I. Mandate: 1.

Responsible for the implementation of Medical and Dental

Health Services
2.Upgrading Medical and Dental Health services with emphasis on
Elective
Surgery, Obstetrics and Gynecology Medicine, Womens Health
and Safe Motherhood Program, Basic Obstetric and Care and
Newborn Screening

II. Vision: To be the leading quality and sustainable healthcare provider in

the2nddistrict of Capiz

lll. Mission: To provide excellent and sustainable healthcare services by

exceeding clients’ satisfaction through Complete healthcare
facilities and Compassionate healthcare provider.
 LIST OF SERVICES

Frontline Service Office

Sen. Gerardo M. Roxas Memorial District Hospital 4
1. Information/ Consultation 5
2. Pre-natal Check-Up 7
3. Family Planning 8
4. Animal Bite Treatment Center 9
5. TB DOTS 10
6. Issuance of Medical/ Medico-legal Certificate 11
7. Admission 12
8. Laboratory Services 14
9. X-Ray/ Ultrasound 15
10. Pharmacy Service 16
11. Cashier Services 17
12. Issuance of Billing Statements and Discharge of Patient 18
13. Issuance of Birth Certificate 19
14. Issuance of Death Certificate 20
15. PhilHealth 21
16. Medical Social Service – MAIP 23
17. Medical Social Service – POS 24
18. Patient Transport/Referral 25
19. Medical Social Service (PCSO/PWSDO) 26
Financial Assistance
20. Triaging 27

Annexes 28
Annex A X-ray Rates 29
Annex B Laboratory Rates 30
Annex C Room Rates and Other Charges 32
Annex D Ultrasound Rates 34
Annex E Accompanying Nurse/ Attendant/ Midwife Transport Fee 35
1. Information/ Consultation
The medical consultation provides support regarding health-disease, suffering,
uncertainty and any other conditions affecting the patient. The doctor will take
medical history, examine, discuss the possible causes symptoms, discuss
treatments, possibly issue a prescription and arrange tests or referral to a specialist if
necessary and discuss any follow up arrangements (the “plan of action”).
Service is available from Monday - Friday at 8:00 am-4:00pm; Saturday 8:00 -12:00
noon; No Consultation services during Holidays and Sundays (except for Emergency
Cases).
Office or Out-Patient Department
Division:
Classification: Complex Transaction
Type of G2C
Transaction:
Who may avail: All patients who seek medical consultation

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Hospital Number (Old Patient) Previously Issued in the OPD

FEES TO PROCESSING PERSON

CLIENT STEPS AGENCY ACTIONS
BE PAID TIME RESPONSIBLE
1. For patients/ 1.1 Receive the None 2 Minutes Medical Records
folks with hospital number. Clerk & Nurse,
previous Retrieves index assigned to OPD
OPD record: card and patient’s
Present the records
hospital Out Patient,
number Administrative,
None 5 Minutes Medical Service
For patients/ 1.1 Interview the
folks with no patient take vital Case to case
OPD record signs and take basis
(New): record
Provide inputs
and answer
the interviews
None 2 Minutes
1.2 Give instructions;
organize patients
record according to
assigned numbers
1.3 Call the patient None 10 Minutes Nurse and
according to priority Doctors’ on duty
number and conduct (varies on the assigned to OPD
interview and sickness of the
 examination patient)

1.4 Prepare the medical See 5 Minutes Out Patient,

test requests and give Annexes Medical,
instructions A, B, C, D, Ancillary,
E (varies on Administrative
(Medical requests medical test Services
varies on the (Varies on procedures)
sickness of the medical
patient per doctors’ tests
assessment. Patient requested)
may be advised for
admission or OPD
consultation)

2. Receive call 2.1 Patient for (Varies per 5 Minutes Nurse and
for final Consultation: drugs and Doctors’ on duty,
instructions Prescribe medicines medicine Pharmacist,
and give instruction purchased Cashier

Patient for
Admission: None 5 Minutes Out Patient,
Give instructions to Medical, ER,
patient and endorse WARD Nursing
patient to the Nurse Service Section,
Administrative
Services

with previous OPD See Annexes 4 Hours & 8

A, B, C, D, Minutes
record TOTAL: E,F
(Varies on
medical
tests,
medicine
requested)
with no OPD record See Annexes 27 Minutes
A,B,C,D,E ,F
(New) TOTAL: (Varies on
medical
tests,
medicine
requested)
END OF TRANSACTION
Data Privacy Act 2012

2. Pre-Natal Checkup
Pre-natal checkup service is provided as type of preventive healthcare for pregnant
women. Prenatal involves education and counseling about how to handle different
aspects of your pregnancy. The doctor may discuss many issues, such as healthy
eating and physical activity, screening tests you might need, and what to expect during
labor and delivery. Pre-natal check-up reduces frequency of maternal death
miscarriage, birth defects, low birth weight, neonatal infectious and other preventable
health problems.
Service is available during Wednesdays and Fridays except Holidays.
Office or Medical Records/ Out-Patient Department, Nursing / Medical Service
Division:
Classification: Complex Transaction
Type of G2C
Transaction:
Who may avail: Pregnant Women

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Hospital Number (Old Patient) Previously Issued in the OPD

FEES TO PROCESSING PERSON

CLIENT STEPS AGENCY ACTIONS
BE PAID TIME RESPONSIBLE
1. For patients/ 1.1 Receive the None 2 Minutes Medical Records
folks with hospital number. Clerk & Nurse,
previous Retrieves index assigned to OPD
OPD record: card and patient’s
Present the records
Out Patient,
hospital Administrative,
number Medical Service
None 5 Minutes Case to case
For patients/ 1.1 Interview the basis
folks with no patient take vital
OPD record signs and take
(New): records
Provide inputs
and answer
the interview

2. Attends to 2. Conduct lecture to None 20 Minutes Nurse

lecture patient assigned to
program

3. Receive call 3.1 Interview and None 5 Minutes OPD Nurse and
and answer conduct physical Doctor
interview examination.
 3.2 Give instructions to (Varies 3 Minutes
the patient according
to health
condition)
with previous OPD None 30 Minutes
record TOTAL: (Varies
according
to health
condition)
with no OPD record None 33 Minutes
(New) TOTAL: (Varies
according
to health
condition)
END OF TRANSACTION
Data Privacy Act 2012

3. Family Planning
Family Planning services allow individuals to achieve desired birth spacing and family
size, and contribute to improved health outcomes for infant, children, women and
families. These services involve contraceptive services, pregnancy testing and
counseling, physical examination and referrals.
Service is available from Monday- Friday, except Holidays.
Office or Medical Records/ Out-Patient Department, Nursing / Medical Service
Division:
Classification: Complex Transaction
Type of G2C
Transaction:
Who may avail: Pregnant Women , women about to give birth

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Hospital Number (Old Patient) Previously Issued in the OPD

FEES TO PROCESSING PERSON

CLIENT STEPS AGENCY ACTIONS
BE PAID TIME RESPONSIBLE
1. For patients/ 1.1 Receive the None 2 Minutes Medical Records’
folks with hospital number. Clerk & Nurse,
previous Retrieves index assigned to OPD
OPD record: card and patient’s
Present the records
Out Patient,
hospital
 number Administrative,
Medical Service
For patients/ 1.1 Interview the None 5 Minutes Case to case
folks with no patient take vital basis
OPD record signs and take
(New): record
Provide inputs
and answer
the interview None
1.2 Call the patient, 5 Minutes
Nurse assigned
conduct interview to FP Program
and physical
examination; and
take records

