copies (client copy
presents routing slip and hospital copy)
to Nurse or Clerk On of the completed
Duty then goes back form and instruct
to Registration Table client to proceed
accompanied by the to the consulting
Nurse or Clerk on doctor to sign the
Duty. medical
certificate.
5. Proceeds to the 5. Verifies medical (paused-clock)
consulting doctor’s certificate and Depends on Consulting
table for verification signs it, and the availability Doctor on Duty
and signing of medical indicates number of the doctor
certificate. of days if he/she
is advised to rest.
6. Goes back to the 6. Examines 5 minutes
Registration table with completeness of
the signed document medical
and waits for certificate. Administrative
instruction. Officer III
6.1 Logs in the Registration
patient’s name Clerk
and consulting
department on the
Medical Certificate
Releasing
Logbook.

6.2 Asks client to

sign logbook and
hospital copy of
the medical
certificate.
7. Acknowledges 7. Dry seal of 4 minutes
receipt of Medical Medical Certificate
Certificate. 7.1 Releases
Medical
Certificate.
TOTAL: P50.00 25 minutes
Old and New Data Registration for Emergency Department Consultation
This service is intended for encoding of patient’s information into the data base for registration and
assignment of Consulting Department and printing of ER Clinical Form after triaging.

Availability of Service: 24 Hours, 7 Days, including Holidays.

Office/Division: HIMD-Admitting Section – Registration Area (Main)

Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: 1. Patients (Emergency Cases and Referrals)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patient Data Form Triage Nurse
2. Yellow Card (If Available) HIMD (Hospital Information Management
Department)
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. For New Patients, 1. Receives None 10 minutes
present Patient Data PDF/Yellow Card, Administrative
Form (PDF) with verify accuracy of Officer III
complete and information Registration
accurate information provided and Clerk
of the patient. checks database
for existing
1.1 For patients with records to avoid
existing records, creating
present PDF with duplicates.
complete information
and YELLOW CARD. 1.1 For New
Patients, encodes
information in the
database, assigns
department
designated by the
triage nurse.

1.2 For patients

with existing
records, access
patient’s records
and assigns
department
designated by
triage nurse.

2. Prints out ER
Clinical Form of
the patient and
instructs
patient/watcher to
go back to the
triage nurse for
endorsement to
Consulting
Department.

**for patients for ** Prints out ER **5 Minutes **Nurse

consultation as clinical form and
COVID – 19 suspect, endorse to
 NOD shall be the one Isolation Triage
to fill out the PDF, Nurse.
then proceed to step
1.1
TOTAL: None 10 minutes
**5 Minutes

Old and New Data Registration of Patients at Institute for Women and
Newborn Health (IWNH) Emergency Room
This service is intended for registration of patients with obstetrics/gynecology-related cases seeking
immediate medical attention.

Availability of Service: 24 Hours, 7 Days, including Holidays.

Office/Division: HIMD-Admitting Section (IWNH)

Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: 1. Patients (Emergency Cases and Referrals)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patient Data Form Admitting Clerk
2. Yellow Card (If Available) HIMD
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Informs clerk about 1. Interviews None 5 Minutes
seeking consult for patient about the
OB/Gyne concerns. reason for Administrative
consult/or if with Officer III
referral. Registration/Ad
mitting Clerk
1.1 Issues PDF
and instruct
patient/watcher to
fill out necessary
details.

2. Fills out PDF. 2. Receives None 5 minutes

PDF/Yellow Card,
2.1 For New verify accuracy of
Patients, present information
Patient Data Form provided and
(PDF) with complete checks data base Administrative
and accurate for existing Officer III
information of the records to avoid Registration/Ad
patient and referral creating mitting Clerk
form/note. duplicates.

2.2. For patients with 2.1 For New

existing records, Patients, encodes
present PDF with information in the
complete information database, assigns
and/or YELLOW department under
CARD, referral Obstetrics and/or
form/note. Gynecology.

2.2 For patients

with existing
records, access
patient’s records
and assigns
department under
Obstetrics and/or
Gynecology.
2.3 Prints out ER
Clinical Form of
 the patient and
hands it over to
the patient then
instruct patient to
proceed to the
emergency room.
TOTAL: None 10 Minutes

Registration for Hyperbaric Procedure

This service is intended for the registration of patients undergoing Hyperbaric Procedures. This
service is conducted at the IWNH Registration/Admitting Area for the convenience of Hyperbaric
Unit staff since it is located near the IWNH Building.

Availability of Service: Monday – Saturday, 7:00am – 10:00pm, including Holidays.

Office/Division: HIMD-Admitting Section (IWNH)

Classification: Simple
Type of Transaction: G2C - Government to Citizen; G2G – Government to Government
Who may avail: Patient’s Watcher, Hyperbaric Unit Nurse On Duty
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patient Data Form Triage Nurse (Hyperbaric)
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present fully filled- 1. Receives PDF None 10 Minutes Hyperbaric Unit
out Patient Data and checks for Nurse On
Form. completeness and Duty/Patient’s
accuracy. Watcher

1.1 Access Administrative

patient’s hospital Officer III
record and Registration
encodes Clerk
consultation under
Hyperbaric-
Emergency
Medicine.

1.2 Prints out ER

Clinical Cover
Sheet and
endorse to
Hyperbaric Nurse
On Duty.
TOTAL: None 10 Minutes
Registration of Indigenous People (IP) for Emergency Department
Consultation
This service is intended for IP patient. These patients are able to identify themselves but are not
able to read and/or write. The patient or watcher is then interviewed for necessary information to
be encoded as identification.

Availability of Service: 24 Hours, 7 Days, including Holidays.

Office/Division: HIMD-Admitting Section – Registration Area(Main)

Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: 1. Patients (Emergency Cases and Referrals)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patient Data Form Triage Nurse, Emergency Responder
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Gives PDF and 1. Receives PDF. None 15 minutes Administrative
informs Registration Officer III
Clerk of indigence. 1.1 Interviews Registration
patient or watcher Clerk
for necessary
information for
encoding of
identification.

1.2 Prints out ER

Clinical Form to
be endorsed to
ER triage nurse.

TOTAL: None 15 minutes

Registration of Unidentified Person for Emergency Department Consultation
This service is intended for patients who are brought to the ER without identifications and/or if
patient cannot provide any information due to medical conditions. Most of this type of patient are
likely brought by rescuers and/or concerned citizens and are not able to identify patient directly,
hence, these patients are registered as Mr./Ms. X.

Availability of Service: 24 Hours, 7 Days, including Holidays.

Office/Division: HIMD-Admitting Section – Registration Area(Main)

Classification: Simple
Type of Transaction: G2C – Government to Citizen, G2G – Government to Government
Who may avail: 1. Patients (Emergency Cases and Referrals)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patient Data Form Triage Nurse, Emergency Responder
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Informs clerk that 1. Receives PDF. None 15 minutes ER Triage
patient is unidentified Nurse/
then gives unfilled 1.1 Interviews Emergency
PDF. concerned citizen Responder
or responder for
information which Administrative
can be used as Officer III
temporary Registration
identification of Clerk
the patient. (i.e.
what the patient is
wearing, when
and where the
patient was found)

1.2 Registers
patient as MR/MS
X according to
when he/she was
found and as to
what he/she is
wearing with
these information
as the patient’s
temporary
identification.

1.3 Prints out ER

Clinical Form and
gives it back to
Triage Nurse or
Responder.

1.4 Registers
unidentified
patient in the
Mr./Ms. X registry
for endorsement
to the ER Social
Service.
 TOTAL: None 15 minutes

Admission of Patient from Institute for Women and Newborn Health (IWNH)
Emergency Room
The IWNH Emergency Room caters patients who are delivering newborn babies, vaginal bleedings,
and obstetrics/gynecology-related cases. This service is intended for admission of patient from
IWNH Emergency Room.

Availability of Service: 24 Hours, 7 Days, including Holidays.

Office/Division: HIMD-Admitting Section (IWNH)

Classification: Simple
Type of Transaction: G2G – Government to Government
Who may avail: 1. Patients (Emergency Cases and Referrals)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.ER Clinical Cover Sheet Doctor

*For Pay Patient Admission, clinical

cover sheet must indicate PAY ROOM
NUMBER and PREFERRED DOCTOR
2. Consent on Admission Doctor

* If patient is classified as Covid-19

Suspect, Nurse on Duty from
corresponding ward must make a call for
admission and remote printing (refer to
client steps with ** )
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Presents ER 1. Receives ER None 15 minutes
Clinical Cover Sheet Clinical Cover Nurse on Duty
with written admitting Sheet and
diagnosis, fully filled Consent on
out Consent on Admission.
Admission. Administrative
1.1 Checks the Officer III
completeness and Registration
accuracy of Clerk
details. Signs
Witness Section
of the consent.

1.2 Access patient

record and
encode admission
details. Prints out
Admission Clinical
cover sheet and
attach consent.

1.3 Hands over

the Admission
cover sheet and
Clinical Form with
consent to the
nurse on duty.

1.4 Instruct Nurse

on Duty to ask the
 patient to review
the details. Affix
their name and
signature on the
lower left portion
of the clinical
cover sheet.

**Calls admitting ** Access patient **10 Minutes **Nurse on Duty

section for admission record and
of Covid – 19 suspect. encode admission Administrative
details. Prints out Officer III
admission Clinical Registration
cover sheet Clerk
remotely.
TOTAL: None 15 minutes
** 10 Minutes
Health Information Management Department

Admitting Section

Internal Services
Authentication of In-Patient Registry by PHIC for Closing and Opening of New
Registry Logbook
All admissions are recorded into the In-patient Registry Logbook. Once Registry Logbook is full, it
will then be brought to the Philhealth Main Office.

Availability of Service: Monday – Friday, 8:00am – 5:00pm

Office/Division: HIMD-Admitting Section (Main)

Classification: Simple
Type of Transaction: G2G – Government to Government
Who may avail: Registration/Admitting Section Clerk
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
In-patient Registry Logbook (Old) Admitting Section
In-patient Registry Logbook (New) Admitting Section
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
Travel time Administrative
from SPMC to Officer III
PHIC varies Registration/ad
depending on mitting Clerk
the traffic

1. Receives In-patient 1. Presents In- None 15 Minutes PHIC Main

Registry. patient Registry to Office Staff
PHIC Clerk In-
charge.
2. Reviews In-patient 2. Waits for final None (paused clock) PHIC Main
Registry Logbook instructions as Depends on Office Staff
submitted then signs it PHIC Clerk how long the
as closed. checks In-patient reviewing will
Registry. take
3. Signs new In- 3. Receives In- None Travel time Administrative
patient Registry patient Registries from PHIC to Officer III
Logbook as open and and goes back to SPMC varies Registration/ad
endorses both old and office for depending on mitting Clerk
new In-patient endorsement. the traffic
Registry to
Registration/Admitting
Clerk.
TOTAL: None
Change of Admitting Diagnosis
This is intended for doctors who are requesting to update admitting diagnosis of patients who were
already admitted for more than 30 minutes (for all other wards except NICU) and 4 hours for NICU.

Availability of Service: 24 Hours, 7 Days, including Holidays.

Office/Division: HIMD-Admitting Section (Main and IWNH)

Classification: Simple
Type of Transaction: G2G – Government to Government
Who may avail: Resident Doctors on Duty and Consultants
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Admission Clinical Cover Sheet Nurses’ Station
Explanation Letter Resident Doctors on Duty and Consultants

*Must be signed by Resident Doctor On

Duty or Consultant and signed and
approved by Dr. Ma. Elinore A. Concha*
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Presents 1. Receives and 10 Minutes Resident
Explanation Letter reads Explanation Doctors on Duty
and Admission Letter, and checks and
Clinical Cover Sheet. for complete Consultants
content and
signatories.

1.1 Access Administrative

patient’s Officer III
admission record Registration/Ad
and update mitting Clerk
diagnosis
according to what
is specified in the
letter.

1.2 Update or
reprint Admission
Clinical Cover
Sheet.

*For minimal
changes in
Admitting
Diagnosis – only
update diagnosis
on the clinical
cover sheet based
on the update
made in the HIS
and have it
countersigned by
the Resident
Doctor on duty.
 *For major
changes in the
Admitting
Diagnosis –
reprint clinical
cover sheet and
instruct doctor to
have the patient
or watcher sign at
the designated
area at the bottom
part of the sheet.
TOTAL: None 10 Minutes
Creation of Record and Direct Admission of Newborn Babies at the Nursery
Intensive Care Unit (NICU)
This service is intended for the admission of newborn babies who are transferred to NICU after
delivery. Most babies who are at the NICU are babies delivered via Cesarean Section, Preterm
babies, Small for Gestational Age,babies who develop complications after birth and/or babies who
need urgent medical attention.

Availability of Service: 24 Hours, 7 Days, including Holidays.

Office/Division: HIMD-Admitting Section (IWNH)

Classification: Simple
Type of Transaction: G2G – Government to Government, G2C – Government to Citizen
Who may avail: NICU Nurse on Duty; Patient’s Mother/Father, Authorized
Representative
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Admitting Diagnosis to be relayed via local NICU Nurse on Duty
phone call
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Calls IWNH 1. Writes down None 5 Minutes Nursery ICU
Admitting Section for notes for Nurse on Duty
admission. admission as
dictated by NICU
NOD.

1.1Creates patient 5 Minutes Administrative

record using Officer III
information Registration
provided by NICU Clerk
NOD.

1.2 Access patient

record for
admission and
encodes admitting
diagnosis.

1.3 Prints out

Admission Cover
Sheet and records
in the Newborn
Admission Cover
Sheet Releasing
Logbook and
waits for patient’s
watcher to pick up
Cover Sheet.

1.4 Calls NICU

NOD to inform of
patient’s Hospital
Record Number
 and Time of
Admission.
2. Inform Admitting 2.1Instructs client None 5 Minute Administrative
clerk on duty to review the Officer III
regarding pick up of details. Affix their Registration
Cover Sheet. name and Clerk
signature on the
lower left portion
of the clinical
cover sheet.

2.1 Instruct client

to sign releasing
logbook. Gives
Admission Clinical
Cover Sheet to
client and instruct
client to submit it
to NICU NOD.
TOTAL: None 15 Minutes
Creation of Record and Direct Admission of Newborn Babies from Delivery
Room, IWNH Operating Room/Post-Anesthesia Care Unit
This service is intended for the admission of newborn babies delivered via cesarean section
and/or babies who are affected by maternal conditions and are for further examination by the
attending physician for possible complications during and after birth.

Availability of Service: 24 Hours, 7 Days, including Holidays.

Office/Division: HIMD-Admitting Section (IWNH)

Classification: Simple
Type of Transaction: G2G – Government to Government
Who may avail: Nursing Attendant
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Newborn Clinical Cover Sheet Doctor
Admission Consent Doctor
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Presents Newborn 1. Receives None 5 Minutes Nursing
Clinical Cover Sheet Newborn Clinical Attendant
with Admission Cover Sheet with
Consent. Admission
Consent and
check for
completeness.

1.1 Creates 10 Minutes Administrative

patient record Officer III
using information Registration
available from the Clerk
Clinical Cover
Sheet and by
accessing
Newborn’s
mother’s record.

1.2 Access patient

record and
encode admitting
diagnosis as
provided and
written at the
Newborn Clinical
Cover Sheet.

1.3 Prints out

Admission Clinical
Cover Sheet.

1.4 Gives
Admission Clinical
Cover Sheet to
 Nursing Attendant
and instructs N.A.
to have the
newborn’s mother
sign at the
designated area.
TOTAL: None 15 Minutes

Receiving of Emergency Department Patients Health Records

This service includes receiving of ER Health records from the nurses’ station after patient is
discharged.

Availability of Service: 24 Hours, 7 Days, including Holidays.

Office/Division: HIMD-Admitting Section (Main)

Classification: Simple
Type of Transaction: G2G – Government to Government
Who may avail: Nurses
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. ER Health Records Doctors, Nurses
2. Out-Patient and Discharged Health Nurses
records Logbook
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Endorses ER 1. Receives ER 15 Minutes
Health records of Health records
discharged patients and checks Supervising
for the day that are completeness of Nurse On Duty
recorded in the Out- endorsement
patient Logbook. through checking
logbook versus
actual ER Health
records
1.1. Signs logbook
in confirmation of Administrative
completeness of Office III
endorsed files. Encoder 1
TOTAL: None 15 Minutes
Receiving of 2nd Page of Admission Cover Sheet and 24-Hours Daily Census
from Wards
This service is intended for receiving 2 nd page of Admission Cover Sheet 24-hours Daily Census
copy from all wards for compiling and are used as reference for discharging admitted patients online
should the patient comes at the Out-Patient Department for follow-up checkup.

Availability of Service: 10:00pm – 7:00am, 7 Days, including Holidays.

Office/Division: HIMD-Admitting Section (IWNH)

Classification: Simple
Type of Transaction: G2G – Government to Government
Who may avail: Nurse on Duty, Nursing Attendant
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
24-Hours Daily Census Forms Ward Nurses’ Station
2nd Page of Admission Cover Sheet Ward Nurses’ Station
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submits 24-Hours 1. Receives 24- None 5 Minutes Ward Nurse On
Daily Census. Hours Daily Duty, Nursing
Census and Attendant
checks for
accuracy and
completeness of
charts endorsed.

1.1 Ticks Check Administrative

on Ward Checklist Officer III
for each ward that IWNH Admitting
submits complete Clerk
Census.
TOTAL: None 5 minutes
Request for 2nd Copy of Clinical Cover Sheet
This service isfor requesting to reprint another copy of the ER and/or Admission Clinical Cover
Sheet in cases where Clinical Cover Sheets are lost by the doctors or nurses on duty or by the
clients. Torn, spilled with beverages or inks or other circumstances which causes the documents
to be unpresentable or unreadable.

Availability of Service: 24 Hours, 7 Days, including Holidays.

Office/Division: HIMD-Admitting Section (Main and IWNH)

Classification: Simple
Type of Transaction: G2G – Government to Government
Who may avail: Doctors and Nurses on Duty
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Request Letter signed by requesting Doctors and Nurses on Duty
Doctors and Nurses on Duty
Clinical Cover Sheet

*In the event that the cover sheet has been

found after reprinting the 2nd copy, and for
other reasons for the request, ORIGINAL
COPY MUST ALWAYS BE
SURRENDERED at the Admitting Section*
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Presents request 1. Receives and 15 Minutes Doctors and
letter and Clinical reviews request Nurses on Duty
Cover Sheet. letter for
completeness and
accuracy

1.1 Access Administrative

patient’s record Officer III
and prints clinical Admitting Clerk
cover sheet and
writes “2nd Copy”
label at the upper
right part of the
newly printed
Clinical Cover
Sheet.

1.2 Endorse
Clinical Cover
Sheet to Doctor
and/or Nurse on
Duty and instructs
them to have the
watcher sign at
the designated
area at the lower
part of the chart.
 TOTAL: None 15 Minutes

Transmittal of ER Health Records to HIMD

This refers to the endorsement and transmittal of ER Health records to HIMD after health records
are processed.

Availability of Service: 24 Hours, 7 Days, including Holidays.

Office/Division: HIMD-Admitting Section (Main)

Classification: Simple
Type of Transaction: G2G – Government to Government
Who may avail: HIMD
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
ER Health Records Nurses’ Station
Endorsement List/Emergency Room HIS Report Launcher
Registry
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Receives ER 1.Transmits and 15 Minutes Administrative
Registry and Health endorses ER Officer III
Records endorsed by Registry and Admitting Clerk
Admitting Clerk and Health Records to HIMD Staff
checks for HIMD.
completeness and
accuracy.
TOTAL: None 15 Minutes
Health Information Management Department

Birth Registration Unit

External Services
Birth Registration of Newborns with Married Parents
Birth registration for MARRIED PARENTS.

Location: 3rd Floor, Birth Registration Unit, IWNH Building

Availability of Service: 8:00 am to 400 pm, Mondays to Saturdays (including Holidays)
No Noon Break.

Office/Division: Health Information Management Department - Birth Registration

Unit .
Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: Parents of newborn delivered within the Institution
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Birth Data Form Nurse Station/Birth Registration Unit
2. Birth Certificate of Parents PSA/LCR
3. Marriage Contract PSA/LCR
4. At least two (2) valid identification cards,
if necessary:
 Voter’s ID Personal, Commission on Election (COMELEC)
 SSS Personal, Social Security System (SSS)
 UMID Personal, Government Insurance System
(GSIS) / SSS
 TIN ID Personal, Bureau of Internal Revenue (BIR)
 PRC (Updated) Personal, Professional Regulation Commission
(PRC)
 Driver’s License (Updated) Personal, Land Transportation Office (LTO)
 Passport (Updated) Personal, Department of Foreign Affairs (DFA)
 Company ID Personal, Place of Employment
 School ID (within the school year) Personal, School
 Police Clearance Personal, Police Station
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present fully filled 1. Receive and None 30 minutes Administrative
up Birth Data Form validate entries in Officer III
with requirements. the Birth Data
Form and Birth
requirements Registration
presented. staff in-charge
1.1 Transcribe
data to Official
Birth Certificate
Form.
1.2 Proofread
data and print
draft copy of
 Certificate of Live
Birth.
2. Review all entries 2. Print official None 10 minutes Administrative
on the draft copy of copy of the Officer III
the Certificate of Live Certificate of Live Birth
Birth for completeness Birth and Release Registration
and accuracy. Affix of Responsibility staff in-charge
signature on the draft for Erroneous
copy of the Certificate Entry Form.
of Live Birth.
3. Affix signature on 3. Validate and None 5 minutes Administrative
official copies: check client’s Officer III
signature. Birth
> Certificate of Live Registration
Birth staff in-charge
>Release of
Responsibility for
Erroneous Entry.
4. Acknowledge 4. Issue Birth None 5 minutes Administrative
receipt of Birth claim claim stub and log Officer III
stub. at Birth Certificate Birth
issuance logbook. Registration
staff in-charge
TOTAL: None 50 minutes
Birth Registration (Processing of Certificate of Live Birth for Late
Registration)

Location: 3rd Floor, Birth Registration Unit, IWNH Building

Availability of Service: Per scheduled date

Office/Division: Health Information Management Department - Birth Registration

Unit
Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: Parents of newborn delivered within the Institution
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Birth Certificate of Parents PSA/LCR
2. Marriage Contract (if married during PSA/LCR
the date of birth)
3. For unregistered claimed Certificate SPMC Legal Office, Public Attorney’s office,
of Live Birth: Private Practice Lawyer’s Office
 Affidavit of explanation
4. For lost Certificate of Live Birth SPMC Legal Office, Public Attorney’s office,
 Affidavit of Loss Private Practice Lawyer’s Office
5. Certificate of No Record Local Civil Registrar (LCR)
6. Negative Certification of Birth Philippine Statistics Authority (PSA)
7. Recent Community Tax Certificate Brgy. Hall/City Treasurer’s Office
(CEDULA)
8. At least two (2) valid identification
cards, if necessary:
 Voter’s ID Personal, Commission on Election (COMELEC)
 SSS Personal, Social Security System (SSS)
 UMID Personal, Government Insurance System
(GSIS) / SSS
 TIN ID Personal, Bureau of Internal Revenue (BIR)
 PRC (Updated) Personal, Professional Regulation Commission
(PRC)
 Driver’s License (Updated) Personal, Land Transportation Office (LTO)
 Passport (Updated) Personal, Department of Foreign Affairs (DFA)
 Company ID Personal, Place of Employment
 School ID (within the school year) Personal, School
 Police Clearance Personal, Police Station
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present receipt 1. Check None 25 minutes Administrative
with indicated corresponding Officer III
schedule together requirements Birth
with the 1.1 Search and Registration
requirements verify the Transcriptionist
Health
 Information
System on the
entry on the
Certificate of
Live Birth
1.2 Fills-out and
prints the
Affidavit for
Delayed
Registration of
Birth (back
page).

*For re-issuance
and lost copies, a
draft copy of the
Certificate of Live
Birth is printed*
2. For Re-issuance 2. Print official None 10 minutes Administrative
and lost copies: copy of the Officer III
Review all entries Certificate of Birth
on the draft copy of Live Birth Registration
the Certificate of including the Transcriptionist
Live Birth for Affidavit for
completeness and Delayed
accuracy. Affix Registration of
Birth (back
signature on the
page) and
draft copy of the
Release of
Certificate of Live Responsibility
Birth. for Erroneous
Entry Form.

3. Affix signature on 3. Validate and None 5 minutes Administrative

official copies: check client’s Officer III
signature. Birth
>Certificate of Live Registration
Birth Transcriptionist
> Affidavit for Delayed
Registration of Birth
(back page)
>Release of
Responsibility for
Erroneous Entry.
4. Acknowledge 4.Give 3 copies of None 5 minutes Administrative
receipt of the Certificate of Officer III
Certificate of Live Live Birth and Birth
Birth instruct client to Registration
proceed to Local Transcriptionist
Civil Registrar
(LCR) for birth
registration
TOTAL: None 45 minutes
Birth Registration (Request for Late Registration)

 Clients who have the claim stub but was not able to get the Certificate of Live Birth of their
child.
 Clients who have received the Certificate of Live Birth but was not able to submit to the
Local Civil Registrar
 Clients who lost the Certificate of Live Birth

Location: HIMD Window 2, OPD JICA Building

Availability of Service: Mondays to Fridays 8:00am -12:00nn to 1:00pm-4:00pm,

Except Holidays

Office/Division: Health Information Management Department - Birth Registration

Unit
Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: Parents of newborn delivered within the Institution
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Birth Certificate of Parents PSA/LCR
2. Marriage Contract (if married during PSA/LCR
the date of birth)
3. For unregistered claimed Certificate SPMC Legal Office, Public Attorney’s office,
of Live Birth: Private Practice Lawyer’s Office
 Affidavit of Explanation
4. For lost Certificate of Live Birth SPMC Legal Office, Public Attorney’s office,
 Affidavit of Loss Private Practice Lawyer’s Office
5. Certificate of No Record Local Civil Registrar (LCR)
6. Negative Certification of Birth Philippine Statistics Authority (PSA)
7. Recent Community Tax Certificate Brgy. Hall/City Treasurer’s Office
(CEDULA)
8. At least two (2) valid identification
cards, if necessary:
 Voter’s ID Personal, Commission on Election (COMELEC)
 SSS Personal, Social Security System (SSS)
 UMID Personal, Government Insurance System
(GSIS) / SSS
 TIN ID Personal, Bureau of Internal Revenue (BIR)
 PRC (Updated) Personal, Professional Regulation Commission
(PRC)
 Driver’s License (Updated) Personal, Land Transportation Office (LTO)
 Passport (Updated) Personal, Department of Foreign Affairs (DFA)
 Company ID Personal, Place of Employment
 School ID (within the school year) Personal, School
 Police Clearance Personal, Police Station
 CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Proceed to window 1. Interviews the None 10 minutes ADA III
1, Health client HIMD Staff
Information 1.1 Instruct the
Management client to comply
Department, the necessary
OPD JICA Building requirements
2. Present needed 2. Check and 10 minutes ADA III
requirements validate HIMD Staff
completeness
of needed
requirements Refer to
2.1 Instruct patient approved
to pay
schedule of
appropriate
fees
fees

3. Pay corresponding 3. Check receipt None 5 minutes ADA III

fees and present 3.1 Instruct to go HIMD Staff
the receipt to to Birth
window 1, Health Registration
Information Unit, Institute
Management for Women
Department, and Newborn
OPD JICA Building Health
(IWNH)on the
given
schedule
4. N/A 4. Retrieve None 30 minutes ADA III
Newborn’s HIMD Staff
record / Birth
Data Form
and endorse
to Birth
Registration
Unit
TOTAL: None 55 minutes

HEALTH INFORMATION MANAGEMENT DEPARTMENT Schedule of Fees

RETRIEVAL FEE:
Medical Records filed 5 years > 18 years P 100.00
Medical Records and Registry books 18 years and above P 100.00
CERTIFICATION:
Medical Certificate P 50.00
Certificate of Confinement P 50.00
Certificate of No Record P 50.00
Certificate to Support Late Filing of Birth/Death Certificate P 50.00
Medical Certificate for Insurance with Supporting Documents P 100.00
RE-ISSUANCES:
Birth/Death Certificate P 100.00
Medical Certificate P 50.00
AUTHENTICATED COPY OF CLINICAL RECORD P 15.00/COPY
Birth Registration (Single Mothers)
Newborn uses the SURNAME OF THE MOTHER ONLY.

Location: 3rd Floor, Birth Registration Unit, IWNH Building

Availability of Service: 8:00 am to 4:00 pm, Mondays to Saturdays, including Holidays
No Noon Break.
Office/Division: Health Information Management Department - Birth Registration
Unit
Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: Mother of the newborn delivered within the Institution
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Birth Data Form Nurse Station/Birth Registration Unit
2. Birth Certificate of Mother PSA/LCR
3. At least two (2) valid identification cards,
if necessary:
 Voter’s ID Personal, Commission on Election (COMELEC)
 SSS Personal, Social Security System (SSS)
 UMID Personal, Government Insurance System
(GSIS) / SSS
 TIN ID Personal, Bureau of Internal Revenue (BIR)
 PRC (Updated) Personal, Professional Regulation Commission
(PRC)
 Driver’s License (Updated) Personal, Land Transportation Office (LTO)
 Passport (Updated) Personal, Department of Foreign Affairs (DFA)
 Company ID Personal, Place of Employment
 School ID (within the school year) Personal, School
 Police Clearance Personal, Police Station
4. Mother or Father – for minor patients N/A
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present fully filled 1. Receive and None 30 minutes Administrative
up Birth Data Form validate entries in Officer III
with requirements. the Birth Data
Form and Birth
requirements Registration
presented. staff in-charge
1.1 Transcribe
data to Official
Birth Certificate
Form.
 1.2 Proofread
data and print
draft copy of
Certificate of Live
Birth.
2. Review all entries 2. Print official None 10 minutes Administrative
on the draft copy of copy of the Officer III
the Certificate of Live Certificate of Live
Birth for completeness Birth and Release Birth
and accuracy. Affix of Responsibility Registration
signature on the draft for Erroneous staff in-charge
copy of the Certificate Entry Form.
of Live Birth.
3. Affix signature on 3. Validate and None 5 minutes Administrative
official copies: check client’s Officer III
signature.
>Certificate of Live Birth
Birth Registration
>Release of staff in-charge
Responsibility for
Erroneous Entry
4. Notarize the 4. Instruct client to None 5 minutes Administrative
Certificate of Live have the Officer III
Birth Certificate of Live
Birth notarized. Birth
Registration
staff in-charge
5. Submit notarized 5. Receive and None 5 minutes Administrative
Certificate of Live check the Officer III
Birth. notarized
document. Birth
Registration
staff in-charge
6. Acknowledge 6. Issue Birth None 5 minutes Administrative
receipt of Birth claim claim stub and log Officer III
stub. at Birth Certificate
issuance logbook. Birth
Registration
staff in-charge
TOTAL: None 60 minutes
Birth Registration of Newborns with Unmarried Parents
This caters to UNMARRIED PARENTS in which the newborn uses the surname of the father.

Location: 3rd Floor, Birth Registration Unit, IWNH Building

Availability of Service: 8:00 am to 4:00 pm, Mondays to Saturdays including Holidays
No Noon Break.

Office/Division: Health Information Management Department - Birth Registration

Unit
Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: Parents of the newborn delivered within the Institution
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Birth Data Form Nurse Station/Birth Registration Unit
2. Birth Certificate of both parents PSA/LCR
3. Recent Community Tax Certificate Brgy. Hall/City Treasurer’s Office
(CEDULA)
4. For minor parents: Birth Registration Unit
>Affidavit of Attestation
> Mother / Father of both parents For notarization of the affidavit:

SPMC Legal Office, Public Attorney’s office,

Private Practice Lawyer’s Office
5. At least two (2) valid identification cards,
if necessary:
 Voter’s ID Personal, Commission on Election (COMELEC)
 SSS Personal, Social Security System (SSS)
 UMID Personal, Government Insurance System
(GSIS) / SSS
 TIN ID Personal, Bureau of Internal Revenue (BIR)
 PRC (Updated) Personal, Professional Regulation Commission
(PRC)
 Driver’s License (Updated) Personal, Land Transportation Office (LTO)
 Passport (Updated) Personal, Department of Foreign Affairs (DFA)
 Company ID Personal, Place of Employment
 School ID (within the school year) Personal, School
 Police Clearance Personal, Police Station
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present fully filled 1. Receive and None 30 minutes Administrative
up Birth Data Form validate entries in Officer III
with requirements. the Birth Data
Form and Birth
requirements Registration
presented. staff in-charge
1.1 Transcribe
data to Official
Birth Certificate
Form.
1.2 Proofread
data and print
draft copy of
Certificate of Live
Birth.
2. Review all entries 2. Print official None 10 minutes Administrative
on the draft copy of copy of the Officer III
the Certificate of Live Certificate of Live
Birth for completeness Birth and Release Birth
and accuracy. Affix of Responsibility Registration
signature on the draft for Erroneous staff in-charge
copy of the Certificate Entry Form.
of Live Birth. 2.1 Print Affidavit
to Use the
Surname of the
Father (AUSF)
and Affidavit of
Attestation for
minor parents.
3. Affix signature on 3.Validate and None 5 minutes Administrative
official copies: check client’s Officer III
signature.
>Certificate of Live Birth
Birth Registration
>Release of staff in-charge
Responsibility for
Erroneous Entry
> Affidavit to Use the
Surname of the
Father (AUSF)
>Affidavit of
Attestation (for minor
parents).
4. Notarize the 4. Instruct client to None 5 minutes Administrative
following: have the Officer III
> Certificate of Live Certificate of Live
Birth Birth, AUSF, and Birth
> Affidavit to Use the Affidavit of Registration
Surname of the Attestation staff in-charge
Father (AUSF) notarized and pay
> Affidavit of corresponding fee
Attestation (for minor at the Cashier.
parents).
5. Pay corresponding 5. Receive and P 300 5 minutes Administrative
fees (AUSF/Birth) and check the official (Filipinos) Officer III
present back the receipt and
official receipt to the notarized P 700 Birth
Birth Registration Unit documents. (Foreigners) Registration
together with the staff in-charge
notarized Certificate
of Live Birth and
AUSF.
6. Acknowledge 6. Issue Birth None 5 minutes Administrative
receipt of Birth claim claim stub and log Officer III
stub. at Birth Certificate
issuance logbook. Birth
Registration
staff in-charge
TOTAL: 60 minutes

Health Information Management Department

Birth Registration Unit

Internal Services
Birth Registration (Endorsement of Certificate of Live Birth)

All prepared Certificate of Live Birth must be endorsed to the Local Civil Registrar within 30 days
from the date of birth.

Location: Local Civil Registrar

Availability of Service: Every Wednesday of the week or as the need arise.

Office/Division: Health Information Management Department - Birth Registration

Unit
Classification: Simple
Type of Transaction: G2G – Government to Government
Who may avail: Birth Registration Staff
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Endorsement List Birth Registration Unit
2. Certificate of Live Birth Birth Registration Unit
3. Affidavit to Use the Surname of the Birth Registration Unit
Father (For unmarried parents)
4. Other supporting documents which may Birth Registration Unit
be needed by the Local Civil Registrar
(Islam attachment, Affidavit of
Attestation, Certification for entry
corrections)
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1.Receive Certificate 1.Endorse Travel time
of Live Birth and Certificate of Live from SPMC to Administrative
Endorsement List Birth, None Local Civil Officer III
Endorsement List, Registrar may Birth
and Transmittal vary Registration
for Paternal depending on Transcriptionist
Acknowledgment
the traffic
with
corresponding
amount paid to 10 minutes
Birth Certificate
section in-charge
 2.Reviews Certificate 2.Waits for other None Time may vary Administrative
of Live Birth and instructions and depending on Officer III
Endorsement List concerns if any the queuing Birth
time. Registration
Transcriptionist
3.Affixes full name 3.Receives None Travel time Administrative
and signature on the Endorsement List from Local Officer III
Endorsement List and travels back Civil Registrar Birth
to SPMC to SPMC may Registration
vary Transcriptionist
depending on
the traffic
TOTAL: None

Birth Registration (Photocopying of Certificate of Live Birth)

All prepared Certificate of Live Birth are photocopied for PHIC attachment.

Location: Main Billing Section/HIMD

Availability of Service: Any day of the week.

