Republic of the Philippines

Department of Health
Regional Field Office No. 3
JOSE B. LINGAD MEMORIAL REGIONAL HOSPITAL
City of San Fernando, Pampanga

INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR)

I, EMILY D. PARAS , of the HIM Divison of ADMITTING SECTION commit to deliver and agree to be rated on the attainement of the following targets in accordance with the indicated measures for
the period JANUARY to JUNE, 2017.

EMILY D. PARAS
Ratee Name

Date: January 5, 2017

Approved by Date

MICHELLE P. OCAMPO

Immediate Supervisor
5–
Outstanding
4 – Very
Satisfactory
3–
Satisfactory
2-
Success Indicator Rating Unsatisfactor
Output Actual Accomplishments Remarks
(Target + Measure) Q1 E2 T3 A4 y
1 - Poor
Support Functions:

6 meetings attended and reechoed to staffs

Represents the Admitting 6 meetings attended and reechoed to staffs after
after the meeting with 3 minor 4 5 5 4.67
Section on meetings the meeting with 2 delays/absences.
delays/absences.

750 Med., Cert. & CTC MR Sheets 800 Med. Cert. & CTC MR Sheets requested &
Request Form for Issuance of
requested & Issued Claim Slip in 15 issued Claim Slip in 5 mins/client with 1 minor 4 3 5 4.00
Medical Information
mins/client with 3 minor errors error.

750 Certificates & CTC MR Sheets, Birth & 900 Med. Cert, & CTC MR Sheets requested &
Issuances Death Certificates issued in 7 mins/client issued Claim Slip in 5 mins/client with 3 minor 3 4 5 4.00
with 3 minor errors/ complaints errors.

Entertains patient's relative with
changes on patient's personal
data on Admission and
Discharge Record.
Helps in verifying patient
philhealth membership in PHIC
Portal.
data on Admission & Discharged Record
entertained in 10 mins/patient with no error.
645 Relatives with changes on patient's
personal data on Admission & Discharge
5 3 5 4.33
Record entertained in 15 mins/patient with
no error
.
900 Admitted Patients verified & issued
1,120 Admitted Patients verified & issued PBEF
PBEF Printscreen in 5 mins/patient with 1-2 4 5 5 4.67
Printscreen in 3 mins/patient with 1 minor error.
minor error.

RATING 26.33

Total Overall Rating 4.33

Final Average Rating

Adjectival Rating VS
Comments and Recommendation for Development Purposes (Please do not leave this blank)

Discussed With: Assessed by: Date Final Rating by: Date

I certify that I discussed my assessment of the perfomance with the employee
EMILY D. PARAS MICHELLE P. OCAMPO ALFONSO C. DANAC, MD. FPCS,FPSGS,FPALES
July 26, 2017

Employee Supervisor Head of Office

Legend: 1- Quality 2 -Efficiency 3 - Timeliness 4 - Average

ISO CERTIFIED HOSPITAL - QUALITY MANAGEMENT SYSTEM

This document is a property of Jose B. Lingad Memorial Regional Hospital and the content are treated confidential therefore, unauthorized reproduction is
strictly prohibited unless otherwise permitted by JBLMRH Top Management
 OFFICE PERFORMANCE COMMITMENT AND REVIE

I,___________________________, Head of the ____________________________________, commit to delive

targets in accordance with the indicated measures for the period _______________ to _________________

Head of Office Date: _______________

Approved By:

<Name of Agency Head>

Head of Agency

RATING SCALE

KP PERFORMANCE Alloted
Major Final Output Functional Objectives
THRUST INDICATORS Budget

RATING

Total Overall Rating

Final Average Rating

Adjectival Rating
Comments and Recommendation for Development Purposes

Assessed by: Final Rating by:

Date Date

Planning Office PMT Immedia

Legend: 1- Quantity 2 -Quality 3 - Timeliness 4 - Average

 DOH - SPMS Form 1

OMMITMENT AND REVIEW (OPCR)

_______, commit to deliver and agree to be rated on the attainment of the following
___ to __________________, 20_____.

___________

Date

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RATING
Remar
Actual Accomplishment
QLY ks
QTY (1) T (3) A (4)
(2)
 Date

Immediate Supervisor