DOH - SPMS Form 4 Document Code:

Revision No. :
Effectivity:

INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR)

I, CASELYN L. DE GUZMAN, NURSE II under HRH Deployment Program, assigned at MUNICIPALITY OF SAN JOSE, commit to deliver and agree to be rated on the attainment of the following targets in accordance with the
indicated measures for the period July to December, 2022.

Name of Employee: CASELYN L. DE GUZMAN, RN Date: JANUARY 04,2023

Approved By: Date: JANUARY 04,2023

KENNETH M. DIVINAGRACIA R.N

Name and Signature of Supervisor /DMO IV

RATING
Stategic Goals and Objectives Success Indicator (Targets + Measure) Actual Accomplishment Q E T A Remarks / Justification of Unmet Targets
(1) (2) (3) (4)
Strategic Functions
100% of engagement activities conducted related to 100% (124/124) of engagement activities conducted related to
COVID19 and engagement activities related to Typhoon COVID19 and engagement activities related to Typhoon
Karding and Paeng vaccination Karding and Paeng vaccination
> Attend to 6 Trainings/ > Attended to 6 Trainings/
Orientations/Meeting related to COVID19 Vaccination Orientations/Meeting related to COVID19 Vaccination
> Participate on 85 COVID19 vaccination activities in the > Participated on 85 COVID19 vaccination activities in the
Municipality Municipality

> Deploy to 1 vaccination site and 29 community outreach > Deployed to 1 vaccination site and 29 community outreach
Covid 19 vaccination activities Covid 19 vaccination activities
> Assist 1 LGUs for the Covid 19 vaccination PinasLakas > Assisted 1 LGUs for the Covid 19 vaccination PinasLakas

> 5 5.00
> Render 2 duty as a member of Health Emergency Rendered 2 duty as a member of Health Emergency Response
Response Team in response to Typhoon Karding and Paeng Team in response to Typhoon Karding and Paeng

1. Engage sectoral and local stakeholders to

achieve outputs and outcomes related to
Typhoon and COVID-19 reponse
1. Engage sectoral and local stakeholders to
achieve outputs and outcomes related to
Typhoon and COVID-19 reponse
RATING
Stategic Goals and Objectives Success Indicator (Targets + Measure) Actual Accomplishment Q E T A Remarks / Justification of Unmet Targets
(1) (2) (3) (4)

100% of engagement activities conducted in response to 100% (156/156) of engagement activities conducted in
COVID-19 pandemic response to COVID-19 pandemic
> Attend 6 meetings related to COVID > Attended 6 meetings
19 related to COVID 19
> Assist in 65 Contact tracing > Assisted in 65 Contact tracing 5 5.00
> Facilitate and >
assist in 85 naso pharyngeal antigen swabb test for close Facilitated and assisted in 85 naso pharyngeal antigen swabb
contacts,suspect and probable case test for close contacts,suspect and probable case

100% of planned technical assistance on province/city-wide 100% (12/12) of planned technical assistance on province/city-
2. Identify cross-cutting concerns on province-
integration provided to UHC sites wide integration provided to UHC sites
and city-wide integration through the Local
> Facilitate 8 meetings > Facilitated 8 meetings 5 5.00
Health System Maturity Model and engage
related to UHC related to UHC
respective DOH-CO units and bureaus
> Assisted 4 barangays regarding UHC profiling > Assisted 4 barangays regarding UHC profiling