Office/Division: Health Information Management Department - Birth Registration

Unit
Classification: Simple
Type of Transaction: G2G – Government to Government
Who may avail: Birth Registration Staff, Billing Section Staff
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Endorsement List Birth Registration Unit
2. Certificate of Live Birth Birth Registration Unit
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Waits for the 1. Prepares the None Time will Administrative
endorsement endorsement depend on the Officer III
list and total number of Birth
arrange the prepared Registration
prepared Certificate of Transcriptionist
Certificates of Live Birth
Live Birth
HIMD staff
based on date
of birth
1.1 Photocopies
all prepared
Certificate of
Live Birth
1.2 Stamps
Certified True
Copy and
affixes
signature with
date on each
Certificate of
Live Birth
2. Checks the 2. Reads the None Time will Administrative
endorsement list Certificate of depend on the Officer III
while the Birth Live Birth one total number of Birth
Registration Staff by one prepared Registration
reads the Certificate of Transcriptionist
photocopy Live Birth
3. Receives the 3. Receives None 5 minutes Administrative
photocopies and Endorsement Officer III
affixes full name List Birth
and signature on Registration
the endorsement Transcriptionist
list.
TOTAL: None

Health Information Management Department

Cancer Institute

External Services
Patients Data Registration at the Outpatient Cancer Institute- New/Old
(Without Yellow Card)
Health Record Number generation for new and old patients seeking consultation at the Outpatient
Department-Cancer Institute

Availability of Service: 8:00 am to 4:00 pm, Monday to Friday, except Holidays. No Noon Break.

Office/Division: Health Information Management Department – Cancer Institute

Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: All Out-patients diagnosed with Cancer except Gyne-Onco patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patient’s Information Sheet CI OPD Triage Nurse
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Proceeds to Triage 1. Evaluates None 20 minutes Nurse II
For Evaluation and patient. CI OPD Triage
Fills-out the Patient’s 1.2 Issues Nurse
Information Sheet. Patient’s
Information Sheet
1.3 Instructs the
patient to fully
accomplish the
Patient’s
Information Sheet
1.4 Triage patient
according to signs
Note: Minor or and symptoms.
mentally incapacitated 1.5 Instructs
patients preferably patient to proceed
accompanied by a to CI-HIMD 2nd
parent or guardian floor.
2. Completes the 2. Verifies the 20 minutes Administrative
registration process accuracy of the Officer I
entries in the CI HIMD Staff
 *** For first time Patient’s
patients (patients with Information Sheet
no history of 2.1 Encodes
consultation)- to pay patient’s
for Consultation fee information in the
only. Hospital
Information
***For old patients System (HIS).
with lost yellow card – 2.2 Generates
to pay for consultation Patient’s Health
and yellow card. Record Number
2.3 Return the
Patient’s
Information Sheet
2.4 Instructs P50.00 –
patient to pay at Consultatio
the cashier and n Fee
endorse to triage
nurse their P50.00 –
Patient’s Patient’s
information sheet Identificatio
then proceeds to n Card (lost)
their assigned
clinic.
TOTAL: P 100.00 40 minutes

Provision of Outpatient Health Records for New and Old Patients at the
Cancer Institute Outpatient Department
Retrieval of patients’ health records for old patient and provision of Clinical Cover Sheet of new
patients seeking consultation at Cancer Institute Outpatient Department.

Availability of Service: 8:00 am to 4:00 pm, Monday to Friday, except Holidays. No Noon Break.

Office/Division: Health Information Management Department - Main

Classification: Simple
Type of Transaction: G2C – Government to Citizen; G2G – Government to Government
Who may avail: All Out-patients diagnosed with Cancer except Gyne-Onco patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patient’s Information Sheet OPD Triage Nurse
2. Patient’s Identification Card Personal (for old patients with yellow card)
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit Patient’s 1. Evaluates and None 5 minutes Nurse I
Information Sheet Or accept the CI OPD Triage
Patient’s Identification Patient’s Nurse
Card with official Information Sheet
receipt or Social Or Patient’s
Worker’s note at the Identification
Triage area. Card.
1.1 Instructs 20 minutes
patient to proceed
to their assigned
clinic
1.2 Endorses the
collected Patient’s
Information Sheet
or Patient’s
Identification Card
(yellow card) to
 HIMD (Medical
Records)
2. Waits for the name 2.1 Encode 10 minutes Administrative
to be called at the patient’s Officer I
assigned clinic. information for CI HIMD Staff
consultation
based on the
endorsement of
the triage nurse.
2.2 Note the last
check up of old
patient in the
triage note.
2.3 Print Clinical
Cover Sheet – for
new patients
2.4 Issues 5 minutes
Patient’s
Identification Card
(Yellow Card)
2.5 Retrieves 5 minutes
patient’s health
record – for old
patient
2.6 Logs in the
Outpatient
Retrieval Logbook
2.7 Places it to the
assigned basket
2.8 Waits for the
nurse attendant/
nurse on duty to
get the retrieved
records.
Five (5)
Note: The minutes
endorsement of retrieval of
yellow card/ records and
information sheet release from
for retrieval to HIMD is for
HIMD and active files
retrieval of health only. Old
records is done by records filed in
batch that might the storage
affect the waiting areas may
time of patient. consume more
retrieval time.)
TOTAL: None 45 minutes
Health Information Management Department

Heart Institute

External Services
Patients Data Registration at the Heart Institute Outpatient Department-
New/Old (Without Yellow Card)
Health Record Number generation for new and old patients seeking consultation at the Outpatient
Department- Heart Institute

Availability of Service: 7:00 am to 3:00 pm, Monday to Friday, except Holidays. No Noon Break.

Office/Division: Health Information Management Department – Heart Institute

Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: 1. Patients (Out-patient and Walk-in patients).
2. Patients for follow-up check-up
3. Patients with referral from General Medicine, Cardiologist
Consultant and any Internal Medicine Consultants
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patient’s Information Sheet Triage Window
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Proceeds to Triage 1. Verifies patient None 10 minutes Nurse I
and Fills-out the if new or old. HI OPD Nurse
Patient’s Information 1.1 Issue Patient’s
Sheet Information Sheet
1.2 Instructs the
patient to fully
accomplish the
Patient’s
Information Sheet
2. Completes the 2. Verify the None 10 minutes ADAS I
registration process. accuracy of the HI HIMD Staff
entries in the
*** For first time Patient’s
patients (patients with Information Sheet
 no history of 2.1 Encode 5 minutes
consultation)- to pay patient’s
for Consultation fee information in the
only. computer system
2.2 Generate
***For old patients Patient’s Health
with lost yellow card – Record Number
to pay for consultation 2.3 Return the 2 minutes
and yellow card. Patient’s P50.00 –
Information Sheet Consultatio
3.4 Instructs client n Fee 3 minutes
to pay to cashier
or ask assistance P50.00 –
from social worker Patient’s
Identificatio
n Card (lost)

TOTAL: P 100.00 30 minutes

Provision of Outpatient Health Record at the Heart Institute Outpatient

Department
Retrieval of patients’ health records for old patient and provision of Clinical Cover Sheet of new
patients seeking consultation at Heart Institute Outpatient Department.

Availability of Service: 7:00 am to 3:00 pm, Monday to Friday, except Holidays. No Noon Break.

Office/Division: Health Information Management Department – Heart Institute

Classification: Simple
Type of Transaction: G2C – Government to Citizen; G2G – Government to Government
Who may avail: 1. Patients (Out-patient and Walk-in patients).
2. Patients for follow-up check-up
3. Patients with referral from General Medicine, Cardiologist
Consultant and any Internal Medicine Consultants
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patient’s Information Sheet OPD Triage Nurse
2. Patient’s Identification Card Personal (for old patients with yellow card)
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submits Patient’s 1. Evaluate and None 10 minutes ADAS I
Information Sheet Or accept the HI HIMD Staff
Patient’s Identification Patient’s
Card with official Information Sheet
receipt or Social Or Patient’s
Worker’s note to Identification
triage window. Card.
1.1 Encode
patient’s
information for
consultation
based on
 endorsement of
the triage nurse.
1.2 Note the last
check up of old
patient in the
triage note.
1.3 Print Clinical
Cover Sheet – for
new patients
1.4 Issues
Patient’s
Identification Card
(Yellow Card)
1.5 Instructs
patient to wait at
the waiting area.
2. Waits for the 2. Retrieves 5 minutes ADAS I
name to be called. patient’s health HI HIMD Staff
record- for old
patient
2.1 log in patient 5 minutes
retrieval logbook
2.2 Endorses
retrieved record to
triage nurse. Five (5)
minutes
Note: The retrieval of
endorsement of records and
yellow card/ release from
information sheet HIMD is for
for retrieval to active files
HIMD and only. Old
retrieval of health records filed in
records is done by the storage
batch that might areas may
affect the waiting consume more
time of patient. retrieval time.)
TOTAL: None 20 minutes
Health Information Management Department

Renal Dialysis Unit

 External Services

PROVISION OF OUTPATIENT HEALTH RECORD AT RENAL DIALYSIS UNIT

Retrieval of patients’ health records for old patient and provision of Clinical Cover Sheet of new
patients having dialysis session at Renal Dialysis Unit.

Availability of Service: 5:00 am to 8:00 pm, Monday to Friday, Holidays except Sundays. No Noon
Break.

Office/Division: Health Information Management Department – Renal Dialysis Unit

Classification: Simple
Type of Transaction: G2C – Government to Citizen; G2G – Government to Government
Who may avail: 1. Patients scheduled for a dialysis session.
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patient’s Identification Card, if Personal (for old patients with yellow card)
available
2. Patient’s hemodialysis bill Billing Section
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submits 1. Accepts, None 10 minutes ADA I
hemodialysis bill to verifies and signs HIMD Staff
HIMD Staff the Patient’s
nd
(applicable for 2 to hemodialysis bill.
4th session). 1.1 Logs in the
patient’s name for
Schedule for encoding and
collection/signing of retrieval of health
bills: record.
st
1 session: 5:00 am 1.2 Encode
nd
2 session: 7:00 am patient’s
3rd session: 11 :00 am information in the
4th session: 3:00 pm HIS.
1.3 Print Clinical
Schedule for Cover Sheet – for
encoding of new patients
transaction: 1.4 Instructs
1st session: 5:00 am patient to wait at
2nd session: 8:30 am the waiting area.
3rd session: 1:00 pm
4th session: 6:00 pm

Endorsement of
health records to
nurses’ station
1st session: 7:00 am
2nd session: 10:00 am
3rd session: 3:00 pm
4th session: 7:00 pm

2. Waits for the 2. Retrieves 5 minutes ADA I

name to be called. patient’s health HIMD Staff
record- for old
patients
2.1 Endorse 5 minutes
retrieved records
to Nurse on duty
(RDU main and
Annex).

TOTAL: None 20 minutes

Health Information Management Department

 Main Office

External Services

Certificate and Supporting Documents for SSS, GSIS, HDMF and Other
Insurances – Previously Admitted, Outpatient and ER Patients

Availability of Service: 8:00 am to 4:00 pm, Monday to Friday except Holidays. No Noon Break.

Location: HIMD Window 6 – For Previously Admitted Patients

HIMD Window 12 – For OPD and ER Patients

Office/Division: Health Information Management Department – Main

Classification: Complex
Type of Transaction: G2C – Government to Citizen
Who may avail: 1. Patient
2. Parent or legal guardian (with Certificate of Guardianship) in case
of minors or incapacitated patients
3. Nearest of kin or legal heirs for died patients
4. Authorized representative
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
A. Patient, or Parent of minor, or Legal
Guardian (with Certificate of
Guardianship)
1. Request Slip HIMD
2. At least two (2) valid identification cards Personal, Any Government Issued IDs
of patient and/or authorized representative
3. Proof of payment/Official Receipt or Cashier/ Social Service
Social Worker’s Approval
B. Other Authorized Requesting Party
1. Request Slip HIMD
2. Special Power of Attorney or Affidavit of Personal, Notary Public or SPMC Legal Office
Authorization with at least two (2) valid
identification cards of patient and
authorized representative
3. Proof of payment/Official Receipt or Cashier/ Social Service
Social Worker’s Approval
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Accomplishes 1. Receives, 20 minutes Administrative
request slip and validates and Officer I
submits Insurance verifies request. HIMD Staff
Claim Form 1.1 Verifies
availability of
records and
consultation
history from
Hospital
Information
System (HIS).
1.1 Issues charge P100-
slip. Certificate
1.2 Instructs client
to pay to cashier P100-
or assistance from Retrieval
social worker Fee for
1.3 Issues claim Records
stub filed 5 years
above

After Five (5) Working Days

2. Present claim stub 2. Check None 15 minutes Administrative
and required requirements Officer I
documents together 2.1 Release HIMD Staff
with proof of payment requested
or Charge Slip with documents
Social Worker’s
Approval

3. Acknowledges Logs in the None 5 minutes Administrative

receipt of Certificate Issuance of Officer I
with Supporting Requested HIMD Staff
Documents Documents
Logbook.
TOTAL: Refer to 5 days, 40
approved minutes
schedule
of fees

HEALTH INFORMATION MANAGEMENT DEPARTMENT Schedule of Fees

RETRIEVAL FEE:
Medical Records filed 5 years > 18 years P 100.00
Medical Records and Registry books 18 years and above P 100.00
CERTIFICATION:
Medical Certificate P 50.00
Certificate of Confinement P 50.00
Certificate of No Record P 50.00
Certificate to Support Late Filing of Birth/Death Certificate P 50.00
Medical Certificate for Insurance with Supporting Documents P 100.00
RE-ISSUANCES:
 Birth/Death Certificate P 100.00
Medical Certificate P 50.00
AUTHENTICATED COPY OF CLINICAL RECORD P 15.00/COPY

Certificate of Confinement
This applies to the issuance on a valid request of a Certificate of Confinement on an admitted
patient.

Availability of Service: 8:00 am to 4:00 pm, Monday to Friday except Holidays. No Noon Break.
Location: HIMD Window 6, OPD JICA Building

Office/Division: Health Information Management Department – Main

Classification: Simple
Type of Transaction: G2C – Government to Client
Who may avail: 1.Patient
2. Parent or legal guardian (with Certificate of Guardianship) in case
of minors or incapacitated patients
3. Nearest of Kin or Immediate Family
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
A. Patient, or Parent of minor, or Legal
Guardian (with Certificate of
Guardianship) and Other Authorized
Requesting Party
1. Request Slip HIMD
2. At least two (2) valid identification cards Personal, Any Government Issued IDs
of patient and/or authorized representative
3. Proof of payment/Official Receipt or Cashier/ Social Service
Social Worker’s Approval
 CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Accomplishes 1. Receives, 20 minutes Administrative
request slip and fills- validates and Officer I
out Draft Copy- verifies request. HIMD Staff
Certificate of 1.1 Issues charge
Confinement slip.
1.2 Instructs client P50-
to pay to cashier Certificate
or ask assistance
from social worker
1.3 Instructs client
to bring draft form
to Nurse-on-duty
to confirm
patient’s
admission and for
signature.

After Nurse-On-Duty Confirmation

2. Present Draft Form 2. Check None 20 minutes Administrative
with Nurse’s signature documents Officer I
together with proof of 2.1 Transcribes HIMD Staff
payment or Charge Certificate of
Slip with Social Confinement
Worker’s Approval 2.2 Facilitates
signing of
Certificate of
Confinement
3. Acknowledges Logs in at the None 5 minutes Administrative
receipt of Certificate Issuance of Officer I
of Confinement. Requested HIMD Staff
Documents
Logbook.
TOTAL: P 50.00 45 minutes

Death Certificate – Initial Issuance

This applies to all Death occurred at the Southern Philippines Medical Center.

Availability of Service: 8:00 am to 4:00 pm, Mondays to Saturdays & Holidays, except Sundays
No Noon Break.
Location: HIMD Window 3, OPD JICA Building

Office/Division: Health Information Management Department – Main

Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: 1. Parent or legal guardian (with Certificate of Guardianship) in case
of minors or incapacitated patients
2.Nearest of kin or legal heirs for died patients
3. Authorized representative
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Request Slip HIMD
2. Settled Statement of Account Billing Section
3. At least two (2) valid identification cards Personal, Any Government Issued IDs
of patient and/or authorized representative
4. PSA Birth Certificate and/or PSA Personal, Philippine Statistics Authority
Marriage Certificate, if necessary
5. Sworn Statement, if necessary Notary Public, SPMC Legal Office
 CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Accomplishes 1. Interviews client None 20 minutes ADA I
request slip. Present to verify HIMD Staff
hospital Statement of relationship with
Account (SOA) and the deceased.
valid identification 1.1 Verifies status
cards. of patient’s
medical records
thru the Hospital
Information
System (HIS)
1.2 Retrieves
patient’s record.
1.3 If SOA is not
available, advice
client to secure
from Billing
Section.
1.4 If clearance
and SOA are not
settled, advice
client to pay, or
ask assistance
from social
worker.
2. Checks patient’s 2. Encode and None 25 minutes ADA I
data and validate the proofread entries HIMD Staff
required information. on death
certificate
3. Review all entries 3. Prints Death None 10 minutes ADA I
for completeness and Certificate HIMD Staff
accuracy. Affix 3.1Releases
signature on copy of death certificate
Death Certificate and with instruction to
“Release of complete the
Responsibility for process with Local
Erroneous Entry” Civil Registrar in
form. Davao City.
4. Acknowledges Logs in at the None 5 minutes ADA I
receipt of Death issuance of Death HIMD Staff
Certificate. Certificate
Logbook.
TOTAL: None 60 minutes
Death Certificate – Re-Issuance

Availability of Service: 8:00 am to 4:00 pm, Mondays to Saturdays & Holidays, except
Sundays.
No Noon Break
Location: HIMD Window 3, OPD JICA Building

Office/Division: Health Information Management Department – Main

Classification: Complex
Type of Transaction: G2C – Government to Citizen
Who may avail: 1. Parent or legal guardian (with Certificate of Guardianship) in case
of minors or incapacitated patients
2.Nearest of kin or legal heirs for died patients
3. Authorized representative
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Request Slip HIMD
2. At least two (2) valid identification cards Personal, Any Government Issued IDs
of patient and/or authorized representative
3. PSA Birth Certificate and or PSA Personal, Philippine Statistics Authority (PSA)
Marriage Certificate, if necessary
4. Certificate of Guardianship, if necessary Lawyer, Notary Public or SPMC Legal Office
5. Affidavit of Loss or Sworn Lawyer, Notary Public or SPMC Legal Office
Statement for non registration of previously
issued death certificate
6. Certificate of No Record LCR or PSA
7. Proof of payment/Official Receipt or Cashier/Social Service
Charge Slip with Social Worker’s Approval
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Accomplishes 1. Interviews client 20 minutes ADA I
request slip for the re- to verify HIMD Staff
issuance of Death relationship with
certificate and present the deceased.
valid identification 1.1 Issues charge
card/s. slip.
1.2 Instructs client P100- Re-
to pay to cashier issuance
or assistance from fee
social worker
P100-
Retrieval
Fee for
Records
filed 5 years
above
After Five (5) Working Days
2. Present proof of 2. Encode and None 25 minutes ADA I
payment or Charge proofread entries HIMD Staff
Slip with Social on death
Worker’s Approval certificate
and other required
documents.

3. Review all entries 3. Prints Death None 10 minutes ADA I

for completeness and Certificate HIMD Staff
accuracy. Affix 3.1 Releases
signature on copy of death certificate
Death Certificate and with instruction to
“Release of complete the
Responsibility for process with Local
Erroneous Entry” Civil Registrar in
form. Davao City.
4. Acknowledges Logs in at the None 5 minutes ADA I
receipt of Death issuance of Death HIMD Staff
Certificate. Certificate
Logbook.
TOTAL: Refer to 5 days, 60
approved minutes
schedule
of fees

HEALTH INFORMATION MANAGEMENT DEPARTMENT Schedule of Fees

RETRIEVAL FEE:
Medical Records filed 5 years > 18 years P 100.00
Medical Records and Registry books 18 years and above P 100.00
CERTIFICATION:
Medical Certificate P 50.00
Certificate of Confinement P 50.00
Certificate of No Record P 50.00
Certificate to Support Late Filing of Birth/Death Certificate P 50.00
Medical Certificate for Insurance with Supporting Documents P 100.00
RE-ISSUANCES:
Birth/Death Certificate P 100.00
Medical Certificate P 50.00
AUTHENTICATED COPY OF CLINICAL RECORD P 15.00/COPY
ISSUANCE OF MEDICAL CERTIFICATE – OUTPATIENT CONSULTATION
This applies to the issuance of a valid request of a medical certificate on same day Outpatient
consultation.
Availability of Service: 8:00 am to 4:00 pm, Monday to Friday, except Holidays. No Noon Break.
Location: Window 12, Ground floor, OPD JICA Building-Medical Records

Office/Division: Health Information Management Department - Main

Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: 1.Patient
2. Parent or legal guardian in case of minors or incapacitated
patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patient’s Identification Card (Yellow HIMD
card)
2. Draft Copy – Medical Certificate Doctor
3. At least two (2) valid identification cards Personal, Any Government issued IDs
4. Proof of payment/Official Receipt or Cashier/Social Service
Social Worker’s Approval
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
 1. Submit Patient’s 1. Receives, None 5 minutes ADA I
Identification Card validates and HIMD Staff
(yellow card) and verifies request.
completely filled out
draft copy of medical 1.1 Issues charge Php 50.00 5 minutes ADA I
certificate from clinic. slip HIMD Staff

1.2 Instructs client None 5 minutes ADA I

to pay to cashier HIMD Staff
or ask assistance
from social worker
2. Presents Official 2. Encodes the None 5 minutes ADA I
Receipt or Charge diagnosis in the HIMD Staff
Slip with Social system
Worker’s Approval.
2.1 Prints Medical None 5 minutes ADA I
Certificate HIMD Staff

2.2 Facilitates None 15 minutes ADA I

signing of Medical HIMD Staff
Certificate by
Attending
Physician.
3. Presents valid 3. Checks None 5 minutes ADA I
identification card/s submitted HIMD Staff
and other required requirements.
documents.
3.1 Stamps dry None 5 minutes ADA I
seal of Medical HIMD Staff
Certificate then
releases the
certificate.
4. Acknowledges 4. Logs in the None 10 minutes ADA I
receipt of Medical Issuance of HIMD Staff
Certificate Medical Certificate
Logbook.
TOTAL: Php 50.00 1 hour

Issuance of Medical Certificate – Outpatient Consultation at Satellite Clinics

(Heart and Cancer Institute, RDU, ABTC, HACT)
This applies to the issuance of a valid request of a medical certificate on same day Outpatient
consultation.

Availability of Service: 8:00 am to 4:00 pm, Monday to Friday, except Holidays. No Noon Break.

Office/Division: Health Information Management Department

Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: 1.Patient
2. Parent or legal guardian in case of minors or incapacitated
patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patient’s Identification Card HIMD
2. Draft Copy – Medical Certificate Doctor
3. At least two (2) valid identification cards Personal, Any Government Issued IDs
4. Proof of payment/Official Receipt or Cashier/Social Service
Social Worker’s Approval
 CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit Patient’s 1. Receives, None 15 minutes Administrative
Identification Card validates and Officer I
(yellow card) and verifies request. HIMD Staff
completely filled out 1.1 Issues charge P 50.00
draft copy of medical slip
certificate from clinic. 1.2 Instructs client
to pay to cashier
or ask assistance
from social worker
2. Presents Official 2. Encodes the None 25 minutes Administrative
Receipt or Charge diagnosis in the Officer I
Slip with Social system HIMD Staff
Worker’s Approval. 2.1 Prints Medical
Certificate
2.2 Facilitates
signing of Medical
Certificate by
Attending
Physician.
2.3 Instructs
patient to proceed
to HIMD Window
12 located at OPD
JICA Building
Ground Floor for
Dry Seal.
3. Present valid 3. Check None 10 minutes Administrative
identification card/s requirements Officer I
and other required 3.1 Dry seal of HIMD Staff
documents. Medical Certificate
3.2 Releases
Medical
Certificate.
4. Acknowledges 4. Logs in the None 10 minutes Administrative
receipt of Medical Issuance of Officer I
Certificate Medical Certificate HIMD Staff
Logbook.
TOTAL: P50.00 60 minutes

Issuance of Medical Certificate – Previously Admitted, Outpatient and ER

Patients
This applies to the issuance of a valid request of a medical certificate on previous Outpatient
consultation at OPD Main, Heart and Cancer Institute, RDU, ABTC and HACT Clinic, ER
consultation and Previously Admitted Patients.

Availability of Service: 8:00 am to 4:00 pm, Monday to Friday, except Holidays. No Noon Break.

Office/Division: Health Information Management Department - Main

Classification: Complex
G2C – Government to Citizen
Type of Transaction:
Who may avail: 1.Patient
2. Parent or legal guardian (with Certificate of Guardianship) in case
of minors or incapacitated patients
3.Nearest of kin or legal heirs for died patients
4. Authorized representative
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
A. Patient, or Parent of minor, or Legal
Guardian (with Certificate of
Guardianship)
1. Request Slip HIMD
2. At least two (2) valid identification cards Personal, Any Government issued IDs
of patient and/or authorized representative
3. Certificate of Guardianship, if necessary Lawyer, Notary Public or SPMC Legal Office
4. Proof of payment/Official Receipt or Cashier/Social Service
Social Worker’s Approval
B. Other Authorized Requesting Party
1. Request Slip HIMD
2. Special Power of Attorney or Affidavit of Lawyer, Notary Public or SPMC Legal Office
Authorization
3. At least two (2) valid identification cards Personal, Any Government issued IDs
of patient and/or authorized representative
4. Proof of payment/Official Receipt or Cashier/Social Service
Social Worker’s Approval
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Accomplishes 1. Receives, None 15 minutes ADA I
request slip validates and HIMD Staff
verifies request.
1.1 Issues charge (Refer to
slip approved
1.2 Instructs client schedule of
to pay to cashier fees)
or ask assistance
from social worker
1.3 Issues claim
stub- schedules
client when and
where to come
back
After Five (5) Working Days
2. Present claim stub 2. Check None 10 minutes HIMD Staff
and other required requirements
documents together 2.1 Dry seal of
with proof of payment, Medical Certificate
or Social Worker’s 2.2 Releases
approval. Medical
Certificate.
HIMD Window 4 – for
previously admitted
patients

HIMD Window 12 –
for previous ER and
Oupatient consultation

3. Acknowledges 3. Logs in the None 5 minutes HIMD Staff

receipt of Medical Issuance of
Certificate Medical Certificate
Logbook
TOTAL: Refer to 5 days, 30
approved minutes
schedule
of fees

HEALTH INFORMATION MANAGEMENT DEPARTMENT Schedule of Fees

RETRIEVAL FEE:
 Medical Records filed 5 years > 18 years P 100.00
Medical Records and Registry books 18 years and above P 100.00
CERTIFICATION:
Medical Certificate P 50.00
Certificate of Confinement P 50.00
Certificate of No Record P 50.00
Certificate to Support Late Filing of Birth/Death Certificate P 50.00
Medical Certificate for Insurance with Supporting Documents P 100.00
RE-ISSUANCES:
Birth/Death Certificate P 100.00
Medical Certificate P 50.00
AUTHENTICATED COPY OF CLINICAL RECORD P 15.00/COPY

Change or Update of Patient’s Demographic Data at the Outpatient

Department
The service is intended to those patients whose data was erroneously given and encoded in the
system.

Availability of Service: 8:00 am to 4:00 pm, Monday to Friday, except Holidays. No Noon Break.

Office/Division: Health Information Management Department - Main

Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: Out Patients, Previous ER patients, Previously admitted patients
whose data was erroneously given and encoded in the system.
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patient’s Information Sheet PACD, Patients Assistance and Complaints
Desk
2. Patient’s Identification Card Personal (for old patients with yellow card)
For Correction of Name and Birthday
**Kindly submit one (1) of the following:
1.PSA Birth Certificate Personal, Philippine Statistic Authority
2. Certified True Copy of Birth Certificate LCR, Local Civil Registrar
3. Two (2) valid Government issued Personal, Any Government Issued IDs
identification cards
-SSS SSS, Social Security System
-GSIS GSIS, Government Service Insurance System
-UMID SSS, GSIS
-Philippine Postal ID (not expired) Post Office
-Passport (not expired) DFA, Department of Foreign Affairs
-PRC (not expired) PRC, Professional Regulation Commission
-Driver’s License (not expired) LTO, Land Transportation Office
-TIN ID BIR, Bureau of Internal Revenue
4. PSA Certificate of No Record, if Philippine Statistic Authority
necessary
5. Affidavit or Sworn Statement, if Notary Public, SPMC Legal Office
necessary
For Update on Marital Status
**Kindly submit one (1) of the following:
1.Marriage Certificate, or Personal, Philippine Statistic Authority or
National Commission on Muslim Filipinos (for
Muslim Marriage)
2. Certified True Copy of Marriage LCR, Local Civil Registrar
Certificate
3. PSA Certificate of No Marriage PSA, Philippine Statistic Authority
(CENOMAR), if necessary
For Update on Address
1. Voter’s Identification Card, or Personal, COMELEC
2. Recent Voter’s Certificate COMELEC
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Presents 1. Accept and None 15 minutes ADAS I
completely filled out evaluate the HIMD Staff
Patient’s Information Patient’s
Sheet or Patient’s Information Sheet
Identification Card Or Patient’s
with required Identification
documents, if Card.
available. 1.1 Verify the
Health Record
Number (HRN) in
the Hospital
Information
System
Note: If supporting 1.2 Instructs client
documents are not to fill out pink form
available or lacking, 1.3 Updates
Instructs the patient to patient’s record in
secure them and to the HIS and on
come back right after. the Patient’s
Identification
Card.
TOTAL: None 15 minutes
Patients Data Registration at the Outpatient Department- New/Old (Without
Yellow Card)
Health Record Number generation for new and old patients seeking consultation at the Outpatient
Department

Availability of Service: 7:00 am to 4:00 pm, Monday to Friday, except Holidays.

No Noon Break.
Location: HIMD Windows 8,9,and 10, OPD JICA Building

Office/Division: Health Information Management Department - Main

Classification: Simple
Type of Transaction: G2C – Government to Client
Who may avail: All Out-patients (Non-emergency cases)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patient’s Information Sheet PACD Counter near OPD patients entrance
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
 1. Proceeds to PACD 1. Issues Patient’s None 10 minutes PACD Officer
near OPD JICA Information Sheet
patients’ entrance. 1.2 Instructs the
patient to fully
accomplish the
Patient’s
Information Sheet

2. Fills-out the 2. Instructs the 10 minutes

Patient’s Information patient to proceed
Sheet to the HIMD
Window 8 (for
Senior Citizen,
PWD, Pregnant,
IP) or Window 9
(for general
patients)
3. Completes the 3. Verifies the None 10 minutes ADA I
registration process at accuracy of the HIMD Staff
the HIMD OPD entries in the
Window 8 or 9. Patient’s
Information Sheet
3.1 Encodes 5 minutes
patient’s
information in the
computer system
3.2 Generates 2 minutes
Patient’s Health
Record Number
3.3 Returns the 3 minutes
Patient’s
Information Sheet
3.4 Instructs
patient to proceed
to Triage area for
the assignment of
clinic.
TOTAL: None 40 minutes

Provision of Outpatient Health Records for New and Old Patients at the
Outpatient Department
Retrieval of patients’ health records for old patient and provision of Clinical Cover Sheet of new
patients.

Availability of Service: 7:00 am to 4:00 pm, Monday to Friday, except Holidays. No Noon Break.
Location: HIMD, OPD JICA Building

Office/Division: Health Information Management Department - Main

Classification: Simple
Type of Transaction: G2C – Government to Citizen; G2G – Government to Government
Who may avail: All Out-patients (Non-emergency cases)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patient’s Information Sheet PACD Counter near OPD patients entrance
2. Patient’s Identification Card Personal (for old patients with yellow card)
 CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit Patient’s 1. Evaluates and None 5 minutes ADA I
Information Sheet Or accepts the Clinic Encoder
Patient’s Identification Patient’s
Card with official Information Sheet
receipt or Social Or Patient’s
Worker’s note at the Identification
respective clinic. Card.
1.1 Encodes 10 minutes
patient’s
information for
consultation in the
HIS based on
endorsement of
the triage nurse.
1.2 Notes the last
check up of old
patient in the
triage note and
place it on the
basket for
transport to HIMD
(retrieval of health
records).
1.3 Prints Clinical
Cover Sheet – for
new patients
1.4 Issues 5 minutes ADA I/ ADA III
Patient’s Recording
Identification Card Clerk/ Clinic
(Yellow Card) Receptionist
2. Waits for the name 2. Retrieves 5 minutes ADAS III
to be called. patient’s health OPD Retrieval
record Clerk
2.1 Logs in the 5 minutes
Outpatient
Retrieval Logbook
2.2 Places it to the
assigned basket
2.2 Waits for the
dedicated
transporter to
endorse it to the
assigned clinic.
Five (5)
minutes
Note: The retrieval of
endorsement of records and
yellow card/ release from
information sheet HIMD is for
for retrieval to active files
HIMD and only. Old
retrieval of health records filed in
records is done by the storage
batch that might areas may
affect the waiting consume more
time of patient. retrieval time.)
TOTAL: None 30 minutes
 Health Information Management Department

Main Office

Internal Services

ACCESS TO ELECTRONIC/ HARD COPIES OF PATIENT’S HEALTH RECORDS

Facilitation of access of electronic/hard copies of patient’s health records for use on approved
case studies, research, and mortality/morbidity reviews etc.

Availability of Service: 8:00 am to 4:00 pm, Monday to Friday, except Holidays.

No Noon Break

Office/Division: Health Information Management Department – Main

Classification: Simple
Type of Transaction: G2G – Government to Government
Who may avail: 1. Doctors
2. Nurses
 3. Billing Staff
4.Composite Team
5. HIMES
6. Other Stakeholders
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Letter of Request duly approved by the Personal
Department Chairperson, Chief Resident,
Chief Nurse, and Hospital Research and
Ethics Committee, if necessary
2. Request from other stakeholders with Personal
the approval of the Medical Center Chief
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submits duly 1. Receives, None 10 minutes ADAS I
approved letter of validates, verifies HIMD Staff
request. request to access
patient’s medical
record.
1.1 Instructs the
client to read and
sign the
Responsibility
Clause for the
access of Medical
Records
1.2 Validates and
approves the
request.
1.3 Verify medical
records in the
Hospital
Information
System for
availability

For Scanned
health records-
instructs the client
to proceed to
IHOMP to register
for the access of
Manage
Anywhere

For Hard Copies

of health
records- queues
for the retrieval of
the patient’s
health records

1.4 Schedules the

client to come
back after 3
working days for
chart review
After 3 Working Days
2. Acknowledge 2. Releases 10 minutes ADAS I
receipt of requested requested medical HIMD Staff
medical records records.
 2.1 Logs in the
Monitoring
Logbook or
Borrower’s Index
Card.
TOTAL: None 3 days, 20
minutes

Receiving of Discharged In-Patients’ Health Records

Receiving of discharged in-patients’ health records from the different wards.

Availability of Service: 8:00 am to 4:00 pm, Mondays to Saturdays including Holidays

No Noon Break

Office/Division: Health Information Management Department - Main

Classification: Simple
Type of Transaction: G2G – Government to Government
 Who may avail: 1. Nurses
2. Nursing Attendants
3. CF4 Composite Team
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patients’ health records Wards
2. Daily Floor Census Report Wards
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Endorse patients’ 1. Checks the None 15 minutes ADAS I
health records to following for HIMD Staff-
HIMD. completeness: Receiving Clerk
a. Clinical Cover
Sheet
b. ER Clinical
Form, if necessary
c. Clinical
Summary
d. History Record
e. OR block
f. Doctors’ Orders
g. Nurses’ Notes
h. Discharge
Instructions
1.1 Checks and
verifies health
records against
the Daily Floor
Census Report
1.1 Encodes
receipt of medical
records in
Hospital
Information
System (HIS).
TOTAL: 15 minutes

Request for Retrieval of Patients’ Health Records for Ambulatory Surgery Unit
(ASU) and Clinic (Department) Procedure
Ambulatory surgical procedures done at the Ambulatory Surgery Unit, Outpatient Clinics, Heart
Institute Operating Room and Cancer Institute Mini Operating Room.

Availability of Service: 8:00 am to 4:00 pm, Monday to Friday, except Holidays. No Noon Break.

