ANNEX

Republic of the Philippines

Department of Health Region VI “A”
Treatment and Rehabilitation Center
(033) 529-8955 / (+63) 9178802117/ dohtrclegal01@gmail.com

MANDATORY REQUIREMENTS FOR

INPATIENT PLEA- BARGAINING CLIENTS/ACCUSED
A. Requirements for Admission (ORIGINAL)
1. Documents
 COURT ORDER – to be secured from the Regional Trial Court directing the clients/accused to undergo residential program.
 DRUG DEPENDENCY EVALUATION (DDE) – examined by DOH-Accredited Physician (attesting that the clients are Substance
dependent/Abuser, not acutely psychotic, violent, suicidal and homicidal).
 DETOXIFICATION- either private or government hospital (if applicable)
 Birth Certificate, or Marriage Contract (if married)
 2 pcs. 2x2 latest picture of the client/accused/pdl and Government Issued I.D. -of the client and his family/custodian/lawyer.
 Orientation-Acknowledgement Form- issued by DOH-TRC staff after Orientation/Inquiry of the clients/accused and/or his family.
 Pre-Admission Screening Form
 Vaccination Card

2. Status of the clients/accused/PDL

a. □ Certificate of Discharged– issued by the BJMP showing “SERVED SENTENCE FOR ALL CASES”;
b. □ Certificate of Detention– issued by the BJMP showing “SERVED SENTENCE”, and;
□ Court Clearance– issued by the Office of the Clerk of Court showing NO PENDING CASE OR RECENT CASE, except the
aforementioned case;
c. □ Bail/Bonded – proof that clients/pdl was released through bail.
d. □ Granted Probation – specified in the court order.
e. □ Approved Release of Recognizance – specified in the court order.

B. Personal Supplies and Apparels

1. Beddings A. (✓) Check the 8. ECG (12 LEADS)
□ 2 thin blankets (color white) requirements applicable:
9. FBS
□ 2 single bed sheets (color white, w/o garter) 1. Official Drug Test
10. SGPT
□ 1 single size foam 2. Sputum AFB (2x)
□ 2 pcs pillows 3.CBC
11. Lipid Profile
□ 4 pcs pillow case (color white) 12. BUN, Creatinine,
4. Fecalysis
Na and K
13. Psychological Testing
2. Clothes/Attires 5. Urinalysis
(Optional)
6. HBSAG

7. CHEST XRAY (PA VIEW)

□ 7 pcs plain white t-shirt (round neck) □7 pcs underwear □ 1 pair rubber shoes
□ 7 pcs short pants (navy blue) without pocket □1 pc sweat shirt □ 7 pairs socks (white)
□ 5 pcs white sando shirts □ 2 sets of semi-formal attire (long □ 1 pair rubber slippers
□ 2 jersey t-shirts (for sports) pants, polo shirt or t-shirts with collar) □ 1 pair bedroom slippers
3. Toiletries
□ Toiletry basket (color white) □ 2 pcs disposable shavers □ Shampoo (sachet)
□ 2 traveler’s tooth brushes □ Deodorant (roll-on/sachets) □ Cotton buds (plastic)
□ 1 nail cutter without sharp nail file □ Toothpaste (sachet) □ Lotion (optional)
□ Bath soap (bar)
4. Laundry
□ 7 pcs face towel (color white) □ 1 medium size plastic basin (color □ 1 dozen plastic hanger flat/square
□ 2 bath towels black) type (color black)
□ 1 laundry bin (black) □ 1 tabo □ 1 dozen plastic clothes pin
□ 1 big pail (plastic/nylon handle) (color black) □ 1 soap dish (color white) □ Laundry soap (powder/bar)
□ Fabric conditioner (optional

5. Activity Supplies
□ 1 pc small (50 leaves) notebook without spring □ 1 pc 200 leaves record book □ 2 pcs ballpen
□ 1 pc big (100 leaves notebook without spring) □ 3 pcs pencil
6. Electric fan with heavy duty extension cord (plastic blades) (Non-stand fan)
a. Groceries
1. Biscuits (solo pack)
NOTE:
2. Coffee/milk/milo/energen (in sachets)
b. Medicines (if any)  Please don’t bring expensive/branded clothes, shoes
c. Others (Starter Pack) and slippers. Requirements must be clean and
1. Gloves (disposable/unsterile) – 1 box appropriate, not necessarily brand new.
2. Alcohol - 250ml
3. Surgical Face Mask – 20 Pcs.  Requirements must be properly labeled with resident’s
4. Cotton Balls – 1 small pack name.
5. Laundry Gloves – 1 pair
6. Digital Thermo- 1
 ANNEX
Republic of the Philippines
Department of Health Region VI “A”
Treatment and Rehabilitation Center
(033) 529-8955 / (+63) 9178802117/ dohtrclegal01@gmail.com

***Updated as of March 2023***

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