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  • Doh Maintenance Form

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    Seriel Tismo
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    This document is a maintenance medicines utilization report from a health facility in the Philippines for 2018. It contains patient information including name, age, sex, address, and PhilHealth number. It also lists the medications dispensed to each patient including the number of treatment packs of amlodipine, losartan, metoprolol, simvastatin, metformin, and gliclazide. The report must be signed by both the preparer and approver before it is received.

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    DOH MAINTENANCE FORM

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    This document is a maintenance medicines utilization report from a health facility in the Philippines for 2018. It contains patient information including name, age, sex, address, and PhilHealth number. It also lists the medications dispensed to each patient including the number of treatment packs of amlodipine, losartan, metoprolol, simvastatin, metformin, and gliclazide. The report must be signed by both the preparer and approver before it is received.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    188 views2 pages

    Doh Maintenance Form

    Uploaded by

    Seriel Tismo
    This document is a maintenance medicines utilization report from a health facility in the Philippines for 2018. It contains patient information including name, age, sex, address, and PhilHealth number. It also lists the medications dispensed to each patient including the number of treatment packs of amlodipine, losartan, metoprolol, simvastatin, metformin, and gliclazide. The report must be signed by both the preparer and approver before it is received.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    of 2

    Republic of the Philippines

    DEPARTMENT OF HEALTH
    OFFICE OF THE SECRETARY
     

    DOH MAINTENANCE MEDICINES UTILIZATION REPORT


    Name of Health Facility_________________________________________
    Report Year: 2018
    Report Month:___________

    SEX MEDICATION GIVEN


    NAME OF PATIENT ( DATE OF ( indicate the number of treatment packs dispensed ) RECEIVED BY:
    DATE Last Name, Fmily Name, Middle ADDRESS AGE Philhealth No. ( Signature over printed
    BIRTH Gliclazide 30 name)
    Name ) M F Amlodipine 10mg 30 Losartan 50 mg 30 Metropolol 50 mg, 60 Simvastatin 10 mg, Metformin 500mg,
    mg,MR, 30
    tablet/ TP tablets/TP tablets/TP 30 tablets/ TP 90 tablets/TP
    tablest/TP
    SEX MEDICATION GIVEN
    NAME OF PATIENT ( indicate the number of treatment packs dispensed ) RECEIVED BY:
    DATE OF
    DATE ( Last Name, Fmily Name, Middle ADDRESS AGE Philhealth No. Gliclazide 30 ( Signature over
    BIRTH M F Amlodipine 10mg 30 Losartan 50 mg 30 Metropolol 50 mg, 60 Simvastatin 10 mg, Metformin 500mg,
    Name ) tablet/ TP tablets/TP tablets/TP 30 tablets/ TP 90 tablets/TP
    mg,MR, 30
    tablest/TP
    printed name)

    Prepared by: Approved by: Received by:

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