Office/Division: Health Information Management Department - Main

Classification: Simple
Type of Transaction: G2G – Government to Government
 Who may avail: 1. Clinic, ASU, HI-OR, CI-OR Nurse-on-duty
2. Clinic Receptionist
3. Clinic, ASU, HI-OR, CI-OR Nursing Attendant on duty
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Request for Retrieval of Medical Record- Ambulatory Surgery Unit or Clinics
Ambulatory Surgery
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submits completely 1. Receives, None 5 minutes ADAS III
filled out Request for validates, and HIMD OPD
Retrieval of Medical verifies the Staff
Records to HIMD request for
Main/ HIMD Cancer retrieval.
Institute/ HIMD Heart 1.1 Instructs the
Institute. client to come
back on the next
Note: The requestor working day for
must submit the the release of the
Request for Retrieval requested
of Medical Records a patients’ health
day before the records.
scheduled procedure.
On the day of the procedure
2. Acknowledge 2. Encodes None 10 minutes ADAS III
receipt of requested patient’s HIMD OPD
patients’ health information for Staff
records transaction in the
HIS based on the
Request for
Retrieval of
Medical Records
form submitted.
2.1 Releases the
requested
patients’ health
records together
with the request
form thru the
transporter/Nurse/
Nursing Aide
TOTAL: None 15 minutes

REQUEST FOR STATISTICAL DATA

- Provision of hospital statistical report related to studies, researches, monitoring and surveillance.
- Provision of statistical comparison of past and present performance of the hospital, guide for
planning future development and funding of the hospital, appraisal of work performed by the
medical, nursing and other staff.

Availability of Service: 8:00 am to 4:00 pm, Monday to Friday, except Holidays.

No Noon Break

Office/Division: Health Information Management Department – Main

Classification: Simple
Type of Transaction: G2G – Government to Government
Who may avail: 1. Doctors
2. Nurses
3. Other Staff (Ancillary, Administration, etc.)
4. Other Stakeholders
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Letter of Request duly approved by the Personal
Department Chairperson, Chief Resident,
Chief Nurse, and Hospital Research and
Ethics Committee, if necessary
2. Letter of Request from other Personal
stakeholders with the approval of the
Medical Center Chief
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submits duly 1. Receives, None 10 minutes Statistician III
approved letter of validates, and HIMD Staff
request. verifies official
request of
statistical data or
other request.
1.1 Schedule
client to come
back after 3
working days
After 3 Working Days
2. Acknowledge 2. Releases 5 minutes Statistician III
receipt of Data requested HIMD Staff
data/report.
2.1 Logs in the
Monitoring
Logbook
TOTAL: None 3 days,15
minutes
 Nutrition and Dietetics Section

External Services

1. ISSUANCE OF MARKET ORDERS AND RECEIVING OF DELIVERIES FOR

FRONTLINERS AND PATIENTS SEPARATELY.
Availability of Service: 6:00 am to 2:00 pm, Monday to Friday.

Office/Division: Food Procurement Unit, Nutrition and Dietetics Service

Classification: Simple
Type of Transaction: G2B
Who may avail: Suppliers of Foodstuff
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
 Market Order Food Procurement Dietitian
Food Items Suppliers
Filled Statement of Account with Delivery Suppliers
Receipt and Cash Invoice.
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1.Suppliers receive 1. Issue Market None 2 minutes Food
and signify Market Order for the Procurement
Order a week prior the following week. Dietitian
delivery date (Orders for
Frontliners and
patients must be
separated)

2. Deliver Food Items 2. Checking, None 2 hours Receiving

with complete PPE Weighing and Dietitian and
Inspecting of Resident
items based on Inspector
specifications.

3. Presentation of 3. Verify and None 5 minutes Receiving

Delivery Receipt, validate Dietitian and
Cash Invoice and documents Resident
SOA. (Separate presented. Inspector
frontliners from
patients)
TOTAL: 2 hours 7
minutes

2. PROCESSING OF DISBURSEMENT VOUCHERS FOR FRONTLINERS AND

PATIENTS SEPARATELY
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Food Procurement Unit, Nutrition and Dietetics Service

Classification: Complex
Type of Transaction: G2B; G2G
Who may avail: Suppliers of Foodstuff
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
 Completely filled up and inspected Suppliers
Statement of Account with corresponding
Delivery Receipt, Cash Invoice and Market
Order. Ordered items are separated from
frontliners and patients.
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit completed 1. Receive SOA None 5 minutes Procurement
SOA with Delivery with the receipts. Dietitian
and Invoice receipts.
Ordered items are 1.1 Check None
separated from accuracy of 30 minutes
frontliners and submitted Procurement
patients. SOA and Dietitian
receipts with
Market
Orders.

1.2 Approval of None 1 hour Chief

SOA by the Nutritionist-
Chief Dietitian
Nutritionist-
Dietitian.

1.3 Compute None 4 hours Procurement

taxes to be Dietitian
deducted from &
payables; Administrative
prepare Officer I
disbursement
vouchers,
summary and
Attachments.

1.4 Review None 1 hours Procurement

vouchers and Dietitian
attachments
for verification

1.5 Submit SOA, None

vouchers and 10 minutes Procurement
attachments to Dietitian
the accounting
office.
TOTAL: 6 hours and
45 minutes

3. Provision of Enteral Formula to In-patients

Availability of Service: 6:00 am to 7:00 pm, Monday to Sunday.

Office/Division: Nutrition and Dietetics Service

Classification: Simple
Type of Transaction: G2C
Who may avail: All In-patients prescribed with Enteral Feeding
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
 1.Diet list Hospital Information System (HIS)
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Client’s Diet will be 1. Print out Diet None 20 minutes Clinical Dietitian
prescribed by the list through
Physicians and Hospital
transcribed by the Information
nurses into the Diet System (HIS)
list.
1.1 Patients on
blenderized None 1 hour Clinical Dietitian
feeding are listed
on a separate diet
list.

1.1.2. Endorse to
the Formula None 5 minutes Clinical Dietitian
Room Aides

1.1.3 Preparation
of blenderized Formula Room
formula according None 2 hours Aides
to doctor’s diet
order

For Adult Patients:

Pure Commercial
Formula in
powdered form is
given.

For Pedia
Patients:
Natural
Blenderized
Formula/
Alternative
Formula is given.
2. Receives Formula 2. Deliver None 1 hour Food Service
formulas to nurse Workers
stations according & Formula
to patient’s diet Room Aides
prescription.
TOTAL: 4 hours 25
minutes

4. Provision of Meals to In-patients

Availability of Service: 6:00 am to 7:00 pm, Monday to Sunday.

Office/Division: Nutrition and Dietetics Service

Classification: Simple
Type of Transaction: G2C
 Who may avail: All In-patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Diet list Hospital Information System (HIS)
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Client’s Diet will be 1. Print out Diet None 20 minutes Food Service
prescribed by the list through Dietitian
Physicians and Hospital
transcribed by the Information
nurses into the Diet System (HIS)
list.
1.1 Generate None 1 hour Food Service
Meal Census Dietitian

1.1.2. Endorse to None 5 minutes Food Service

Food Production Dietitian
Dietitian

1.1.3 Cooking and Cook & Food

dishing out of food None 3 hours Service
according to the Workers
menu.
2. Receives food 2. Deliver and None 1 hour Food Service
serve meals Workers
according to diet
prescription.

2.1 Nurse signs the 2.1 Assist nurse in None 5 minutes Food Service
Acknowledgment form signifying Workers
Acknowledgement
Form
TOTAL: 5 hours 30
minutes

5. PROVISION OF MEALS TO OUT-PATIENTS, AND WATCHERS REFERRED

BY MSWS/ PDPU/ WCPU.
Availability of Service: 6:00 am to 6:00 pm, Monday to Sunday

Office/Division: Nutrition and Dietetics Service

Classification: Simple
 Type of Transaction: G2C
Who may avail: Out-patients and Watchers referred by MSWS/ PDPU/ WCPU for
Food Assistance
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Referral Form/ Routing Slip MSWS/ PDPU/ WCPU
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Client presents 1. Receives None 2 minutes Food Service
referral form/ routing referral form Dietitian
slip.
1.1 Returns 2nd None 1 minute Food Service
copy Dietitian

1.2 Get the details None 2 minutes

of the client and Food Service
transcribe it into Dietitian
the Food
Assistance List.

1.3 Prepares
appropriate meal None 5 minutes Food Service
for the client Dietitian

2. Receives Food 2. Provide meal None 2 minutes Food Service

Assistance and claim and claim stub. Dietitian
stub.
2.1 Instruct client None 3 minutes Food Service
regarding the Dietitian
schedule of
claiming meals.
TOTAL: 15 minutes

6. PROVISION OF NUTRITION CARE PROCESS TO REFERRED THERAPEUTIC

INPATIENTS.
Availability of Service: 8:00 am to 8:00 pm, Monday to Sunday.

Office/Division: Nutrition and Dietetics Service

Classification: Simple
Type of Transaction: G2C
Who may avail: Referred In-patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Referral form Doctor
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Watcher or Doctor 1.1 Receives None 2 minutes Clinical Dietitian
presents referral form referral form and
return 2nd copy.

1.2 Endorses to None 2 minutes Clinical Dietitian

Nutritionist
Dietitian-in-
Charge

2. Patient undergoes 2.1 Nutritionist None 15 minutes Clinical Dietitian

Nutritional Dietitian check
Assessment patient’s chart and
gather relevant
data through the
Hospital
Information
System

2.2 Computation None 20 minutes Clinical Dietitian

& translation of
diet order into
Food Exchange
List.

2.3 Meal Planning None 10 minutes Clinical Dietitian

based on calorie/
nutrient
requirements.

3. Watcher Listens to 3. Conducts None 15 minutes Clinical Dietitian

Diet Consultation and counselling to the
receive instruction watcher regarding
materials on behalf of the prescribed diet
the patient of the patient &
Provision of
supplementary
food if necessary

3.1 If the watcher

is not present, and
the patient is
admitted in NON-
COVID wards, the
Nutritionist-
Dietitian will
conduct bedside
counselling.

3.2 If the watcher

is not present, and
patient is admitted
in COVID wards,
the diet
prescription will be
endorsed to the
nurse on duty.
 A cellphone
number will be
provided if ever
there will be
points to clarify
regarding the diet.
4. Signs Conforme 4. Assists None 2 minutes Clinical Dietitian
Sheets patients/ watcher /
nurse to sign the
Conforme sheet

4.1 Monitoring of None 1 day Clinical Dietitian

Lab results and
diet compliance.

TOTAL: Refer to 1 day, 1 hour

approved and 6
schedule minutes
of fees

7. RECEIVE, AND DISTRIBUTE FOOD DONATIONS FROM OUTSIDE

INSTITUTIONS/ ORGANIZATIONS/ COMPANIES TO FRONTLINERS.
Availability of Service: 6:00 am to 7:00 pm, Monday to Sunday
Office/Division: Nutrition and Dietetics Service
Classification: Simple
Type of Transaction: G2B, G2G
Who may avail: NGOs, LGU, Private Sectors , National Agencies
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Endorsement Form PT REHAB
CLIENT STEPS AGENCY ACTION FEES TO PROCESSI PERSON
BE PAID NG TIME RESPONSIBLE
1. Representative 1.1 Once the PT None 2 minutes PT REHAB
of the donating Rehab are
group will informed, they
contact SPMC will be the one
PT REHAB to to contact NDS.
inform
regarding their 1.2 The Dietitian
food donations. who receives
the call will None 3 minutes Nutitionist-
inform the Dietitian,
Chief Dietitian Chief Dietitian,
and the and Production
Production Dietitian
Dietitian for
adjustment of
food
preparation

2. Drop donations 2. Food donations None 10 minutes Food Service

at PT REHAB will be checked Dietitian
or directly to and received.
Dietary when
instructed.
3. Submit 3. Receive None 5 minutes Food Service
endorsement Endorsement Dietitian
Form and Sign Form
on the Logbook
3.1 Assist in None 3 minutes Food Service
signing the Logbook. Dietitian

3.2 Distribute food

to designated areas. None 2 hours Food Service
Worker
TOTAL: 2 hours 23
minutes
 Nutrition and Dietetics Section

Internal Services

1. PROVISION OF MEALS AND SNACKS TO FRONTLINERS.

Availability of Service: 6:00 am to 6:00 pm, Monday to Sunday
Office/Division: Nutrition and Dietetics Service
Classification: Simple
Type of G2G
Transaction:
Who may avail: Staffs working in COVID areas and staying in Transient Homes
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Census of staff per shift Office of the Chief Administrative Officer/
Team Manager/
Nurse Stations
CLIENT STEPS AGENCY ACTION FEES TO PROCES PERSON
BE PAID SING RESPONSIBLE
TIME
1. Provide 1.1 Collect census from the None 15 Food Service
census of staff Office of the Chief minutes Dietitian
per shift Administrative Officer for
inside staff. If it was not
included on the list, it will be
endorsed through a phone
call by the Nurse-on-duty for
updating as approved by
CAO. For those who are
staying in Transient Homes,
the count will be endorsed by
the Team Managers through
email.

1.2 Collate census for None 1 hour Food Service

frontliners and patients. Dietitian

1.3 Endorse to Food

Production Dietitian None 5 minutes Food Service
Dietitian
1.4 Cooking and dishing-out
of food.
None 3 hours Cook &
Foodservice
The snacks and nutritional Worker
drinks will only be provided
to frontliners on duty in None 2 hours Clinical Dietitian
Covid Wards.
2. Receive Food 2. Provision of meals to the None
staff.

2.1 For Frontliners on duty, Food Service

it will be delivered to their 30 Workers
respective wards. minutes

2.2 For Frontliners outside EFM Assigned

SPMC premise: 2 hours Drivers
It will be picked up by the
assigned Drivers.
TOTAL: 8 hours
50
minutes
 Pharmacy

External Services
1. Provision of All Available Drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Cash Transaction Pricing for Regular Client)
Provision of available needs of OPD paying patients

Office or Division: MURANG GAMOT PHARMACY, MAIN IN-PATIENT

PHARMACY, OPD PHARMACY
Classification: Simple
Type of Transaction: G2C
Who may avail: SPMC- OPD patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing.
Personalized Physicians Prescription Physician of clinic where patient seek
consultation

SPMC Prescription Nurse station at the OPD where patient

presently consulted

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1.Present prescription 1. Accept prescription None 15 minutes Pharmacist
to Receiving window from the client and on duty
for validation process the
prescription by
checking availability
of requested items
2. Inform the 2. Process None 20 minutes Pharmacist
pharmacy personnel transaction on HIS on duty
which of the listed
items will be bought 2.1 Compute the
and the quantity to be total cost of the
purchased item/s requested in
the prescription then

2.2 Return the

prescription and
inform client the total
amount to be paid.

NOTE:
A. Maximum one-
month maintenance
medications.
B. One week for
antibiotics
prescribed.

C. Epoetin alfa and

beta one-week
supply consumption
(releasing mon-fri
8am-5pm)
2.1 Buy ice cubes to 2.3 Instruct the client Pharmacist on
the nearest store to proceed to cashier duty
for payment. then
Instruct client to
return to the
pharmacy after
payment

NOTE:
Instruct client to buy
ice cubes before
claiming biological
drugs
TOTAL: 35 minutes
2. Provision of All Available Drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Cash Transaction- Availment of Medicines for Regular
Client)
Provision of available needs of OPD paying patients

Office or Division: OPD PHARMACY, MURANG GAMOT PHARMACY,

MAIN IN-PATIENT PHARMACY
Classification: Simple
Type of Transaction: G2C
Who may avail: SPMC- OPD patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not be
accepted for processing.

Official receipt SPMC Cashier

Personalized Physicians Prescription Physician of clinic where patient seek

consultation

SPMC Prescription Form Nurse station at the OPD where patient

presently consulted
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1.Present prescription 1. Accept prescription None 5 minutes Pharmacist
to Receiving window and check validity of on duty
with official receipt the Official Receipt

2. Receive 2. Issue the items None 30 minutes Pharmacist

purchased items and and receipt to the on duty
receipt client

TOTAL: 35 minutes
3. Provision of All Available Drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Cash Transaction- Pricing Senior Citizen/PWD)
Provision of available needs of paying Senior Citizen/PWD patients

Office or Division: OPD PHARMACY, MURANG GAMOT PHARMACY,

MAIN IN-PATIENT PHARMACY
Classification: Simple
Type of Transaction: G2C
Who may avail: SPMC patients/ Patients of Physicians aged 60 years old
and above (Senior Citizen) or with disability (PWD)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing.
Personalized Physicians Prescription Physician of clinic where patient seek
consultation

SPMC Prescription Nurse station at the OPD where patient

presently consulted
Medical Abstract Physician of clinic where patient seek
consultation

PRINCIPAL

ID of Senior Citizen or PWD Local Government Unit

OSCA or PWD Medicine booklet
Medical Abstract Physician of clinic where the patient seek
consultation

REPRESENTATIVE

ID of Senior Citizen or PWD Local Government Unit

OSCA or PWD Medicine booklet

Authorization Letter with present date Person being represented

Medical Abstract Physician of clinic where the patient seek

consultation
Government Issued Identification card of the
representative BIR, POST OFFICE, DFA, PSA, SSS, GSIS,
PAG-IBIG, LTO, PRC

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1.Present client 1. Accept prescription None 15 minutes Pharmacist
prescription and other and check on duty
pertinent documents completeness of
to Receiving window required information,
to avail discount and validity and
for validation. requirements
1.1 Process the
prescription by
checking availability
of requested item/s.

2. Inform which of the 2. Process None 30 minutes Pharmacist

listed items will be transaction on HIS on duty
bought and the and inform client the
quantity to be total amount to be
purchased. paid.

2.1 Return the

prescription to the
client
2.3 Instruct the client
to bring the
prescription to the
cashier and pay the
indicated amount

NOTE:
A. Maximum one-
month maintenance
medications.
B. One week for
antibiotics
prescribed.
C. Epoetin alfa and
beta one-week
supply consumption
(releasing Monday-
Friday 8am-5pm)
D. Instruct client to Pharmacist
provide ice cubes on duty
before claiming the
biological medicineS

TOTAL: 45 minutes
4. Provision of All Available Drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Cash Transaction- availment Senior Citizen/PWD)
Provision of available needs of paying Senior Citizen/PWD patients

Office or Division: OPD PHARMACY, MURANG GAMOT PHARMACY,

MAIN IN PATIENT PHARMACY
Classification: Simple
Type of Transaction: G2C
Who may avail: SPMC patients/ Patients of Physicians aged 60 years old
and above (Senior Citizen) or with disability (PWD)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing.
Personalized Physicians Prescription Physician of clinic where patient seek
consultation

SPMC Prescription Nurse station at the OPD where patient

presently consulted
Physician of clinic where patient seek
Medical Abstract
consultation

PRINCIPAL

ID of Senior Citizen or WD Local Government Unit

OSCA or PWD Medicine booklet
Medical Abstract Physician of clinic where the patient seek
consultation

REPRESENTATIVE

ID of Senior Citizen or PWD Local Government Unit

OSCA or PWD Medicine booklet

Authorization Letter with present date Person being represented

Medical Abstract Physician of clinic where the patient seek
consultation
BIR, POST OFFICE, DFA, PSA, SSS, GSIS,
Government Issued Identification card of the
PAG-IBIG, LTO, PRC
representative

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1.Present prescription 1. Accept prescription None 5 minutes Pharmacist
to Receiving window and check validity of on duty
with official receipt the receipt and
and other pertinent completeness of
documents required information
2. Receive 2.Record transaction None 30 minutes Pharmacist
purchased items, on the medicine on duty
receipt and other booklet and issue the
documents items and receipt to
the client including
documents presented.

TOTAL: 35 minutes
5. Provision of All Available Drugs/Medicines/Medical Supplies and other
Pharmaceuticals (Cash transaction- PRICING for admitted patients)
Provision of available needs of admitted paying patients
(Anytime during Weekends and Holidays)
Office or Division: MURANG GAMOT PHARMACY, MAIN IN PATIENT PHARMACY
Classification: Simple
Type of Transaction: G2C
Who may avail: Clients admitted in SPMC and ER patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing.
SPMC Prescription Doctor/s

Pink card Social Worker

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1.Present SPMC 1. Receive the None 30 minutes Pharmacist
prescription and Pink prescription from the on duty
card to Receiving client and process
window for validation the prescription by
checking availability
of requested item/s

1.1 Compute the

total cost of the
item/s requested in
the prescription

1.2 Return the

Prescription (with the
total amount) to the
client

1.3 Instruct the client

to bring the
Prescription (with the
total amount) to the
cashier and pay the
indicated amount.

TOTAL: 30 minutes
6. Provision of All Available Drugs/Medicines/Medical Supplies and other
Pharmaceuticals (Cash transaction- AVAILMENT- for admitted paying patient)
Provision of available needs of admitted paying patients
(Anytime during Weekends and Holidays)
Office or Division: MURANG GAMOT PHARMACY, MAIN IN-PATIENT PHARMACY
Classification: Simple
Type of Transaction: G2C
Who may avail: Clients admitted in SPMC and ER patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing.
SPMC Prescription Doctor/s

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Present SPMC 1. Fill the None 30 minutes Pharmacist
prescription and prescription on duty
Official Receipt
(proof of
payment) at the
dispensing area

2. Receive/claim the 2. Issue the 10 minutes Pharmacist

item/s. purchased item/s to on duty
the client

TOTAL: 40 minutes
7. Provision of all Available Drugs/Medicines/Medical Supplies and other
Pharmaceuticals ( PHIC Patient in service ward and Payward)
Provision of available needs of PHIC Patient in service ward and Payward

Office or Division: MURANG GAMOT PHARMACY, MAIN IN-PATIENT PHARMACY

Classification: Simple
Type of Transaction: G2C
Who may avail: Clients admitted in Service ward and Payward
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing.
SPMC Prescription Doctor/s

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1.Bring the bulk 1. Receive the None 3 hours Pharmacist on
prescription to the prescription in bulk duty
pharmacy per ward
1.1 Inform the client
that they will receive a
call if request is ready
for pick up
1.2 Process the
prescription by
checking availability
of requested items
1.3 Encode the
requested items on
HIS for charging
1.4 Print issuance
log book
1.5 Prepare all the
items encoded
1.6 Call the client that
the requested items
are ready for pick up

2. Approach the 2. Issue the requested 5 minutes Pharmacist on

releasing personnel item/s to the nursing duty
attendant

2.1Receive/claim the 2.1 Request to sign

item/s on the space
provided for in
the issuance
report

TOTAL: 3 hours & 5

minutes
8. Replacement of all Available Drugs/Medicines/Medical Supplies and other
Pharmaceuticals in the Emergency Cart
Provision of Emergency Cart Replacement of the different wards/units/clinics
Of the hospital
Office or Division: MAIN IN-PATIENT PHARMACY
Classification: Simple
Type of Transaction: G2C
Who may avail: All wards/units/clinics of the hospital
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing.

Requisition and Issue Slip Requesting unit/ward/clinics

SPMC Prescription (FS) Doctor/s

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Submit Requisition 1.Receive the None 1 hour Pharmacist
and Issue Slip Requisition and Issue on duty
(RIS) for regular Slip for regular stocks/
stocks while for prescription for
consignment Consignment
medicines and medicines and
supply submit supplies
prescriptions
1.1 Check RIS versus
stock on hand
1.2 Process and fill
the request RIS
1.3 Call the client
2.Approach the 2. Ask client to sign 10 minutes Pharmacist
releasing counter to over printed name at on duty
receive the the space provided
Emergency cart (RIS and ward stock
replacement logbook)

2.1 Sign over printed 2.1 Issue the

name on the space requested
provided in the RIS Emergency cart
replacement drugs

TOTAL: 1 hour & 10

minutes
9. Replacement of all Available Drugs/Medicines/Medical Supplies and other
Pharmaceuticals
Provision of Narcotics/Dangerous drugs of different wards/units/clinics of the hospital

Office or Division: MAIN IN-PATIENT PHARMACY

Classification: Simple
Type of Transaction: G2C
Who may avail: All wards/units/clinics of the hospital
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Requisition for Dangerous Drug Pharmacy window 1
Preparation or Drug Preparation
Containing Controlled Chemical for
In-Patient Use Form
Accomplished Record of Dangerous Requesting Unit/wards/clinics
Drug Preparation Containing
Controlled Chemical dispensing to
In-Patient (through floor stock)/
Controlled Drugs Administration
Sheet form
Requisition and Issue Slip Form (RIS) Requesting Unit/wards/clinics

For replacement of stocks, empty Requesting Unit/wards/clinics

ampule or vial of previously issued
drug

CLIENT STEPS AGENCY FEES TO BE PROCESSIN PERSON

ACTION PAID G TIME RESPONSIBLE
1. For initial request: 1. Receive the None 15mins Pharmacist on
Submit Requisition and Requisition and duty
Issue slip Form and Issue Slip and
Requisition for other required
Dangerous Drug documents
Preparation or Drug
Preparation Containing 1.1 Check RIS
Controlled Chemical versus stock
on hand

1.2 Check if all

fields are
completely
accomplished

1.3 Inform the

client that
they will
receive a call
if request is
For replacement of ready for pick
Narcotics/Dangerous up
Drugs stocks:
1.4 Process and
Submit RIS and fill the
accomplished Record request RIS
of Dangerous Drug
Preparations 1.5 Call the client
Containing Controlled that the item
Chemical Dispensed to is ready for
in- Patients (through pick up
floor stock)/Controlled
Administration Sheet
Form
2. Proceed to 2. Issue 5minutes Pharmacist on
Pharmacy and receive processed item, duty
the item, duplicate administration
copy of RIS and sheet and
Controlled duplicate copy
Administration Sheet of the RIS

2.1 Ask client to

sign over printed
name at the
space provided
for in the RIS
3.Sign over printed 3. Accept the 10minutes Pharmacist on
name on the space signed original duty
provided in the RIS RIS

3.1 Encode Pharmacist on

requested item duty
to our DDB
database for
monitoring

3.2 File the Pharmacist on

requisition sheet duty
and
administration
sheet

TOTAL: 30mins
10. Provision of All Available Drugs/Medicines/Medical Supplies and other
Pharmaceuticals
Provision of Narcotics/Dangerous Drugs for OPD patients and admitted patients
(Anytime during Weekends and Holidays)
Office or Division: MAIN IN-PATIENT PHARMACY
Classification: Simple
Type of Transaction: G2C
Who may avail: SPMC patients/ Patients of Physician
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing.
SPMC Prescription triplicate copy Doctor/s

Special Prescription for Dangerous Drugs Doctor/s

Form (1 original 1 patients copy with two (2)
months validity from date of issuance

Pink card Social Worker

Yellow card/ Green card Billing

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1.Present triplicate 1. Receive the None 15minutes Pharmacist
SPMC prescription from the on duty
prescription/SPDDF, client and process
yellow card/green card the prescription by
and Pink card to checking availability
Receiving window for of requested item/s &
validation completeness of the
required information

1.1 Encode the

prescription on
HIS for charging

1.2 Compute the

total cost of the
item/s requested
in the
prescription

1.3 A. If for PHIC

charging: issue
the items to the
client
1.3 B. If for payment:
Return the
Prescription (with the
total amount) to the
client

1.4 Instruct the client

to bring the
prescription (with the
total amount) to the
cashier and pay the
indicated amount
TOTAL: 15 minutes
11. Provision of All Available Drugs/Medicines/Medical Supplies and other
Pharmaceuticals
Provision of Narcotics/Dangerous Drugs for paying patients
(Anytime during Weekends and Holidays)
Office or Division: MAIN IN-PATIENT PHARMACY
Classification: Simple
Type of Transaction: G2C
Who may avail: SPMC patients/ Patients of Physician
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing.
SPMC Prescription triplicate copy Doctor/s

Special prescription form for Dangerous Doctor/s

Drugs (1 original 1 patients copy with two
(2) months validity from date of issuance

Pink card Social Worker

Official receipt Cashier

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Present 1. Fill the prescription None 15minutes Pharmacist
triplicate SPMC on duty
prescription/ SPFDD
and Official Receipt
(proof of payment)
at the dispensing
windows

2. Receive/claim the 2. Issue the 15 minutes Pharmacist

item/s purchased item/s to on duty
the client
2.1 Sign over printed 2.1 Instruct client to
name at the back of write complete
the prescription name, address
signature and
contact number at
the back of the
prescription

TOTAL: 30MINS
12. Provision of all Available Drugs/Medicines/Medical Supplies and other
Pharmaceuticals
Provision of available needs of Service ward and Pay ward Patients with PHIC

Office or Division: MURANG GAMOT PHARMACY, MAIN IN-PATIENT PHARMACY

Classification: Simple
Type of Transaction: G2C
Who may avail: Clients with PHIC admitted in Service ward and Pay ward
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing.
SPMC Prescription Doctor/s

Orange Card BILLING SECTION

Yellow Card BILLING SECTION

Green Card BILLING SECTION

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Present prescription 1. Receive the None 20mins Pharmacist on
and PHIC card to prescription from the duty
receiving windows client

1.1 Process the

prescription by
checking availability
of requested items

1.2 Encode the

requested items on
HIS for charging

1.3 Prepare all the

items encoded

2. Receive/claim the 2. Issue the 5minutes Pharmacist on

item/s requested item/s duty

TOTAL: 25mins
13. Provision of all available Drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Charge to Donor with Government Funds) (OP) for
REGULAR STOCKS
Provision of available needs of patients charge to donor with government funds (OP)

Office or Division: MURANG GAMOT PHARMACY, MAIN IN-PATIENT PHARMACY,

OPD PHARMACY
Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: SPMC Out-patients, Employees, Patients admitted in
SPMC, Patients in different hospital with donor from
government
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not be
accepted for processing.

SPMC Prescription original with signature of the SPMC Doctor/s

client

Physician Prescription from other government Physician prescription of other government

hospital and health center with signature of the hospital and health center where patient seek
client consultation

Government Issued Identification Card or BIR, Post Office, DFA, PSA, SSS, GSIS, Pag-
Yellow Card (photocopy) with signature ibig, LTO, PRC

Approved Guarantee Letter (Original) Malasakit Center

RAF form Malasakit Center

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Submit the complete 1. Accept and check None 15 minutes Pharmacist
requirements to the completeness of on
receiving window for required duty/Clerk
checking and information, validity
validation. and requirements

1.1 If insufficient 1.1 Process the Pharmacist

fund-Proceed to prescription by
cashier checking
availability of
requested item

1.2 Process
transaction on HIS
for tracking and
inventory

1.3 Request
additional payment
if total amount of
items exceeds the
approved fund
1.4 Instruct clients
to proceed to
cashier for
payment then
instruct the client
after paying to
 return to the
pharmacy

2. Present the 2. Receive signed 15 minutes Pharmacist

prescription and prescription with on duty
Official Receipt with complete required
complete requirements documents

2.1 Sign over printed 2.1 Fill the

name in Rx and prescription
GL and its 2.2 Issue the items
photocopy 2.3 Stamp MG to
2.2 Receive the items prescription
and other 2.4 File prescription,
documents GL and I.D. or
yellow card
photocopy with
signature for
transmittal

TOTAL: 30MINS
14. Provision of all available drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Charge to Donor with Government Funds) (OP) for
CONSIGNMENT STOCKS
Provision of available needs of patients charge to donor with government funds (OP)

Office or Division: MURANG GAMOT PHARMACY, MAIN IN-PATIENT PHARMACY,

OUT-PATIENT PHARMACY
Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: SPMC Out-patients, Employees, Patients admitted in
SPMC, Patients in different hospital with donor from
government
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not be
accepted for processing
SPMC Prescription original with signature of SPMC Doctor/s
the client

Physician Prescription from other government Physician prescription of other government

hospital and health center with signature of the hospital and health center where patient seek
client consultation
Government Issued Identification Card or BIR, Post Office, DFA, PSA, SSS, GSIS, Pag-
Yellow Card (photocopy) with signature ibig, LTO, PRC
Approved Guarantee Letter (Original) Malasakit Center

RAF Malasakit Center

Photocopy Rx with signature Client

Photocopy Guarantee Letter Client

AGENCY ACTION FEES TO PROCESSING PERSON

CLIENT STEPS BE PAID TIME RESPONSIBLE
1. Submit the complete 1. Accept and check None 15 minutes Pharmacist
requirements to the completeness of on duty/Clerk
receiving window required
1,2,3,6,7 and 8 for information, validity
checking and and requirements
validation Pharmacist
1.1 Process the
prescription by
checking
availability of
requested item/s

1.2 Process
transaction on HIS
for tracking and
inventory

1.3 Request additional

payment if total
amount of items
exceeds the
approved fund.

1.4 Instruct clients to

pay at the cashier
2. Present the 2. Receive signed 15 minutes Pharmacist
prescription and prescription with on duty
Official Receipt with complete required
complete documents
requirements to the
releasing window 2.1 Fill the
prescription
2.1 Sign over printed
name in Rx and GL 2.2 Issue the items
and its photocopy
2.3 Stamp FS to
prescription

3. Receive the items 3. File prescription,

and other documents GL, RAF Form and
valid I.D. or yellow
card photocopy
with signature for
transmittal

TOTAL: 30mins
15. Provision of all available drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Charge to Donor with Government Funds) (OP) for
CONSIGNMENT STOCKS and REGULAR STOCKS (MIX)
Provision of available needs of patients charge to donor with government funds (OP)

Office or Division: MURANG GAMOT PHARMACY, MAIN IN-PATIENT PHARMACY,

OUT-PATIENT PHARMACY
Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: SPMC Out-patients, Employees, Patients admitted in
SPMC, Patients in different hospital with donor from
government
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing
SPMC Prescription original with signature of SPMC Doctor/s
the client
Physician Prescription from other government Physician prescription of other government
hospital and health center with signature of hospital and health center where patient seek
the client consultation

Government Issued Identification Card or BIR, Post Office, DFA, PSA, SSS, GSIS, Pag-
Yellow Card (photocopy) with signature ibig, LTO, PRC

Approved Guarantee Letter (Original) Malasakit Center

RAF Malasakit Center

Photocopy Rx with signature Client

Photocopy Guarantee Letter Client

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Submit the complete 1. Accept and check None 15 minutes Pharmacist
requirements to the completeness of on
receiving window required duty/Clerk
1,2,3,6,7 and 8 for information, validity
checking and and requirements
validation
1.1 Process the
prescription by
checking availability
of requested item/s

1.2 Process
transaction on HIS
for tracking ang
inventory

1.3 Request
additional payment
if total amount of
items exceeds the
approved fund.

1.4 Instruct clients

to pay at the
cashier.
2. Present the 2. Receive signed 15 minutes Pharmacist
prescription and prescription with on duty
Official Receipt with complete required
complete documents
requirements to the
releasing window 2.1 Fill the
prescription
2.1 Sign over printed
name in Rx and GL 2.2 Issue the items
and its photocopy
2.3 Stamp FS/MG
to prescription

3. Receive the items 3. File prescription,

and other documents GL, RAF Form and
valid I.D. or yellow
card photocopy
with signature for
transmittal

TOTAL: 30mins
16. Provision of all available drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Charge to Donor with Government Funds) (LINGAP) for
REGULAR STOCKS
Provision of available needs of patients charge to donor with government funds (LINGAP)

Office or Division: MURANG GAMOT PHARMACY, MAIN IN-PATIENT PHARMACY,

OUT-PATIENT PHARMACY
Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: SPMC Out-patients, Employees, Patients admitted in
SPMC, Patients in different hospital with donor from
government
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing

SPMC Prescription original with signature of SPMC Doctor/s

the client

Physician Prescription from other government Physician prescription of other government

hospital and health center with signature of hospital and health center where patient seek
the client consultation

Approved Guarantee Letter (Original) Malasakit Center

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Submit the complete 1. Accept and check None 15 minutes Pharmacist
requirements to the completeness of on duty/Clerk
receiving window required
1,2,3,6,7 and 8 for information, validity
checking and and requirements
validation
1.1 Process the
prescription by
checking
availability of
requested item/s

1.2 Process
transaction on HIS
for tracking and
inventory

1.3 Request additional

payment if total
amount of items
exceeds the
approved fund

1.4 Instruct clients to

pay at the cashier
2. Present the 2. Receive 15 minutes Pharmacist
prescription and signed prescription on duty
Official Receipt with with complete
complete required documents
requirements to the
releasing window 2.1 Fill the
prescription
2.1 Sign over printed
name in Rx 2.2 Issue the items

2.3 Stamp MG to
prescription

3. Receive the items 3. File

and other documents prescription and
guarantee letter for
transmittal

TOTAL: 30 mins
17. Provision of all available drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Charge to Donor with Government Funds) (LINGAP) for
CONSIGNMENT STOCKS
Provision of available needs of patients charge to donor with government funds (LINGAP)

Office or Division: MURANG GAMOT PHARMACY, MAIN IN-PATIENT PHARMACY,

OUT-PATIENT PHARMACY
Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: SPMC Out-patients, Employees, Patients admitted in SPMC,
Patients in different hospital with donor from government
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing

SPMC Prescription original with signature of SPMC Doctor/s

the client
Physicians Prescription from other Physician prescription of other government
government hospital or health center with hospital and health center where patient seek
signature of the client consultation

Approved Guarantee Letter (Original) Malasakit Center

Approved Guarantee Letter (Photocopy) Client

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Submit the complete 1. Accept and check None 15 minutes Pharmacist
requirements to the completeness of on duty/Clerk
receiving window for required
checking and information, validity
validation and requirements

1.1 Process the

prescription by
checking
availability of
requested item/s

1.2 Process
transaction on HIS
for tracking and
inventory

1.3 Request
additional payment if
total amount of items
exceeds the approved
fund

1.3 Instruct clients to

pay at the cashier

TOTAL: 30 minutes
18. Provision of all available drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Charge to Donor with Government Funds) (LINGAP) for
CONSIGNMENT and REGULAR STOCKS
Provision of available needs of patients charge to donor with government funds (LINGAP)

Office or Division: MURANG GAMOT PHARMACY, MAIN IN-PATIENT PHARMACY,

OUT-PATIENT PHARMACY
Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: SPMC Out-patients, Employees, Patients admitted in SPMC,
Patients in different hospital with donor from government
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not be
accepted for processing

SPMC Prescription original with signature of SPMC Doctor/s

the client
Physician Prescription from other government Physician prescription of other government
hospital and health center with signature of the hospital and health center where patient seek
client consultation
Approved Guarantee Letter (Original) Malasakit Center

FS prescription photocopy Client

(2) Approved Guarantee Letter (Photocopy) Client

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Submit the complete 1. Accept and check None 15 minutes Pharmacist
requirements to the completeness of on duty/Clerk
receiving window for required
checking and information, validity
validation and requirements

1.1 Process the

prescription by
checking availability
of requested item/s

1.2 Process
transaction on HIS
for tracking and
inventory

1.3 Request
additional payment
if total amount of
items exceeds the
approved fund

1.4 Instruct clients

to pay at the
cashier

2. Present the 2. Receive signed 15 minutes Pharmacist

prescription and prescription with on duty
Official Receipt with complete required
complete requirements documents
to the releasing
window 2.1 Fill the
prescription
2.1 Sign over printed
name in Rx 2.2 Issue the items
 2.3 Stamp FS to
prescription

3. Receive the items and 3. File prescription

other documents and guarantee
letter for
transmittal

TOTAL: 30mins
19. Provision of all available drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Charge to Donor with Government Funds) (MAP) for
CONSIGNMENT and REGULAR STOCKS
Provision of available needs of patients charge to donor with government funds (MAP)

Office or Division: MURANG GAMOT PHARMACY, MAIN IN-PATIENT PHARMACY,

OUT-PATIENT PHARMACY
Classification: Simple
Type of G2C, G2G
Transaction:
Who may avail: SPMC Out-patients, Employees, Patients admitted in SPMC,
Patients in different hospital with donor from government
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not be
accepted for processing

SPMC Prescription original with signature of SPMC Doctor/s

the client
Personalized Physicians Prescription with Physician of clinic where patient seek
signature of the client consultation
Approved Guarantee Letter (Original) PAD (PUBLIC ASSISTANCE DESK)

Approved Guarantee Letter (Photocopy) Client

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Submit the 1. Accept and check None 15 mins Pharmacist
complete completeness of on duty/Clerk
requirements to required
the receiving information, validity
window for and requirements
checking and
validation 1.1 Process the
prescription by
checking availability
of requested item/s

1.2 Process
transaction on HIS
for tracking and
inventory

1.3 Request
additional payment
if total amount of
items exceeds the
approved fund

1.4 Instruct clients

to pay at the
cashier

2. Present the 2. Receive prescription None 15 mins Pharmacist

prescription and with complete on duty
Official Receipt with required documents
complete
requirements to the 2.1 Fill the
releasing window prescription

2.1 Photocopy the 2.2 Issue the items

guarantee letter if
the amount given 2.3 Stamp FS/MG to
by PAD is not prescription
consumed
 2.4 Write SERVE to
the original guarantee
letter with signature

2.5 Return the original

copy of the guarantee
letter if there is still
remaining balance

2.6 Retain the original

copy of guarantee
letter if the approved
funds are consumed

3. Receive the items 3. File prescription and

and other guarantee letter for
documents transmittal

TOTAL: 30mins
20. Provision of All Available Drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Cash Transaction- Pricing for Regular Client)
Provision of available needs of paying patients

Office or Division: IWNH PHARMACY

Classification: Simple
Type of Transaction: G2C
Who may avail: SPMC patients admitted in IWNH
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing.
Personalized Physicians Prescription Physician of clinic where patient seek
consultation

SPMC Prescription Nurse station where the patient presently

consulted

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Present prescription 1. Accept prescription None 10 minutes Pharmacist
to Receiving window from the client and on duty
for validation process the
prescription by
checking availability
of requested items
2. Inform which of the 2. Process None 15 minutes Pharmacist
listed items will be transaction on HIS on duty
bought and the
quantity to be 2.1 Compute the
purchased total cost of the
item/s requested in
the prescription then

2.2 Return the

prescription and
inform client the total
amount to be paid.