Average Rating (Strategic Function) 5.00


Stategic Goals and Objectives Success Indicator (Targets + Measure)
Core Functions
100% of health services provided (Antenatal/Postnatal Care,
Immunization, Family Planning Counseling, Usapan Serye,
Dental Services, Health Promotion activities, Laboratory
services, Nutrition Counselling, etc.).
>
Render 70 antenatal care and 70 postnatal care
> Immunize 405 children during National immunization
program and 70 pregnant women give Tetanus toxoid
> toxoid
Immunize and screen 140 children aged 5-11 years old for
covid 19 vaccines
> Immunize and screen 150 12 to 17 years old,
350, 18 to 59 years old and 150 , 60 years old and above.
> Conduct 8 Family
planning counseling for New acceptors
> > Conducted
Conduct and participate in 10 Health promotion activities
(Buntis Class, Dengue Bench Conference, HIV awareness
campaign, Nutrition Month Celebration, Non Communicable
program activity)
> Assist 5 patients for DOTS Program
1. Ensure efficiency on the provision of technical
assistance to LGUs and other health partners
towards the achievement of UHC
RATING
Actual Accomplishment Q E T A Remarks / Justification of Unmet Targets
(1) (2) (3) (4)
100% (1,428/1,428) of health services provided
(Antenatal/Postnatal Care, Immunization, Family Planning
Counseling, Usapan Serye, Dental Services, Health Promotion
activities, Laboratory services, Nutrition Counselling, etc.).
> Rendered 70 antenatal care and 70 postnatal care
> Immunized 405 children during National
immunization program and 70 pregnant women give Tetanus
> Immunized and screened 140 children aged 5-11 years old
for covid 19 vaccines
> Immunized and screened 150 12 to 17 years
old, 350, 18 to 59 years old and 150 , 60 years old and above.
> Conducted 8 Family
planning counseling for New acceptors 5 5 5 5.00
and participated in 10 Health promotion activities (Buntis
Class, Dengue Bench Conference, HIV awareness campaign,
Nutrition Month Celebration, Non Communicable program
activity)
> Assisted 5 patients for DOTS Program
 RATING
Stategic Goals and Objectives Success Indicator (Targets + Measure) Actual Accomplishment Q E T A Remarks / Justification of Unmet Targets
(1) (2) (3) (4)
100% of identified reports (M1, TCL, Non-Com Reports, 100% (113/113) of identified reports (M1, TCL, Non-Com
COVID Reports, HEMS, PIDSR, KRA, Telemedicine Report, Reports, COVID Reports, HEMS, PIDSR, KRA, Telemedicine
Nutrition, COVID19 vaccination reports) submitted Report, Nutrition, COVID19 vaccination reports) submitted
>
Assist in 15 target client list ( Pregnant ,Postpartum, > Assisted in 15 target client list ( Pregnant ,Postpartum,
EPI,Family Planning) report consolitadion and updating EPI,Family Planning) report consolitadion and updating
>
> Accomplish and submit 55 Case investigation report
Accomplished and submitted 55 Case investigation report in
1. Ensure efficiency on the provision of technical in PIDSR and contact tracing for covid 19 Disease PIDSR and contact tracing for covid 19 Disease
assistance to LGUs and other health partners > Accomplish and submit > Accomplished and submitted 5
towards the achievement of UHC 5 Case investigation report in PIDSR for Hands,Foot and Case investigation report in PIDSR for Hands,Foot and Mouth
Mouth Disease Disease
>Accomplished and submitted 6 KRA 2 reports, 6
>Accomplish and submit 6 KRA 2 reports, 6 EO 12 reports, 2 EO 12 reports, 2 QUARTERLY KRA 1,KRA 2,KRA3,KRA 4,KRA5, 6
QUARTERLY KRA 1,KRA 2,KRA3,KRA 4,KRA5, 6 Safe Safe motherhood program reports, 6 RPRH Reports to point
motherhood program reports, 6 RPRH Reports to point person for consolidataion and submission to Program
person for consolidataion and submission to Program coordinators, PdoHo and PHO
coordinators, PdoHo and PHO > Accomplished and 5 5 4 4.67
> Accomplish and submitted 6 Teenage pregnancy tracking reports , 6 Pregnancy
submit 6 Teenage pregnancy tracking reports , 6 Pregnancy Tracking Reports
Tracking Reports

