Professional Documents
Culture Documents
AccreTool EPCBforHCI
AccreTool EPCBforHCI
Annex C
Address: __________________________________________________________________
1. PhilHealth accredited L1, L2, and L3 hospitals, infirmaries, ambulatory surgical clinics
2. Medical outpatient clinics (e.g. HMO clinics)
B. Accreditation Requirements
Instructions:
Indicate the type of provider being evaluated by placing a tick mark on the selection.
For each of the items in the (4) categories of standards, indicate compliance by
writing YES or NO in the appropriate column of the facility being evaluated.
PROVIDERS PHIC
Accredited Medical
L1, L2, and outpatien
L3 hospital t clinic
INDICATORS
Accredited
FOR
infirmary REMARKS
ACCREDITATION
STANDARDS Accredited
ambulatory
surgical
clinic
Page 1 of 9
PROVIDERS PHIC
Accredited Medical
L1, L2, and outpatien
L3 hospital t clinic
INDICATORS
Accredited
FOR
infirmary REMARKS
ACCREDITATION
STANDARDS Accredited
ambulatory
surgical
clinic
Page 2 of 9
PROVIDERS PHIC
Accredited Medical
L1, L2, and outpatien
L3 hospital t clinic
INDICATORS
Accredited
FOR
infirmary REMARKS
ACCREDITATION
STANDARDS Accredited
ambulatory
surgical
clinic
Diabetes
screening
1.7 The EPCB HCI has
a policy on providing
services during ______ ______ ______
weekends (at least 1
day every week) and
during the extended
hours of the clinic until
8:00 pm on weekdays
to accommodate patient
needs.
1.8 The EPCB HCI has
a policy and procedures ______ ______ ______
for referral of patients
to higher level of care,
when needed.
1.9 The EPCB HCI has
adequate and
appropriate information
materials (e.g. flyers, ______ ______ ______
brochures, posters,
audio visual
presentation) on health
and wellness such as
anti-smoking, and
promotion of proper
diet, exercise, and
immunization.
2.0 Well-placed
signages to ensure ease ______ ______ ______
of access of EPCB
clients to the
consultation area and
ancillary services.
2.1 The fixed co-
payment rates are ______ ______ ______
posted in a conspicuous
area in the consultation
room/ area.
2.2 The EPCB HCI has Signage
clearly posted ______ ______ ______ indicating hours
information on the of operation
extended hours of the clearly posted.
clinic.
2.3 A clean, adequate,
and safe area for EPCB
consultations and
examinations that
ensures privacy and
Page 3 of 9
PROVIDERS PHIC
Accredited Medical
L1, L2, and outpatien
L3 hospital t clinic
INDICATORS
Accredited
FOR
infirmary REMARKS
ACCREDITATION
STANDARDS Accredited
ambulatory
surgical
clinic
equivalent (auto
clave)
Vaginal speculum
(big)
Vaginal speculum ______ ______ ______
(small)
Decontamination ______ ______ ______
solutions ______ ______ ______
70% Isopropyl ______ ______ ______
alcohol
3% to 5% acetic ______ ______ ______
acid
Glass slides
Storage cabinet for
sterile instruments
and supplies
2.8 Availability of
EPCB medicines:
Generic ______ ______ ______
Branded ______ ______ ______
2.9 A designated, If the storage
secure and appropriate area is the same
drug storage area for as the facility’s
EPCB medicines. main pharmacy,
Storage the EPCB HCI
rooms/shelves or ______ ______ ______ should at least be
cabinets where able to
medicines and ______ ______ ______ demonstrate that
controlled drugs are there is a
kept is properly separate
secured. ______ ______ ______ inventory of the
If locked, ask who drugs used for
holds the key to the EPCB.
storage
There are visual If any ONE of the
discriminators such items is not
as signs or markers complied with,
that are helpful to mark NO.
differentiate
medications from
one another; this is ______ ______ ______
to avoid confusion
between strengths,
similar-looking
labels and names
that sound or look
familiar
Observe where
expired medicines
are kept, if any
Page 5 of 9
PROVIDERS PHIC
Accredited Medical
L1, L2, and outpatien
L3 hospital t clinic
INDICATORS
Accredited
FOR
infirmary REMARKS
ACCREDITATION
STANDARDS Accredited
ambulatory
surgical
clinic
Page 6 of 9
PROVIDERS PHIC
Accredited Medical
L1, L2, and outpatien
L3 hospital t clinic
INDICATORS
Accredited
FOR
infirmary REMARKS
ACCREDITATION
STANDARDS Accredited
ambulatory
surgical
clinic
2. If the
microscopist is a
______ ______ ______
shared resource
across several
facilities, the
facility must be
able to show
proof that the
microscopist has
a regular
schedule for
DSSM services.
3. If the
sputum is
collected in other
laboratory, the
facility must be
able to present a
Certificate of
Service Delivery
Support.
4.1 Individual health Ask for print outs
profiles in EMR or of an individual
______ ______ ______
equivalent health profile
from the EMR
4.2 Monthly and annual ______ ______ ______ Ask for a sample
Page 7 of 9
PROVIDERS PHIC
Accredited Medical
L1, L2, and outpatien
L3 hospital t clinic
INDICATORS
Accredited
FOR
infirmary REMARKS
ACCREDITATION
STANDARDS Accredited
ambulatory
surgical
clinic
Page 8 of 9
Attested correct by: _________________________________________________________
Medical Director/ Chief of Hospital or Medical Center Chief / Head of
Facility
(Signature over name and date)
PhilHealth Surveyors:
Date of Survey:______________________________________
Noted by:
______________________________________________________________
Medical Director/ Chief of Hospital or Medical Center Chief / Head of Facility/
(Signature over name and date)
Page 9 of 9