NOTE:
A. Maximum one-
month maintenance
medications.
B. One week for
antibiotics prescribed
C. Epoetin alfa and
beta one-week
supply consumption
(releasing mon-fri
8am-5pm)
2.3 Instruct the client
to bring the
prescription to the
cashier

TOTAL: 25mins
21. Provision of All Available Drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Cash Transaction- Availment of Medicines for Regular
Client)
Provision of available needs of paying patients

Office or Division: IWNH PHARMACY

Classification: Simple
Type of Transaction: G2C
Who may avail: SPMC patients admitted in IWNH
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not be
accepted for processing.
Official receipt SPMC Cashier

Personalized Physicians Prescription Physician of clinic where patient seek

consultation

SPMC Prescription Form Nurse station where patient presently

consulted

HRN Hospital Reference HIMD

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Present prescription 1. Accept prescription None 5 minutes Pharmacist
to Receiving window and check validity of on duty
with official receipt the Official Receipt

2. Receive 2. Issue the items None 15minutes Pharmacist

purchased items and and receipt to the on duty
receipt client

TOTAL: 20mins
22. Provision of All Available Drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Cash Transaction- Pricing Senior Citizen/PWD)
Provision of available needs of paying Senior Citizen/PWD patients

Office or Division: ICU PHARMACY

Classification: Simple
Type of Transaction: G2C
Who may avail: SPMC patients/ Patients of Physicians aged 60 years old
and above (Senior Citizen) or with disability (PWD)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing.
Personalized Physicians Prescription Physician of clinic where patient seek
consultation
SPMC Prescription Nurse station at the OPD where patient
presently consulted
Medical Abstract Physician of clinic where patient seek
consultation
PRINCIPAL

ID of Senior Citizen or PWD Local Government Unit

OSCA or PWD Medicine booklet
Medical Abstract Physician of clinic where the patient seek
consultation

REPRESENTATIVE

ID of Senior Citizen or PWD Local Government Unit

OSCA or PWD Medicine booklet

Authorization Letter with present date Person being represented

Medical Abstract Physician of clinic where the patient seek

consultation

Government Issued Identification card of the BIR, POST OFFICE, DFA, PSA, SSS, GSIS,
representative PAG-IBIG, LTO, PRC

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Present client 1. Accept prescription None 5 minutes Pharmacist
prescription and other and check on duty
pertinent documents completeness of
to Receiving window required information,
to avail discount and validity and
for validation requirements

1.1 Process the

prescription by
checking availability
of requested item/s
2. Inform which of the 2. Process None 15 minutes Pharmacist
listed items will be transaction on HIS on duty
bought and the and inform client the
quantity to be total amount to be
purchased paid.

2.1 Return the

prescription to the
client
2.3 Instruct the
client to bring the
prescription to the
cashier and pay the
indicated amount

NOTE:
A. Maximum one-
month maintenance
medications.

B. One week for

antibiotics prescribed

C. Epoetin alfa and

beta one-week
supply consumption
(releasing mon-fri
8am-5pm)

D.Instruct the patient

to provide ice cubes
before claiming the
biological medicines
TOTAL: 20 minutes
23. Provision of All Available Drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Cash Transaction- availment Senior Citizen/PWD)
Provision of available needs of paying Senior Citizen/PWD patients

Office or Division: ICU PHARMACY

Classification: Simple
Type of Transaction: G2C
Who may avail: SPMC patients/ Patients of Physicians aged 60 years old
and above (Senior Citizen) or with disability (PWD)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not be
accepted for processing.

Personalized Physicians Prescription Physician of clinic where patient seek

consultation

SPMC Prescription Nurse station at the OPD where patient

presently consulted

Medical Abstract Physician of clinic where patient seek

consultation

PRINCIPAL

ID of Senior Citizen or PWD Local Government Unit

OSCA or PWD Medicine booklet
Medical Abstract Physician of clinic where the patient seek
consultation

REPRESENTATIVE

ID of Senior Citizen or PWD Local Government Unit

OSCA or PWD Medicine booklet

Authorization Letter with present date Person being represented

Physician of clinic where the patient seek
consultation
Medical Abstract
BIR, POST OFFICE, DFA, PSA, SSS, GSIS,
PAG-IBIG, LTO, PRC
Government Issued Identification card of the
representative

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Present prescription 1. Accept prescription None 5minutes Pharmacist
to Receiving window and check validity of on duty
with official receipt the receipt and
and other pertinent completeness of
documents required information

2. Receive Record transaction on None 15 minutes Pharmacist

purchased items, the medicine booklet on duty
receipt and other and issue the items
documents and receipt to the
client including
documents presented.
Record transaction on
OSCA

TOTAL: 20mins
24. Provision of All Available Drugs/Medicines/Medical Supplies and other
Pharmaceuticals (Cash transaction- pricing Regular Client)
Provision of available needs of admitted paying patients

Office or Division: ICU PHARMACY

Classification: Simple
Type of Transaction: G2C
Who may avail: Patients admitted in ICU building
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing.
SPMC Prescription Doctor/s

Pink card Social Worker

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Present SPMC 1. Receive the None 15minutes Pharmacist
prescription and Pink prescription from the on duty
card to Receiving client and process
window for validation the prescription by
checking availability
of requested item/s

1.1 Compute the

total cost of the
item/s requested in
the prescription

1.2 Return the

Prescription (with the
total amount) to the
client

1.3 Instruct the client

to bring the
Prescription (with the
total amount) to the
cashier and pay the
indicated amount

TOTAL: 15 minutes
25. Provision of All Available Drugs/Medicines/Medical Supplies and other
Pharmaceuticals (Cash transaction- AVAILMENT - Regular Client)
Provision of available needs of admitted paying patients

Office or Division: ICU PHARMACY

Classification: Simple
Type of Transaction: G2C
Who may avail: Patients admitted in ICU building
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing.
SPMC Prescription Doctor/s

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Present SPMC 1. Fill the prescription None 15 minutes Pharmacist on
prescription and duty
Official Receipt (proof
of payment) at the
dispensing window

2. Receive/claim the 2. Issue the purchased 5 minutes Pharmacist on

item/s item/s to the client duty

TOTAL: 20 minutes
26. Provision of all Available Drugs/Medicines/Medical Supplies and other
Pharmaceuticals
Provision of available needs of admitted Patient

Office or Division: ICU PHARMACY

Classification: Simple
Type of Transaction: G2C
Who may avail: Patients admitted in ICU building
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not be
accepted for processing.

SPMC Prescription Doctor/s

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Bring the bulk 1. Receive the None 30mins Pharmacist
prescription to the prescription in bulk on duty
pharmacy per charity ward

1.1 Inform the client

that they will receive a
call if request is ready
for pick up

1.2 Process the

prescription by
checking availability
of requested items

1.3 Encode the

requested items on
HIS for charging

1.4 Print issuance log

book

1.5 Prepare all the

items encoded

1.6 Call the client that

the requested items
are ready for pick up
2. Approach the 2.Issue the requested 10 minutes Pharmacist
releasing personnel item/s to the nursing on duty
attendant
2.1 Receive/claim the
item/s 2.1 Request to sign
on the space provided
for in the issuance
logbook

TOTAL:
40 minutes
27. Provision of all Available Drugs/Medicines/Medical Supplies and other
Pharmaceuticals
Provision of available needs of Patient in Service ward

Office or Division: IWNH PHARMACY

Classification: Simple
Type of Transaction: G2C
Who may avail: Patients admitted in IWNH building
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not be
accepted for processing.
SPMC Prescription Doctor/s

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1.Bring the bulk 1.Receive the None 2 hours Pharmacist
prescription to the prescription in bulk on duty
pharmacy per service ward

1.1 Inform the client

that they will receive a
call if request is ready
for pick up

1.2 Process the

prescription by
checking availability
of requested items

1.3 Encode the

requested items on
HIS for charging

1.4 Print issuance log

book

1.5 Prepare all the

items encoded

1.6 Call the client that

the requested items is
ready for pick up
2. Approach the 2. Issue the requested 5 minutes Pharmacist
releasing personnel item/s to the nursing on duty
attendant/nurse

2.1 Receive/claim the 2.1 Request to sign

item/s on the space provided
for in the issuance
logbook

2 hours & 5
TOTAL:
minutes
28. Provision of all Available Drugs/Medicines/Medical Supplies and other
Pharmaceuticals
Provision of available needs of patient Service ward

Office or Division: CCI PHARMACY

Classification: Simple
Type of Transaction: G2C
Who may avail: Patients admitted in CCI building
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing.
SPMC Prescription Doctor/s

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Bring the bulk 1. Receive the None 30mins Pharmacist
prescription to the prescription in bulk on duty
pharmacy per service ward

1.1 Inform the client

that they will receive a
call if request is ready
for pick up

1.2 Process the

prescription by
checking availability
of requested items

1.3 Encode the

requested items on
HIS for charging

1.4 Print issuance log

book

1.5 Prepare all the

items encoded

1.6 Call the client that

the requested items is
ready for pick up
2. Approach the 2. Issue the requested 10 minutes Pharmacist
releasing personnel item/s to the nursing on duty
attendant/nurse

2.1 Receive/claim the 2.1 Request to sign

item/s on the space provided
for in the issuance
logbook

TOTAL: 40 minutes
29. Provision of All Available Drugs/Medicines/Medical Supplies and other
Pharmaceuticals (Cash transaction- PRICING Regular Client)
Provision of available needs of admitted paying patients

Office or Division: CCI PHARMACY

Classification: Simple
Type of Transaction: G2C
Who may avail: Patients admitted in CCI building
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing.
SPMC Prescription Doctor/s

Pink card Social Worker

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Present SPMC 1. Receive the None 30 minutes Pharmacist
prescription and Pink prescription from the on duty
card to Receiving client and process
window for validation the prescription by
checking availability
of requested item/s

1.1 Compute the

total cost of the
item/s requested in
the prescription

1.2 Return the

Prescription (with the
total amount) to the
client

1.3 Instruct the client

to bring the
Prescription (with the
total amount) to the
cashier and pay the
indicated amount

TOTAL: 30 minutes
30. Provision of All Available Drugs/Medicines/Medical Supplies and other
Pharmaceuticals (Cash transaction- AVAILMENT- Regular Client)
Provision of available needs of admitted paying patients

Office or Division: CCI PHARMACY

Classification: Simple
Type of Transaction: G2C
Who may avail: Patients admitted in CCI building
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing.
Doctor/s
SPMC Prescription

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBL
E
1. Present SPMC 1. Fill the prescription None 30 minutes Pharmacist
prescription and on duty
Official Receipt (proof
of payment) at the
dispensing window

2. Receive/claim the 2. Issue the 10 minutes Pharmacist

item/s purchased item/s to on duty
the client

TOTAL: 30 minutes
31. Provision of All Available Drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Cash Transaction- Pricing Senior Citizen/PWD)
Provision of available needs of paying Senior Citizen/PWD patients

Office or Division: CCI PHARMACY

Classification: Simple
Type of Transaction: G2C
Who may avail: SPMC patients/ Patients of Physicians aged 60 years old
and above (Senior Citizen) or with disability (PWD)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not be
accepted for processing.
Personalized Physicians Prescription Physician of clinic where patient seek
consultation
SPMC Prescription Nurse station at the OPD where patient
presently consulted
Medical Abstract Physician of clinic where patient seek
consultation
PRINCIPAL

ID of Senior Citizen or PWD Local Government Unit

OSCA or PWD Medicine booklet
Medical Abstract Physician of clinic where the patient seek
consultation

REPRESENTATIVE

ID of Senior Citizen or PWD Local Government Unit

OSCA or PWD Medicine booklet

Authorization Letter with present date Person being represented

Physician of clinic where the patient seek
consultation
Medical Abstract
BIR, POST OFFICE, DFA, PSA, SSS, GSIS,
Government Issued Identification card of the
PAG-IBIG, LTO, PRC
representative

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Present client 1. Accept prescription None 15 minutes Pharmacist
prescription and other and check on duty
pertinent documents completeness of
to Receiving window required information,
to avail discount and validity and
for validation requirements

1.1 Process the

prescription by
checking
availability of
requested
item/s
2. Inform which of the 2. Process None 30 minutes Pharmacist
listed items will be transaction on HIS on duty
bought and the and inform client the
quantity to be total amount to be
purchased paid.

2.1 Return the

prescription to the
client

2.3 Instruct the client

to bring the
prescription to the
cashier and pay the
indicated amount

NOTE:
A. Maximum one-
month maintenance
medications.
B. One week for
antibiotics prescribed
C. Epoetin alfa and
beta one-week
supply consumption
(releasing mon-fri
8am-5pm

TOTAL: 45minutes
32. Provision of All Available Drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Cash Transaction- availment Senior Citizen/PWD)
Provision of available needs of paying Senior Citizen/PWD patients

Office or Division: CCI Pharmacy

Classification: Simple
Type of Transaction: G2C
Who may avail: SPMC patients/ Patients of Physicians aged 60 years old
and above (Senior Citizen) or with disability (PWD)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not be
accepted for processing.
Personalized Physicians Prescription Physician of clinic where patient seek
consultation
SPMC Prescription Nurse station at the OPD where patient
presently consulted
Medical Abstract Physician of clinic where patient seek
consultation
PRINCIPAL

ID of Senior Citizen or PWD Local Government Unit

OSCA or PWD Medicine booklet
Medical Abstract Physician of clinic where the patient seek
consultation

REPRESENTATIVE

ID of Senior Citizen or PWD Local Government Unit

OSCA or PWD Medicine booklet

Authorization Letter with present date Person being represented

Medical Abstract Physician of clinic where the patient seek

consultation

Government Issued Identification card of the BIR, POST OFFICE, DFA, PSA, SSS, GSIS,
representative PAG-IBIG, LTO, PRC
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Present prescription 1. Accept prescription None 10 minutes Pharmacist
to Receiving window and check validity of on duty
with official receipt the receipt and
and other pertinent completeness of
documents required information

2. Receive Record transaction on None 20 minutes Pharmacist

purchased items, the medicine booklet on duty
receipt and other and issue the items
documents and receipt to the
client including
documents presented.
Record transaction on
OSCA

TOTAL: 30minutes
33. Provision of all Available Drugs/Medicines/Medical Supplies and other
Pharmaceuticals
Provision of available needs of admitted patient wIth PHIC COVERAGE

Office or Division: ICU PHARMACY

Classification: Simple
Type of Transaction: G2C
Who may avail: Clients with PHIC admitted in ICU building
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing.

SPMC Prescription Doctor/s

Orange Card BILLING SECTION

Yellow Card BILLING SECTION

Green Card BILLING SECTION

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Present prescription 1. Receive the None 15mins Pharmacist on
and PHIC card to prescription from the duty
receiving window client
1.1 Process the
prescription by
checking availability of
requested items

1.2 Encode the

requested items on
HIS for charging

1.3 Prepare all the

items encoded

2. Receive/claim the 2. Issue the 5 minutes Pharmacist

item/s requested item/s on duty

TOTAL: 20mins
34. Provision of all Available Drugs/Medicines/Medical Supplies and other
Pharmaceuticals
Provision of available needs of admitted patient with PHIC coverage

Office or Division: CCI PHARMACY

Classification: Simple
Type of Transaction: G2C
Who may avail: Clients with PHIC admitted in CCI building
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing.

SPMC Prescription Doctor/s

Orange Card BILLING SECTION

Yellow Card BILLING SECTION

Green Card BILLING SECTION

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1.Present prescription 1.Receive the None 30mins Pharmacist on
and PHIC card to prescription from the duty
receiving window client
1.1 Process the
prescription by
checking availability of
requested items

1.2 Encode the

requested items on
HIS for charging

1.3 Prepare all the

items encoded
2. Receive/claim the 2. Issue the 5 minutes Pharmacist
item/s requested item/s on duty

TOTAL: 35 minutes
35. Provision of all Available Drugs/Medicines/Medical Supplies and other
Pharmaceuticals
Provision of available needs of admitted Patient with PHIC coverage

Office or Division: IWNH PHARMACY

Classification: Simple
Type of Transaction: G2C
Who may avail: Clients with PHIC admitted in IWNH building
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing.
SPMC Prescription Doctor/s

Orange Card BILLING SECTION

Yellow Card BILLING SECTION

Green Card BILLING SECTION

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Present prescription 1. Receive the None 30mins Pharmacist
and PHIC card to prescription from the on duty
receiving window client
1.1 Process the
prescription by
checking availability of
requested items

1.2 Encode the

requested items on
HIS for charging

1.3 Prepare all the

items encoded

2. Receive/claim the 2. Issue the 5 minutes Pharmacist

item/s requested item/s on duty

TOTAL: 35 minutes
36. Provision of all Available Drugs/Medicines/Medical Supplies and other
Pharmaceuticals
Provision of available needs of admitted Patient with PHIC coverage

Office or Division: HEART INSTITUTE PHARMACY

Classification: Simple
Type of Transaction: G2C
Who may avail: Clients with PHIC admitted in MHI building
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing.

SPMC Prescription Doctor/s

Orange Card BILLING SECTION

Yellow Card BILLING SECTION

Green Card BILLING SECTION

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Present prescription 1. Receive the None 15mins Pharmacist
and PHIC card to prescription from the on duty
receiving window client
1.1 Process the
prescription by
checking availability of
requested items

1.2 Encode the

requested items on
HIS for charging

1.3 Prepare all the

items encoded

2. Receive/claim the 2. Issue the 10 minutes Pharmacist

item/s requested item/s on duty

TOTAL: 25 minutes
37. Provision of All Available Drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Cash Transaction PRICING FOR Regular Client)
Provision of available needs of paying patients

Office or Division: HEART INSTITUTE PHARMACY

Classification: Simple
Type of Transaction: G2C
Who may avail: SPMC patients admitted in heart institute building
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing.
Personalized Physicians Prescription Physician of clinic where patient seek
consultation
SPMC Prescription Nurse station at the OPD where patient
presently consulted
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Present prescription 1. Accept prescription None 15 minutes Pharmacist
to Receiving window from the client and on duty
for validation process the
prescription by
checking availability
of requested items

2. Inform which of the 2. Process None 20 minutes Pharmacist

listed items will be transaction on HIS. on duty
bought and the
quantity to be 2.1 Compute the
purchased total cost of the
item/s requested in
the prescription
then
2.2 Return the
prescription and
inform client the
total amount to be
paid.

NOTE:
A. Maximum one-
month maintenance
medications
B. One week for
antibiotics prescribed

C. Epoetin alfa and

beta one-week supply
consumption
(releasing mon-fri
8am-5pm)
Pharmacist on
2.3 Instruct the
duty
client to bring the
prescription to the
cashier

TOTAL: 35 minutes
38. Provision of All Available Drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Cash Transaction- Availment of Medicines for Regular
Client)
Provision of available needs of paying patients

Office or Division: HEART INSTITUTE PHARMACY

Classification: Simple
Type of Transaction: G2C
Who may avail: SPMC patients admitted in heart institute building
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing.
Official receipt SPMC Cashier

Personalized Physicians Prescription Physician of clinic where patient seek

consultation
SPMC Prescription Form Nurse station at the OPD where patient
presently consulted
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Present prescription 1. Accept prescription None 5 minutes Pharmacist
to Receiving window and check validity of on duty
with official receipt the Official Receipt

2. Receive 2. Issue the items None 10 minutes Pharmacist

purchased items and and receipt to the on duty
receipt client

TOTAL: 15 minutes
39. Provision of All Available Drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Cash Transaction- Pricing Senior Citizen/PWD)
Provision of available needs of paying Senior Citizen/PWD patients

Office or Division: HEART INSTITUTE PHARMACY

Classification: Simple
Type of Transaction: G2C
Who may avail: SPMC patients/ Patients of Physicians aged 60 years old
and above (Senior Citizen) or with disability (PWD)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing.
Personalized Physicians Prescription Physician of clinic where patient seek
consultation

SPMC Prescription Nurse station at the OPD where patient

presently consulted
Medical Abstract Physician of clinic where patient seek
consultation

PRINCIPAL

ID of Senior Citizen or PWD Local Government Unit

OSCA or PWD Medicine booklet
Medical Abstract Physician of clinic where the patient seek
consultation

REPRESENTATIVE

ID of Senior Citizen or PWD Local Government Unit

OSCA or PWD Medicine booklet

Authorization Letter with present date Person being represented

Medical Abstract Physician of clinic where the patient seek

consultation

Government Issued Identification card of the BIR, POST OFFICE, DFA, PSA, SSS, GSIS,
representative PAG-IBIG, LTO, PRC

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Present client 1. Accept prescription None 15 minutes Pharmacist
prescription and other and check on duty
pertinent documents completeness of
to Receiving window required information,
to avail discount and validity and
for validation requirements
1.1 Process the
prescription by
checking availability
of requested item/s
2. Inform which of the 2. Process None 15 minutes Pharmacist
listed items will be transaction on HIS on duty
bought and the and inform client the
quantity to be total amount to be
purchased paid.

2.1 Return the

prescription to the
client
2.3 Instruct the client
to bring the
prescription to the
cashier and pay the
indicated amount

NOTE:
A. Maximum one-
month maintenance
medications.
B. One week for
antibiotics prescribed
C. Epoetin alfa and
beta one-week
supply consumption
(releasing mon-fri
8am-5pm)

TOTAL: 30 minutes
40. Provision of All Available Drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Cash Transaction- availment Senior Citizen/PWD)
Provision of available needs of paying Senior Citizen/PWD patients

Office or Division: HEART INSTITUTE PHARMACY

Classification: Simple
Type of Transaction: G2C
Who may avail: SPMC patients/ Patients of Physicians aged 60 years old
and above (Senior Citizen) or with disability (PWD)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing.
Personalized Physicians Prescription Physician of clinic where patient seek
consultation

SPMC Prescription Nurse station at the OPD where patient

presently consulted
Medical Abstract Physician of clinic where patient seek
consultation
PRINCIPAL

ID of Senior Citizen or PWD Local Government Unit

OSCA or PWD Medicine booklet
Medical Abstract Physician of clinic where the patient seek
consultation

REPRESENTATIVE

ID of Senior Citizen or PWD Local Government Unit

OSCA or PWD Medicine booklet

Authorization Letter with present date Person being represented

Medical Abstract Physician of clinic where the patient seek

consultation

Government Issued Identification card of the BIR, POST OFFICE, DFA, PSA, SSS, GSIS,
representative PAG-IBIG, LTO, PRC
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Present prescription 1. Accept prescription None 10 minutes Pharmacist
to Receiving window and check validity of on duty
with official receipt the receipt and
and other pertinent completeness of
documents required information
2. Receive 2. Record transaction None 20 minutes Pharmacist
purchased items, on the medicine on duty
receipt and other booklet and issue
documents the items and
receipt to the client
including
documents
presented.

2.1 Record
transaction on
OSCA

TOTAL: 30 minutes
41. Provision of All Available Drugs/Medicines/Medical Supplies and other
Pharmaceuticals (Cash transaction- PRICING Regular Client)
Provision of available needs of admitted paying patients
(Anytime during Weekends and Holidays)
Office or Division: HEART INSTITUTE PHARMACY
Classification: Simple
Type of Transaction: G2C
Who may avail: Clients admitted in Heart institute building
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing.
SPMC Prescription Doctor/s

Pink card Social Worker

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Present SPMC 1. Receive the None 15 minutes Pharmacist
prescription and Pink prescription from the on duty
card to Receiving client and process
window for validation the prescription by
checking availability
of requested item/s

1.1 Compute the

total cost of the
item/s requested in
the prescription

1.2 Return the

Prescription (with the
total amount) to the
client

1.3 Instruct the client

to bring the
Prescription (with the
total amount) to the
cashier and pay the
indicated amount

TOTAL: 15 minutes
42. Provision of All Available Drugs/Medicines/Medical Supplies and other
Pharmaceuticals (Cash transaction- AVAILMENT - Regular Client)
Provision of available needs of admitted paying patients
(Anytime during Weekends and Holidays)
Office or Division: HEART INSTITUTE PHARMACY
Classification: Simple
Type of Transaction: G2C
Who may avail: Clients admitted in heart institute building
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing.
SPMC Prescription Doctor/s

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Present SPMC 1.Fill the prescription None 20 minutes Pharmacist on
prescription and duty
Official Receipt (proof
of payment) at the
dispensing window

2. Receive/claim the 2.Issue the 10 minutes Pharmacist

item/s purchased item/s to on duty
the client

TOTAL: 30 minutes
43. Provision of all available drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Charge to Donor with Government Funds) (OP) for
REGULAR STOCKS
Provision of available needs of patients charge to donor with government funds (OP)

Office or Division: CANCER INSTITUTE PHARMACY

Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: SPMC Out-patients, Employees, Patients admitted in
SPMC, Patients in different hospital with donor from
government
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not be
accepted for processing

SPMC Prescription original with signature of SPMC Doctor/s

the client

Physician Prescription from other government Physician prescription of other government

hospital and health center with signature of the hospital and health center where patient seek
client consultation

Government Issued Identification Card or BIR, Post Office, DFA, PSA, SSS, GSIS, Pag-
Yellow Card (photocopy) with signature ibig, LTO, PRC

Approved Guarantee Letter (Original) Malasakit Center

RAF form Malasakit Center

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Submit the 1. Accept and check None 15 minutes Pharmacist
complete requirements completeness of on duty/
to the receiving window required information, Clerk
for checking and validity and
validation requirements

1.1 Process the

prescription by
checking availability
of requested item/s

1.2 Process
transaction on HIS
for tracking and
inventory

1.3 Request
additional payment if
total amount of items
exceeds the
approved fund

1.4 Instruct clients to

proceed to cashier
for payment then
instruct the client
after paying to return
to the pharmacy
2. If insufficient fund- 2. Receive signed 15 minutes Pharmacist
Proceed to cashier prescription with on duty
complete required
2.1 Present the documents
prescription and
Official Receipt with 2.1 Fill the
complete prescription
requirements
2.2 Issue the items
2.2 Sign over printed
name in Rx and GL 2.3 Stamp MG to
and its photocopy prescription

3. Receive the items 3. File 10 minutes Pharmacist

and other documents prescription, GL and on duty
I.D. or yellow card
photocopy with
signature for
transmittal

TOTAL: 40 mins
44. Provision of all available drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Charge to Donor with Government Funds) (OP) for
CONSIGNMENT STOCKS
Provision of available needs of patients charge to donor with government funds (OP)

Office or Division: CANCER INSTITUTE PHARMACY

Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: SPMC Out-patients, Employees, Patients admitted in
SPMC, Patients in different hospital with donor from
government
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing

SPMC Prescription original with signature of SPMC Doctor/s

the client

Physician Prescription from other government Physician prescription of other government

hospital and health center with signature of hospital and health center where patient seek
the client consultation

Government Issued Identification Card or BIR, Post Office, DFA, PSA, SSS, GSIS,
Yellow Card (photocopy) with signature Pag-ibig, LTO, PRC
Approved Guarantee Letter (Original) Malasakit Center

Form RAF Malasakit Center

Photocopy Rx with signature Client

Photocopy Guarantee Letter Client

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Submit the 1. Accept and check None 15 minutes Pharmacist on
complete completeness of duty/Clerk
requirements to required
the receiving information,
window for validity and
checking and requirements
validation
1.1 Process the
prescription by
checking
availability of
requested item/s
1.2 Process
transaction on HIS
for tracking and
inventory
1.3 Request additional
payment if total
amount of items
exceeds the
approved fund.
1.4 Instruct clients to
pay at the cashier

2. Present the 2. Receive signed 15 minutes Pharmacist

prescription and prescription with on duty
Official Receipt with complete required
complete documents
requirements to the
releasing window 2.1 Fill the
prescription
2.1 Sign over printed
 name in Rx and GL 2.2 Issue the items
and its photocopy
2.3 Stamp FS to
prescription

3. Receive the items 4. File 10 minutes Pharmacist

and other documents prescription, GL, on duty
RAF Form and valid
I.D. or yellow card
photocopy with
signature for
transmittal

TOTAL: 40 minutes
45. Provision of all available drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Charge to Donor with Government Funds) (OP) for
CONSIGNMENT STOCKS and REGULAR STOCKS (MIX)
Provision of available needs of patients charge to donor with government funds (OP)

Office or Division: CANCER INSTITUTE PHARMACY

Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: SPMC Out-patients, Employees, Patients admitted in SPMC,
Patients in different hospital with donor from government
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing
SPMC Prescription original with signature of SPMC Doctors
the client
Physician prescription of other government Physician prescription of other government
hospital and health center where patient seek hospital and health center where patient seek
consultation consultation

Government Issued Identification Card or BIR, Post Office, DFA, PSA, SSS, GSIS,
Yellow Card (photocopy) with signature Pag-ibig, LTO, PRC

Approved Guarantee Letter (Original) Malasakit Center

Form RAF Malasakit Center

Photocopy Rx with signature Client

Photocopy Guarantee Letter Client

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Submit the 1. Accept and check None 15 minutes Pharmacist
complete requirements completeness of on duty/Clerk
to the receiving window required
for checking and information,
validation validity and
requirements

1.1 Process the

prescription by
checking
availability of
requested item/s

1.2 Process
transaction on HIS
for tracking ang
inventory

1.3 Request
additional
payment if total
amount of items
exceeds the
approved fund

1.4 Instruct clients

to pay at the
cashier
2.Present the 2. Receive signed 15 minutes Pharmacist
prescription and Official prescription with on duty
Receipt with complete complete
requirements to the required
releasing window documents

2.1 Sign over printed 2.1 Fill the

name in Rx and GL and prescription
its photocopy 2.2 Issue the
items
2.3 Stamp
FS/MG to
prescription

3. Receive the items and 3. File prescription, 10 minutes Pharmacist

other documents GL, RAF Form on duty
and valid I.D. or
yellow card
photocopy with
signature for
transmittal

TOTAL: 40 mins
46. Provision of all available drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Charge to Donor with Government Funds) (LINGAP) for
REGULAR STOCKS
Provision of available needs of patients charge to donor with government funds (LINGAP)

Office or Division: CANCER INSTITUTE PHARMACY

Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: SPMC Out-patients, Employees, Patients admitted in SPMC,
Patients in different hospital with donor from government
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing
SPMC Prescription original with signature of SPMC Doctor/s
the client

Physician Prescription from other government Physician prescription of other government

hospital and health center with signature of hospital and health center where patient seek
the client consultation

Approved Guarantee Letter (Original) Malasakit Center

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Submit the 1. Accept and check None 15 minutes Pharmacist
complete requirements completeness of on duty/Clerk
to the receiving window required
for checking and information, validity
validation and requirements

1.1 Process the

prescription by
checking
availability of
requested
item/s
1.2 Process
transaction on
HIS for tracking
and inventory
1.3 Request
additional
payment if total
amount of items
exceeds the
approved fund
1.4 Instruct clients
to pay at the
cashier

2. Present the 2. Receive signed 15 minutes Pharmacist

prescription and prescription with on duty
Official Receipt with complete
complete required
requirements to the documents
releasing window
2.1 Fill the
2.1 Sign over printed prescription
name in Rx
2.2 Issue the items

2.3 Stamp MG to
prescription
3. Receive the items 3. File prescription 10 minutes Pharmacist
and other documents and guarantee on duty
letter for
transmittal

TOTAL: 40 minutes
 47. Provision of all available drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Charge to Donor with Government Funds) (LINGAP) for
CONSIGNMENT STOCKS
Provision of available needs of patients charge to donor with government funds (LINGAP)

Office or Division: CANCER INSTITUTE PHARMACY

Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: SPMC Out-patients, Employees, Patients admitted in SPMC,
Patients in different hospital with donor from government
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing
SPMC Prescription original with signature of SPMC Doctor/s
the client
Physicians Prescription from other Physician prescription of other government
government hospital or health center with hospital and health center where patient seek
signature of the client consultation