2 Attend to 2. Conduct Lecture None 10 Minutes Nurse assigned

lecture and and initiate to FP Program
wait to be counseling
called
3. Receive the 3. Issue None 5 Minutes Nurse and
applicable contraceptives and Doctor assigned
contraceptive schedule date for (Depends to FP Program
and the next visit on the
instructions availabilit
y of
supply
with previous OPD None 22 Minutes
record TOTAL:
(Depends
on the
availabilit
y of
supply
with no OPD record None 25 Minutes
(New) TOTAL:
(Depends
on the
availabilit
y of
supply
END OF TRANSACTION
Data Privacy Act 2012
4. Animal Bite Treatment Center
Animal Bite Treatment Center (ABTC) is a special unit for the Rabies Prevention and
Control Program accredited under the Department of Health. The Animal Bite Center,
treats bites from domestic animals. A government-operated health facility where
individuals with potential rabies exposure are evaluated and managed with Post-
Exposure Prophylaxis.
The center is open from Monday- Friday, 8:00 AM-4:00 PM.
Office or Medical Records/ Out-Patient Department
Division:
Classification: Complex Transaction
Type of G2C
Transaction:
Who may avail: Patient infected with rabies due to animal bite

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

None None

FEES TO PROCESSING PERSON

CLIENT STEPS AGENCY ACTIONS
BE PAID TIME RESPONSIBLE
1. Provide the 1.1 Receive the None 5 Minutes Nurse & Doctor
information in endorsement from assigned to
the OPD for OPD nurse with (Depends Animal Bite Unit,
service Doctor’s Order for on the Doctors on duty
availabilit at OPD
availment and anti-rabies injection
receive the y of
instructions supply) Animal Bite Unit
1.2 Interview the 5 Minutes
Nursing, Medical
patient and take None Administrative
(For Active
records Service
ARV)
Case to case
1.3 Administer the anti- 2 Minutes basis
rabies vaccine None
(passive and/or (For Passive
active) per doctors’ ARV)
order

(May be referred to
other facility if the
supply is not
available)

2. Receive the 2. Give health advices None 10 Minutes Animal Bite

health and management Nurse
 teachings, instructions
schedule card
and listen to
instructions
For Active ARV None 20 Minutes
TOTAL:
For Passive ARV None 17 Minutes
TOTAL: (Depends
on the
availabilit
y of
supply)

END OF TRANSACTION
Data Privacy Act 2012
5. Tuberculosis Directly Observed Treatment, Short-Course (TB
DOTS)
This is a TB treatment strategy, consisting of (a) quality-assured sputum examination;
(b) uninterrupted supply of anti-TB drugs; (c) supervision of drug intake; (d) patient
monitoring and the like, to quickly make the infectious cases non-infectious and break
the cycle of transmission. All hospital units involved in TB diagnosis and treatment are
the OPD, wards, pharmacy, radiology, laboratory, etc.
The treatment is open from Monday- Friday, 8:00AM - 4:00PM.
Office or Medical Records/ Out-Patient Department
Division:
Classification: Complex Transaction
Type of G2C
Transaction:
Who may avail: Referred patient with TB diagnosis

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

None None

FEES TO PROCESSING PERSON

CLIENT STEPS AGENCY ACTIONS
BE PAID TIME RESPONSIBLE
1. Receive and 1.1 Receive None 2 Minutes Nurse & Doctor
follow the endorsement TB X- assigned to TB
Nurses’ ray positive/ Gene program,
instruction Xpert positive Chief of Hospital
patient from OPD/
ER/ Ward Nurse

1.2 Evaluate the None 5 Minutes

Nurse and
patient for Doctor assigned
treatment to TB program
None 20 Minutes
1.3 Issue medicines for Nurse and
patients per Doctor assigned
doctor’s order and to TB program
give health advices
and instructions

TOTAL: None 27 Minutes

END OF TRANSACTION

6. Issuance of Medical/ Medico-legal Certificate

A medical certificate or doctor’s certificate is a written statement which attests to the
result of medical examination of a patient. Medico-legal certificate is also prepared by a
Physician in all medico-legal cases. Request and issuance of the certificate is available
from Monday- Friday, except during Holiday.
Office or Medical Records/ Out-Patient Department
Division:
Classification: Simple Transaction
Type of G2C
Transaction:
Who may avail: Patients/folks

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Hospital Number for Old Patient/Police Hospital Outpatient Department / Client
Blotter Request Letter for Medico-legal – Philippine National Police Station/ Client
1 original
Valid ID - 1 Original ,1 Photocopy
(owner or representative)
Authorization letter from Owner- 1 Original
 FEES TO PROCESSING PERSON
CLIENT STEPS AGENCY ACTIONS
BE PAID TIME RESPONSIBLE
1. Request for 1.1 Retrieves the None 5 Minutes Medical Records
medical/ patient chart and Clerk, Attending
medico-legal prepare record for Physician
certificate and new patient
receives
instruction 1.2 Instruct patients/ See 10 Minutes
Annex C Nursing, Medical,
folks for payment Administrative
and prepare and Service
process the Case to case
medical/ medico- basis
legal certificate
None 5 Minutes or 1
1.3 Receive Official to 2 days
receipt from client
and issues (varies on
document Attending
Physicians
Schedule of
Duty)
TOTAL: See 20 Minutes
Annex C
For Attending See 1 to 2 Days
Physicians’ signature Annex C
TOTAL:
END OF TRANSACTION
Republic Act 10173, Data Privacy Act 2012

7. Admission
This is a special area of a hospital facility which provides scheduled tests, procedures,
emergency medical treatment, administration of medication, or to stabilize or monitor an
existing condition of a patient, open for 24 hours, seven days a week. Adequate
resources are made available for the provision of quality care especially to patients in
an emergency situation.
Office or Medical service
Division:
Classification: Complex Transaction
Type of G2C
Transaction:
Who may Patients
avail:
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Patient Hospital Number Outpatient Department / Client
AGENCY FEES TO BE PROCESSING PERSON
CLIENT STEPS
ACTIONS PAID TIME RESPONSIBLE
1. Approach 1.1 Conduct the 8 Minutes Senior Nurse,
hospital for initial interview None Staff Nurse on
medical and first aid (Varies on duty, Attending
complaint intervention patients’ Physician
/initial health
interview situation)

1.2 Retrieves None 5 Minutes ER, Triage,

patient record, Trauma unit,
take the vital Nursing, Medical,
signs and Ancillary &
keep records Administrative
None Service
1.3 Interview, 5 Minutes Case to case
examine and basis
evaluate the
patient
See Annex 3 Minutes
1.4 Give orders A ,B,C, D,E,
and F (varies on the
instructions for medical tests
medical tests, (varies on the requested)
purchase of medical tests
supplies and requested
medicines
2. Read and 2.1 File patient’s None 5 Minutes Senior Nurse,
Sign the consent for Staff Nurse on
consent for admission and (Varies on (Varies on duty, Attending
admission carry out health situation health Physician
and follow doctor’s order and doctor’s situation and
instructions order) doctor’s order)
2.2
Monitor the None 2 Minutes ER, Triage,
patient’s status Trauma unit,
(Varies on Nurse Medical,
health Ancillary &
situation and Administrative
doctor’s order) Service
Case to case
2.3 Prepare the None 5 Minutes basis
patient and
 records for
endorsement
to ward

2.4 Transfer None 2 Minutes

patient to ward
for
endorsement

TOTAL: See Annex 35 Minutes

A, B, C, D, E
(varies on the
medical tests
requested
END OF TRANSACTION
Data Privacy Act 2012

8. Laboratory Services
These are clinical tests provided by a medical laboratory that aid in diagnosis and
treatment of patients. 
The laboratory is open 24 Hours from Monday to Sunday, while HIV Screening and
Gene-Xpert test are available from Mondays to Fridays, except Holidays.

Office or Ancillary Services

Division:
Classification: Complex Transaction
Type of G2C
Transaction:
Who may avail: Patients

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Laboratory Requests – 1 Original Attending Physician, Nurse
AGENCY FEES TO BE PROCESSING PERSON
CLIENT STEPS
ACTIONS PAID TIME RESPONSIBLE
1. Present the 1.1Receive the See Annex B 5 Minutes Medical
doctor’s Doctors’ Technologist
request and request and
carry out give
instructions instruction/s
for payment
None 3 Minutes Cashier, Clinical
1.2 Receive and Laboratory Unit
check the Administrative,
Official receipt Head of Office
and give
instructions for
specimen
collection
None 5 Minutes
1.3 Receive the
specimen/ (varies on the
extract laboratory
specimen; tests
requested)

2.Perform and
process
laboratory tests:

Clinical Chemistry 1 Hours& 13

Minutes

Hematology 4 Hours & 13

Minutes
Microscopy& 1 Hour& 13
Parasitolog Minutes
Bacteriology AFB 2working days

Immunology 3 Hours & 13

Minutes
Gene Xpert 3 Hours
3working days
(Varies on the
number of
specimen
received
 3.Encode results; None 8 Minutes
results released Medical
respective Technologist,
areas Administrative
Officer, Head of
requested by
Office
the doctor
TOTAL: See Annex B

Chemistry 1Hours
Hematology 3 Hours
Microscopy & 1 Hour
Parasitology
Bacteriology AFB 2working days
Immunology 3 Hours
Gene Xpert 3working days
TOTAL See annex B
(varies on
Laboratory
Test
Requested)
END OF TRANSACTION
Data Privacy Act 2012

9. X-ray/ Ultrasound
This is an imaging test which helps in diagnosing, treating and monitoring a number of
different medical conditions of patients. Radiologist uses an array of imaging
technologies. The acquisition of medical images is usually conducted by the radiologic
technologist. The radiologist interprets “or reads” the images and procedures to come
up with a report of their findings. This report is then transmitted to the ordering
physician, either routinely of emergently.
X-ray services are available for 24 Hours (Monday-Sunday) while Ultrasound is
available during Mondays and Fridays.
Office or Xray service
Division:
Classification: Complex Transaction
Type of G2C
Transaction:
Who may Patients
 avail:
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Letter Request Attending Physician
AGENCY FEES TO BE PROCESSING PERSON
CLIENT STEPS
ACTIONS PAID TIME RESPONSIBLE
1. Present the 1.1Receive the See 2 Minutes Radiologist/
doctor’s Doctors’ Annex A X Ray
Request and request and Technologist,
receive the give Cashier
instructions instruction/s for
payment
3 Minutes X-Ray,
1.2Present the Cashiering,
request, None
Administrative
receive Service, Head of
payment and Office
issue the
official receipt 3 Minutes
None
1.3Receive and
check the
Official
Receipt, and
prepare the
patient for
examination
2.1Perform X-ray/ None 8 Minutes Radiologist/
Ultrasound X Ray
procedure; (varies on the Technologist
develop the X- diagnostic
ray results/ requests)
film; give
instructions;
and forward
the initial
results
(wet reading) 5 Minutes
None X-Ray,
2.1Advise the Radiologic
patient on the Technologist
next visit (may
take 2-3 days
for final
reading); type
the results; and
keep records
 TOTAL: See Annexes A 21 Minutes
(Varies on Xray/
test Requested)

END OF TRANSACTION
Data Privacy Act 2012

10. Purchase of Drugs and Medicine / Pharmacy Service

This covers process on purchasing medicines with prior prescription from a
Physician. These services include dispensing and distribution of medication,
processing medication orders, providing quality improvement programs,
participating in hospital activities, and ensuring the availability of medications with
affordable prices.
The Pharmacy is open for 24 hours from Monday to Sunday, including Holidays.
Office or Ancillary Service
Division:
Classification: Complex Transaction
Type of G2C
Transaction:
Who may Patients/ Folks ,client
avail:
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Doctor’s Prescription- 1 Original Attending Physician
AGENCY FEES TO BE PROCESSING PERSON
CLIENT STEPS
ACTIONS PAID TIME RESPONSIBLE
1. Present the 1.1 Receive the (price of drugs 2 Minutes Pharmacist,
Doctors' prescription and medicine) Cashier
Prescription, and give
receives instruction on
instruction payment

1.2Receive the None 3 Minutes

Pharmacy
payment and Section,
issue an Administrative,
Official Receipt Head of Office

1.3 Receive and None 3 Minutes

check the
official receipt,
and
prepare/issue
drugs/
medicine/s
2. Give None 2 Minutes Pharmacist
instructions on
how to take
medicines and
their proper
storage
TOTAL: See Annexes F 10 Minutes
END OF TRANSACTION

11. Cashier Services

This covers issuance of official receipt to clients for payment/s received. Service is
available for 24 hours from Monday to Friday and Holiday. We follow “No Noon Break”
policy.
Office or Division: Administrative Service
Classification: Simple Transaction
Type of G2C
Transaction:
Who may avail: Patients

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Charge slip/ statement of account Cost Department
Senior Citizen ID/PWD if applicable- 1 Outpatient Department / Client
Original
AGENCY FEES TO BE PROCESSING PERSON
CLIENT STEPS
ACTIONS PAID TIME RESPONSIBLE
1. Present the 1.1 Receive the None 3 Minutes Cashier,
charge slip charge slip/ Administrative
and pay the Statement of Officer
amount Accounts
(SOA) and
compute the Administrative
amount to be Office, Head of
paid and Office
deduct
applicable
discount
None 7 Minutes
1.2 Collect the
payment and
issue the
official receipt

TOTAL: See Annexes 10 Minutes

END OF TRANSACTION
National internal revenue Code of 1997-sec.237

12. Issuance of Billing Statements and Discharge of Patients

This includes steps on processing and payment of hospital bill. The hospital bill is
processed from 7:00 am to 5:00 p.m. Upon receipt of the final bill, folks may settle
account to Cashier’s section. The disposition to discharge the patients at the ward
considers the need for support and continuity of care. This includes follow-up
instructions on diagnosis, medications/pertinent medical advice; and date, time, and
service where to obtain follow-up care. Service is available from Mondays to Fridays,
including Holidays.
Office or Division: Administrative , Nursing Service
Classification: ComplexTransaction
Type of G2C
Transaction:
Who may avail: Patients/Folks

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Hospital bill, discharge clearance- 1 Ward Station
Original
PWD ID, Senior ID – 1 Original Client
AGENCY FEES TO BE PROCESSING PERSON
CLIENT STEPS
ACTIONS PAID TIME RESPONSIBLE
1. Receive “may go 1.1 Check the None 5 Minutes Staff Nurse,
home’’ order from patient’s Chief Nurse,
the Resident on record with Doctors on Duty
Duty and wait to be order and
called and follows prepare the
instruction hospital
discharge
clearance and
other patients’
record.
None 15 Minutes
1.2 Process Ward, Section
patient’s Areas, Cashier,
hospital Administrative
discharge Service, Head of
clearance to Office
all section for
checking and
updating of
patient’s bill
None 5 Minutes
1.3 Inform the
patient or
folks to settle
the Bill in the
Cashier’s
office
2. Pay the bill, 2 Receive the (varies on 3 Minutes Cashier,
receive OR of payment; issue billing Administrative
payment and OR; issue statement) Officer, Head of
discharge slip discharge slip; Office
and give
instruction
3. Forward the 3. Receive the None 3 Minutes Staff Nurse,
Chief Nurse
 discharge to the discharge slip
Nurse Station and give
and receive the instruction for
instruction home
medication
TOTAL: See Annexes 31 Minutes
(varies on
billing
statement)

END OF TRANSACTION
Republic Act No. 11223

13. Issuance of Birth Certificate

This covers process on requesting, processing, and issuance of Birth Certificate. The
birth certificate is issued shortly after an individual’s birth, after mother’s physician files
the required forms with the local civil registrar’s office. After giving birth, the medical
records office or the medical records officer by conducting interview, assess and
validate required documents needed for the prescribed form. This service is available
from Monday to Friday, except Holidays.
Office or Division: Administrative Service
Classification: Simple Transaction
Type of G2C
Transaction:
Who may avail: Patients/Folks

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

 1Original, 1photopy
Birth certificate (mother and  PSA
father) –
 1Original, 1photopy
Marriage Contract (if married)  PSA
 1Original, 1photopy
Community Tax Certificate  Barangay/Municipality
(Cedula) unmarried/single
mother/ Valid ID
 Lawyer
 1Original, 1photopy
Receipt affidavit to use the
surname of the father
(unmarried)