Approved Guarantee Letter Original) Malasakit Center

Approved Guarantee Letter (Photocopy) Client
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. 1. Submit the complete 1. Accept and check None 15 minutes Pharmacist
requirements to the completeness of on duty/Clerk
receiving window for required
checking and validation information, validity
and requirements
1.1 Process the
prescription by
checking availability
of requested item/s
1.2 Process
transaction on HIS
for tracking and
inventory
1.3 Request
additional payment
if total amount of
items exceeds the
approved fund
1.4 Instruct clients
to pay at the
cashier
2. Present the 2. Receive signed 15 minutes Pharmacist
prescription and prescription with on duty
Official Receipt with complete
complete required
requirements to the documents
releasing window
2.1 Fill the
2.1 Sign over printed prescription
name in Rx
2.2 Issue the items

2.3 Stamp FS to
prescription
2.
3. Receive the items 3. File prescription 10 minutes Pharmacist
and other documents and guarantee on duty
letter for
transmittal
3.
TOTAL: 40 minutes

48. Provision of all available drugs/Medicines/Medical Supplies and Other

Pharmaceuticals (Charge to Donor with Government Funds) (LINGAP) for
CONSIGNMENT and REGULAR STOCKS
Provision of available needs of patients charge to donor with government funds (LINGAP)

Office or Division: CANCER INSTITUTE PHARMACY

Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: SPMC Out-patients, Employees, Patients admitted in SPMC,
Patients in different hospital with donor from government
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing
SPMC Prescription original with signature of SPMC Doctor/s
the client
Physician Prescription from other government Physician prescription of other government
hospital and health center with signature of hospital and health center where patient seek
the client consultation

Approved Guarantee Letter (Original) Malasakit Center

FS prescription photocopy Client

(2) Approved Guarantee Letter (Photocopy) Client

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Submit the complete 1. Accept and None 15 minutes Pharmacist
requirements to the check completeness on duty/Clerk
receiving window for of required
checking and information, validity
validation and requirements

1.1 Process the

prescription by
checking availability
of requested item/s
1.2 Process
transaction on HIS
for tracking and
inventory
1.3 Request
additional payment
if total amount of
items exceeds the
approved fund
1.4 Instruct clients to
pay at the cashier

2. Present the 2. Receive 15 minutes Pharmacist

prescription and signed prescription on duty
Official Receipt with with complete
complete required documents
requirements to the
releasing window 2.1 Fill the
prescription
2.1 Sign over printed
name in Rx 2.2 Issue the items

2.3 Stamp FS to
prescription
3. Receive the items 3.File prescription 10 mins
and other documents and guarantee letter
for transmittal

TOTAL: 40mins
49. Provision of all available drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Charge to Donor with Government Funds) (MAP) for
CONSIGNMENT and REGULAR STOCKS
Provision of available needs of patients charge to donor with government funds (MAP)

Office or Division: CANCER INSTITUTE PHARMACY

Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: SPMC Out-patients, Employees, Patients admitted in SPMC,
Patients in different hospital with donor from government
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing
SPMC Prescription original with signature of SPMC Doctor/s
the client
Personalized Physicians Prescription with Physician of clinic where patient seek
signature of the client consultation

Approved Guarantee Letter (Original) PAD (PUBLIC ASSISTANCE DESK)

Approved Guarantee Letter (Photocopy) Client

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Submit the 1. Accept and None 15 minutes Pharmacist
complete check completeness on duty/Clerk
requirements to the of required
receiving window information, validity
for checking and and requirements
validation
1.1 Process the
prescription by
checking availability
of requested item/s

1.2 Process
transaction on HIS
for tracking and
inventory

1.3 Request
additional payment if
total amount of items
exceeds the
approved fund
1.4 Instruct clients to
pay at the cashier
2. Present the 2. Receive 15 minutes Pharmacist
prescription and prescription with on duty
Official Receipt with complete required
complete documents
requirements to the
releasing window 2.1 Fill the
prescription
2.1 Photocopy the
guarantee letter if the 2.2 Issue the items
amount given by PAD is
not consumed 2.3 Stamp FS/MG to
prescription

2.4 Write SERVE to

the original guarantee
letter with signature
 2.5 Return the original
copy of the guarantee
letter if there is still
remaining balance

2.6 Retain the original

copy of guarantee
letter if the approved
funds is consumed

3. Receive the items 3. File prescription

and other and guarantee letter 10 mins
documents for transmittal

TOTAL: 40 mins
50. Provision of All Available Drugs/Medicines/Medical Supplies and other
Pharmaceuticals (Charge to Patients Account)
Provision of available needs of Surgery in-patients

Office or Division: OPERATING ROOM PHARMACY

Classification: Simple
Type of Transaction: G2C
Who may avail: Patients admitted in service ward and Pay ward
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing

Pharmacy Drugs and Supplies charge slip/ OR PHARMACY

Issue Slip (Pay ward and service patient)

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Present 1. Accept PCS/PIS None 30 minutes Pharmacist
Procedure Charge and check name of
Slip/Procedure Issue patient in the OR
Slip to the receiving schedule
window/dispensing
counter 1.1 Process the
PCS/PIS by
1.1 Aspirate the checking
requested dangerous availability of
drugs requested
item/s

1.2 Fill the request

1.3 Prepare the

Anesthesia
Drug Tray

1.4 Request to
accomplish the
administration
sheet

2. Accomplish the 2. Accept the 10 minutes Pharmacist

Administration accomplished
sheet administration sheet
forms and check for
the completeness
and accuracy of the
required information.
3. Receive the items 3. Issue the items 10 minutes Pharmacist
and Anesthesia Drug and Anesthesia Drug
Trays Tray

4. After the operation 4. Accept returned 30 minutes Pharmacist

return Anesthesia Anesthesia trays and
Drug trays and other other unused items
unused items to
receiving window 4.1 Account for the
used and unused
items in the
anesthesian tray

4.2 Return unused

items to their
respective shelves

4.3 Encode all the

items used on HIS
for charging

4.4 File the charge

slip/issue slip

1hour & 20
TOTAL:
minutes
51. Provision of All Available Drugs/Medicines/Medical Supplies and other
Pharmaceuticals (Charge to Patients Account)
Provision of available needs of Surgery in-patients

Office or Division: Heart Institute PHARMACY

Classification: Simple
Type of Transaction: G2C
Who may avail: Patients admitted in Service ward and Pay ward
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing
Pharmacy Drugs and Supplies charge HI PHARMACY
slip/Issue Slip (Pay ward and service
patient)

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Present 1. Accept forms and None 30 minutes Pharmacist
Pharmacy Charge check name of
Slip/Pharmacy Issue patient in the OR
Slip to the receiving schedule and in
window/dispensing HIS
counter
1.1 Process the
PCS/PIS by
checking availability
1.1 Aspirate the of requested item/s
requested dangerous 1.2 Fill the request
drugs 1.3 Prepare the
Anesthesia Drug
Tray
1.4 Request to
accomplish the
administration
sheet

2. Accomplish the 2. Accept forms and 10 minutes Pharmacist

Administration check for the
sheet completeness and
accuracy of the
required information
3. Receive the items 3. Issue the items 10 minutes Pharmacist
and Anesthesia Drug and Anesthesia Drug
Trays Tray
4. After the operation 4. Accept returned 30 minutes Pharmacist
return Anesthesia Anesthesia trays and
Drug trays and other other unused items
unused items to
receiving window 4.1 Account for the
used and unused
items in the
anesthesian tray

4.2 Return unused

items to their
respective shelves

4.3 Encode all the

items used on HIS
for charging

4.4 File the charge

slip/issue slip

1 hour and 20
TOTAL:
mins
52. Provision of All Available Drugs/Medicines/Medical Supplies and other
Pharmaceuticals (Charge to Patients Account)
Provision of available needs of Surgery in-patients

Office or Division: IWNH-OR PHARMACY

Classification: Simple
Type of Transaction: G2C
Who may avail: Patients admitted in SERVICE and PAYWARD
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing

Pharmacy Drugs and Supplies charge IWNH OR PHARMACY

slip/Issue Slip (Pay ward and service
patient)
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Present Pharmacy 1. Accept forms and None 30 minutes Pharmacist
Charge check name of patient
Slip/Pharmacy in the OR schedule
Issue Slip to the
receiving 1.1 Process the
window/dispensing PCS/PIS by checking
counter availability of
requested item/s
1.1 Aspirate
dangerous drugs 1.2 Fill the request
requested
1.3 Prepare the
Anesthesia Drug Tray

1.4 Request to
accomplish the
administration sheet
2. Accomplish the 2. Accept forms and 10 minutes Pharmacist
Administration check for the
sheet completeness and
accuracy of the
required information
in administration
sheet
3. Receive the items 3. Issue the items 10 minutes Pharmacist
and Anesthesia and Anesthesia Drug
Drug Trays Tray
 4. After the operation 4. Accept returned 30 minutes Pharmacist
return Anesthesia Anesthesia trays and
Drug trays and other unused items
other unused items
to receiving window 4.1 Account for the
used and unused
items

4.2Return unused
items to their
respective shelves

4.3 Encode all the

items used on HIS
for charging

4.4 File the charge

slip /issue slip

1 hour and 20
TOTAL:
mins

53. Provision of all available drugs/Medicines/Medical Supplies and Other

Pharmaceuticals (Charge to Donor with Government Funds) (OP) for
REGULAR STOCKS
Provision of available needs of patients charge to donor with government funds (OP)

Office or Division: HEART INSTITUTE PHARMACY

Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: SPMC Out-patients, Employees, Patients admitted in SPMC,
Patients in different hospital with donor from government
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing

SPMC Prescription original with signature of SPMC Doctor/s

the client

Physician Prescription from other government Physician prescription of other government

hospital and health center with signature of hospital and health center where patient seek
the client consultation
Government Issued Identification Card or BIR, Post Office, DFA, PSA, SSS, GSIS, Pag-
Yellow Card (photocopy) with signature ibig, LTO, PRC
Approved Guarantee Letter (Original) Malasakit Center

RAF form Malasakit Center

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Submit the 1. Accept and check None 15 minutes Pharmacist
complete requirements completeness of on duty/Clerk
to the receiving required
window for checking information, validity
and validation and requirements

1.1 Process the

prescription by
checking
availability of
requested item/s

1.2 Process
transaction on HIS
for tracking and
 inventory
1.3 Request
additional payment
if total amount of
items exceeds the
approved fund

1.4 Instruct clients

to proceed to
cashier for
payment then
instruct the client
after paying to
return to the
pharmacy

2. If insufficient fund- 2.Receive signed 30 minutes Pharmacist

Proceed to cashier prescription with on duty
complete required
2.1 Present the documents
prescription and
Official Receipt with 2.1 Fill the
complete prescription
requirements
2.2 Issue the items
2.2 Sign over
printed name in Rx 2.3Stamp MG to
and GL and its prescription
photocopy

3.Receive the items 3.File prescription, GL 5 mins

and other documents and I.D. or yellow
card photocopy with
signature for
transmittal

TOTAL: 50 mins
54. Provision of all available drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Charge to Donor with Government Funds) (OP) for
CONSIGNMENT STOCKS
Provision of available needs of patients charge to donor with government funds (OP)

Office or Division: HEART INSTITUTE PHARMACY

Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: SPMC Out-patients, Employees, Patients admitted in SPMC,
Patients in different hospital with donor from government
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing

SPMC Prescription original with signature of SPMC Doctor/s

the client
Physician Prescription from other Physician prescription of other government
government hospital and health center with hospital and health center where patient seek
signature of the client consultation
Government Issued Identification Card or BIR, Post Office, DFA, PSA, SSS, GSIS,
Yellow Card (photocopy) with signature Pag-ibig, LTO, PRC
Approved Guarantee Letter (Original) Malasakit Center

Form Raf Malasakit Center

Photocopy Rx with signature Client

Photocopy Guarantee Letter Client

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Submit the 1. Accept and check None 15 minutes Pharmacist
complete requirements completeness of on duty/Clerk
to the receiving required
window for checking information,
and validation validity and
requirements

1.1 Process the

prescription by
checking
availability of
requested item/s
 1.2 Process
transaction on HIS
for tracking and
inventory

1.3 Request additional

payment if total
amount of items
exceeds the
approved fund.

1.4 Instruct clients to

pay at the cashier

2. Present the 2. Receive signed None 30 minutes Pharmacist

prescription and prescription with on duty
Official Receipt with complete required
complete documents
requirements to the
releasing window 2.1 Fill the
prescription
2.1 Sign over printed
name in Rx and GL and 2.2 Issue the items
its photocopy
2.3 Stamp FS to
prescription

3. Receive the items 3. File prescription,

and other documents GL, RAF Form and 5 mins
valid I.D. or yellow
card photocopy
with signature for
transmittal

TOTAL: 50 mins
55. Provision of all available drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Charge to Donor with Government Funds) (OP) for
CONSIGNMENT STOCKS and REGULAR STOCKS (MIX)
Provision of available needs of patients charge to donor with government funds (OP)

Office or Division: HEART INSTITUTE PHARMACY

Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: SPMC Out-patients, Employees, Patients admitted in SPMC,
Patients in different hospital with donor from government
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing

SPMC Prescription original with signature of SPMC Doctors

the client
Physician prescription of other government Physician prescription of other government
hospital and health center where patient seek hospital and health center where patient seek
consultation consultation
Government Issued Identification Card or BIR, Post Office, DFA, PSA, SSS, GSIS,
Yellow Card (photocopy) with signature Pag-ibig, LTO, PRC
Approved Guarantee Letter (Original) Malasakit Center

Form Raf Malasakit Center

Photocopy Rx with signature Client

(2) Photocopy Guarantee Letter Client

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Submit the complete 1. Accept and check None 15 minutes Pharmacist
requirements to the completeness of on duty/Clerk
receiving window for required
checking and information, validity
validation and requirements

1.1 Process the

prescription by
checking availability
of requested item/s

1.2 Process
 transaction on HIS
for tracking ang
inventory

1.3 Request
additional payment
if total amount of
items exceeds the
approved fund

1.4 Instruct clients

to pay at the
cashier

2. Present the 2. Receive signed None 30 minutes Pharmacist

prescription and prescription with on duty
Official Receipt with complete required
complete documents
requirements to the
releasing window 2.1 Fill the
prescription
2.1 Sign over
printed name in Rx 2.2 Issue the items
and GL and its
photocopy 2.3 Stamp FS/MG
to prescription

3. Receive the items 3. File prescription, 5 mins

and other GL, RAF Form and
documents valid I.D. or yellow
card photocopy
with signature for
transmittal

TOTAL: 50 mins
56. Provision of all available drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Charge to Donor with Government Funds) (LINGAP) for
REGULAR STOCKS
Provision of available needs of patients charge to donor with government funds (LINGAP)

Office or Division: HEART INSTITUTE PHARMACY

Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: SPMC Out-patients, Employees, Patients admitted in SPMC,
Patients in different hospital with donor from government
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing

SPMC Prescription original with signature of SPMC Doctor/s

the client

Physician Prescription from other Physician prescription of other government

government hospital and health center with hospital and health center where patient seek
signature of the client consultation

Approved Guarantee Letter (Original) Malasakit Center

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Submit the complete 1. Accept and None 15 minutes Pharmacist
requirements to the check on duty/Clerk
receiving window completeness of
1,2,3,6,7 and 8 for required
checking and information, validity
validation and requirements

1.1 Process the

prescription by
checking availability
of requested item/s

1.2 Process
transaction on HIS
for tracking and
inventory

1.3 Request
additional payment
if total amount of
items exceeds the
approved fund

1.4 Instruct clients

 to pay at the
cashier

2. Present the 2. Receive signed None 30 minutes Pharmacist

prescription and prescription with on duty
Official Receipt with complete required
complete documents
requirements to the
releasing window 2.1 Fill the
prescription
2.1 Sign over
printed name in Rx 2.2 Issue the
items

2.3 Stamp MG to
prescription

3. File prescription
3. Receive the items and guarantee
and other letter for 5 mins
documents transmittal

TOTAL: 50 mins
57. Provision of all available drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Charge to Donor with Government Funds) (LINGAP) for
CONSIGNMENT STOCKS
Provision of available needs of patients charge to donor with government funds (LINGAP)

Office or Division: HEART INSTITUTE PHARMACY

Classification: Simple
Type of G2C, G2G
Transaction:
Who may avail: SPMC Out-patients, Employees, Patients admitted in SPMC,
Patients in different hospital with donor from government
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing
SPMC Prescription original with signature of SPMC Doctor/s
the client
Physicians Prescription from other Physician prescription of other government
government hospital or health center with hospital and health center where patient seek
signature of the client consultation
Approved Guarantee Letter (Original) Malasakit Center
Approved Guarantee Letter (Photocopy) Client
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Submit the 1. Accept and check None 15 minutes Pharmacist
complete completeness of on duty/Clerk
requirements to required information,
the receiving validity and
window for requirements
checking and 1.1 Process the
validation prescription by
checking availability
of requested item/s
1.2 Process transaction
on HIS for tracking
and inventory
1.3 Request additional
payment if total
amount of items
exceeds the
approved fund
1.4 Instruct clients to
pay at the cashier

2.Present the 2. Receive signed None 30 minutes Pharmacist

prescription and prescription with on duty
Official Receipt complete required
with complete documents
requirements to
the releasing 2.1 Fill the
window prescription

2.1 Sign over 2.2 Issue the items

printed name in
Rx 2.3 Stamp MG to
prescription

3.Receive the items 3.File prescription and

and other documents guarantee letter for 5 mins
transmittal
 50 mins

58. Provision of all available drugs/Medicines/Medical Supplies and Other

Pharmaceuticals (Charge to Donor with Government Funds) (LINGAP) for
CONSIGNMENT and REGULAR STOCKS
Provision of available needs of patients charge to donor with government funds (LINGAP)

Office or Division: HEART INSTITUTE PHARMACY

Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: SPMC Out-patients, Employees, Patients admitted in SPMC,
Patients in different hospital with donor from government
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing

SPMC Prescription original with signature of SPMC Doctor/s

the client
Physician Prescription from other Physician prescription of other government
government hospital and health center with hospital and health center where patient seek
signature of the client consultation
Approved Guarantee Letter (Original) Malasakit Center

FS prescription photocopy Client

(2) Approved Guarantee Letter (Photocopy) Client

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Submit the complete 1. Accept and check None 15 minutes Pharmacist
requirements to the completeness of on duty/
receiving window for required Clerk
checking and information,
validation validity and
requirements

1.1 Process the

prescription by
checking
availability of
requested item/s

1.2 Process
transaction on HIS
for tracking and
inventory

1.3 Request
additional
payment if total
amount of items
exceeds the
approved fund

1.4 Instruct clients

to pay at the
cashier
2. Present the 2. Receive signed None 30 minutes Pharmacist
prescription and prescription with on duty/
Official Receipt with complete Clerk
complete required
requirements to the documents
releasing window
 2.1 Fill the
2.1 Sign over prescription
printed name in Rx
2.2 Issue the
items

2.3 Stamp FS to
prescription

3. Receive the items 3. File prescription

and other and guarantee 5 mins
documents letter for
transmittal

TOTAL: 50 mins
59. Provision of all available drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Charge to Donor with Government Funds) (MAP) for
CONSIGNMENT and REGULAR STOCKS
Provision of available needs of patients charge to donor with government funds (MAP)

Office or Division: HEART INSTITUTE PHARMACY

Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: SPMC Out-patients, Employees, Patients admitted in SPMC,
Patients in different hospital with donor from government
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing
SPMC Prescription original with signature of SPMC Doctor/s
the client
Personalized Physicians Prescription with Physician of clinic where patient seek
signature of the client consultation
Approved Guarantee Letter (Original) PAD (PUBLIC ASSISTANCE DESK)
Approved Guarantee Letter (Photocopy) Client
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Submit the complete 1. Accept and check None 15 minutes Pharmacist
requirements to the completeness of on duty/Clerk
receiving window for required
checking and information, validity
validation and requirements

1.1 Process the

prescription by
checking availability
of requested item/s
1.2 Process
transaction on HIS
for tracking and
inventory
1.3 Request
additional payment
if total amount of
items exceeds the
approved fund

1.4 Instruct clients

to pay at the
cashier

2. Present the 2. Receive None 30 minutes Pharmacist

prescription and prescription with on duty
Official Receipt with complete
complete required
requirements to the documents
releasing window
2.1 Fill the
2.1 Photocopy the prescription
guarantee letter if
the amount given 2.2 Issue the items
by PAD is not
consumed 2.3 Stamp FS/MG
to prescription

2.4 Write SERVE to

the original
 guarantee letter with
signature

2.5 Return the

original copy of the
guarantee letter if
there is still
remaining balance

2.6 Retain the

original copy of
guarantee letter if
the approved funds
are consumed

3.Receive the items 3.File prescription

and other documents and guarantee letter 5 mins
for transmittal

TOTAL: 50 mins
60. Provision of all Available Drugs/Medicines/Medical Supplies and other
Pharmaceuticals
Provision of available needs of admitted patients in Service ward and Pay ward

Office or Division: IWNH-OR PHARMACY

Classification: Simple
Type of Transaction: G2C
Who may avail: Clients in delivery room and recovery room at IWNH building
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing.
SPMC Prescription Doctor/s

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Present prescription 1. Receive the None 10 minutes Pharmacist on
to receiving window prescription from the duty
client

1.1 Process the

prescription by
checking
availability of
requested items

1.2 Encode the

requested items on
HIS for charging

1.3 Prepare all the

items encoded

2. Receive/claim the 2. Issue the requested None 15 minutes Pharmacist on

item/s item/s duty

TOTAL: 30 mins
61. Provision of All Available Drugs/Medicines/Medical Supplies and Other
Pharmaceuticals (Pricing for Special Prescription Form for Dangerous Drugs)
Provision of available needs of Physician having S2 license

Office or Division: MAIN IN-PATIENT PHARMACY

Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: SPMC Physician and Physician of other hospital having an
S2 license
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing.

PRIMARY
Special Prescription Form for Dangerous Physician
Drugs Booklet (previous booklet)

Photocopy of S2 License with 3 specimen Physician

signatures of physician

Photocopy of PRC License Physician

REPRESENTATIVE
Special Prescription form for Dangerous Physician
Drug Booklet (previous booklet)

Photocopy of S2 License with 3 specimen Physician

signatures of physician

Photocopy of PRC License Physician

Authorization Letter with present date Physician

Government Issued Identification Card of the Representative

Representative with photocopy

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Present all the 1. Accept all the None 10 minutes Pharmacist
documents to documents from on duty
Receiving window client
for validation
2. Inform the 2. Write an order slip None 15minutes Pharmacist
pharmacy for payment on duty
personnel the
quantity of the 2.1 Process
booklet to be transaction on HIS
purchased
2.2 Compute the
total cost of the
booklet requested in
the order slip
2.3 Inform client the
total amount to be
paid.

NOTE:
Maximum quantity 5
Booklet for
consultant physician
and 1 booklet for
resident physician

2.4 Instruct the client

to proceed to cashier
for payment. then
Instruct client to
return to the
pharmacy after
payment

TOTAL: 25 minutes
62. Provision of All Available Drugs/Medicines/Medical Supplies and Other
Pharmaceuticals- (Availment for Special Prescription Form for Dangerous
Drugs)
Provision of available needs of Physician having S2 license

Office or Division:MAIN IN-PATIENT PHARMACY

Classification: Simple
Type of Transaction:
G2C, G2G
Who may avail: SPMC Physician and Physician of other hospital having an
S2 license
CHECKLIST OF REQUIREMENTS WHERE TO SECURE

The following requirements must have the

complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing.

PRIMARY

Special Prescription Form for Dangerous Physician

Drugs Booklet (previous booklet)

Photocopy of S2 License with 3 specimen Physician

signatures of physician

Photocopy of PRC License Physician

REPRESENTATIVE

Special Prescription form for Dangerous Physician

Drug Booklet (previous booklet)

Photocopy of S2 License with 3 specimen Physician

signatures of physician

Photocopy of PRC License Physician

Authorization Letter with present date Physician

Government Issued Identification Card of Representative

the Representative with photocopy

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Present order slip 1. Accept order slip None 5 minutes Pharmacist on
with official receipt and OR and check duty
to Receiving validity of the Official
window Receipt
2. Receive purchased 2. Issue the DDB None 15 minutes Pharmacist on
DDB booklet and booklet and receipt to duty
receipt the client

2.1 Fill up the 2.1 Request the client

required information to fill up the yellow pad
in the yellow pad distribution/sales
distribution/sales record
record 2.2 Check the
completeness of
information entered
2.3 Keep previous
SPFDD booklet

TOTAL: 20 minutes
63. Acceptance of Pharmacy Students for Minor (200 hours) and Major (360
hours) Hospital Pharmacy Internship Program.
This program is offered to Pharmacy students who have completed their minor community pharmacy
internship and Pharmacy students who have completed their minor hospital pharmacy internship

Office or Division: MAIN AND SATELLITE PHARMACIES

Classification: Simple
Type of Transaction: G2C
Who may avail: Pharmacy students who have completed their minor community
pharmacy internship (MINOR HOSPITAL PHARMACY
INTERNSHIP) Pharmacy students who have completed their
minor hospital internship (Major Hospital Pharmacy Internship)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Daily Time Record (DTR) SCHOOL/Clinical Instructor

Endorsement letter PROFESSIONAL EDUCATION TRAINING

AND DEVELOPMENT
Other requirements under taken in the PETD PROFESSIONAL EDUCATION TRAINING
Office AND DEVELOPMENT

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON

BE PAID TIME RESPONSIBLE
1. Present to 1. Coordinate with None 15 mins Head
Pharmacy the letter interns’ clinical Pharmacist
of endorsement to instructor for
the head scheduling
Pharmacist confirmation.

1.1 Orient the

students intern the
hospital Pharmacy
policies, rules and
standard
operating
procedures.
1.2 Assigned the
students intern in
the pharmacy
satellites.
1.3 Instruct the
students to wear
complete
prescribed uniform
and wear the I.D.
 2. Assist the 2. Allow the student None 7 hours and 45 Pharmacist
pharmacist on duty to prepare the mins on duty
and always medicines
endorse the requested by our
medicine prepared clients but with the
to the pharmacist pharmacist
for checking supervision

2.1 Ask the head 2.1 Check the

pharmacist to sign student interns’
your DTR output and sign
the DTR every
after duty.
TOTAL = 8
HOURS

64. Provision of chemotherapy drugs and antibiotics to Children’s Cancer

Institute patients.
Mix chemotherapy drugs, and monitor chemotherapy and antibiotic regimen of CCI patients.

Office or Division: CANCER INSTITUTE PHARMACY – CLINICAL PHARMACY

Classification: Simple
Type of Transaction: G2G
Who may avail: SPMC Children’s Cancer Institute Patients

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

The following requirements must have the
complete information pursuant to RA 6675
(Generics Law). Invalid prescription will not
be accepted for processing.

Doctor’s order SPMC Pedia-Onco Rotator, CCI Fellow

Doctor/s

SPMC Prescription original with signature of SPMC Pedia-Onco Rotator, CCI Fellow
the prescribing doctor/physician Doctor/s

SPMC Restricted Antibiotic Requisition Form SPMC Infection Control Committee, SPMC
Pedia-Onco Rotator, CCI Fellow Doctor/s

FEES TO PROCESSING PERSON

CLIENT STEPS AGENCY ACTION
BE PAID TIME RESPONSIBLE
1. Doctor orders 1. Prepare and mix None 4 hours Clinical
chemotherapy for the chemotherapy Pharmacist on
patient duty

1.1 Doctor informs 1.1 Note patient’s

NOD that there is data and doctor’s
chemotherapy chemotherapy order
ordered for the to CLINICAL
patient PHARMACIST
ENDORSEMENT
1.2 Nurse transcribes LOGBOOK
the doctor’s order to
Kardex and to 1.2 Check
chemotherapy correctness of
sheet and/or chemotherapy
medication sheet ordered based on
chemotherapy
protocol
1.3 Encode
transcribed order to 1.2.1 Recalculate
chemotherapy tag dose of
template chemotherapy
based on patient’s
1.4 Check with BSA or weight
patient or watcher specified in the
the availability of protocol
materials needed for
chemotherapy 1.2.2 Determine if
chemotherapy drug
1.5 Endorse to is compatible with
Clinical Pharmacist the type and amount
on duty the materials of IV fluid ordered
to be used
1.2.3 Review current
1.6 Receive the medication/s for
endorsement of possible drug
prepared interactions
chemotherapy from
Clinical Pharmacist 1.3 Recheck if
doctor’s order is
transcribed
accurately

1.4 Print
chemotherapy tag
with encoded order

1.5 Get the

materials needed
for chemotherapy
from the nurse,
watcher, or patient
itself

1.6 Prepare PPE for

mixing

1.7 Prime the IV line

with its
corresponding IV
fluid and discard
excess amount
until desired is
reached

1.8 Mix the

chemotherapy
using aseptic
technique

1.9 Store the mixed

chemotherapy
appropriately in the
designated area

1.10 Write all the

information
required for
documentation of
chemotherapy
mixed in the
PREPARED
CHEMOTHERAPY
FOLDER
2. Doctor orders 2. Prepare and None 2 hours Clinical
antibiotic/s for the dispense antibiotic/s Pharmacist on
patient duty
2.1 Note patient’s
2.1 Doctor informs data and doctor’s
NOD that there is/are antibiotic/s order to
antibiotic/s ordered CLINICAL
for the patient PHARMACIST
ANTIBIOTIC
2.2 Doctor makes TRACKER
prescription for
regular/restricted 2.1.2 Check and
antibiotic/s recalculate the dose
of antibiotic/s based
2.3 Doctor endorses on patient’s weight
prescription/s to the specified in the
NOD of patient guideline/algorithm

2.4 Nurse transcribes 2.2 Recheck if

the doctor’s order to doctor’s order is
kardex and transcribed
medication sheet accurately

2.5 Endorse to 2.3 Receive and

Clinical Pharmacist check prescription.
on duty the
prescription for 2.4 Prepare and
regular/restricted dispense
antibiotic/s antibiotic/s for each
patient on a daily
2.6 Receive the consumption basis
endorsement of
dispensed 2.5 Account all
antibiotic/s from dispensed
Clinical Pharmacist antibiotics from
on duty stock inventory

TOTAL: 6 hours
65. Pharmacy Services
Provision and Replacement of Emergency Drugs for Service Wards (Charge Transaction-
Admitted Patients)
Provision of available needs of paying patients
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Institute of Psychiatry and Behavioral Medicine – Inpatient Dept.

Classification: Simple
Type of Transaction: G2C
Who may avail: All patients admitted at wards,(CIU, Male Ward and Female Ward),
Requesting ward through the Nurse on Duty
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
4. Accomplished Medicine Issue Slip 1.Requesting ward
(with duplicate) duly signed by the
requesting nurse on duty and the
resident physician of the ward
5. Supporting prescriptions of the 2.Resident physician of the ward
medicines used by individual
patients that need to be replaced
6. Accomplished Monitoring Sheet for 3.Requesting ward
Dangerous Drug preparation
replacement

CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1.For initial request, 1. Receive the None 1 minute Pharmacist
submit accomplished required
medicine issue slip documents and
form and Requisition check if all fields
for Dangerous Drug are completely
1.1For replacement of accomplished.
used emergency 1.1 Inform the
drugs, submit nurse that they
medicine issue slip will receive a call
together with if request is ready
supporting for pick up
prescription of the 1.2 Process and 10 minutes Pharmacist
medicines used by fill the request,
individual patient. and sign over
printed name on
1.2 For replacement the space
of dangerous drugs, designated for
submit accomplished pharmacist
requisition form 1.3 Call the ward
together with the filled that emergency
monitoring sheet from medicines/danger
previous/initial request ous drugs with
of the consumed monitoring sheet
dangerous drug. are ready for pick
up

2. Proceed to 2.Dispense None Pharmacist

pharmacy and receive processed 10 seconds
the requested drugs, medicines/drugs,
monitoring sheet (for monitoring sheet
dangerous drug) and and duplicate
duplicate copy of MIS copy of the MIS
(Medicine Issue Slip) 2.1 Encode/
charge the 45 minutes
served medicines
through the
supporting
prescription given,
to patient’s PHIC
or Hospital bill
(whichever is
applicable)
2.2 File the
requisition form
and monitoring
sheet of the
dangerous drug
requested
TOTAL: 56 minutes
and 10
seconds
66. Pharmacy Services
Provision of All Available Drugs/Medicines/Medical Supplies and Other Pharmaceuticals (cash
Transaction – Regular Client)
Provision of available needs of paying patients
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Institute of Psychiatry and Behavioral Medicine – Outpatient Dept.

Classification: Simple
Type of Transaction: G2C
Who may avail: Outpatient IPBM Clients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
All Clients:
1. Prescription Physician of OPD where client seek
consultation
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present 1. Verifies the None 1 minute Pharmacist
prescription/s to prescription/s
pharmacist for classifies the
availability of prescribed
medicines. medicine as
Regular stock or
Consignment
stock then prices
the meds
2.1. For Socialized 2.1. Interviews None 5 minutes Social Worker
meds (Regular and classifies
stocks), Senior Citizen patient then gives
or with discount to
disability(PWD) prescribed
medicines

2.2 For non- 2.2 Explains to None 5 minutes Social Worker

socialized meds client why
(Consignment stocks) medicines cannot
be discounted.
 3. Provide payment 3. Receives Please refer 2 minutes Cashier
for the items being payment and to the
purchased at the issues official approved
cashier’s window. receipt. schedule of
fees
(subject to
change)
4. Proceed to 4. Receives the None 1 minute Pharmacist
Pharmacy and prescription/s and
present prescription Official Receipt.
and official receipt.

5. Receive purchased 5. Dispenses None 1 minute Pharmacist

item/s and receipt and medicine/s to the
other documents client.
presented
TOTAL: 15 minutes

67. Pharmacy Services

Provision of All Available Drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Charge
to Donor with Government Funds)
Provision of available needs of paying patients
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Institute of Psychiatry and Behavioral Medicine – Outpatient Dept.

Classification: Simple
Type of Transaction: G2C
Who may avail: SPMC-IPBM Outpatients with Donor from Government funds
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Updated Prescription/s
Physician of OPD where client seek
consultation

CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Present 1. Verifies the None 1 minute Pharmacist
prescription/s to prescription/s
pharmacist for classifies the
availability of prescribed
medicines( Good for 1 medicine as
month only) Regular stock
(stamped with
murang gamot) or
Consignment
(stamped with
consignment
stock) then prices
the medicines
2. Receive priced and None None
stamped
prescription/s and
proceed to office
where government
fund is sought such as
(OP, CMAP, DSWD,
LINGAP, PCSO etc. )

3. Return to IPBM 3. Accept and None 1 minute Pharmacist

Pharmacy and check
present the approved completeness of
prescription/s with the required
complete information,
requirements needed. validity and
requirements.

3.1 Request
additional
payment if total
amount of item
exceeds the
approved fund

3.2 Endorse to
cashier to produce
charge slip and
receipt if with
additional
payment
4. Return to pharmacy 4. Check None 1 minute Pharmacist
and present duly prescription and
approved prescription documents, and
with proper ask
documents patient/watcher to
sign over printed
name on the
prescription to
acknowledge
receipt.

5. Sign over printed 5. Dispenses None 1 minute Pharmacist

name of the approved medicine/s to the
prescription/s to client.
acknowledge receipt
6. Receive the item 6. Receive signed None 10 sec. Pharmacist
prescription/s with
the required
documents
TOTAL: 4 minutes
and 10 sec.
68. Pharmacy Services
Provision of All Available Drugs/Medicines/Medical Supplies and Other Pharmaceuticals (cash
Transaction – Regular Client)
Provision of available needs of paying patients
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Institute of Psychiatry and Behavioral Medicine – Outpatient Dept.

Classification: Simple
Type of Transaction: G2C
Who may avail: Walk-in Outpatient Clients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE

1. Prescription Physician of clinic where client seek

consultation.
If senior citizen or PWD:
2. ID of senior citizen or PWD Local Government Unit
OSCA or PWD Medicine booklet
(original).
2.1 Authorization letter with present Person being represented
date (original) if representative only.

CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Present 1. Verifies the None 1 minute Pharmacist
prescription/s to prescription/s
pharmacist for classifies the
availability of prescribed
medicines. medicine as
Regular stock or
Consignment
stock, then prices
the meds
2. For Senior Citizen
or patient with
disability(PWD)

2.1 Present client 2.1 Accept None 5 minutes Pharmacist

prescription and other prescription and
pertinent documents check
to pharmacist to avail completeness of
discount and for required
validation information,
validity and
requirements
2.2 Process
transaction and
inform client the
total amount to be
paid

3. Provide payment 3. Receives Please refer 2 minutes Cashier

for the items being payment and to the
purchased at the issues official approved
cashier’s window. receipt. schedule of
fees
(subject to
change)
4. Proceed to 4. Receives the None 1 minute Pharmacist
Pharmacy and prescription/s and
present official Official Receipt.
receipt.