AGENCY FEES TO BE PROCESSING PERSON

CLIENT STEPS
ACTIONS PAID TIME RESPONSIBLE
1. Fill out the 1.1Present the None 3 Minutes Medical Records
request slip, request form; Clerk, Attending
present to Medical give Physician
Records Clerk and instructions;
wait to be called and retrieve
submits required and check the Medical Records
documents patient’s chart Unit,
receives instruction See Annex Administrative
(Payment Service, Head of
included in Office
the hospital
bill for
admission)
1.2 Receive and None 3 Minutes
assess the
documents
2. Fill out the 2.1 Check and None 5 Minutes Medical Records
patient’s data guide the Clerk, Attending
sheet for birth client for filling Physician
certificate out the data
sheet

2.2Type the 10 Minutes

patient’s data
in the birth
certificate
form and
forward
certificate to
the attending
Physician for
his/her
signature

3. Check the birth 3 Give None 2 Minutes Medical Records

certificate and instructions to Clerk
affix the get Original
signature Copy to the
Municipality
Local Civil
Registrar
TOTAL: See Annexes 23 Minutes
C
END OF TRANSACTION
Republic Act 10173, Data Privacy Act 2012

14. Issuance of Death Certificate

This covers process on requesting, processing, and issuance of Death Certificate. The
death certificate, which shall be issued by the attending physician of the deceased or,
on his default, by the proper health officer, shall contain the following data furnished by
the person reporting the death: (a) date and place of death; (b) full name, (c) age, (d)
sex, (e) occupation or profession, (f) residence; (g) status as regards marriage, (h)
nationality of the deceased, and (i) probable cause of death.This service is available
from Monday to Friday, except Holidays.
Office or Division: Administrative Service
Classification: Complex Transaction
Type of G2C
Transaction:
Who may avail: Patients/Folks

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

 1 Original, 1 Photocopy
Valid ID of Client, Patient’s ID, Government Agency/Other Organizations issuing
 1 Original, 1 Photocopy IDs,
Birth Certificate of the Patient PSA
Client
AGENCY FEES TO BE PROCESSING PERSON
CLIENT STEPS
ACTIONS PAID TIME RESPONSIBLE
1. Receive “may go 1.1Retrieve and None 3 Minutes Medical Records
home’’ order check the Clerk,
from the patient’s chart Administrative
Resident on clearance and Officer, Chief
Nurse
Duty and wait to other patients’
be called and record.
follows 1.2 Receive and
None 3 Minutes
instruction; check the
Present the document
requirements

2.Fill out the 1.1 Guide the None 3 Minutes Medical Records
patient’s data clients and Officer
sheet for death check the Attending
certificate and data Physician
wait to be called
1.2Encode the None 8 Minutes
Death
Certificate to
the logbook
None 3 Minutes
1.3Forward the
death
certificate to
the attending
physician for
his/her
signature
2.Check the death 2.Review the None 3 Minutes Medical Records
certificate and affix death (varies on the Clerk
signature certificate form Attending’s Attending
Physician
 and issue to Physician
client Schedule
3.Fill out Pag- 3.Give the None 3 Minutes Medical Records
papaubaya Form instructions for Clerk,
processing to Administrative
the Municipality Officer
Local Civil
Registrar and
record in the
logbook
4. Fill up charge 4.Give instruction None 2 Minutes Medical Records
slip (For Death for payment Clerk,
Certificate Only) Administrative
Officer
TOTAL: See 28 Minutes
Annexes C
END OF TRANSACTION
Republic Act 10173, Data Privacy Act of 2012

15. PhilHealth
This covers the determination of the case rate amount which shall be deducted by the
HCI from the member's total bill, which includes professional fees of attending
physicians, prior to discharge. This is open from Monday-Sunday.
Office or Administrative Service
Division:
Classification: Complex Transaction
Type of G2C
Transaction:
Who may avail: Patients/Folks

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

1 Original, 1 Photopy of the following
as per required:
 Marriage Contract Local Registrar
 Livebirth Local Registrar
 Senior Citizen ID Municipality
 Premium Contribution PhilHealth/ Employer
PhilHealth/ Employer
 Receipt of Payment

AGENCY FEES TO BE PROCESSING PERSON

CLIENT STEPS
ACTIONS PAID TIME RESPONSIBLE
1. Ask for 1. Entertain the None 3 Minutes Philhealth Clerk,
PhilHealth patient/ folk Administrative
availment; and initiate the Officer
Receives the interview
instructions
1.2Check/ search None 5Minutes
Philhealth Office,
in the Portal or Administrative
PhilHealth Service, Head of
Computer Office
System for
availment
None 2Minutes
a. If the
PhilHealth
Computer
System
confirms the
availment of
patient,may
proceed to data
printing None 5Minutes

b. If the
PhilHealth
Computer
System
confirms that
the patient
could not avail,
ask for
requirements/
necessary
documents None 3Minutes

1.1 Issue a form to Philhealth Clerk,

be filled out Administrative
 and give Officer
instructions

2. Submit the 2. Receive the None 5Minutes Philhealth Clerk,

necessary complete Administrative
documents documents; Officer
accept
PhilHealth
card; and
forward to
PhilHealth for
validation
TOTAL: None
Avails Philhealth None 28 Minutes

Non-availment None 21Minutes

END OF TRANSACTION
Republic Act No. 10606

16. Medical Social Service- Medical Assistance to Indigent Patients

(MAIP)
The Medical Social enables patients (admitted Patient / outpatient) their families to
access Medical / Financial assistance available funds form the Medical Assistance to
indigent patients Program of the Department of Health. Services can extend to
Laboratory Other Diagnostic depending on the availability of medical services of the
facility.
This service is available from Monday to Sunday, 8:00 AM – 4:00 PM.
Office or Administrative Service
Division:
Classification: Complex Transaction
Type of G2C
Transaction:
Who may avail: Patients/Folks

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

 1 Original, 4 Photcopy
Valid ID or Brgy. Certification Agency Issuing ID, Baranggay
 1 Original, 4 Photcopy
 Valid ID (Representative)
 1 Original, 3 Photcopy
Certificate of Indigency

AGENCY FEES TO BE PROCESSING PERSON

CLIENT STEPS
ACTIONS PAID TIME RESPONSIBLE
1. Ask for financial 1. Entertain the None 8 minutes Social Worker
assistance, client, initiate
present Final preliminary Administrative,
billing, initiate interviews to Head of Office
inquiry and determine the
receives eligibility; issue
instructions list of
requirements;
give
instructions
2. Submits 2.1Receives and None 5 Minutes Social Worker
documents, check
receives documents to
instructions assess
answers to discrepancy
series of
interviews If with
discrepancy;
gives
instructions
5 Hours
2.1 Initiate
intensive
interview per
mandatory
assessment
tool, give
instructions,
process
required
documents

3. Present a. Communicates None 5 Minutes Social Worker

Statement of to FS
Account to the coordinator via
Fund source text, call or mail
coordinator per on patients’
instruction bills

b. Patients folks Time of day

are advise to depend on the
 lobby with the availability of
FS coordinator FS coordinator
for the
availment
4 Receive the a. Received If MAIPP is not 5 Minutes Administrative,
Guarantee Guarantee enough to Head of Office
Letter from the Letter of cover the bill Fund Sources,
FS coordinator approval amount as Cashier, Social
presented by Worker
and submit to through call or
fund source,
Social Service email folks is advise
for processing to pay some
Receives 4.2 Photocopies amount
instruction the Guarantee
Letter to
attached to
the bill of
patient and
endorsed to
cashier; gives
instruction

Availability of FS None 2 Days

coordinator,
Document with
discrepancy
TOTAL
TOTAL None 5 Hours and
28 Minutes
END OF TRANSACTION
Data Privacy Act 2012

17. Medical Social Service- Point of Service (POS)

Point of Sevice are given to Indigent patients who are financially incapable to pay
his/her Philhealth membership. Preferably combined at the Service ward
accommodation / no enrolment on weekends & holidays 8:00 am-4:00 PM(Monday-
Friday)

Office or Administrative Service

Division:
Classification: Complex Transaction
Type of G2C
Transaction:
Who may avail: Patients/Folks

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

 1 Original, 4 Photcopy
Valid ID or Brgy. Certification Agency Issuing ID, Baranggay
 1 Original, 4 Photcopy
Valid ID (Representative)
 1 Original, 3 Photcopy
 Certificate of Indigency

AGENCY FEES TO BE PROCESSING PERSON

CLIENT STEPS
ACTIONS PAID TIME RESPONSIBLE
1. Receive “POS” 1.1 Receive the None 3 Minutes Philhealth Clerk,
slip from endorsement Administrative
Philhealth; from Officer
submit the PhliHealth, Social Worker,
Head of Office
required preliminary
documents and inquiries
fill up the PMRF
form

1.2 Receive and None 30 Minutes

check
requirements,
interview folks

2.1Enrolment to None 1 Hour Philhealth Clerk,

the system Administrative
and waits Depends on E- Officer
PHIC for net connection Social Worker
issuance of
PIN of member
None 2 Minutes
2.2 Patient
enrolled; (varies, if
Inform Patient there are
for successful discrepanc
 enrollment y to records
and
documents)

TOTAL: None 1 Hour and 36

mins.
END OF TRANSACTION

18. Patient Transport/ Referral

Referral and transport of patients to higher level facility for further management where
required medical equipment and experts are essential for the treatment per doctors’
assessment and diagnosis. The service is available for 24 hours.
Office or Administrative Service, Nursing Service, Medical
Division:
Classification: Complex Transaction
Type of G2C
Transaction:
Who may avail: Patients/Folks

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

AGENCY FEES TO PROCESSING PERSON

CLIENT STEPS
ACTIONS BE PAID TIME RESPONSIBLE
1. Receive 1.Give instruction; None 8Minutes Resident on
advise from the make a call to the Duty, Nurse
Resident on facility or hospital (Depends on
Duty for referral of choice; and the availability
give initial of the referral
endorsement hospital/
facility)

2.Pay accounts in 2.Prepare patient See 10 Minutes Resident on

the Cashier and referral form, Annex E Duty, Chief
and secure trip for transport Nurse,
ticket fees Administrative
Officer, Chief of
Hospital
3.Receive 3.1Give instruction None 10 Minutes
instructions and and issue the
 referral form referral form

3.2 Transfer patient None Roxas

to hospital of 45 Minutes
choice; endorse Iloilo
patient 1Hour & 45
secs.

(Varies on
the location
of the
referral
hospital)

ROXAS TOTAL: See I Hour,58

Annex D Minutes

ILOILOTOTAL: See 1 Hour,20 mins

Annex D & 45 secs.

END OF TRANSACTION

19. Medical Social Service (PCSO/ PSWDO) Financial Assistance

The Medical Social Service is responsible for providing assistance to patients with
financial limitations, for their diagnostic workup and treatment. Referrals for assistance
are received from the Service Wards and Outpatient Department.
This service is available from Monday to Sunday, 8:00 AM – 4:00 PM.
Office or Administrative Service, Nursing Service, Medical
Division:
Classification: Complex Transaction
Type of G2C
Transaction:
Who may avail: Patients/Folks

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

 Final Billing In lieu of Valid ID Cashier
Personal File Documents
 1 Original, 4 photocopy Barangay
Valid ID of Patients

 1 Original, 4 photocopy
Valid ID of Representative / Folks

 1 Original, 1 photocopy
Medical Abstract

 1 Original, 1 photocopy
Referral Brgy. Indigency
AGENCY FEES TO PROCESSING PERSON
CLIENT STEPS
ACTIONS BE PAID TIME RESPONSIBLE
1. Folks / Patients 1. Check the bill, None 1 hour Medical Social
sought financial give instruction, Worker/Staff
assistance & provides list of
inquire of requirements,
requirement MSW does
intake
2. SOA will be 2.No Balance None 30 Minutes Medical Social
signed by folks Billing Patients Worker/Staff,
& complied (NBB) after Cashier
requirements submitting (Admin. Aide
documents will be VI)
advised to
prepare for
discharge
3. Folks / relatives 3.MSW attached None 5 Minutes Medical Social
will bring the referral to SOA & Service
SOA with give folks after Worker/Staff
referral instructions to
attached & process to the
present to the office PSWDO of
office of any office
PSWDO provided by the
 province

4.For Non-NBB 4.MSW will submit In 1 Hour Medical Social

patients to patient compliance Service Worker
PCSO documents. For the patient/ Cashier
processing financial folks will Liaison Officer
needed IMAP & assistance to the have to
other office PCSO after settle bill
requirements checking before
must be completeness of discharge
submitted to documents
MSW office
TOTAL: None 2 Hours,35
Minutes
END OF TRANSACTION

20. TRIAGE
Service entails collection of data, physical assessment and classification of patients /
clients either suspect, probable or confirmed COVID 19 case before intensive service is
carried out.
Service is available anytime
Monday to Friday, 8am-3pm and Saturday, 8am- 12 noon in OPD Area

Office or Administrative Service, Nursing Service, Medical

Division:
Classification: Complex Transaction
Type of G2C
Transaction:
Who may avail: Patients/Folks

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

1 Original, 1 Photocopy
 Valid ID or Brgy. Certification  Client
1 Original, 1 Photocopy  Client
 Valid ID (Representative)  Triage Area
 Hospital Declaration Form  Issued by OPD/ Medical Records
 Hospital OPD Number (Old client)

AGENCY FEES TO PROCESSING PERSON

CLIENT STEPS
ACTIONS BE PAID TIME RESPONSIBLE
2. Patient / folk 1. General Physical None 5 Minutes Chief Nurse ,
submit Assessment of Administrative
him/herself at patient Officer, Doctors
triage area on Duty
2. Refer patient to
Resident on
Duty

Fill up health 1.1 Verify, review None 5 Minutes Chief Nurse ,

declaration and checked the Administrative
form completeness of Officer, Doctors
the data being on Duty
declared

1.2 Refer to
resident on duty if
with respiratory
symptoms
Patient / Folks 1.3Take vital signs None 7 Minutes Chief Nurse ,
submit him/herself and take history Administrative
for physical ROD do (Depends Officer, Doctors
examination physical on the on Duty
 assessment, clients
examination and condition)
evaluation of
patient condition
/ clients
2. Follow 2.1 Carry out In 20 minutes Chief Nurse ,
instructions doctors’ compliance Administrative
order the patient/ (Depends Officer, Doctors
folks will on the on Duty
have to clients
May follow any of 2.2 Instruct clients settle bill condition)
the following for order before
depends on discharge
doctors’
assessment;

a.) Follow referral 2.3 Verifies patient/

process for Clients data
referral
b.) Admission 2.4 Encodes,
process records
c.) Observation patient /client
d.) Consultation data in iHOMIS
Laboratory
2.5 Instruct patient/
Clients for
swabbing and
waits to be called

Collect patients /
folks specimen
TOTAL: Varies on 37 minutes
Medical
Test
request

END OF TRANSACTION
ANNEXES
ANNEX A

NEW RATE RADIOLOGY DEPARTMENT AS OF JANUARY 2022

  OPD IN PATIENT

CHEST PA 190.00 270.00

CHEST PAL 320.00 370.00

EXTREMITIES 250.00 300.00

ABDOMEN UPRIGHT
420.00 480.00
& SUPINE
 PLAIN ABDOMEN 250.00 280.00

SKULL APL 340.00 450.00

SKULL TOWNE'S 250.00 280.00

CERVICAL 370.00 420.00

CHEST BUCKY 260.00 300.00

LUMBO SACRAL 450.00 500.00

THORACO LUMBAR 450.00 500.00

PELVIS AP 250.00 280.00

WATER'S VIEW 250.00 280.00

ULTRASOUND RATE AS OF JANUARY 2022

EXAMINATIONS OPD IN PATIENT

  PATIENT PATIENT
PRO. FEE TOTAL PRO. FEE TOTAL
  FEE FEE

WHOLE ABDOMEN 1,000.00 300.00 1,300.00 1,200.00 300.00 1,500.00

 UPPER ABDOMEN
900.00 200.00 1,100.00 1,000.00 200.00 1,200.00
(HBT)
LOWER ABDOMEN
900.00 200.00 1,100.00 1,000.00 200.00 1,200.00
(KUB+ PROSTATE)
PELVIC ULTRASOUND
700.00 300.00 1,000.00 800.00 200.00 1,000.00
(PREGNANT)
PELVIC ULTRASOUND
800.00 200.00 1,000.00 1,000.00 200.00 1,200.00
(NON-PREGNANT)
CHEST ULTRASOUND
800.00 200.00 1,000.00 900.00 200.00 1,100.00
HEMOTHORAX
CRANIAL
800.00 200.00 1,000.00 900.00 200.00 1,100.00
ULTRASOUND
NECK ULTRASOUND
800.00 200.00 1,000.00 900.00 200.00 1,100.00
GOITER