5. Receive purchased 5. Dispenses None 1 minute Pharmacist

item/s and receipt. medicine/s to the
client.

TOTAL: 15 minutes
69. Pharmacy Services
Provision of All Available Drugs/Medicines/Medical Supplies and Other Pharmaceuticals (Charge
Transaction- Admitted Patients)
Provision of available needs of paying patients
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Institute of Psychiatry and Behavioral Medicine – Inpatient Dept.

Classification: Simple
Type of Transaction: G2C
Who may avail: All admitted patient at Wards(CIU, Male Ward and Female Ward)
through the request of the Nurse on Duty
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Accomplished Medicine Issue Slip 1.Requesting ward
(with duplicate) duly signed by the
requesting nurse on duty and the
resident physician of the ward
2. Supporting prescriptions of the 2.Resident physician of the ward
requested medicines for admitted
patients
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit medicines 1. Receive the None 1 minute Pharmacist
and issue slip to the medicine issue
pharmacy together slip with the
with the supporting prescriptions from
prescriptions. the nurse and
process the MIS
by checking the
availability of the
requested
medicines
1.1 Prepare the 10 minutes Pharmacist
available
medicines
 requested and
sign over printed
name designated
for pharmacist
1.2 Call/inform the 10 seconds Pharmacist
nurse on duty of
the requesting
ward that the
requested
medicines are
ready for pick-up
1.3 encode/ 45 minutes Pharmacist
charge the served
medicines through
the prescription
given, to patient’s
PHIC or Hospital
bill (whichever is
applicable)
2. Proceed to 2.Dispenses the None 10 seconds Pharmacist
pharmacy and receive medicines to the
the requested requesting Nurse
medicines and
duplicate copy of MIS

TOTAL: 56 minutes
and 20
seconds
Medical Social Work Section (MSWS)
 Main Office

External Services

1. Assessment and Classification

Process in the Assessment and Classification of patients in accordance to AO 51-A, series of
2000.

Availability of Service: 7:00 am to 6:00pm Monday to Friday and 8:00-5:00 - Saturday

Office/ Division: Medical Social Work Section- Main Office
Classification: SIMPLE
Type of Transaction G2C, G2G
Who may avail WALK-IN and REFERRED CLIENTS
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
None
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Presents 1. Interviews None
problems/ and classifies 10 minutes Medical Social
concerns Client Worker

2. Signs in Daily 2. Issues Service None 5 minutes Medical Social

Accomplishment card Worker
form, Service
card 2.1 Orients client
on the use of
service card

Total 15 minutes
2. Managing Medical Assistance to No watcher Patients
Provision of Medical Assistance
Availability of Service: 7:00 am to 6:00pm Monday to Friday and 8:00-5:00 - Saturday
Office/ Division: Medical Social Work Section- Main Office
Classification: SIMPLE
Type of G2C
Transaction
Who may avail No watcher Patients – Foundling, Abandoned/ Neglected Adult and
Children
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Ward Referral Nurse station
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Endorses 1. Receives Ward None 15 minutes Medical Social
Ward Referral Worker
Referral
1.1 Gathers
Information
and classifies
patient

1.2 Makes
referrals to
concerned
units/agencies
1.3 Records and
updates
intervention
Total None 15 minutes
3. CADAVER RELEASE
Facilitating Release of Cadaver
Availability of Service: 7:00 am to 6:00pm Monday to Friday and 8:00-5:00 - Saturday
Office/ Division: Medical Social Work Section- Main Office
Classification: SIMPLE
Type of G2C
Transaction
Who may avail Walk-in and Referred Clients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Cadaver Slip
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE
1. Presents 1. Accommodates None 15 Medical Social
cadaver referred and Worker
slip walk-in clients
1.1 Verifies name of
client
1.2 Evaluates
authenticity of
document
presented
1.3 Signs cadaver
slip
1.4 Instructs
claimant to
proceed to
morgue
None
Total 15 minutes
 4 .POINT OF SERVICE
Availment of Hospital Sponsored Membership PHILHEALTH
Availability of Service: 7:00 am to 6:00pm Monday to Friday and 8:00-5:00 - Saturday
Office/ Medical Social Work Section- Main Office
Division:
Classification: SIMPLE
Type of G2C
Transaction
Who may avail Walk-in and Referred Clients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
None
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE
1. Presents 1. Conducts NONE 1 hour Medical Social
financial interview and Worker
difficulty assessment,
classifies
patient
1.1 Advises
client to
secure and
submit
documents
1.2 Verifies
documents,
scan and e-
mail POS
required
documents
1.3 Advises
client to
return the ff.
day for
PHIC reply
1.4 Enrolls
Patient
None 1 hour
Total
 5. REFERRALS
Facilitation of Referrals
Availability of Service: 7:00 am to 6:00pm Monday to Friday and 8:00-5:00 - Saturday
Office/ Division: Medical Social Work Section- Main Office
Classification: Simple
Type of Transaction G2c
Who may avail Walk-in and referred patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
None
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Presents 1. Accommodates None 10 minutes Medical Social
issues/concerns client Worker
1.1 Interviews
and
Gathers
data
1.2 Evaluates
and
assesses
needs of
client
1.3 Makes
referral
letter or
print-out
forms

2. Proceeds to 2. Instructs None 5 minutes Medical Social

referred pt./watcher to Worker
agency proceed to
referred agency
and advised to
bring back copy
of return slip

Total None
15 minutes
6. Process of Encoding Lingap Assistance
Encoding of Lingap Medical Assistance
Availability of Service: 7:00 am to 6:00pm Monday to Friday and 8:00-5:00 - Saturday

Office/Division: Medical Social Work Section- Main Office

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients with Lingap Assistance
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Medical Request Doctor/Nurse from the Ward
2. Guarantee Letter from Lingap Lingap Office
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE

1. Submit original 1.1 Evaluate None 1 hour Medical Social

copy and guarantee Worker
photocopy of letter of the
approved patient
laboratory
request for 1.2 Encodes the
encoding of amount
Lingap indicated on
Assistance the Lingap
Guarantee
Letter to reflect
assistance of
the patient

1.3 Instruct Patient

/ Watcher to
go to
laboratory to
submit
approved
request and to
undergo
procedure or
for scheduling.
TOTAL: None 1 hour
Medical Social Work Section (MSWS)

Children’s Cancer Institute

External Services
1. Assessment and Classification of Patients
Provision of Medical Discount
Availability of Service: 7:00 am to 5:00 pm, Monday to Friday and Holidays

Office/Division: Medical Social Work Section- Children’s Cancer Institute (CCI)

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. OPD and in-patient Adult and Children who are diagnosed of
cancer
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Yellow Card HIMD
1. Medical Request Doctor/Nurse from the Ward and OPD Clinic
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Walks-in for 1. Conducts None 30 minutes Medical Social
interview and express intake interview Worker
the need of medical
assistance 1.1 Assess and
Classifies the
patient to avail
medical
discount

1.2 Updates the

existing data of
the patient

1.3 Issues service

card

2.Received Service 2. Explains the None 15 minutes Medical Social

Card to avail Medical benefit and Worker
Discount coverage of the
card

TOTAL: Payment/ 1 hour

Discount
depends on
the
Classification
of patient

Availment of Medical discount

Classification and its discount
C1 25%
C2 50%
C3 75%
D- Full Charity 100%
2. Process of Availing Lingap Assistance
Referring patient for Assistance on non- socialized medical needs
Availability of Service: 7:00 am to 5:00 pm, Monday to Friday

Office/Division: Medical Social Work Section- Children’s Cancer Institute (CCI)

Classification: Simple
Type of Transaction: G2C and G2C
Who may avail: 1. All Adult and Children patients who are diagnosed of cancer both
from In-patient and Out-patient Department
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Yellow Card (OPD) HIMD
2. Medical Request Doctor/Nurse from the Ward and OPD Clinic
3. Service Card (Pink Card) Medical Social Work Section
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present 1. Conducts None 1 hour Medical Social
medical intake interview Worker
request for
assistance to 1.4 Assess /
Lingap Office Update
Classification
of the patient

1.5 Evaluates non-

socialized
laboratory
needs and
medical
procedure of
the patient

1.6 Generates
Lingap print-
out form

1.7 Instruct Patient

/Watcher to go
to Lingap to
secure
assistance
TOTAL: None 3 hours
3. Process of Encoding Lingap Assistance
Encoding of Lingap Medical Assistance
Availability of Service: 7:00 am to 5:00 pm, Monday to Friday

Office/Division: Medical Social Work Section- Children’s Cancer Institute (CCI)

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients with Lingap Asistance
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
4. Medical Request Doctor/Nurse from the Ward / OPD Clinic
5. Guarantee Letter from Lingap Lingap Office
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE

2. Submit original 1.8 Evaluate None 1 hour Medical Social

copy and guarantee Worker
photocopy of letter of the
approved patient
laboratory
request for 1.9 Encodes the
encoding of amount
Lingap indicated on
Assistance the Lingap
Guarantee
Letter to reflect
assistance of
the patient

1.10 Instruct
Patient /
Watcher to go
to laboratory to
submit
approved
request and to
undergo
procedure or
for scheduling.
TOTAL: None 1 hour
4. Process of Availing Referrals
Referring patient for Medical Assistance
Availability of Service: 7:00 am to 5:00 pm, Monday to Sunday and Holidays

Office/Division: Medical Social Work Section- Children’s Cancer Institute (CCI)

Classification: Simple
Type of Transaction: G2C, G2B and G2C
Who may avail: 1. Walk-in and referred patient from CCI Charity Ward
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
6. Medical Request Doctor/Nurse from the Ward and OPD Clinic
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
3. Present 1. Conducts None 1 hour Medical Social
medical intake interview Worker
request for
assistance 1.11 Assess /
Update
* Hospital Bill Classification
*Medical Request of the patient
*Supplies
*Procedure 1.12 Prepares
* Medicine referral letter
and instruct
patient to go
to partner
agency to
process /
secure
assistance
2. Submit Referral 2.1 Received None 2 hours Medical Social
Return Slip from Referral Return Worker
partner agency Slip and verify
assistance thru
Guarantee Letter

2.2 facilitate
action according
to the following
transaction/s:
Hospital Bill:
Facilitate
Hospital bill
Cleared
Medicine :
Refer to
Pharmacy to get
medicine/ supplies
Procedure:
Refer to its
respective cost
centers for the
procedure/
scheduling
TOTAL: None 3 hours
Medical Social Work Section (MSWS)

Emergency Room

External Services
1. Assessment and Classification of Patient
Provision of Medical Discount
Availability of Service: Opens 24 hours, Monday to Sunday and Holidays

Office/Division: Medical Social Work Section- Emergency Room (ER)

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. All walk-in and referred patients at the Emergency Room
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Medical Request Doctor/Nurse from the Ward and OPD Clinic
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Walks-in for 1. Conducts None 45 minutes Medical Social
interview and express intake interview Worker
the need of medical
assistance 1.13 Assess and
Classifies the
patient to avail
medical
discount

1.14 Updates
the existing
data of the
patient

1.15 Issues
service card

2.Received Service 2. Explains the None 15 minutes Medical Social

Card to avail Medical benefit and Worker
Discount coverage of the
card

TOTAL: Discount 1 hour

depends on
the
Classification
of patient

Availment of Medical discount

Classification and its discount
C1 25%
C2 50%
C3 75%
D- Full Charity 100%
2. Availment of Point of Service (POS) Philhealth
Facilitating POS Enrolment
Availability of Service: Opens 24 hours, Monday to Sunday and Holidays

Office/Division: Medical Social Work Section- Emergency Room (ER)

Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: 1. walk-in and referred Non Philhealth patients at the charity ward
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
2. Medical Request Doctor/Nurse from the Ward and OPD Clinic
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Walks-in for 1. Conducts None 20 minutes Medical Social
interview and intake interview Worker
presents Routing Slip
from Billing Section 1.16 Assess and
Classifies the
patient to avail
medical
discount

1.17 Updates
the existing
data of the
patient

1.18 Issue
service card to
avail medical
discount

1.19 Advise the

Watcher to
secure
document

2.Submit valid 2.Review the data None 15 minutes Medical Social

documents and Evaluates Worker
the document
submitted by
the client

2.1 Scan the

document and
and sends e-
mail to
Philhealth
Office for
verification
process

2.2 Advise to wait None 2 days Medical Social

for the worker
verification
result

None 25 minutes
3. Received P.O.S 3.Prepares POS Medical Social
Confirmation Result document for Worker
enrolment

3.1 Enroll the

patient in the POS
Portal

3.2 Issues POS

Certification and
inform the client
about the POS
benefits and its
entitlement

4. Availed P.O.S No 4.1 Instruct the None 25 minutes Medical Social

Balance Billing (NBB) client to submit Worker
Philhealth POS documents
to Billing Section
to avail Hospital
Sponsored
Membership
(HSM) POS Card

TOTAL: None 2 days and 1

hour
3. Process of Availing Referrals for Medical Assistance
Referring patient for Medical Assistance
Availability of Service: 7:00 am to 5:00 pm, Monday to Sunday and Holidays

Office/Division: Medical Social Work Section- Emergency Room

Classification: Simple
Type of Transaction: G2C, G2B and G2C
Who may avail: 1. Walk-in and referred patient from ER Charity Ward
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
7. Medical Request Doctor/Nurse from the Ward and OPD Clinic
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
4. Present 1. Conducts None 1 hour Medical Social
medical intake interview Worker
request for
assistance 2.1 Assess /
Update
* Hospital Bill Classification
*Medical Request of the patient
*Supplies
*Procedure 2.2 Prepares
* Medicine referral letter
and instruct
patient to go
to partner
agency to
process /
secure
assistance
2. Submit Referral 2.1 Received None 2 hours Medical Social
Return Slip from Referral Return Worker
partner agency Slip and verify
assistance thru
Guarantee Letter

2.2 facilitate
action according
to the following
transaction/s:
Hospital Bill:
Facilitate
Hospital bill
Cleared
Medicine :
Refer to
Pharmacy to get
medicine/ supplies
Procedure:
Refer to its
respective cost
centers for the
procedure/
scheduling
TOTAL: None 3 hours
Medical Social Work Section (MSWS)

HIV-AIDS Care Team (HACT)

External Services
HIV Counseling and Testing
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays

Office/Division: MSWS - HIV / AIDS Core Team (HACT)

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Clients (Out-patient, In-patient , Walk-in patient and referred
patient from other hospitals/clinics)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Identification Card Client
2. Information sheet (new client) Admin Aide I (Clerk)
3. Yellow Card HIMD
4. Referral form Doctor
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Presents yellow 1. Verifies and None 10 minutes Administrative
card, referral form and encode client’s Aide I
client’s information record/information
sheet 1.2 Instruct patient
to wait to be
called by the
counselor
2. Undergo Pre-test 2. Provide lecture None 20 minutes Medical Social
and Counseling on HIV/AIDS Worker
2.1 Conducts 20 minutes (Trained
counseling and Counselor)
assessment
2.2 Instructs 5 minutes
schedule of the
release of results
3. Testing for blood 3. Prepares None 10 minutes MedTech
extraction materials and
instruct the client
to wait to be
called by the
Medtech
TOTAL: None 1 hour and 5
minutes
Post Test Counseling
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays

Office/Division: MSWS - HIV / AIDS Core Team (HACT)

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Clients (Out-patient, In-patient , Walk-in patient and referred
patient from other hospitals/clinics)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Identification Card Client
2. Information sheet (new client) Admin Aide I (Clerk)
3. Yellow Card HIMD
4. Referral form Doctor
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Presents yellow 1. Verifies client’s None 30 minutes Administrative
card and claim stub record/information Aide I
1.2 Instruct patient
to wait to be
called by the
counselor
2. Undergo Post Test 2. Explains the None 30 minutes Medical Social
Counseling result of HIV Worker
screening and (Trained
emphasize the Counselor)
importance of the
test
2.1 Assess the
knowledge of the
patient about
HIV/AIDS

TOTAL: 1 hour
Classification of Patient According to their Financial Capability
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays

Office/Division: MSWS - HIV / AIDS Core Team (HACT)

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients ( In-patient, Out-patient and referred patient)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Laboratory Request and Prescriptions Doctor
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Presents laboratory 1. Conducts refer to 55 minutes Medical Social
request and intake interview approved Worker
prescriptions 1.1 Assess and of
classifies patient schedule
to avail discounts of fees
and other free
services
1.2 provide
service card to the
admitted patients
1.3 Regulate
Laboratory Fees
(fees may vary
according to
patients’
classification)
2. Proceed to 1. Record the None 5 minutes
Laboratory and transaction of the
Pharmacy patient
Refer to
TOTAL: approved 1 hour
schedule
of fees
Provision of Medical Assistance
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays

Office/Division: MSWS - HIV / AIDS Core Team (HACT)

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients ( In-patient, Out-patient and referred patient)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Referral, Laboratory Request and Doctor
Prescriptions
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Presents referral 1. Conducts Refer to 20 minutes Medical Social
form, Laboratory intake interview approved Worker
Request and 1.1 Assess and schedule 20 minutes
Prescriptions classifies patient of fees
to avail discounts
and other free
services
1.3 Provide 15 minutes
referral letter to
PAD for further
assistance and
Printed Lingap
form for laboratory
request

2. Availed medical 1. Record the None 5 minutes Medical Social

assistance and submit transaction of the Worker
the returned slip to the patient
social worker
Refer to
TOTAL: approved 1 hour
schedule
of fees
Referral for Temporary Shelter
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays

Office/Division: MSWS - HIV / AIDS Core Team (HACT)

Classification: Complex
Type of Transaction: G2C
Who may avail: 1. Patients (Out-patient and referred patient)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Living outside Davao City Data Profile

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Request for 1. Conducts None 30 minutes Medical Social
temporary shelter interview Worker
1.1 Provide 15 minutes
referral letter to
the Capernaum
Care Facility
1.2 Provide 5 minutes
Identification Card
for the
accommodation

2. Submit the referral 1. Record the None 10 minutes Medical Social

letter to the transaction of the Worker
Capernaum Care patient
Facility
None
TOTAL: 1 hour
Ward Rounds
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays

Office/Division: MSWS - HIV / AIDS Core Team (HACT)

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients (admitted patients)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Referrals Doctor

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Receives referrals 1. Conducts ward None 1 hour Medical Social
from Nurses, rounds Worker
Watchers and Doctors
1. 2 Assess and
facilitate the
needs of the
patient

TOTAL: 1 hour
Medical Social Work Section (MSWS)

Heart Institute

External Services
1. Process in availing classification, discount and medical assistance for OPD
patients
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays week ends.
Office/Division: Medical Social Work Section – Heart Institute
Classification: SIMPLE
Type of Transaction: G2C
Who may avail: OPD Patients who are diagnosed with heart disease.
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Filled up financial assistance form Doctor
2. Yellow Card HIMD
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Submit filled up 1.In depth interview Php 50.00 20 minutes Medical Social
financial Worker
assistance 1.1 Assess and
form from OPD classify
Cardio patients
residents
Pedia/Adult 1.2 Apply
(medical discount on
management consultation
case) fee

2. Present guide 2. Issuance of print None 20 minutes Medical Social

/request of encoded out request for Worker
laboratory / SP lab Office of the
and recommended President and
procedure Lingap.

2.1 Encode
approved
medical
assistance from
OP and Lingap

2.2 Issuance of
referral to MAIP
to complete
payment if
medical
assistance from
OP and Lingap
is not enough

TOTAL: Php 50.00 40 minutes

2. Process in availing classification and assessment for Admitted Patients
with/ without plan of surgery
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays week ends.

Office/Division: Medical Social Work Section – Heart Institute

Classification: HIGHLY TECHNICAL
Type of Transaction: G2C and G2G
Who may avail: Patients who are diagnosed with heart diseases.
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Filled up financial assistance form by IM/ Pedia Cardio, TCVS and non-Cardio
Resident physician Residents at HI and other wards
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE

1. Submit filled up 1. Classify and None 30 minutes Medical Social

financial assess patients Worker
assistance
form 1.1 Issuance of
MSWS card
for admitted
patients
1.2 Prepare
Social Case None 2 hours Medical Social
Summary for Work Section
admitted
cardio patient
but non-
surgical case
1.3 Issuance of
request for
Costing/Presc
ription of
Forward
Stocking
supplies for
patient with
plan of
surgery
cardiac and
non-cardiac
1.4 Issuance of
checklist of
requirements
for OPD
cardiac
patient.
1.5 Counselling
1.6 Follow up on
wards for
 cardiac
patients

2. Present 2.Evaluate financial None 3 days Medical Social

Accounting/ OR assistance acquired Worker
clearance for from funding
patient with plan of agency ( consigned
surgery together device/ medical
with prescription of supplies use for
consigned supplies OR).
with complete
payment/financial 2.1Issuance of
assistance referral to medical
team, Re: Billing
section

TOTAL: None 3 days and 2

hours and 30
minutes
3. Process for OPD/ Admitted Z-Package Patients
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays

Office/Division: Medical Social Work Section – Heart Institute

Classification: SIMPLE
Type of Transaction: G2C, G2G and G2B
Who may avail: Patients who are diagnosed with heart diseases ( CABG, TOF and
VSD case).
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Filled up financial assistance form 1. IM/ Pedia Cardio, TCVS Residents at
OPD clinic and HI-wards
2. Routing Slip 2. Z-Package Coordinator
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE

1. Submit filled up 1. Classify and None 30 minutes Medical Social

financial assess Worker
assistance patients
form with
routing slip 1.1 Establish
Co-pay for Z-
pack patients

1.2 Issuance of
checklist of
requirements

TOTAL: None 30 minutes

4. Pre-admission Planning and Counselling for OPD and Z- package patients
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays

Office/Division: Medical Social Work Section – Heart Institute

Classification: HIGHLY TECHNICAL
Type of Transaction: G2C, G2G and G2B
Who may avail: Patients who are diagnosed with heart diseases with plan of
surgery.
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Filled up financial assistance form 1.IM/ Pedia Cardio,TCVS Residents at OPD
clinic and HI-wards
2. Routing Slip 2. Z-Package Coordinator
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE

1. Submit filled up 1. Classify and None 30 minutes Medical Social

financial assess Worker
assistance patients
form with
routing slip 1.1 Establish
from Z package Co-pay or
Coordinator Zero Co-pay
for Z-pack
patients

1.2 Issuance of
checklist of
requirements
2. Submits 2.Re-assess /
complete list of evaluate based on None 30 minutes Medical
documents requirements Social
required submitted Worker

2.1 Counselling

2.2 Determine
Co-pay or
Zero Co-pay
for Z-
package
patients

2.3 Issuance of
referral to
medical
team RE:
IM/Pedia
 cardio
residents

TOTAL: none 1 hour

5. Referral and networking for OPD/ admitted patients for fund sourcing
(Outgoing)

Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays

Office/Division: Medical Social Work Section – Heart Institute

Classification: HIGHLY TECHNICAL
Type of Transaction: G2C
Who may avail: 1. Patients who are diagnosed with heart diseases with plan of
surgery.
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Filled up financial assistance form by 1.IM/ Pedia/ TCVS Cardio Residents at OPD
resident physician clinic and HI-wards

2. Laboratory/ Splab and procedure

request

3. MSWS card for admitted patient 2. HI-Medical Social Worker

4. yellow card for OPD patient 3. HIMD

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Submit filled up 1. Classify and None 30 minutes Medical Social
financial assess patients Worker
assistance
form, price 1.2 Issuance of
quotation of list of funding
device and GO/ NGO
prescription of agencies
consigned
medicines/ 1.3 Issuance of
medical checklist of
supplies. requirement
s of Tzu Chi
Foundation

2. Submits 2.Issuance of None 1 month Medical Social

complete list of referral to Tzu Chi Worker
documents Foundation
required for
Tzu Chi 2.1 Follow- up the
Foundation approval of
financial
assistance
from Tzu Chi

3. Present 3.Re-evaluate if None 30 minutes Medical Social

letter of assistance is Worker
approval enough for the
from Tzu payment of
Chi recommended
Foundation procedure
(Pedia/Adult
Cardio Patients)

3.1 Issuance of
referral to
medical team
for schedule
of surgery

TOTAL: none 1 month and

1 hour
6. Process on availing Point of Service for Non-Phic Patients
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays week ends.

Office/Division: Medical Social Work Section – Heart Institute

Classification: SIMPLE
Type of Transaction: G2C and G2G
Who may avail: Patients who are diagnosed with heart diseases with/ without plan of
surgery.
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Filled up financial assistance form by 1.IM/ Pedia/ TCVS Cardio Residents at HI-
resident physician wards / nurse station
2. MSWS Service Card 2. MSWS
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE

1. Submit filled up 1. Classify and None 30 minutes Medical Social

financial assess Worker
assistance patients
form 1.1 Issuance of
MSWS card
2. Submits valid 2.Verify None 3 days Medical Social
documents and documents to Worker
ID’s Philhealth via
email and wait
for the reply. If
eligibility is no
then enroll
member/depend
ent patient.
2.1 Accomplish
PMRF and
 CSF and
attach valid
documents
2.2 Enroll to
POS
Philhealth
Portal and
wait for the
registration
slip
2.3 Issuance of
POS
certification
2.4 Issuance of
routing slip
to billing
section for
processing
and claim
TOTAL: none 3 days and 1
hour

7. Facilitation of hospital bill of May-Go-Home (MGH) patients, in excess to

Philhealth.
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays week ends.
Office/Division: HEART INSTITUTE-MEDICAL SOCIAL WORK SECTION
Classification: SIMPLE
Type of Transaction: G2C and G2G
Who may avail: Admitted patients who are diagnosed with heart diseases with/
without surgery.
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Final hospital bill / Statement of account 1.ROD who ordered MGH patients
2. Billing Section

2. MSWS Service Card 1. HI-MSWS

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Present final 2. Evaluate None 30 minutes Medical Social
hospital bill/ patients Worker
statement of acquired
accounts financial
assistance
from other
funding
agency

2.1 Facilitate
hospital bill
thru MAIP if
assistance is
not enough
 2.2 If payment
for hospital
bill is
enough,
waive the
remaining
balance and
record to
quantified
free
services.

TOTAL: 30 minutes

8. Releasing of Cadaver
Facilitating Release of cadaver
Endorsement of belongings
Availability of Service: Opens 8:00 to 5:00 pm, Monday to Friday

Office/Division: Medical Social Work Section- Heart Institute (HI)

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Legitimate claimant of the expired patient
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
3. Valid Identification Card/ documents Legitimate Claimant of the patient
of legitimate claimant
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIB
LE
1. Present 1. Verify the None 10 minutes Medical
Cadaver authenticity of the Social Worker
Clearance Slip document
and valid
identification 2.3 Record the
Card / docs of name of the
the claimant cadaver and
its legitimate
claimant in the
cadaver
logbook
 2.4 Signed the
Cadaver
Clearance Slip

2. Affix Signature 4. Instruct the None 5 minutes Medical

on the legitimate Social Worker
Cadaver Claimant to
logbook proceed to
morgue for
the
releasing of
cadaver

TOTAL: None 15 minutes

 Medical Social Work Section (MSWS)

Institute for Women and Newborn Health (IWNH)

External Services

1. Assessment and Classification

Assessment and Classification of Patients
Availability of Service: 24 hours/ 7 days a week including Holidays

Office/Division: Medical Social Work Section- IWNH

Classification: Simple
Type of Transaction:
G2C and G2G
Who may avail: 1. Patients
2. Watchers
3. General Public
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
None

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Walk’s in for 1. Conduct None 30 minutes Medical Social
Interview interview and Worker
Assessment for
Availment of
Assistance

2. Receive MSWS 2. Issues MSWS None 5 minutes Medical Social

Card Card Worker
 2.1 Explain the
Benefit of MSWS
Card

TOTAL: None 35 minutes

2. Cadaver Release
Process in Facilitating Release of Cadaver
Availability of Service: 24 hours/7 days a week including Holidays

Office/Division: Medical Social Work Section- IWNH

Classification: Simple
Type of Transaction: G2C and G2G
Who may avail: 1. Patients
2. Watchers
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Cadaver Clearance Slip Nurse Station

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Walk’s in with 1. Verify the name None 15 minutes Medical Social
Cadaver Release of the authorized Worker
claimant indicated
in the slip
1.2 Record the
transaction on the
Cadaver Release
Logbook
 1.3 Identify the
hired Funeral
Parlor

2. Affix Signature of 2. Affix Signature None 5 minutes Medical Social

the Authorized of the Medical Worker
Claimant Social Worker on
duty
2.1 Advise
claimant to
proceed to the
Morgue for further
transaction

TOTAL: None 20 minutes

3. Facilitating of No Watcher
Process in Managing Medical Assistance for Abandoned, Foundling and Neglected Adult and
Children
Availability of Service: 24 hours/7 days a week including Holidays

Office/Division: Medical Social Work Section- IWNH

Classification: Simple
Type of Transaction:
G2C and G2G
Who may avail: 1. Nurses
2. Doctors
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. MSWS Ward Referral Nurse Station

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Endorse Ward 1. Receives Ward None 24 hours Medical Social
Referral Referral Worker
1.2 Identify the
need for availment
of Medical
Assistance
 1.3 Update
Intake/Profile
1.4 Process
Public Service
Assistance
1.5 Provide
Progress Notes
and endorse to
next shift for
follow-up

2. Walk’s in for 2. Verify Watcher None 30 minutes Medical Social

Interview 2.1Conduct Worker
thorough Interview
and Assessment

TOTAL: None 1 day and 30

minutes

4. POS Enrolment- For Mothers

Process in Availing Point of Service (POS) Philhealth Program
Availability of Service: 24 hours/7 days a week including Holidays

Office/Division: Medical Social Work Section- IWNH

Classification: Simple
Type of Transaction: G2C and G2G
Who may avail: 1. Patients
2. Watchers
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Valid Documents: Birth Certificate;
Marriage Contract
2. Valid Identification Card issued by
Government
3. Endorsement Slip Billing Section- IWNH
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Presents MSWS 1. Validate None 45 minutes Medical Social
Card and documents Worker
Endorsement Slip presented
1.2 Scan 2 days
documents and
 send to Philhealth
through E-mail for
PHIC Verification
1.3 Advise follow-
up PHIC
verification result
1.4 Provide
Progress Notes
and endorse to
next shift for
follow-up
2. Follow up PHIC 2. Check None 1 hour Medical Social
Verification Verification result Worker
from PHIC
2.1 Enrolment to
POS
2.2 Explain the
benefits of POS
Program
2.3 Issuance of
POS Certification
and other
requirements
2.4 Advise to
proceed to Billing
Section for
processing of
POS-PHIC and
issuance of PHIC
Card
TOTAL: None 2 days and 45
minutes

5. POS Enrolment- For Additional Dependent

Process of Adding Newborn Dependents in the POS Philhealth (POS)

Availability of Service: 24 hours/7 days a week including Holidays

Office/Division: Medical Social Work Section- IWNH

Classification: Simple
Type of Transaction: G2C and G2G
Who may avail: 1. Patients
2. Watchers
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Valid Documents: Birth Certificate; Nurse Station
Marriage Contract
2. Valid Identification Card issued by
Government
3. Birth Certificate Claim Stub Birth Registration Unit
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present MSWS 1.Verify None 45 mins Medical Social
Card; POS Documents and Worker
Requirement of Birth Certificate
Member and Claimstub
 other 1.1 Explain
documents benefits of POS
Program.
1.2 Issuance of
POS requirements
and other
requirements.
1.3 Advise to
proceed to Billing
Section for
processing of
POS-PHIC and
issuance of PHIC
Card
TOTAL: None 45 minutes

6. Referrals
Process in Facilitating Referrals
Availability of Service: 24 hours/7 days a week including Holidays

Office/Division: Medical Social Work Section- IWNH

Classification: Simple
Type of Transaction: G2C and G2G
Who may avail: 1.Patients
2.Watchers
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. MSWS Service Card Nurse Station
2. Prescription of Medicine
3. Request form for Laboratory and
Procedures
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present MSWS 1.Interview and None 8 hours Medical Social
Card and Update intake Worker
prescription of 1.1 Provide
Medicines; referral letter
Laboratory
 request with 1.2 Advised
indicated amount Watcher to
process referral.
2. Presents return 2.Receive Return None 15 mins Medical Social
slip Slip Worker
2.1 Advise to
proceed to
Pharmacy or
Labortary

TOTAL: None 8 hours and

15 minutes

7. Process of Encoding Lingap Assistance

Encoding of Lingap Medical Assistance
Availability of Service: Opens 24 hours, Monday to Sunday and Holidays

Office/Division: Medical Social Work Section- Institute for Women and Newborn
Health (IWNH)
Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients with Lingap Assistance
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
8. Medical Request Doctor/Nurse from the Ward
9. Guarantee Letter from Lingap Lingap Office
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE

5. Submit original 2.5 Evaluate None 1 hour Medical Social

copy and guarantee Worker
photocopy of letter of the
approved patient
laboratory
 request for 2.6 Encodes the
encoding of amount
Lingap indicated on
Assistance the Lingap
Guarantee
Letter to reflect
assistance of
the patient

2.7 Instruct Patient

/ Watcher to
go to
laboratory to
submit
approved
request and to
undergo
procedure or
for scheduling.
TOTAL: None 1 hour

8. Receiving and Safekeeping of Personal Belongings

Receiving and Safeguarding of belongings
Availability of Service: Opens 24 hours, Monday to Saturday and Holidays

Office/Division: Medical Social Work Section- Institute for Women and Newborn
Health (IWNH)
Classification: Simple
Type of Transaction: G2C
Who may avail: 1. All No watcher patient who has personal belongings
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
5. Personal belongings of No watcher Nurse/ Attendant from the Ward
patient/s
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Endorse personal 1. Receives Cash None 15 minutes Medical Social
belongings of No and personal Worker
Watcher patient from belongings of the
the ward patient
 2.8 Register at
the logbook
and record
belongings
and Cash
received to its
corresponding
forms

2.9 Updates the

existing data of
the patient

2.10 Indicate
proper
labelling of
items

2.11 Safekeep
belongings
inside the
cabinet

TOTAL: None 15 minutes

9. Releasing of Personal Belongings to Legitimate Claimant

Endorsement of belongings
Availability of Service: Opens 24 hours, Monday to Sunday and Holidays

Office/Division: Medical Social Work Section- Institute for Women and Newborn
Health (IWNH)
Classification: Simple
Type of Transaction: G2C
Who may avail: 2. No watcher patient who has belongings endorsed at the
office
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
6. Valid Identification Card/ documents Legitimate Claimant of the patient
of legitimate claimant
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIB
LE
3. Present valid 1. Verify the None 10 minutes Medical
identification authenticity of the Social Worker
Card / docs of document
the claimant
2.12 Review
record of the
patient

2.13 Identify
and validate
each item

2.14 Release
the personal
belongings/
Cash to
legitimate
claimant

4. Received the 7. Endorse all None 5 Medical

items and belongings Social Worker
Signed the of the client
Belongings to his/her
Logbook legitimate
Claimant

TOTAL: None 15 minutes

 Medical Social Work Section (MSWS)

Outpatient Department

External Services

1. Classification of Patient and Provision of Consultation Discount

Availability of Service: 7:00 am to 5:00 pm Monday to Friday EXCEPT HOLIDAYS.

Office/ Division: Medical Social Work Section – Out Patient Department
Classification: Simple
Type of G2C
Transaction
Who may avail Patient who seek consultation discount.
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Yellow Card Hospital Information
Management Department
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE
 1. Walks-in for 1. Interview and Payment 10 minutes Medical Social
interview gather data of the depends on Worker
and Present patient the
Yellow card Classification
together 2. Facilitates of the patient
with the assistance /
Priority discount on
Number Consultation Fee

Full Charity:
2.1 Refer Charity
patients to proceed
to assigned Clinics
for medical check -
up

To Pay :
2.2 Instruct the
Watcher/ Patient to
proceed to
Cashier for
payment before
proceeding to
assigned Clinics
for medical
checkup
TOTAL: 10 minutes
Payment
depends on
the
Classification
of the pati

2. Process on availing Medical assistance.

Availability of Service: 7:00 am to 5:00 pm Monday to Friday EXCEPT HOLIDAYS.