ANNEX B

LABORATORY RATES
IN
TEST OPD PATIENT
HEMATOLOGY
CBC 120.00 160.00
PLATELET COUNT 80.00 120.00
BLOOD TYPING (ABO/RH) 140.00 160.00
WBC COUNT 80.00 100.00
HEMATOCRIT/
HEMOGLOBIN 100.00 120.00
DIFFERENTIAL COUNT 80.00 100.00
CT/ BT 50.00 60.00
ESR 90.00 100.00
RETIC COUNT 70.00 80.00

TEST OPD IN
 PATIENT
CLINICAL CHEMISTRY    
FBS 100.00 150.00
LIPID PROFILE 500.00 600.00
CBG/RBS 90.00 110.00
URIC ACID 130.00 150.00
SGPT 140.00 160.00
SGOT 140.00 160.00
CREATININE 115.00 130.00
BUN 115.00 130.00
CHOLESTEROL 120.00 150.00
TRIGLYCERIDES 200.00 220.00
ALBUMIN 160.00 170.00
TOTAL PROTEIN 150.00 170.00
ELECTROLYTES (Na, K) 400.00 500.00
EXPANDED NEWBORN
SCREENING 1,750.00 1,750.00
SARS-COV 2 RAPID
ANTIGENT RESULT 660.00 660.00

TEST OPD IN PATIENT

CLINICAL MICROSCOPY AND PARASITOLOGY
URINALYSIS 70.00 80.00
FECALYSIS 70.00 80.00
FECAL OCCULT BLOOD 200.00 240.00

TEST OPD IN PATIENT

SEROLOGY
HBsAG 185.00 200.00
SERUM PREGNANCY TEST 165.00 190.00
URINE PREGNANCY TEST 155.00 185.00
TYPHIDOT 600.00 700.00
TROPONIN I
(QUALITATIVE) 700.00 800.00
TROPONIN I
(QUANTITATIVE) 978.00 1050.00
Anti HAV IgG/IgM 500.00 600.00
HBA1C 880.00 950.00
DENGUE DUO(IgG,IgM,NS1) 850.00 950.00
H. PYLORI TEST 700.00 800.00
 RPR 250.00 330.00
TSH 845.00 845.00
T3 1,155.00 1,155.00
T4 1,155.00 1,155.00
TSH, T3, T4 2,000.00 2,000.00

ANNEX C
ROOM RATES AND OTHER CHARGES
  OPD IN-PATIENT
WARD   150.00
ISOL I   150.00
ISOL II   150.00
MALE AIRCON WARD   975.00
FEMALE AIRCON WARD   975.00
SEMI-PRIVATE AIRCON I   1,195.00
SEMI-PRIVATE AIRCON II   1,195.00
SEMI-PRIVATE NON AIRCON   500.00
WHSM   300.00
WHSM(AIRCON)   1,000.00
MISCELLANEOUS FEE   75.00/DAY
ER FEE 50.00 200.00
ER FEE AFTER CONSULTATION &
WITHOUT CONSULTATION 100.00  
DR FEE 650.00 1,200.00
OPERATING ROOM FEE 650.00  
HAMA   50.00
CHARGING   50.00
IV INSERTION   100.00
INJECTION FEE 100.00 100.00
TRIAGE FEE 100.00 100.00
NEBULIZATION FEE   50.00
SUTURING FEE 150.00 150.00
D & C FEE 1,000.00 1,000.00
I&D 150.00 150.00
REMOVAL OF FOREIGN BODY 150.00 150.00
OXYGEN 10.00/kg. 10.00/kg.
OXYGEN MINIMUM 65.00  
OXYGEN SAT 100.00 100.00
PHOTOTHERAPY 100/day 100/day
MEDICAL CERTIFICATE 50.00 100.00
MED. CERT FEE :STUDENT FROM GOV'T.
SCHOOLS, INMATES, EXEMPTED EXEMPTED
ARRESTED PERSON, INDIGENT PERSON    
MEDICO LEGAL CERTIFICATE    
WITHIN THE PROVINCE 500.00 500.00
OUTSIDE THE PROVINCE 1,800.00 1,800.00
MEDICAL ABSTRACT 50.00 50.00
MEDICAL CERTIFICATE FOR INSURANCE 300.00 300.00
BIRTH CERTIFICATE/DEATH CERTIFICATE 100.00 100.00
CERTIFIED COPY 50.00 50.00
DRESSING FEE 20.00 20.00
ECG 150.00 350.00
 

ANNEX D
Charges for accompanying Nurse/Attendant/Midwife:
   
Registered Nurse
600.0
Dao to Roxas 0
1,000.
Dao to Iloilo City 00
300.
Dao to Mambusao 00
   
Nursing Attendant/Midwife
500.
Dao to Roxas City 00
800.
Dao to Iloilo City 00
200.
Dao to Mambusao 00
   
Ambulance Rate
600.
Dao to Roxas City 00
 1,700.
Dao to Iloilo City 00
250.
Dao to Mambusao 00
150.
Dao to Sigma 00

ANNEX E
CENTRAL SUPPLY (MEDICAL SUPPLIES)

  OPD IN PATIENT
SILK (SINGLE) 250.00 250.00
SILK (DOUBLE) 350.00 350.00
CHROMIC (SINGLE) 300.00 300.00
CHROMIC (DOUBLE)] 350.00 350.00
OXYGEN CATHETER 150.00 150.00
NEBULIZER TUBE 180.00 180.00
E.T. TUBE 250.00 250.00
NGT TUBE 100.00 100.00
FOLEY CATHETER 100.00 100.00
URINE BAG 100.00 100.00
SUCTION CATHETER 100.00 100.00
ELASTIC BANDAGE "6" 100.00 100.00
ELASTIC BANDAGE "4" 95.00 95.00
ELASTIC BANDAGE "3" 85.00 85.00
ELASTIC BANDAGE "2" 75.00 75.00
THERMOMETER 160.00 160.00
IV KIT 75.00 75.00
SUTURING KIT 110.00 100.00
DRESSING KIT 75.00 75.00
OS 10.00 10.00
PLATER 15.00 15.00
HYPOALLERGENIC 50.00 50.00
TRANSPORE 80.00 80.00
MICROPORE 50.00 50.00
ASEPTO SYRINGE 100.00 100.00
SYRINGE 1cc,3cc,5cc,10cc 10.00 10.00
SYRINGE 1cc,3cc,5cc,20cc 20.00 20.00
BETADINE 30ml 35.00 35.00
BETADINE 15 ml 25.00 25.00
PEDIATRIC URINE COLLECTOR 25.00 25.00
HYDROGEN PEROXIDE 25.00 25.00
ALCOHOL 60ml 25.00 25.00
ALCOHOL 500ml 115.00 115.00
ALCOHOL 90ml 35.00 35.00
KY JELLY (SACHET) 25.00 25.00
KY JELLY (TUBES) 285.00 285.00
RUBBER SUCTION 75.00 75.00
CORD CLAMP 75.00 75.00
GLOVES 25.00 25.00
NAME TAG 10.00 10.00
HEPLOCK 75.00 75.00
BLADE 25.00 25.00
MEASURING CUP 75.00 75.00
VAGINAL PACK 15.00 15.00
BOILED H2O 30.00 30.00
SALINE 40.00 30.00
SPECIMEN CUP 10.00 10.00
MEDICINE CUP 10.00 10.00