Office/ Division: Medical Social Work Section – Out Patient Department
Classification: Simple
Type of G2C
Transaction
Who may avail OPD Walk in and referred patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Hospital Bill Ambulatory Surgery Unit - Billing
2. Laboratory Request and other medical procedures Physician
3. Priority Number Queuing Machine -Triage
 CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE
2. Walks-in 3. Assess and None 20 minutes Medical Social
for Classify / Worker
interview Update record
and of the patient
present
priority 3.1 Evaluates
Number medical needs of
the patient

3.2 Facilitates
assistance/
discount on
socialized and
non-socialized
medical request

3.3 Instruct patient to

go to cashier for
payment of non
socialized
request before
proceeding to
laboratory
procedure or
Make a referral
letter for
assistance of
their non-
socialized
medical needs

TOTAL: 20 minutes

3. Facilitating Hospital Bill-ASU

Availability of Service: 7:00 am to 5:00 pm Monday to Friday EXCEPT HOLIDAYS
Office/ Division: Medical Social Work Section – Out Patient Department
Classification: Simple
Type of G2C
Transaction
Who may avail OPD-ASU Patients with hospital bill with PHIC excess
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Hospital Bill OPD Clinic
CLIENT STEPS AGENCY ACTION FEES TO PROCES PERSON
BE PAID SING RESPONSIBL
TIME E
 1. Walks-in 4. Interview and gather None 10 Medical Social
for medical data of the patient or minutes Worker
assistance Update record of the
patient
4.1 Evaluates the medical
needs of the patient
2. Availed 5. Facilitates hospital Bill None 10 Medical Social
Hospital Cleared of the patient minutes Worker
Bill
Assistance 2.1 Instruct the patient
to proceed to nurse
station for discharge
clearance
20
Total minutes

4. Facilitating Referrals
Availability of Service: 7:00 am to 5:00 pm Monday to Friday EXCEPT HOLIDAYS
Office/ Division: Medical Social Work Section – Out Patient Department
Classification: Simple
Type of G2C and G2G
Transaction
Who may avail OPD Patients with non-socialized medical Request / Requirement
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
2. Patients Medical Request OPD Clinic
3. OPD Yellow Card OPD HIMD
CLIENT STEPS AGENCY ACTION FEES TO PROCES PERSON
BE PAID SING RESPONSIBL
TIME E
3. Walks-in 6. Interview and gather None 10 Medical Social
for medical data of the patient or minutes Worker
assistance Update record of the
patient
6.1 Facilitates referral for
assistance
For Lingap:
Generate print out for Lingap
Request

For PAD:
Prepares Referral
Letter for PAD for Assistance
1.2 Instruct the patient to
go to Lingap / PAD for
Assistance
c. Inform the patient to
bring back the copy of
Referral Return Slip/
Guarantee Letter for
encoding
4. Submit 7. Received Return Slip None 10 Medical Social
Guarantee and Encode Guarantee minutes Worker
Letter / Letter
Referral 2.1 Instruct the patient
Return Slip to proceed to
respective cost centers
for laboratory or for
scheduling
20
Total minutes

5. Process of Encoding Lingap Assistance

Encoding of Lingap Medical Assistance
Availability of Service: Opens 7:00 am to 5:00 pm, Monday to Friday except Holidays

Office/Division: Medical Social Work Section- Out Patient Department (OPD)

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients with Lingap Assistance
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
10.Medical Request Doctor/Nurse from the Ward
11. Guarantee Letter from Lingap Lingap ( Malasakit) Office
12. Photocopy of the Guarantee Letter
and Patient Request for Lingap
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE

6. Submit original 2.15 Evaluate None 1 hour Medical Social

copy and guarantee Worker
photocopy of letter of the
approved patient
laboratory
request for 2.16 Encodes
encoding of the amount
Lingap indicated on
Assistance the Lingap
Guarantee
Letter to reflect
assistance of
the patient

2.17 Instruct
Patient /
Watcher to go
to laboratory to
submit
approved
request and to
undergo
procedure or
for scheduling.
TOTAL: None 1 hour
 Medical Social Work Section (MSWS)

Ortho

External Services

Assessment and Classification of Patient

Provision of Medical Discount
Availability of Service: Opens 24 hours, Monday to Sunday and Holidays

Office/Division: Medical Social Work Section- Orthopedic and Rehabilitation Institute

(ORI)
Classification: Simple
Type of Transaction: G2C
Who may avail: 1. All walk-in and referred patients at the Emergency Room
 CHECKLIST OF REQUIREMENTS WHERE TO SECURE
8. Medical Request Doctor/Nurse from the Ward and OPD Clinic
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE

1. Walks-in for 1. Conducts None 45 minutes Medical Social

interview and express intake interview Worker
the need of medical
assistance 2.18 Assess and
Classifies the
patient to avail
medical
discount

2.19 Updates
the existing
data of the
patient

2.20 Issues
service card

2.Received Service 2. Explains the None 15 minutes Medical Social

Card to avail Medical benefit and Worker
Discount coverage of the
card

TOTAL: Discount 1 hour

depends on
the
Classification
of patient

Availment of Medical discount

Classification and its discount
C1 25%
C2 50%
C3 75%
D- Full Charity 100%

Availment of Point of Service (POS) Philhealth

Facilitating POS Enrolment
Availability of Service: Opens 24 hours, Monday to Sunday and Holidays

Office/Division: Medical Social Work Section- Orthopedic and Rehabilitation Institute

(ORI)
Classification: Simple
Type of Transaction: G2C, G2G
Who may avail: 1. walk-in and referred Non Philhealth patients at the charity ward
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
9. Medical Request Doctor/Nurse from the Ward and OPD Clinic
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Walks-in for 1. Conducts None 20 minutes Medical Social
interview and intake interview Worker
presents Routing Slip
from Billing Section 2.21 Assess and
Classifies the
patient to avail
medical
discount

2.22 Updates
the existing
data of the
patient

2.23 Issue
service card to
avail medical
discount

2.24 Advise the

Watcher to
secure
document

2.Submit valid 2.Review the data None 15 minutes Medical Social

documents and Evaluates Worker
the document
submitted by
the client

2.3 Scan the

document and
and sends e-
mail to
Philhealth
Office for
verification
process

2.4 Advise to wait None 3 days Medical Social

for the worker
verification
result

3. Received P.O.S 3.Prepares POS None 25 minutes Medical Social

Confirmation Result document for Worker
enrolment

3.1 Enroll the

patient in the POS
Portal

3.2 Issues POS

Certification and
inform the client
about the POS
benefits and its
entitlement
 4. Availed P.O.S No 4.1 Instruct the None 25 minutes Medical Social
Balance Billing (NBB) client to submit Worker
Philhealth POS documents
to Billing Section
to avail Hospital
Sponsored
Membership
(HSM) POS Card

TOTAL: None 2 days and 1

hour

Process of Availing Referrals

Referring patient for Medical Assistance
Availability of Service: 7:00 am to 5:00 pm, Monday to Sunday and Holidays

Office/Division: Medical Social Work Section- Orthopedic and Rehabilitation Institute

(ORI)
Classification: Simple
Type of Transaction: G2C, G2B and G2C
Who may avail: 1. Walk-in and referred patient from ORI Charity Ward
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
13.Medical Request Doctor/Nurse from the Ward and OPD Clinic
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
7. Present 1. Conducts None 1 hour Medical Social
medical intake interview Worker
request for
assistance 3.1 Assess /
Update
* Hospital Bill Classification
*Medical Request of the patient
*Supplies 3.2 Prepares
*Procedure referral letter
* Medicine and instruct
patient to go
to partner
agency to
process /
secure
assistance
2. Submit Referral 2.1 Received None 2 hours Medical Social
Return Slip from Referral Return Worker
partner agency Slip and verify
assistance thru
Guarantee Letter
2.2 facilitate
action according
to the following
transaction/s:
Hospital Bill:
Facilitate
Hospital bill
Cleared
Medicine :
Refer to
Pharmacy to get
medicine/ supplies
Procedure:
Refer to its
respective cost
centers for the
procedure/
scheduling
TOTAL: None 3 hours
 Medical Social Work Section (MSWS)

Patient Discharge Planning Unit (PDPU)

External Services

1. Facilitation of Pending Blood Transaction

Assisting Clients with Pending Blood Account
Availability of Service: 8:00 am to 6:00 pm, Monday to Saturday and Holidays.

Office / Division Patient Discharge Planning office

 Classification: Simple
Type of Transaction: G2C
Who may avail: All charity patients who has pending blood account.
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Routing Slip from Blood Medical Technologist / Admin Aid
Transfusion Service
2. Copy of Settled Blood Processing Medical Technologist/ Admin Aid
Fee
3. Copy of Temporary Hospital Bill Billing Personnel
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE

1. Present 1. Verifies the None 30 minutes Medical Social

Routing Slip pending blood Worker
with borrowed account of the
blood from the patient
Blood
Transfusion 1.1 Encourage
Services (BTS) the
watcher to
replace
blood or
to look for
a blood
donor
1.2 Prepares
and issue
Routing
Slip
1.3 Instruct the
Watcher/p
atient to
submit the
Promissor
y Note to
Blood
Transfusio
n Services
(BTS)

2. Submit 2.1 Advised to None 30 minutes Medical Social

Promissory submit Worker
Note to Blood Cleared
Transfusion pending blood
Services (BTS) to Nurse
for Clearance Station for
processing of
Final
Statement Of
Account (Re-
billing)
TOTAL: None 1 hour

2. Hospital Bill Assistance of Overstaying Patients

Facilitating Hospital Bill Assistance
Availability of Service: 8:00 am to 6:00 pm, Monday to Saturday and Holidays.
Office/Division: Patient Discharge Planning office
Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Over-staying patients who has unsettled Hospital Bill from
Charity Ward
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
4. Hospital Bill Billing
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
2. Walks-in and 3. Evaluates the None 30 minutes Medical Social
expressed the needs of the Worker
need of medical/ patient
hospital bill
assistance 3.1 Prepares
referral letter
3.2 Instruct the
Watcher to
submit
referral to
PAD office
4. Submits Return 3. Receives None 1hour and 30 Medical Social
Slip and Guarantee minutes Worker
Guarantee Letter from
Letter from PAD
PAD Office
4.1 Facilitates
hospital Bill
Cleared and
prepares
Progress
note
4.2 Advise the
patient to go
back to
Nurse station
for discharge
clearance
TOTAL: None 2 hours
 Emergency Room and Trauma Complex

External Services

1. TRIAGING AND CONSULTATION PROCEDURE

(EMERGENCY DEPARTMENT / EMERGENCY MEDICINE)
Triaging and Consultation of Patients in the Emergency Department from receiving up to disposition of ESI
1 and 2 Category patients.
Availability of Service: 24 hours Open (including weekends and Holidays)

Office/Division: Emergency Department / Emergency Medicine

Classification: Complex
Type of Transaction: G2C
Who may avail: All patients seeking Emergency Care Services
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patient Data Form Triage Officer (Doctor / Nurse)
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE
1. Arrives at ER Tent 1. Triage officer None 2 minutes Transporter /
Area and waits to be (ROD/NOD) assess Orderly
classified by the Triage and classify patients
Officer for Risk
Stratification,
sign/symptoms and
severity relating to
Covid-19.

2. Assessed by Triage 2.1 Triage officer None 5 minutes Triage Officer

Officer (Emergency (Tent Area) classifies (EM ROD) /
Medicine Resident / patient according to Triage Nurse
Triage Nurse on Duty) risks, sign/symptoms
and severity relating
to CoVid-19

2.2 Place patient

accordingly:

Hotzone/Tent 1:
Infectious respiratory
cases needing
resuscitation

Warm Zone /Tent 2,

Tent 3 and Surgery
Area: Non-infectious
cases, mild to
moderate symptoms

3. Receives immediate 3. Immediately None 1 to 2 hours or EM Treatment

resuscitative measures transports patient to until patient is Officer /
while significant other the Resuscitation stable Resuscitation
facilitates registration Bay. Nurse on Duty
process. (If no SO,
triage NOD fills-out 3.1 Takes vital signs.
patient data form).
3.2 Performs
immediately
emergency medical
and nursing care
management.
3.3 Registers patient
through the HIS and None 5 minutes Registration
prints out ED Clinical Clerk
Form which will
serve as patient
chart.

4 Waits for Disposition 4. After resuscitation None 60 minutes EM Treatment

and plan of care from / stabilization of Officer
Resident in Charge patient, advises
(Admission or watcher or significant
Discharge) other of patient
disposition.
Endorses patient to
appropriate
department for
admission
procedures.

For Dead on Arrival

cases:
4.1. All Dead on
Arrival patients shall
be classified as
Covid suspect and
swabbing will be
done.

4.2 Covers expired

patients with black
body bag

4.3Transported to
morgue via hospital
ambulance

If for Admission:
4.1. Endorses
patient to Infectious
Disease Consultant
for IDS Clearance
prior to entry to Cold
Zone (Inside the ED)

4.2 For patients

classified as Covid
suspect/probable
case, immediately
endorses patient to
Isolation Facility,
CoVid Wards via 60 minutes
hospital ambulan

4.3 If for Discharge,

Transfer or HAMA:
FOLLOW
DISCHARGE
PROCEDURE
TOTAL None 247 minutes
2. TRIAGING AND CONSULTATION TO DIFFERENT CLINICAL DEPARTMENTS
Triaging and Consultation of Patients in the Emergency Department from receiving up to disposition of ESI
Category 3, 4 and 5 Category patients.
Availability of Service: 24 hours Open (including weekends and Holidays)

Office/Division: Emergency Department

Classification: Complex
Type of Transaction: G2C
Who may avail: All patients seeking Emergency Care Services
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patient Data Form Triage Officer (Doctor / Nurse)
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE
1. Waits to be classified 1. All patients shall None 1 minute Transporter /
by the Triage Officer be examined at the Orderly
Tent Area as per
Risk stratification by
the Triage Officer.

2. Waits at the Area 2. Takes vital signs None 3 minutes Triage Officer /
assigned by the Triage and triages patient Triage Nurse
Officer according to ESI
and Clinical
Department
(Internal Medicine,
Family Medicine,
Pediatrics, Surgery,
Orthopedics,
Ophthalmology,
ENT-HNS, Dental
Medicine,
Urosurgery,
Neurosurgery)
3. Gives patient 3. Fills-out Patient None 5 minutes Registration
information to Triage Data Form and Clerk
Nurse Officer for submits to
Registration Registration Area.

Triage Nurse on
Duty
4. Waits at the Area 4. Triage Nurse None 1 minute Triage Nurse on
assigned by the Triage endorses patient Duty
Officer chart to ROD

5. Seen and examined 5. Examines patient None ESI 3: Resident on Duty

by Resident in Charge at the Tent Area 30 minutes
at the Tent Area while where the patient
waiting for IDS was initially ESI 4 and 5:
Clearance as non-covid assigned to 2 hours
case
6. Diagnostic Laboratory 6. Laboratory Charged to 30 minutes Medical
and Initial Chest Xray Department: Statement of Technologist /
will be done at the Tent Collects and Account prior Phlebotomist
Area submits sample for to Discharge
procedure
6.1 Radiologic and Charged to 30 minutes Radiology
Imaging Statement of Technologist
Department: Account prior
Performs Imaging to Discharge
procedures
6.2. Charged to 30 minutes Respiratory
Cardiopulmonary Statement of Therapist
Services: Account prior
 Collects and to Discharge
processes
specimen for
Blood Gas
Analysis
 Performs
ECG taking
7. Awaits diagnostic 7. After thorough None 120 minutes Resident In
results and disposition examinations and Charge
advice from Resident in diagnostic results,
Charge endorses patient to
IDS Consultant for
Clearance prior to
transfer of patient
inside the Cold
Zone (Inside the
ED).
TOTAL Varies ESI 3:
according to 4.1 hours
charges ESI 4:
incurred 5.6 hours
3. ADMISSION PROCESS (ALL CLINICAL DEPARTMENTS)
Covers admission process from the time of disposition up to transport to ward.
Availability of Service: 24 hours Open (including weekends and Holidays)
Office/Division: Emergency Department
Classification: Complex
Type of Transaction: G2C
Who may avail: All patients seeking Emergency Care Services
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. ED Admission Slip Resident in Charge (Clinical Department)
2. Consent Form for Admission Resident in Charge (Clinical Department)
3. ED Clinical Cover Sheet Admitting Clerk
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE
1. Receives admission 1. Fills out ED None 5 minutes Resident In
instruction Admission Slip and Charge
Consent Form for
Admission

Advises watcher or
significant other on
the Admission
Process
2. Submits signed 2. Register patient None 10 minutes Admitting Section
Admission Slip and as an In-patient Clerk
Consent Form for case and prints out
Admission to the ED Clinical Cover
Admitting Section and instructs
watcher to hand
over it to the
Resident in Charge
3. Waits for further 3. Creates admitting None 1 hour Resident In
admission orders orders and prepares Charge
patient chart.

Encodes diagnostic
tests, makes
prescriptions and
endorses chart to
Nurse In Charge
3.1 Carry out Charged to 20 minutes Nurse on Duty
admission orders. statement of
- Gives STAT account
medications
- Starts IVF
- Follow up
diagnostic
orders and
results

4. Transported to 4. Endorses patient None 5 minutes Nurse In Charge

Observation Area while to Observation Area
waiting for or CIU (Surgery
patients stays at
Surgery
Observation Area)

5. Waits for ward/ICU 5. Updates None Clock Pause Nurse In Charge

admission and receives ward/ICU for
necessary medical and vacancy
nursing care
Updates HIS for
ward
accommodation

Follow up pending
diagnostics and
referral, if applicable

Provide direct
nursing care and
medications
6. Transported to 6. Endorses patient None 15 minutes Nurse in Charge
receiving unit (if to the receiving unit
applicable) through telephone
and informs Nursing
Attendant /
transporter
TOTAL All services 1 hour 55
charged to minutes
Statement (Waiting time
of Account for transport
prior to varies
discharge depending on
the availability
of Wards/
ICUs)
4. DISCHARGE PROCEDURE ON OUTPATIENT CASES
(MAY GO HOME, HAMA, TRANSFER TO HOSPITAL OF CHOICE)
Discharge and release from a course of care in the Emergency Department.
Availability of Service: 24 hours Open (including weekends and Holidays)

Office/Division: Emergency Department

Classification: Complex
Type of Transaction: G2C
Who may avail: All patients seeking Emergency Care Services
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. ED Discharge Slip Resident In Charge (Clinical Department)
2. Prescription Resident In Charge (Clinical Department)
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE
1. Receives discharge 1. Provides None 15 minutes Resident In
instructions (ED discharge order and Charge
Discharge Slip) from the print ED Discharge
resident in charge. If slip.
opted to Home Against
Medical Advice or Provides
Transfer to Hospital of prescription.
Choice, patient or
watcher signs waiver For transfer to other
form. facility (THOC):
creates Referral
form and endorses
patient to receiving
hospital once with
reserved
accommodation.

2. Proceed to Billing 2. Encodes charges None 5 minutes Billing Clerk

Section, present Billing and prints out
Charges Form and Statement of
Discharge Slip to the Account
Clerk on duty
3. Proceed to Cashier (if 3. Receives Depending 5 minutes Cashier
able to pay) payment and marks on Statement
Statement of of Account
Account as paid

3.1 If unable to pay, 3.1 Interviews 15 minutes ED Social

proceed to Social clients and gives Worker
Service Section for appropriate advice /
assistance assistance
4. Present cleared 4. Provides None 5 minutes Nurse In Charge
Statement of Account to discharge
the Nurse In Charge instructions (Home
medications and
follow-up check up)

Signs discharge slip

after making sure
that the patient /
significant other
fully understands
the instructions.

Removes any
contraptions as
needed.
5. Proceed to the Exit 5. Check the None 1 minute Security
and presents the Statement of Personnel
cleared Statement of Account presented
Account to the Security making sure that it
Personnel. is cleared.

Collects back
watcher’s ID
TOTAL Charges as Cash Payment:
reflected on 31 minutes
SOA
If with Social
Worker’s
approval: 46
minutes
Diving and Hyperbaric Medicine Unit

External Services
 1. HYPERBARIC OXYGEN THERAPY (HBOT) CONSULTATION

Availability of Service: 7:00 am to 11:00 pm, Monday to Friday, on-call for emergency patients
that needs stat HBOT during OFF duty hours.

Office/Division: Emergency Department – Diving & Hyperbaric Medicine Unit

Classification: Complex
Type of G2C Consultation
Transaction:
Who may avail: 1. Patients (In Out-patient and Walk-In patients)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Referral for HBOT Physician

CLIENT STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Present referral 1. Gather patient None 10 minutes Nurse
form. information and
schedule patient
for appointment of
consultation.

2. Consultation. 1. Triaged the None 5 minutes ED Physician &

Patient need to be patient. Nurse
screened at ED for
ILI/SARI 2. Taking of None 5 minutes Nurse
baseline Vital
Signs, CBG (if
Diabetic), Weight
& Height

3. The patient will None 15 minutes Physician

be interviewed by
ED Physician for
ILI/SARI.

4. Diagnostics - 2 hours Medical

Technologist &
Radiology
Technician

5. Coaching on None 30 minutes Nurse

what to expect
and how to
equalize

6. Thoroughly None 60 minutes Physician

examines the
patient for
Hyperbaric
Oxygen Therapy
with pictures of
wound with
consent for future
comparison) and
adjunctive
diagnostics to
primary survey

If with wound, - 30 minutes Physician & Nurse

initial wound
dressing done (w/
consent from
primary physician
 & patient). Wound
specimen taken
for GSCS.

3. Watcher will go to 1. Instructions on None 15 minutes Nurses

JICA Microbiology for process Medical
submission of Technologies
specimen.

4. Watcher will go to 1. Instructions on None 15 minutes Nurses

CT-Scan / MRI Unit process Radiologist
for scheduling.

5. Emergency 1. Will explain the None 30 minutes Doctor

Department treatment to the
client.

2. Will identify the - 10 minutes Doctor

sessions needed.

3. Issuance of - 5 minutes Nurse

Accounting
Clearance based
on identified
sessions of the
doctor (Schedule
of HBOT depends
on patient settled
accounting
clearance.)

4. Discharge - 10 minutes Doctor

patient.

6. Billing & Payment 1. Issuance of - 5 minutes Nurse

charges.

2. Issuance of - 15 minutes Billing

Official Statement
of Account.

3. Issuance of - 10 minutes Cashiering

Official Receipt.
7. Discharged w/ 1. Discharge - 5 minutes Nurse
settled account Instructions
TOTAL: Refer to 6 days, 35
approved minutes
schedule
of fees

Consultation & Wound Dressing

Reflected in the Statement of Account

Consultation Fee 90.00 Laboratories

Dressing small (ER) 100.00 X-ray
Dressing large (ER) 300.00 MRI
OS (2pcs/pack) 14.00 CT-Scan
Plain NSS 110.00
Tongue Depressor 10.00
Cotton Pledget/pack 1.50
 2. HYPERBARIC OXYGEN THERAPY (HBOT)

Availability of Service: 7:00 am to 11:00 pm, Monday to Friday, on-call for emergency patients
that needs stat HBOT during off hours.

Office/Division: Emergency Department – Diving & Hyperbaric Medicine Unit

Classification: Complex
Type of G2C
Transaction:
Who may avail: 1. Patients (In Out-patient and Walk-In patients)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Referral for HBOT Physician
2. Settled Accounting Clearance Cashiering / Accounting
3. All laboratory & diagnostic results Laboratory / Radiology
4. ILI and/or SARI Clearance Emergency Medicine Physician
CLIENT STEPS AGENCY FEES TO PROCESSIN PERSON
ACTION BE PAID G TIME RESPONSIBLE
1. CONSULTATION. 1. Triage the None 5 minutes ER Physician &
Patient will assessed patient. Nurse
in Emergency
Department for 2. Taking of None 5 minutes Nurse
ILI/SARI baseline Vital
Signs, CBG
(optional).

3. Interviewing of None 15 minutes Physician

patient &/or
watcher of
ILI/SARI
guidelines

4. Diagnostics - 2 hours Medical Technician

and Radiology
Technician

5. Coaching on None 30 minutes Nurse

what to expect
and how to
equalize.

2. Patient must arrive 1. Triage the None 5 minutes Nurse

1 hour ahead from patient.
scheduled sessions
with full meal and a 2. Taking of
bottle of water baseline Vital 5 minutes Nurse
Signs, CBG (if
Diabetic).

3. Secure consent 10 minutes Nurse

of procedure
including consent
in taking of photo
of wound for
documentation
purposes

3. Change garments 1. Assist patient None 10 minutes Nurse

to prescribe suit during this time (if
(must be 100% needed)
cotton) or hospital
gown.
3. Transfer to 1. Placed patient None 2 minutes Nurse
Chamber bed. on bed
comfortably.

2. Safety 15 minutes
treatment
checklist ran
through
(removed all
unnecessary,
wipe with water
all the applied
products, and
removed all
flammable
items)
5 minutes
3. Repeat and
coach patient
how to
equalize. Let
the patient re-
demonstrate. 1 minute

4. Placing of
static strap for
grounding

4. HBOT procedure 1. Start treatment: None Nurses

Compression 15 minutes

-Driving of @45FSW – 90
Chamber minutes

-Monitoring of @60FSW –
patient while 8hours & 45
on treatment minutes

Decompressio 15 minutes
n

5. Discharge 1. Will discharge None 10 minutes Doctor

the patient

2. Issuance of - 2 minutes Nurse

charges.

3. Issuance of - 15 minutes Billing /

Official Statement Administrative
of Account. Officer

4. Issuance of - 10 minutes
Official Receipt Cashiering

6. Discharged w/ 1. Clear - 5 minutes Nurse

settled account Discharge
Instructions and
inform patient for
the next
scheduled
sessions. - 1 minute Nurse

2. Logbook the
settled amount
 and the Official
Receipt # and
sign the clearance
TOTAL: Refer to 6hrs & 31
approved minutes
schedule
of fees

Hyperbaric Fees
Reflected in the Statement of Account

Not Indicated 10, 000.00

Private Patient (Indicated) 6,000.00
Charity Indicated 3,500.00
Charity PWD / Senior Citizen 2,800.00
PCSSD (Recreational Diving) 4,338.00/hr
Non PCSSD (Recreational
8,675.00/hr
Diving)
Commercial Diving USD 1,000.00/
hr
Nursing in Special Care Areas and Institutes

ICU Cluster

Internal Services
ICU ADMISSION
Admission of Critically-ill Non-COVID patients from Service Wards or ER to the ICU.
Availability of Service: 24 hours a day/7 days a week.
Office/Division: Critical Care Nursing Service Department
Classification: Simple
Type of G2C
Transaction:
Who may avail: Critically-ill Non-COVID patients needing intensive care
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Written order for ICU Admission Doctor
2. IDS clearance (Adult and Pedia patients) IDS Consultant
3. Vacant ICU Bed Receiving ICU
4. Endorsement Doctor and Nurse
5. Transport Medium Endorsing Unit (equipment, ambulance and
manpower)
6. Patient’s Record Nurses Station
7. Consent for Admission Client
CLIENT STEPS AGENCY ACTION FEES TO PROCESSIN PERSON
BE PAID G TIME RESPONSIBLE
1. Undergoes 1. Assesses patient for None 2 hours ER/Ward
assessment, ICU admission. Performs Resident
history taking appropriate diagnostic
and diagnostic procedures. If with IDS Service
procedure/s for clearance and deemed Consultant
Non-COVID ICU admissible to Non-COVID
admission. ICU, accomplishes Ward/ER Nurses
patient’s record and
proceeds with
endorsement process.
2. Undergoes 2.1 Receives patient from None 30 minutes
transport and endorsing unit. ICU Nurse
admission to
designated Non- 2.2 Confirms and verifies Nursing
COVID ICU. patient for admission. Attendant

2.3 Transfers to ICU bed,

performs physical
assessment,
regulate/hooks or checks
contraptions.

2.4 Informs ICU Rotator 5 minutes ICU Nurse

of patient’s arrival to the
unit.
2.5 Performs
reassessment, explains to
client the disease 1 hour ICU Rotator
process/prognosis and
reason for ICU admission.

2.6 Review patient’s

health record and carries
out Doctors 'orders. 30 minutes ICU Nurse

3. Undergoes 3. Orients client None 15 minutes ICU Nurse

ICU orientation. (patient/watcher) on Unit
Policy/Visitation Policy Nursing
and signs in the Attendant
Orientation logbook.
TOTAL: Refer to 4 hours 20
ICU stay minutes
rate per
day
ICU STAY RATE PER DAY
ICU STAY RATE/DAY
Charity and Pay Php 3,000
COVID-ICU ADMISSION
Admission of COVID-19 patients (Suspect, Probable or Confirmed) from Service Wards, ER or
direct from other hospital to COVID-ICU.
Availability of Service: 24 hours a day/7 days a week.
Office/Division: Critical Care Nursing Services Department
Classification: Simple
Type of Transaction: G2C and G2B
Who may avail: Severe or Critically-ill COVID patients needing intensive care
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Written order for COVID-ICU Admission Doctor
2. IDS Consultation IDS Consultant
3. Consent for Admission Client/Family
4. Vacant COVID-ICU Bed Receiving ICU
5. Endorsement Doctor and Nurse
6. COVID Ambulance EFM
7. Personal Protective Equipment Nurses Station
8. Patient’s Record
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Undergoes 1 Assess patient for None 1 hour COVID
evaluation and COVID-ICU Resident-on-
assessment for admission. If Duty
COVID-ICU admission. deemed admissible,
accomplishes Service
patient’s record and Consultant
proceeds with
endorsement COVID Nurses-
process. on-Duty

For direct
admission, receives
call from
ER/Isolation Facility
about the direct
transport of patient.
2. Undergoes 2.1 Coordinate with None 2 hours COVID-ICU
admission to COVID-ICU Rotator; Nurse
designated COVID- Nurse Supervisor-
ICU. on-Duty; Security Nursing
Guard-on-Duty and Attendant
Housekeeping Staff-
on-duty for the
expected arrival of
patient.

Coordinate with
Cardio-pulmonary
Service for the
preparation of
mechanical
ventilator inside the
cubicle prior to
arrival of expected
patient (for patients
needing mechanical
ventilators only).

2.2 Wear
appropriate and
complete Personal
Protective
Equipment (PPE). COVID-ICU
Rotator
2.3 Receive patient
from other unit.
 2.4 Confirms and
verifies patient for
admission.

2.5 Transfers to ICU

bed.

2.6 Informs COVID-

ICU Rotator of
patient’s arrival to
the unit. COVID-ICU
Nurse
2.7 Perform
reassessment;
explains to
client/family the
disease
process/prognosis
and reason for
COVID-ICU
admission.

Secure consent for

admission. (For direct
admission only)

2.8 Gather/review
health history.

Coordinate with
Admitting Section
for official
registration and
admission (for direct
admission only).

2.9 Update IPCU of

new admission.
3. Undergoes COVID- 3. Orient client None 30 minutes COVID-ICU
ICU orientation. (patient/watcher) on Rotator
COVID-ICU Policy
and about No COVID-ICU
Visitation Policy. Nurse

TOTAL: Refer to 3 hours 30

ICU stay minutes
rate per
day

ICU STAY RATE PER DAY

ICU STAY RATE/DAY
Charity and Pay Php 3,000
Transfer Out of Patient to other Unit
Movement of patient either from one ICU to another or to ward.
Availability of Service: 24 hours a day/7 days a week.

Office/Division: Critical Care Nursing Services Department

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Recovered or Improved admitted patients from Critical Care
Units to ordered designated ward
2. Patients currently admitted in the ICU who developed
complications due to chronic illness or prolonged
hospitalization that need continuous intensive care at other
ICUs.
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Written Order for Trans-out Doctor
2. Vacant bed at Ward or other ICU Receiving Ward/ICU
3. Endorsement ICU and Ward Nurses
4. IDS Clearance (if needed) IDS Consultant
5. Transport Medium Endorsing Unit (equipment and Manpower)
6. Patient’s Record Endorsing Unit
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Receive information 1.1 Provide None 5 minutes ICU Rotator
for transfer out to other explanation of
unit. transfer to patient
and family.

1.2 Coordinate
with family ICU Nurse/
members to Nursing
prepare for Attendant
transfer.

For patients with

no watcher,
coordinate with
Medical Social
Worker about the
plan for transfer.

1.3 Endorse 15 minutes ICU Rotator

significant events
and procedure
done to receiving
resident in charge
at ward.
Coordinate the
goal of care once
at ward/other ICU.

1.4 Carry out 30 minutes ICU Nurse

doctor’s orders.

1.5 Inquire
receiving ward for 5 minutes ICU Nurse
bed vacancy.

-If without vacancy,

893
 deck the patient for
reservation and
prioritization.

1.6 If with vacant 20 minutes Charge Nurses

bed, proceed with of both units
endorsement via
telephone.
2. Undergoes 2.1 Detaches None 30 minutes
preparation for patient from ICU Nurses
transport to other unit. cardiac monitor
and hook to Nursing
portable pulse Attendant
oximeter.

2.2 Transfer
patient from bed to
transport medium
(wheelchair or
stretcher) and
secures all
contraptions
properly.
2.3 Places all
remaining
medications in one
container with
proper label of
patient’s name
and handed to
family members
including all
personal
belongings of the
patient.

2.4 Audits and

prepares patient’s
record. Attaches
all claim stubs on
hand; updated
Kardex and
Medication tickets
to chart.

For patients on
mechanical
ventilator,
coordinate with
Cardio-Pulmonary
Service for
transfer of the
machine and for
the use of
transport
ventilator.
3. Receives Client 3.1 Hands Client None 5 minutes ICU Nurse/
Satisfaction Survey Satisfaction Nursing
Form Survey Form to Attendant
894
 patient or family
member for
evaluation of
services rendered
by the unit.
4. Undergoes transport 4.1 Transport to None 30 minutes ICU Nurse
to the designated other designated
unit. ward/other ICU. Nursing
Attendant

Resident
(must
accompany for
Level 4 patients)

TOTAL: Refer to 2 hours and

ICU Stay 20 minutes
rate per
day

ICU STAY RATE PER DAY

ICU STAY RATE/DAY
Charity and Pay Php 3,000

895
SAFEKEEPING OF PERSONAL BELONGINGS/VALUABLES OF PATIENTS
ADMITTED IN THE ICU
Preservation and endorsement of personal belongings of patients admitted in the
ICU to family members or Medical Social Worker for safekeeping.
Availability of Service: 24 hours a day/ 7 days a week
Office/Division: Critical Care Nursing Services Department
Classification: Simple
Type of Transaction: G2C
Who may avail: Admitted Patients in the Critical Care Units
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patient’s Personal Belongings Logbook ICU Nurse
2. Personal Belongings Received and Medical Social Worker (MSW)
Claimed Logbook
3. Witness (during opening and Security Guard–on Duty
endorsement of valuables)
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Arrives in the ICU. 1.1 Receive patient None 15 minutes ICU
inside the ICU from Nurses
the endorsing Unit.
Nursing
Attendant

2. Undergoes 2.1. Assess and None 1 hour ICU

assessment for check for any Nurses
presence of valuables. personal
belongings/valuabl Nursing
es unnecessary Attendant
during ICU stay.

2.2 Log the patient

personal
belongings/
valuables on
Patient Belongings
Logbook.

2.3 Disinfect and

clean the gathered
unnecessary
personal
belongings/
valuables from the
patient and placed
in one container
with proper label of
patient’s complete
name prior to
endorsement to
family or MSW.

896
 2.4. Endorse to
family members the
collected patient’s
personal ICU
belongings/ Nurse/ Nursing
valuables and let Attendant
them sign in the
logbook provided Security Guard
witnessed by
Security Guard-on-
Duty.

2.5 In case of no
family member
available during
ICU admission or
death, coordinate
with Medical Social
Worker for
endorsement of ICU
patient’s personal Nurse/ Nursing
belongings/ Attendant
valuables.

2.6 Sign in the

Personal
Belongings
Received and
Claimed Logbook
at Medical Social
Work Section after
proper
documentation and
endorsement.
3. Receives feedback 3. Provide None 15 minutes ICU Nurse/
to whom the valuable information to the Nursing
items were endorsed patient once Attendant
consciousness is
regained to whom
their respective
valuable
belongings were
handed/endorsed.
TOTAL: Refer to 1 hour and 30
ICU Stay minutes
rate per day

ICU STAY RATE PER DAY

ICU STAY RATE/DAY
Charity and Pay Php 3,000

897
POST MORTEM CARE OF COVID Patients (Suspect, Probable and Confirmed)
The care and preparation of a newly pronounced dead patient with respect, privacy
and dignity prior to transport to morgue.
Availability of Service: 24 hours a day/ 7 days a week
Office/Division: Critical Care Nursing Services Department
Classification: Simple
Type of Transaction: G2C
Who may avail: All Pronounced Clinically Dead Patients inside the ICU.
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Written Doctor’s Order Declaring the death of Doctor
patient
2. Orange Death Tags Nurses Station/Pathology Section
3. Cadaver Clearance Slip Nurses Station
4. Body bags Nurses Station/IPCU
5. Condemned Linen Nurses Station/Linen Section
6. Referral for Direct Burial or Cremation Nurses Station
7. Stretcher for cadaver Morgue
8. COVID Ambulance EFM
9. Final Diagnosis for the Referral Doctor
10.Personal Protective Equipment (PPE) Nurses Station
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Undergoes 1.1 Pronounces patient None 15 minutes COVID-ICU
Pronouncement clinically dead after Rotator
of being resuscitation process or
clinically dead if with signed NHM/
DNR form (absence vital
signs of life)

1.2 Appraises the family

of patient’s status and
death.
2. Receives Post 2.1 Wears complete None 45 minutes ICU
Mortem Care Personal Protective Nurses
Equipment (PPE) and
observes standard Nursing
precaution in handling Attendant
cadaver.