  OPD IN-PATIENT
DISTILLED WATER NATURE SPPRING
1000ml 50.00 50.00
CALIBRATED CUP 50.00 50.00
CAUTERY PAD 200.00 200.00
CAUTERY PIN 200.00 200.00
PLASTER OF PARIS & WADING 500.00 500.00
SHEET
INSULIN SYRINGE 15.00 15.00
CADAVER BAG 2,500.00 2,500.00
CADAVER COVER 200.00 200.00
DISPOSABLE FACE MASK 5.00 5.00
SUPOT 5.00 5.00
TONGUE DEPRESSOR 5.00 5.00
URINAL (PLASTIC) 50.00 50.00
ADMISSION KIT   300.00
KIDNEY BASIN (PLASTIC) 60.00  
KIDNEY BASIN (STAINLESS) 350.00  
STERILE VAGINAL PACK 20.00 20.00
STERILE GAUZE 4X4 10.00 10.00
CIRCUMCISION KIT 1,000.00  
BED PAD 100.00 100.00
STERILE COOTON APPLICATOR 10/pack 10/pack
EXAMINATION GLOVES 357.50 357.50
BED PAN 250.00 250.00
URINAL MALE 50.00 50.00
ARM SLING(SMALL) 200.00 200.00
ARM SLING(MEDIUM) 200.00 200.00
ARM SLING(LARGE) 200.00 200.00
CERVICAL COLLAR SOFT (SMALL) 1,235.00 1,235.00
CERVICAL COLLAR SOFT (MEDIUM) 1,235.00 1,235.00
CERVICAL COLLAR SOFT (LARGE) 1,235.00 1,235.00
ORAL AIRWAYS #1 180.00 180.00
ORAL AIRWAYS #2 180.00 180.00
ORAL AIRWAYS #3 180.00 180.00
PETROLEUM JELLY 230.00 230.00
VICRYL 3/0 375.00 375.00
VICRYL 2/0 385.00 385.00
VICRYL 1/0 485.00 485.00
MONOCRYL 3/0 580.00 580.00
MONOCRYL 4/0 630.00 630.00
ETHILON 3/0 340.00 340.00
ETHILON 5/0 460.00 460.00
AMBUBAG 1,200.00 1,200.00
 ANNEX F
Drugs and Medicines

PHARMACY RATES AS OF JANUARY 2022

PRIC
  NAME OF MEDICINES E
NO
.    
1 0.9PNSS 50ML BOT 49.00
2 0.9 IRRIGATION 1L BOT 75.00
3 ACETYLCYSTIENE 100MG SACHET 13.00
4 ACETYLCYSTIENE 200MG SACHET 17.00
5 ACETYLCYSTIENE 600MG TAB 38.00
6 ACETYLCYSTIENE INHALATION AMP 150.00
7 ACTIVATED CHARCOAL- 200.00
8 ACYCLOVIR 400MG TAB 25.00
9 ALLOPURINOL 100MG TAB 7.00
10 ALLOPURINOL 300MG TAB 12.00
11 ALUMINUM MAGNESIUM 200MG/100MG PER 5ML SUSP 120ML 50.00
12 ALUMINUM MAGNESIUM 200MG/100MG TABLET 7.00
13 AMIKACIN 250MG/ML VIAL 100.00
14 AMINO ACID AMP 325.00
15 AMINOPHYLLINE AMP 60.00
16 AMIODARONE AMP 320.00
17 AMLODIPINE 10MG TAB 6.00
18 AMLODIPINE 5MG TAB 4.00
19 AMOXICILLIN 250MG/5ML SUSP 60ML 68.00
20 AMOXICILLIN 100MG/ML DROPS 45.00
21 AMOXICILLIN 500MG CAP 5.00
22 AMOXICILLIN 250MG CAP 3.00
23 AMPICILLIN 1G VIAL 70.00
24 AMPICILLIN 250MG VIAL 60.00
25 AMPICILLIN 500MG VIAL 60.00
26 AMPICILLIN SULBACTAM 1.5G VIAL 400.00
27 AMPICILLIN SULBACTAM 750MG VIAL 300.00
28 ASCORBIC ACID SYRUP 55.00
29 ASCORBIC ACID + ZINC SYRUP 60.00
30 ASCORBIC ACID 500MG TAB 3.00
31 ASPIRIN 80MG TAB 3.00
32 ATORVASTATIN 20MG TAB 16.00
33 ATORVASTATIN 40MG TAB 22.00
34 ATS 1,500 iu AMP 110.00
35 AZITHROMYCIN 200MG/5ML SUSP 250.00
36 AZITHROMYCIN 500MG TAB 68.00
37 BENZYLPENICILLIN SODIUM 1M UNITS VIAL 27.00
38 BETAHISTINE 16MG TAB 18.00
39 BISACODYL 10MG SUPPOSITORY 50.00
40 BISACODYL 5MG SUPPOSITORY 45.00
41 BISACODYL 5MG TAB 18.00
42 BLUMEA BALSMIFERA TAB 8.80
43 BUDESONIDE NEBULE 58.00
44 BUTAMIRATE CITRATE 50MG TAB 20.00
45 CALCIUM CARBONATE TAB 5.00
46 CALCUIM GLUCONATE VIAL 50.00
47 CAPTOPRIL 25MG TAB 5.00

48 CARBOPROST AMP -
49 CARVEDILOL 25MG TAB 10.00
50 CARVEDILOL 6.25MG TAB 8.00
51 CEFALEXIN 250MG/5ML SUSP 78.00
52 CEFALEXIN 500MG CAP 10.00
53 CEFALEXIN 100MG/ML DROPS 50.00
54 CEFAZOLIN 1G VIAL 200.00
55 CEFIXIME 100MG/5ML SUSP 30ML -
56 CEFIXIME 100MG/5ML SUSP 60ML 390.00
57 CEFIXIME 20MG/ML DROPS 190.00
58 CEFIXIME 200MG TAB 43.00
59 CEFOTAXIME 1G VIAL 300.00
60 CEFTAZIDIME 1G VIAL 300.00
61 CEFTRIAXONE 1G VIAL 220.00
62 CEFUROXIME 250MG/5ML SUSP 210.00
63 CEFUROXIME 500MG TAB 28.00
64 CEFUROXIME 750MG VLS 220.00
65 CELECOXIB 200MG CAP 15.00
66 CELECOXIB 400MG CAP 28.00
67 CILOSTAZOLE 100MG TAB 22.00
68 CETIRIZINE 2.5MG/ML DROPS 60.00
69 CETIRIZINE 5MG/5ML SYRUP 60.00
70 CETIRIZINE 10MG TAB 5.00
71 CHLORPHENERAMINE 10MG AMP 50.00
72 CHOLECALCIFEROL+CALCIUM TAB 5.00
73 CINNARIZINE 25MG TAB 4.00
74 CIPROFLOXACIN 200MG VIAL 300.00
75 CIPROFLOXACIN 500MG TAB 7.00
76 CITICOLINE 1G AMP 210.00
77 CLARITHROMYCIN 125MG/5ML SUSP 210.00
78 CLARITHROMYCIN 250MG/5ML SUSP 240.00
79 CLARITHROMYCIN 500MG TAB 28.00
80 CLINDAMYCIN 300MG CAP 15.00
81 CLINDAMYCIN 600NG/4ML AMP 300.00
82 CLOBETASOL CREAM 170.00
83 CLONIDINE 150MG/ML AMP 213.00
84 CLONIDINE 75MCG SL TAB 21.00
85 CLOPIDOGREL 75MG TAB 10.00
86 CLOXACILLIN 250MG/5ML SUSP 75.00
87 CLOXACILLIN 500MG CAP 10.00
88 CO-AMOXICLAV 228MG/5ML SUSP 200.00
89 CO-AMOXICLAV 457MG/5ML SUSP 318.00
90 CO-AMOXICLAV 625MG TAB 32.00
91 COLCHICINE 500MCG TAB 5.00
92 COTRIMOXAZOLE 240MG/5ML SUSP 55.00
93 D5 WATER 500ML BOT 75.00
 94 D10 WATER 500ML BOT 75.00
95 D5 IMB 1L BOT 75.00
96 D5.03 1L BOT 75.00
97 DEXTROSE 50% 50ML BOT 75.00
98 D5LRS 1L BOT 75.00
99 D5NM 1L BOT 75.00
100 D5NSS 1L BOT 75.00
101 DEXAMETHASONE 4MG AMP/2ML 70.00
102 DIGOXIN 250MCG/ML AMP 250.00
103 DIGOXIN 25 MCG TAB 25.00
104 DILOXANIDE 500MG TAB 35.00
105 DILOXANIDE 125MG/5ML SYRUP 170.00

106 DIPHENHYDRAMINE 12.5MG/5ML SYRUP 80.00

107 DIPHENHYDRAMINE 50 MG AMP 100.00
108 DOBUTAMINE 250MG/20ML VLS 320.00
109 DOMPERIDONE 10MG TAB 10.00
110 DOMPERIDONE 1MG/ML SYRUP 145.00
111 DOPAMINE 40MG AMP 120.00
112 DOXYCYCLINE 100MG CAP 20.00
113 EPINEPHRINE 1MG AMP 100.00
114 FENOFIBRATE 160MG CAP 42.00
115 FERROUS SULFATE DROPS 35.00
116 FERROUS SULFATE 325MG TAB 5.00
117 FERROUS+FOLIC CAP 5.00
118 FUROSEMIDE 20MG AMP 44.00
119 FUROSEMIDE 20MG TAB 2.00
120 FUROSEMIDE 40MG TAB 6.00
121 GENTAMYCIN 80MG AMP 50.00
122 GLICLAZIDE 6OMG TAB 21.00
123 GLICLAZIDE 80MG- 8.00
124 HTIG 250 IU AMP 930.00
125 HYDRALAZINE 20MG AMP 300.00
126 HYDROCORTISONE 100MG VLS 195.00
127 HYDROCORTISONE 250MG VLS 400.00
128 HYDROXYZINE 10MG TAB 25.00
129 HYOSCINE-N-BUTYLBROMIDE 20MG AMP 50.00
130 IBUPROFEN 100MG/5ML SYRUP 80.00
131 IBUPROFEN 400MG TAB 5.00
132 IPRATOPIUM BROMIDE NEB 75.00
133 ISOSORBIDE DINITRATE 5MG SL TAB 15.00
134 ISOXSOPHRINE 5MG AMP 150.00
135 ISOXSUPRINE 10MG TAB 10.00
136 IV CANNULA G.18 100.00
137 IV CANNULA G.20 100.00
138 IV CANNULA G.22 100.00
139 IV CANNULA G.24 100.00
140 IV CANNULA G.26 100.00
141 KETOANALOGUE 600MG TAB 45.00
142 LACTULOSE 3.33G/5ML SOLN 120ML 210.00
143 LEVOFLOXACIN 500MG TAB 48.00
144 LEVOFLOXACIN 750MG TAB 68.00
145 LIDOCAINE 2% NEB 50.00
146 LORATADINE 10MG TAB 12.00
147 LOSARTAN +HCTZ 50MG/12.5MG TAB 10.00
148 LOSARTAN 100 MG TAB 10.00
149 LOSARTAN 50 MG TAB 6.00
150 MACROSET 50.00
151 MAGNESIUM SULFATE 25% 20 ML VL 60.00
152 MANNITOL 20% 500ML BOT 160.00
153 MEBENDAZOLE 500MG TAB 5.00
154 MEBENDAZOLE 100MG/5ML SUSP 38.00
155 MEFENAMIC ACID 250MGCAP 3.00
156 MEFENAMIC ACID 500MG CAP 4.00
157 MEFENAMIC 50MG/5ML SYRUP 50.00
158 METFORMIN 500MG TAB 4.40
159 METHYLDOPA 250MG TAB 13.00
160 METHYLPREDNISOLONE 16MG TAB 15.00
161 METOCLOPRAMIDE 10MG AMP 50.00
162 METOPROLOL 50MG TAB 3.00
163 METOPROLOL 100MG TAB 4.90

164 METRONIDAZOLE 500MG TAB 10.00

165 METRONIDAZOLE 500MG VLS 115.00
166 METRONIDAZOLE 125MG/5ML SUSP 65.00
167 METYLERGOMETRINE AMP -
168 MICROSET 50.00
169 MONTELUKAST 10MG TAB 15.00
170 MONTELUKAST 5MG TAB 12.00
171 MULTIVITAMINS DROPS 60.00
172 MULTIVITAMINS SYRUP 60.00
173 MULTIVITAMINS CAP 8.00
174 MULTIVITAMINS+IRON CAP 8.00
175 MULTIVITAMINS+IRON SYRUP 60.00
176 MULTIVITAMINS+MINERALS TAB 5.00
177 MUPIROCIN CREAM 120.00
178 NIFEDIPINE 5MG CAP 4.00
179 NOREPINEPHRINE 1MG/ML 4ML AMP 765.00
180 OMEPRAZOLE 20MG CAP 5.00
181 OMEPRAZOLE 40MG CAP 18.00
182 OMEPRAZOLE 40MG VS 200.00
183 ORS SACHET 8.00
184 OXYTOCIN 10 IU AMP 100.00
185 PARACETAMOL 100MG/ML DROPS 55.00
186 PARACETAMOL 125MG/5ML SYR 30.00
187 PARACETAMOL 250MG/5ML SYR 45.00
188 PARACETAMOL 500MG TAB 2.00
189 PARACETAMOL 300MG AMP 20.00
190 PHYTOMENADIONE 10MG AMP 100.00
191 PIPERACILLIN TAZOBACTAM4.5G VLS 850.00
192 PIRACETAM 400MG CAP 20.00
193 PLRS 1L BOT 75.00
194 PNSS 1L BOT 75.00
195 POTASSIUM CITRATE 10MG TAB 10.00
196 POTASSUIM CHLORIDE 2 mEq 20ML /VS 60.00
197 POTASSIUM CHLORIDE 600 MG TAB 8.00
198 PRDENISONE 20MG TAB 10.00
199 PREDNISONE 10MG TAB 7.00
200 PREDNISONE 10MG/5ML SYRUP 150.00
201 RANITIDINE 150MG TAB 6.00
202 RANITIDINE 50MG AMP 60.00
203 REGULAR INSULIN 100IU/ML 10ML/VL 750.00
204 SALBUTAMOL NEB 15.00
205 SALBUTAMOL 2MG/5ML SYRUP 39.00
206 SALBUTAMOL 2MG TAB 3.00
207 SALBUTAMOL+IRPATROPIUM NEB 25.00
208 SALBUTAMOL+ IPRATROPIUM BOT 168.00
209 SALMETEROL+FLUTICASONE 25MCG/250MCG MDI 550.00
210 SILVER SULFADIAZINE 10MG/G CREAM 130.00
211 SIMVASTATIN 20MG TAB 8.80
212 SIMVASTATIN 40MG TAB 14.00
213 SODIUM BICARBONATE 650MG TAB 1.65
214 SODIUM BICARBONATE 50ML IMEQ/ML VLS 150.00
215 SODIUM CHLORIDE 1G TAB 3.00
216 SOLUSET 200.00
217 STERILE WATER 50.00
218 SULTAMICILLIN 750MG CAP 68.00
219 TAMSULOSIN + FINASTERIDE 200MCG/5MG CAP 85.00
220 TETANUS TOXOID AMP 120.00
221 TRAMADOL 100MG AMP 50.00

222 TRAMADOL 50MG CAP 15.00

223 TRANEXAMIC ACID 500MG AMP 120.00
224 TRANEXAMIC ACID 500MG CAP 15.00
225 TRIMETAZIDINE 35MG TAB 35.00
226 URSODEOXYCHOLIV ACID 250MG CAP 33.00
227 VERAPAMIL 80MG TAB 39.50
228 VITAMIN B. COMPLEX 100MG AMP 120.00
229 VITAMIN B. COMPLEX TAB 8.00
230 VIT B COMP + BUCLIZINE CAP 20.00
231 ZINC SULFATE 27.5MG/ML DROPS 80.00
232 ZINC SULFATE 20MG/ 5ML SYRUP 85.00