2.2 Prepares and

completes 3 orange
death tags for proper
patient identification. ICU
Nurse/ Nursing
Attendant

898
 2.3 Places one orange
death tag on the
patient’s body.

For Dead on Arrival

cases or for post COVID-ICU
mortem swab, Rotator
completes Case
Investigation Form (CIF)
and RITM form and
performs OPS or NPS
tests.

2.4 Wrap the body

properly with
condemned linen
making sure no body
part is exposed.
2.5 Places 2nd orange
death tag on the linen.

2.6 Place the body

inside a leak proof
cadaver bag and zipped
properly.

For direct burial

purposes, place the
body in a double body
bag.

2.7 Places the 3rd

orange death tag inside
the pocket of the body
bag located at the outer
part of the bag.
3. Being 3.1 Coordinate with None 45 minutes ICU Nurse
transported to Nurse Supervisor;
Morgue Security Guard-on-Duty Nursing
or EFM for the use Attendant
of COVID ambulance.

3.2 Coordinate with

Security Guard-on-Duty
and Housekeeping Staff
for clearing of exit and
disinfection of pathways
going towards the
COVID ambulance.

3.3 Transports expired COVID

patient to the morgue. Ambulance
Driver

899
4. Family receives 4.1 Instructs significant None 5 minutes COVID -ICU
instructions others about the process Rotator
of claiming the cadaver
and how the body will be
managed.

4.2 Releases Cadaver

Clearance Slip and
Referral for Cremation
or Direct Burial to
significant others. ICU Nurse

TOTAL: Refer to 1 hour and 50

ICU Stay minutes
rate per
day

ICU STAY RATE PER DAY

ICU STAY RATE/DAY
Charity and Pay Php 3,000

900
Special Laboratory

External Services

901
1. Endorectal and Endoanal Ultrasound Procedure
Diagnostic Endorectal and Endoanal Ultrasound procedure
Availability of Service: 8:00 am to 4:00 pm, Monday to Friday, except Holidays.

Office/Division: Special Laboratory

Classification: Complex
Type of Transaction: G2C
Who may avail: In-Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Telephone Referral Doctor
2. IDS clearance Doctor
3. Proof of payment Cashier or medical assistance agencies, PHIC
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Receives Charge 2.1. Provide Ultrasound 5-10 minutes Nurse I,II, III
slip at Special Charge slip once (Refer to Special
Laboratory outside with telephone approved Laboratory
counter. referral. schedule of
fees)

2.3 Instructs 480 minutes Nurse I,II, III

In-patient without patient to proceed Special
PHIC or has to cashier or Laboratory
exceeded PHIC medical
coverage assistance
agencies
medical
assistance
agencies
2.Present proof of 3.Provides None 10-45 minutes Ward Nurse
payment and schedule for Colorectal
receives schedule of procedure and Surgeon
procedure with instructs patients
instructions on pre-procedural
preparation
3.Undergo the 4. Prepares None 30 minutes Nurse I,II, III
ultrasound procedure materials and Special
instructs patient Laboratory
on what to do.
4.1 Performs 45 minutes Colorectal
procedure. Surgeon
4.2 Examines 20 minutes Colorectal
images and Surgeon
provides result of
procedure
4.3 Releases 60 minutes Nurse I,II, III
result to patient Special
attached to chart Laboratory
and give
instruction
4.Return to Ward 5.Transported None 5-10 minutes Ward attendant
back to ward
TOTAL: 11 hours and
40 minutes

Endorectal and Endoanal Ultrasound Schedule of Fees

902
 ENDORECTAL ULTRASOUND
Php 9,800.00 / Php 7,840.00 (Senior citizens and Persons with disability)
ENDOANAL ULTRASOUND
Php 8,300.00 / Php 6,640.00 (Senior citizens and Persons with disability)

903
2. ELECTROCARDIOGRAPHY (ECG)
Diagnostic test for patient
Availability of Service: 7:00 am to 4:00 pm, Monday to Friday, except Holidays.

Office/Division: Special Laboratory Section

Classification: Simple
Type of Transaction: G2C
Who may avail: SPMC Personnel (Non-Covid)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patient’s Identification Card HIMD
2. Encoded ECG request Doctor
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Presents Patient’s 1. Verifies ECG Fee 20 minutes Administrative
Identification Card to encoded request (Refer to Aide 1
Special Laboratory approved Special
receiving counter. schedule of Laboratory
fee)
2. Undergoes the 2. Informs patient None 5 minutes Nursing
ECG procedure. to prepare for the Attendant 1/
procedure and Administrative
instructs to rest for Aide1
2 to 5 minutes. Special
Laboratory
2.1 Encodes 3 minutes NA1/ADA 1
patient’s Special
information in the Laboratory
ECG machine.

2.2 Performs 10 minutes NA1/ADA 1

procedure. Special
Laboratory
2.2 Examines 15 minutes NA1/ADA 1
captured ECG Special
tracings and Laboratory
transmit it to
Hospital
Information
System.
3. Returns to clinic the 3. Verifies date on None 15 minutes Requesting
following day for the the ECG Stub. physician
viewing of result
during follow up 3.1 Verifies date 5 minutes NA1/ADA 1
check-up or claims for on the ECG Stub Special
an official printed then print result Laboratory
result at the Special and releases
Laboratory releasing result to patient.
counter.
TOTAL: Refer to 1 hour and 13
approved minutes
schedule
of fees

904
ELECTROCARDIOGRAPHY (ECG) Schedule of Fees

ECG
REGULAR FEES Php 320
Senior Citizen/PWD/SPMC Personnel
Free of charge

905
3. EEG Procedure for Admitted Patients
Neurodiagnostic test for patient
Availability of Service: 8:00 am to 4:00 pm, Monday to Friday, except Holidays

Office/Division: Special Laboratory Section

Classification: Complex
Type of Transaction: G2C
Who may avail: In-patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Request for EEG Doctor
2. Telephone Referral Doctor
3. Proof of payment for paid procedure Cashier/ Medical Assistance Agencies
4. Patient’s Chart Ward
5. Clearance form IDS Doctor
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Presents EEG 1. Verifies request EEG Fees 5 minutes Administrative
request with prior and instructs (Refer to Aide I
telephone referral to patient to proceed approved Special
Special Laboratory to EEG procedure schedule of Laboratory
outside counter. room. fees)
2. Undergo EEG 2. Prepares the None 10 minutes Laboratory Aide
procedure. room and II, Nursing
materials and Attendant 1
instructs patient Special
on what to do. Laboratory

2.1 Conducts 1 hour and 30 Lab. Aide II,

procedure. minutes NA1
Special Lab.

2.2 Provides claim 5 minutes Lab. Aide II,

stub for official NA1
result. Special Lab.

2.3 Read the 6 days Electroencepha

recorded EEG lographer
data.
3. Return to Special 3. Verifies claim None 8 minutes Administrative
Laboratory receiving stub then releases Aide I
counter and presents result to patient. Special
claim stub after 6 Laboratory
days.

TOTAL: Refer to 6 days and 1

approved hour and 58
schedule minutes
of fees

906
 EEG Schedule of Fees

EEG Procedure
Routine EEG 2,000.00
EEG with Q video 2,500.00
Long Term Monitoring (1 hour) 3,000.00
Long Term Monitoring (2 hours) 3,800.00
Long Term Monitoring (3 hours) 4,600.00
Long Term Monitoring (4 hours) 5,400.00
Long Term Monitoring (5 hours) 6,200.00
Long Term Monitoring (6 hours) 7,000.00

907
4. ENDOSCOPY UNIT: SCHEDULING AND PROCEDURE
Diagnostic and Therapeutic Digestive/Pulmonary Procedures
Availability of Service: 8:00 am to 4:00 pm, Monday to Friday (on call Sat/Sun)

Office/Division: Special Laboratory

Classification: Simple
Type of Transaction: G2C
Who may avail: IN-PATIENT
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Telephone Referral Doctor
2. Proof of payment Cashier/Lingap/MAP(other support agencies)
3. Patient’s chart Ward
4. Clearance from IDS Doctor
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Receives charge 1. Issues charge Endoscopy
slip at OPD ground slip for procedure Staff
floor entrance. and instructs
client to settle
their account ,or none 5 minutes
ask financial
assistance from
social worker or
other support
agencies.
2. Settles the account. 2. Receives proof Refer to 24 hrs Endoscopy
of payment approved Staff
Charges
3. Proceed to 3. Call and
Endoscopy Unit for prepare patient for none 10 minutes Nurse /Gastro
procedure. procedure resident
>provide
disposable
blanket for
procedure
4. Undergo 2. a)Performs Refer to Diagnostic= 30 a)Gastroenterol
procedure. procedure approved minutes ogist/Anesthesi
charges ologist
b)assist during the Therapeutic= b)Nurse /Gastro
procedure 90 minutes resident
5. Receives official 3. Releases
result and discharge official result and none 30 minutes Nurse/ Doctor
instructions and gives discharge
histopathology referral instructions/referr
if there is any. al to other
departments.
Total Diagnostic -1
day, 1 hr and
15 mins/
Therapeutic –
1 day, 2
hours and 15
minutes

908
PROCEDURES: with PHIC without PHIC PROCEDURES:

-Upper Gastrointestinal Endoscopy: □ Ᵽ 5,314.00 □ Ᵽ 8,667.50 -Upper Gastrointestinal Endoscopy:

-Colonoscopy: □ Ᵽ 6,047.00 □ Ᵽ 9,792.50 -Colonoscopy:
-Endoscopic Retrograde -Endoscopic Retrograde
Cholangio Pancreatography: □ Ᵽ 14,335.50 □ 19,867.50 Cholangio Pancreatography:
-Proctosigmoidoscopy: □ Ᵽ 1000.00 □ Ᵽ 1,500.00 -Proctosigmoidoscopy:
-Bronchoscopy: □ Ᵽ 5,927.50 □ Ᵽ 8,855.00 -Bronchoscopy:
-Flexible Proctosigmoidoscopy

THERAPEUTIC PROCEDURES:

UGIE w/ Rubber band ligation: □ Ᵽ 7,538.50 □ Ᵽ 11,480.00

UGIE w/ Injection Hemostasis □ Ᵽ 9,938.50 □ Ᵽ 16,280.00
UGIE w/ Snare Polypectomy □ Ᵽ 6,884.50 □ Ᵽ 11,592.50
UGIE w/ Dilatation □ Ᵽ 9,017.50 □ Ᵽ 15,017.50
Colonoscopy + Forcep Polypectomy □ Ᵽ 6,288.50 □ Ᵽ 10,667.50
Colonoscopy + Snare Polypectomy □ Ᵽ 7,530.00 □ Ᵽ 11,855.00
Colomoscopy + Injection Hemostasis □ Ᵽ 9,763.50 □ Ᵽ 16,322.00
UGIE+ PEG □ Ᵽ 10,417.50 □ Ᵽ 14,480.00
UGIE + PEG Replacement □ Ᵽ 3,456.00 □ Ᵽ 6,417.50
Flexisigmoidoscopy □ Ᵽ 4,393.00 □ Ᵽ 7,355.00
Rectal Imprint □ Ᵽ 3,867.50 □ Ᵽ 6,605.00
Flexisigmoid Polypectomy □ Ᵽ 5,039.00 □ Ᵽ 8,980.00
ERCP + Stent □ Ᵽ 16,491.00 □ Ᵽ 22,720.00
ERCP + Stone Extraction □ Ᵽ 16,295.00 □ Ᵽ 22,720.00

909
5. Transrectal Ultrasound Guided Prostate Biopsy Procedure
Diagnostic Transrectal Ultrasound Guided Prostate Biopsy procedure
Availability of Service: 8:00 am to 4:00 pm, Monday to Friday, except Holidays.

Office/Division: Special Laboratory

Classification: Complex
Type of Transaction: G2C
Who may avail: IN-PATIENT
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Telephone Referral Doctor
2.IDS,Cardiopulmonary and Anesthesia Doctor
clearance
3. Proof of payment Cashier or medical assistance agencies, PHIC
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Receives Charge 2.1. Provide Ultrasound 5-10 minutes Urology Nurse
slip at Special charge slip once guided
Laboratory outside with telephone prostate
counter. referral. biopsy
Fees
(Refer to
approved
schedule
of fees)

In-patient without 2.2 Instructs 480 minutes Urology Nurse

PHIC or has patient to proceed
exceeded PHIC to cashier or
coverage medical
assistance
agencies
medical
assistance
agencies

2.Present proof of 3.Provides None 10-45 minutes Ward Nurse

payment and schedule for Urology Fellow
receives schedule of procedure and
procedure with instructs patients
instructions on pre-procedural
preparation

3.Proceed to Special 4.1 Transport None 5-15 minutes Ward attendant

Laboratory for patient
procedure 4.2Prepares Urology Nurse
materials and Urologist
instructs patient Anesthesia
on what to do. Nurse
4.3 Performs 10-45 minutes Urology Fellow
procedure. Urology Nurse

4.2 Send 5-10 minutes Patient’s

specimen to watcher
Histopathology

5-10 minutes Urology Fellow

910
 4.2 Examines Urology Nurse
ultrasound images
Releases official
result of
procedure
attached to chart
4.Return to Ward 5. . Endorse to None 5-10 minutes Urology Nurse
ward nurse on Ward Nurse
duty

TOTAL: Refer to 10 hours and

approved 25 minutes
schedule
of fees

Transrectal Ultrasound Guided Prostate Biopsy Schedule of Fees

PAY PATIENT with PHIC without Senior Citizen Senior Citizen

Php 24,000 – 25,000 excess PHIC with PHIC without PHIC

Ultrasound-Guided Needle 15,700 24,000 10,000 21,000 to 23, 000

Prostate Biopsy to to 15,000
25, 000

SERVICE PATIENT with PHIC without Senior Citizen Senior Citizen

Php 13,500-14,000 PHIC with PHIC without PHIC

Ultrasound-Guided Needle 4,300- 5,000 10,600- IF NBB patient 10,600 to

Prostate Biopsy 12,000 NO EXCESS 14, 0000

Inclusive of professional fee, machine fee, supplies, Anesthesia medications and room fees.

911
FINANCE SERVICES
Billing
External Services

912
1. Preparation of Statement of Accounts
Statement of Accounts
Availability of Service: In patient 7:00 am to 5:00 pm, Monday to Sunday, including Holidays.
.
Office/Division: Billing / PHIC
Classification: Simple
Type of Transaction: G2G
Who may avail: 1.HIMES
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. original copy of HIMES EVALUATION HIMES
SHEET
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. submits original 1. Checks the None 3 minutes Billing Staff
copy of HIMES completeness of
EVALUATION HIMES
SHEET EVALUATION
SHEET

1.1. Logs in
receipt of
HIMES
EVALUATI
ON SHEET

1.2. Submits
HIMES
Evaluation
Form to
PHIC
counter for
PHIC
eligibility

2. Opens Patient’s None 30 minutes Billing Staff

HIS account

2.1. Checks
completeness of
patient’s entry in
HIS (PPE charges
,Room
accommodation,
pertinent OR
done, death date,
date of Birth, LMP
& sticker number)

2.2. Ensures
approval of non-
socialized
services (e.g.
pending blood
settlement, CPS)

2.3 Ensures
completeness of

913
 accommodation
dates

2.4 scans suitable

charges

2.5 checks
consistency of
encoded final
diagnosis In HIS
vs. HIMES
Evaluation Sheet

2.6. encodes
assigned PHIC
benefit package &
Doctor’s
Professional Fee

2.7. encodes &

applies applicable
discounts (senior,
pwd) and PHIC
coverage

2.8. checks and

reviews charges

3. Generates 2 minutes
Statement of Account 3.1 reviews
correctness of all
SOA entries

3.2 calls Nurse

Station for
availability of
SOA’s

TOTAL: 30-35 minutes

914
2. Processing of PhilHealth Claims
Processing of PhilHealth claims
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday.
Office/Division: Billing / PHIC – Claims Processing
Classification: Complex
Type of Transaction: G2G
Who may avail: 1. SPMC
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Claims Signature Form (CSF) Billing and Receiving Counter
2. Statement of Account (SOA)
3. Generated Philhealth Benefit Eligibility
Form (PBEF)
4. Claim Form 4 (CF4) Health Electronic Record (EHR)
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1.Submits documents 1. Receives PHIC None 12 minutes Claims
documents, Processing
conformed SOA Clerk
and PBEF

2. Pairs CSF,
SOA, PBEF and
other supporting
documents

3. Forwards PHIC
claims for
signature to
authorized
signatories

4. Prepares
transmittal for
processing of
claims

2. Endorses PHIC 1.Receives PHIC None 20 minutes Claims

documents for documents Processing
processing of claims Clerk
2.Processes PHIC
claims

3. Prepares
transmittal of
processed PHIC
claims

3. Submits PHIC 1. Receives None 15 minutes Claims

processed claims for processed PHIC Processing
transmittal claims Clerk

2. Categorizes
claims per cases

3. Scans PHIC
documents

915
4. Encodes
transmittal in the
HIS

5. Generates
xray/lab/birth
cert/cf4

6. Attaches files 60 days

(120 days due
7. Uploads PHIC to fortuitous
claims to events)
Philhealth Office
via eclaims

7. Files PHIC
documents
60 days (120
TOTAL: days due to
fortuitous
events) and
47 minutes

916
3. Availing of PHIC Benefit
Receiving of PHIC documents
Availability of Service: 8:00 am to 5:00 pm, Monday to Sunday including Holiday.
Office/Division: Billing / PHIC- Main Billing/ IWNH/ONCO/ORTHO/ASU/ER/RDU
Classification: Simple
Type of Transaction: G2C
Who may avail: 1.Patients and their Relatives/Authorize Representative
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.PHIC Claim Signature Form (CSF) a. Employer for employed
b. PhilHealth website:
www.philhealth.gov.ph/downloads/forms
c. SPMC PHIC claims counter
2.PHIC ID/ any valid ID/ valid MDR PhilHealth Office, Personal
3.PhilHealth Membership Registration a. PhilHealth website:
Form (PMRF) (as needed) www.philhealth.gov.ph/downloads/forms
b. SPMC PHIC claims counter
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Presents 1. Checks and None 15 minutes Administrative
documents. verifies PHIC Aide III
portal for HI- Billing clerk
membership
eligibility

3. Opens patients
account in the HIS

4. Evaluates
presented
documents for
consistency
versus HIS patient
account

5. Encodes
patient information
in the HIS and
links to e-claims

6. Issues PHIC
Benefit Card and
Routing Slip

7. Files
documents

2. Submits PHIC 8. Receives PHIC None 2 minutes Nurse-on-Duty

routing slip to routing slip and
respective Nurse attaches to clinical
Station cover sheet.
TOTAL: 17 minutes

917
4. Payward Accomodation – Heart Institute
Payward Room Reservation & Admission
Availability of Service: 8:00 am to 7:00 pm, Monday to Friday.

Office/Division: Billing / PHIC – Payward

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Elective Case patient
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Clinical Cover Sheet Admitting Section
CLIENT STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Presents 1. Receives None 10 minutes HI- Payward
clinical Clinical Cover Counter Staff
cover sheet Sheet

2. Fill up 2. Orients and

Payward issues
Patient estimated cost
consent per procedure
form.
3. Issues charge
slip for partial
payment

4. Issues PHIC
requirement
and temporary
PHIC benefit
card.

5. Indorses to
nursing
attendant

TOTAL: 10 minutes

918
5. Releasing of Statement of Accounts

Availability of Service: 8:00 am to 7:00 pm, Monday to Sunday, including Holidays.

Office/Division: Billing / PHIC – Service (PHIC/NPHIC)

Classification: Simple
Type of G2C, G2G
Transaction:
Who may avail: 1. In – Patients, Wards
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Claim Stub – Blue (Main) Nurse Station
2. Claim Stub – Pink (IWNH and OB
Stepdown)
3. Statement of Account (SOA)
CLIENT STEPS AGENCY ACTION FEES PROCESSIN PERSON
TO G TIME RESPONSIBLE
BE
PAID
1. Patients 1. Verifies classification, 1 minute Releasing Billing
inquiry If: Clerk
about their •NPHIC – directs
SOA watchers
to respective
Ward
•PHIC – present claim
stub
Pink – IWNH and OB
stepdown 3 minutes
2. Confirmatio Blue – Main Billing Releasing Billing
n of SOA Clerk
2. Assists clients in
conformance of SOA

2.1 Client identifies

relationship to the
member (PHIC) and
writes contact number 1 minute
3. Release of as required by PHIC
SOA Billing Releasing
2. Releases client’s copy of clerk
SOA to watcher and
acknowledges receipt of
SOA on SPMC-F-BIL-
86-a

TOTAL: 5 minutes

919
FINANCE SERVICES
Cashier
External Services

920
1. RELEASING OF CHECK

Releasing of check payments to various clients, business entities, government agencies,

government employees or officials.

Availability of Service:
Main Hospital Cashier: 7:00am to 3:00pm Mondays to Fridays, except Holidays

Office/Division: Cashier (Main)

Classification: Simple
Type of Transaction: G2C, G2B,G2G
Who may avail: Those clients, business entities, government agencies, government
employees or officials with accounts receivable/claims from SPMC.
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Check Payable to Business Company/Agency
Entity/Government Agency:

Official Receipts for

services/Collection Receipts for
goods/Acknowledgment Receipts
for refund.

2. Check Payable to name of Person:

If claimant is Payee – One (1) Valid Claimant/Representative

ID

If claimant is representative of
payee – SPA (if not immediate
family)/Authorization Letter (if
immediate family), photocopy of
One (1)valid ID of representative &
payee

CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
1. Inquire at 1. Checks None 5 minutes Supervising
check releasing Masterfile (Check Administrative
window for Issuance) for Officer
check availability. Cashier
availability.

2. If available, 2.Verifies None 3 minutes Supervising

present requirements. Administrative
applicable Officer
requirements. 2.1 Releases None 2 minutes Cashier
Checks
TOTAL: Applicable 10 minutes
Fees
reflected in
the
request.

921
2. COLLECTION OF PAYMENT
Collection of payment for various hospital services rendered to clients.
Availability of Service:

Main Hospital Cashier: 24 hours, Monday to Sunday, including Holidays

OPD: Monday to Friday, except Holidays (temporarily closed due to COVID)
FamMed, Pedia, IM & Surgery: 7:00 am to 3:00 pm
OB: 8:00 am to 5:00 pm
Heart Institute: 7:00 am to 3:00 pm, Monday to Friday, except Holidays
IWNH: 7:00 am to 3:00 pm, Monday to Sunday, including Holidays
HSSC: 7:00 am to 3:00 pm, Monday to Friday, except Holidays
CI/ONCO: 7:00 am to 3:00 pm, Monday to Friday, except Holidays

Office/Division: Cashier (Main and satellites)

Classification: Simple
Type of Transaction: G2C
Who may avail: PGH Patients/Payor
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Request Form/Charge Slip/Hospital Bill/ Ward/Laboratory/Clinic/Pharmacy/Office In
Prescription Charge of the service rendered
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present request 1. Verifies Applicable 10 minutes Supervising
form/charge request. Fees Administrative
slip/hospital bill/ 1.1 Receives reflected in Officer
prescription and payment and the request. Cashier
payment. issues official
receipt.
TOTAL: Applicable 10 minutes
Fees
reflected in
the
request.

922
3. RELEASING OF PETTY CASH

Releasing of petty cash fund to various agency employees/departments.

Availability of Service:
Main Hospital Cashier: 7:00am to 3:00pm, Mondays to Fridays, except Holidays

Office/Division: Cashier (Main)

Classification: Simple
Type of Transaction: G2G
Who may avail: Those agency employees/departments with petty cash requests.
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
3. Petty Cash Voucher Main Cashier Office

4. Purchase Request Form Requesting Department

5. 3 Quotation/Canvass forms (for Procurement Office

purchases above P1,000.00.)

CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON

ACTION BE PAID TIME RESPONSIBLE
3. Presents Petty 1. Verifies None 5 minutes Supervising
Cash request documents for Administrative
documents. accuracy & Officer
completion. Cashier

1.1 Releases cash None 3 minutes

if documents
are complete.

4. Affixing name 2 Checks None 2 minutes

& signature in signature
PCF form after
receipt of cash.

TOTAL: Applicable 10 minutes

Fees
reflected in
the
request.

923
4. RELEASING OF REFUND

A. Refund of Unserved Procedure or Medicine (CASH REFUND for refund

below Php 15,000.00)

Availability of Service:
Main Hospital Cashier: Window 1 Only
8:00 am to 3:00 pm, Monday to Friday
***ONLY OUTRIGHT REFUNDS are allowed during Saturdays,
Sundays and Holidays

Office/Division: Cashier Main (Window 1 Only)

Classification: Simple
Type of Transaction: G2C
Who may avail: Patients/Payor
CHECKLIST OF REQUIREMENTS WHERE TO SECURE

1. Official receipt/s Client

Doctor/Nurse/Pharmacists/Billing/
2. Note of Justification for refund with Laboratory In-Charge/MRI/CT Scan/Ultrasound
Trodat and Signature In-Charge

3. Photocopy of Valid ID Patient and Claimant

4. Authorization Letter (if patient is Patient

unable to claim personally the
refund)
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present all the 1. Verifies the None 1 minute Administrative
requirements validity of refund. Officer
indicated Cashier
above. 1.1 Interview None 2 minutes
Claimant

1.2 Provide the None 5 minutes

Credit Memo and
Logbook for the
claimant for
signature

1.3 Release the

Cash Refund None 2 minutes

TOTAL: None 10 minutes

924
5. Refund of Unserved Procedure or Medicine (CHEQUE REFUND for refund
above Php 15,000.00)

Availability of Service:
Main Hospital Cashier: Window 1 Only
8:00 am to 3:00 pm, Monday to Friday

Office/Division: Cashier Main (Window 1 Only)

Classification: Complex
Type of Transaction: G2C
Who may avail: Patients/Payor
CHECKLIST OF REQUIREMENTS WHERE TO SECURE

1. Official receipt/s Client

Doctor/Nurse/Pharmacists/Billing/
2. Note of Justification for refund with Laboratory In-Charge/MRI/CT Scan/Ultrasound
Trodat and Signature In-Charge

3. Photocopy of Valid ID Patient and Claimant

4. Authorization Letter (if patient is Patient

unable to claim personally the
refund)
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Present all the 1. Verifies the None 1 minute Administrative
requirements validity of refund. Officer
indicated Cashier
above.
1.1 Interview None 2 minutes
Claimant

1.2 Prepares the None 5 minutes

required
documents

1.3 Forward the None 2 minutes

documents to
Accounting
Section.

TOTAL: None 10 minutes

925
FINANCE SERVICES
PHIC and Claims

Z Benefits Package Main

External Services

926
1. Inquiry on PhilHealth Eligibility

Give PHIC mandatory requirements

Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Z Benefits Package Office - Main / Medical Professional Service

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients referred by the Nurse Navigators
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Routing Slip Z Package Nurse Navigator
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Inquire on 1. Provide Claim None Administrative
requirements for Signature Form Officer
Philhealth eligibility (CSF) and instruct
client on how to fill Z Package
up form. Main Office

1.1 Instructs client None

to proceed to
PhilHealth
Regional Office XI
to request for
Member Data
Record (MDR)
and Certificate of
Contribution (if
applicable) and/or
Billing
Department,
Philhealth Section
for printed
Philhealth Benefit
Eligibility Form
(PBEF)

1.2 Instructs client None

to come back after
requirements are
complied

TOTAL: None 5 minutes

927
2. Securing of Pre-Authorization Request and Member Empowerment Form

Issue Pre-authorization Request and Member Empowerment Forms

Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Z Benefits Package Office - Main / Medical Professional Service

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Patients referred by the Nurse Navigators and PHIC eligible
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Claim Signature Form (CSF) Z Package Office
2. Member Data Record (MDR) PHIC Regional Office
3. Certificate of Contribution (if applicable) PHIC Regional Office
4. PhilHealth Benefits Eligibility Form ( Billing Section, SPMC
PBEF)
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit the 1. Checks the None 3 minutes Administrative
completely filled up completeness of Officer
CSF, MDR and the requirements
certificate of Z Package
contribution (if 1.1 Prints the None 4 minutes Main Office
applicable) or PBEF requested
documents and
intructs client on
how to fill up the
CSF

1.2 Instructs to go None 2 minutes

back to his/her
nurse navigator
and submit the
forms and wait for
further instructions

TOTAL: None 10 minutes

928
3. SUBMISSION OF PRE-AUTHORIZATION REQUESTS

Transmit Pre-Authorization Requests and Member Empowerment Forms to PhilHealth Regional

Office XI
Availability of Service: 8:00 am to 5:00 pm, Monday to Friday, except Holidays.

Office/Division: Z Benefits Package Office - Main / Medical Professional Service

Classification: Simple
Type of Transaction: G2C
Who may avail: 1. Nurse Navigators
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Claim Signature Form (CSF) Z Package Office
2. Member Data Record (MDR) PHIC Regional Office
3. Certificate of Contribution (if applicable) PHIC Regional Office
4. PhilHealth Benefit Eligibility Form ( Billing Section
PBEF)
5. Pre-Authorization Request form Z Package Office
6. Member Empowerment Form Z Package Office
CLIENTS STEPS AGENCY FEES TO PROCESSING PERSON
ACTION BE PAID TIME RESPONSIBLE
1. Submit the 1. Checks the None 3 minutes Administrative
completely filled up completeness of Officer
CSF, MDR and the requirements
certificate of Z Package
contribution (if 1. Makes None 10 minutes Main Office
applicable) or PBEF, transmittal of all
signed Pre- Pre-Authorization
Authorization Requests and
Requests and Member
Member Empwerment
Empowerment Forms Forms to be
submitted to 2 minutes
Philippine Health
Insurance
Corporation
(PHIC)

1.2 Informs to wait None

for the approval of
the Pre-
Authorization
Requests from the
PHIC.

TOTAL: None 15 minutes

929
 VI. Feedback and Complaints

FEEDBACK AND COMPLAINTS MECHANISM

How to send feedback SPMC’s feedback mechanism is thru Client Satisfaction
Survey done actual by PACD officers. Survey forms are
available at the wards, clinics, and offices.

Walk-in
 Fill up SPMC Client Satisfaction Survey Form
available at the wards, clinics and offices.
 We also do online survey thru the following links:
https://bit.ly/2Z7qMMx - Visayan version
https://bit.ly/3iHwcWA - English version
 Approach the officers designated at any Public
Assistance & Complaints Desk (PACD)/Information
Counters located at the lobby of the following
buildings:
o Main Hospital
o ER & Trauma Center
o Outpatient Department
o Central ICU
o Heart Institute
o Institute for Women & Newborn Health
(IWNH)

Phone Call
 Dial (082) 227-2731 local 5036, Main PACD Counter
 Call cellphone number 0999 224 9785
 Provide details of the feedback.

Email
 Send feedback to info@spmc.com.ph or to
spmcpacd@gmail.com

How feedbacks are processed Feedbacks are being collated, processed and made reports
every quarter.

Walk-In
 The SPMC PACD Officer collects feedback through
the filled-out Client Satisfaction Survey (CSS)
conducted and collected by them
 Feedbacks are collated and included in CSS quarterly
report for each area.
 Feedback requiring action is forwarded to the
office/unit concerned thru NCAR and asked to
respond within 3 days.
 The response of the office/unit is then relayed to the
client thru the contact information provided.

Email
The SPMC PACD representative opens/checks email on
Mondays to Fridays from 8 AM to 4:30 PM (except holidays,
declared non-working day/half-day).
Feedback is received, acknowledged and documented.
Feedback requiring action is forwarded to the office/unit
concerned and asked to respond within 3 days.

930
 The response of the office/unit is received and relayed to
the citizen/client thru email.

Telephone Call
Feedback is received 8am to 5pm on Mondays to Fridays
and 2 PM to 4 PM on Saturdays, Sundays and Holidays.

How to file a complaint SPMC adopted a complaint form from DOH/CSC the
“MAMAMAYAN MUNA HINDI MAMAYA NA”.
Complainants are asked to fill-up the form with the details
of his/her complaint.

Walk-in
 Fill up the SPMC complaint form adopted from DOH
“MAMAMAYAN MUNA HINDI MAMAYA NA” available
at the PACD / Information counters of the hospital.
 Submit the filled-out complaint form to any Public
Assistance & Complaints Desk (PACD)/Information
Counters located at the lobby of the following
buildings:
o Main Hospital
o ER & Trauma Center
o Outpatient Department
o Central ICU
o Heart Institute
o Institute for Women & Newborn Health
(IWNH)

Phone Call
 Dial (082) 227-2731 local 5036, Main PACD Counter
 Call cellphone number 0999 224 9785
 Provide details of the complaint/incident and contact
information.

Email
 Send complaint, provide details of the incident and
contact information to info@spmc.com.ph or to
spmcpacd@gmail.com

How complaints are processed Complaints will be received by the PACD officer. PACD
will then issue an NCAR with attached copy of the
complaint to concerned department/section/unit for
investigation and reply within 72hours. After receiving the
reply, PACD will inform the complainant of the result of
investigation and action taken. If s/he is satisfied,
complaint will be closed; otherwise it will be forwarded to
ethics committee for further investigation.

Walk-In
 The SPMC PACD representative receives complaint
at any PACD Information counters on Mondays to
Fridays from 8 AM to 5 PM (on holidays, declared
non-working day/half day only at Main Information
counter, 8 to 5pm)
 Complaint is checked for completeness of information
and documented.
 Complaint is analyzed, given initial intervention and
coordinated with the office/unit concerned.
931
  If the complaint cannot be resolved with the initial
intervention, the matter is forwarded to the office/unit
concerned for appropriate action.
 See NOTES below.

Email
 The SPMC PACD representative opens/checks email on
Mondays to Fridays from 8 AM to 4:30 PM (except
holidays, declared non-working day/half-day).
 Complaint is received, acknowledged and documented.
 Complaint is forwarded to the office/unit concerned for
appropriate action.
 See NOTES below.

Telephone Call
 Complaint is received anytime on Mondays to Fridays
and 2 PM to 4 PM on Saturdays, Sundays and
Holidays.
 SPMC PACD representative documents the
complaint. (Note: May also advise citizen/client to
email complaint, if possible.)
 Complaint is analyzed, given initial intervention and
coordinated with the office/unit concerned.
 If the complaint cannot be resolved with the initial
intervention, the matter is forwarded to the office/unit
concerned for appropriate action.
 See NOTES below.

NOTES: Office/unit concerned conducts investigation and

prepares response within the prescribed period based on
RA 11032. (Note: The Office/Unit concerned determines the
no. of days needed to resolve the complaint to be relayed to
the complainant.) Official response is sent to the
complainant based on the contact information provided.
For inquiries and follow-ups, client may contact: (082) 227-
2731 local 4618/5036, mobile 0999 224 9785 or email
spmcpacd@gmail.com

Contact Information of CCB, Anti-Red Tape Authority:

PCC, ARTA • Email: complaints@arta.gov.ph
• Call: 8478-5091 | 8478-5093 | 8478-5099

Presidential Complaints Center:

• 8888
• Email: pcc@malacanang.gov.ph
• Letter: thru PCC official address at
Bahay Ugnayan, J.P. Laurel Street Malacañang,
Manila
• Telefax: +63(2)-87368621

Contact Center ng Bayan:

• SMS: 0908-8816565
• Email: email@contactcenterngbayan.gov.ph
• Call: 1-6565

932
 VII. List of Offices

Office Address Contact Information

Southern Philippines J.P. Laurel, Avenue corner Telephone trunk line:
Medical Center Dumanlas Road, Bajada, (082) 227-2731, connecting to all
Davao City departments

(Main Hospital Compound) Telefax: (082) 221-7029

Email: info@spmc.com.ph
spmcpacd@gmail.com

Institute of Psychiatry and J.P. Laurel Avenue corner Telephone trunk line:
Behavioral Medicine Sta. Ana Avenue, Bajada, (082) 227-2731
Davao City Local: 5086 (Security)
5077 (OPD)
(IPBM Compound,
formerly Davao Mental Email:
Hospital) davaomental_hospital@yahoo.com

ss

933