100% of coordination to LGU/DOH personnel performed 100% of coordination to (60/60) LGU/DOH personnel
> performed
Conduct 25 coordination for RHU personnel > Conducted 25 coordination for RHU personnel
> Conduct 6 coordination for PDOHO > Conducted 6 coordination for
personnel PDOHO personnel
> Conduct 26 coordination for > Conducted 26 coordination for
LGUpersonnel (Barangay) LGUpersonnel (Barangay) 5 5 4 4.67
> Conduct 1 coordination > Conducted 1 coordination for
for LGUpersonnel (Mayor) LGUpersonnel (Mayor)

> Conduct 1 > Conducted 1 coordination to

coordination to PHO personnel PHO personnel >
> Conduct 1 coordination to DSWD personnel Conducted 1 coordination to DSWD personnel
 RATING
Stategic Goals and Objectives Success Indicator (Targets + Measure) Actual Accomplishment Q E T A Remarks / Justification of Unmet Targets
(1) (2) (3) (4)

100% of outbreak related activities like investigation, 100% (70/70) of outbreak related activities like investigation,
result/CIF follow-ups, contact tracing of COVId and Non- result/CIF follow-ups, contact tracing of COVId and Non-COVID
COVID notifiable diseases conducted notifiable diseases conducted
2. Ensure the provision of immediate
> Conduct 65 contact tracing and case > Conducted 65 contact tracing and case
investigation on outbreaks in identified 5 5.00
investigation investigation
population
for covid notifiable . for covid notifiable .
> Conduct 5 > Conducted 5 HFMD
HFMD case investigation case investigation

Average Rating (Core Function ) 4.83

Support Function
1. Ensure efficient utilization of DOH funds 100% of DTRs submitted 100% (6/6)
>Submit 6 DTR of DTRs submitted 5 5 5.00

Average Rating (Support Function ) 5.00

 RATING
Stategic Goals and Objectives Success Indicator (Targets + Measure) Actual Accomplishment Q E T A Remarks / Justification of Unmet Targets
(1) (2) (3) (4)
RATING

Average Rating Final Rating per Function (Average Rating x Percentage Final Average Adjectival
Function Percentage Distribution* Remarks
per Function Distribution) Rating Rating

Strategic Functions 40% 5.00 2.00

Core Functions 50% 4.83 2.42 4.92 VS
Support Functions 10% 5.00 0.50
Comments and Recommendations for Development Purposes:

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

I certify that I discussed my assessment of the JANUARY 04,2023

performance with the employee JANUARY 04,2023

CASELYN L. DE GUZMAN, RN KENNETH M. DIVINAGRACIA R.N ELIZABETH V. SARIO M.D.,MPH

Employee Supervsior Next Higher Supervisor
Legend: 1 - Quality 2- Efficiency 3 - Timeliness 4- Average; *In the event that there is no strategic output, the percentage distribution as as follows: Core output - 80% and Support output - 20%
 Republic of the Philippines
Department of Health
CENTER FOR HEALTH DEVELOPMENT - CaLaBaRZon
BATANGAS PROVINCIAL DOH OFFICE
Batangas Medical Center Compound, Kumintang Ibaba, Batangas City
Telephone No.: 043-984-4510

CLIENT SATISFACTION SURVEY (CSS) ON PROVISION OF SERVICES

Good day!
The Batangas Provincial DOH Office (PDOHO) would like to seek your feedback on the health services
provided by our Human Resources for Health (HRH).
Please put a check mark (/) on the box corresponding to your response.
Information gathered through this CSS shall be the office reference for acknowledging good health service
provision.
Thank you!

Name of Office: ________________________________________

Date / Period Covered: ________________________________________

Name of HRH: ________________________________________

Position of HRH: ______________________________

Type of Health Services Provided (Multiple responses are expected)

HEALTH SERVICES PROVIDED
Antenatal Care Provision of FP Commodities
Postnatal Care Health Promotion Activities
Immunization Provision of Non-Com Medicines
Family Planning Counseling Other health services provided:
Usapan Serye

Outstanding Very Satisfactory Satisfactory Unsatisfactory Poor

Criteria
(5) (4) (3) (2) (1)
1. Quality
Services was effectively provided
(competent, clear, proficient)
2. Timeliness
Services was effectively provided
(competent, clear, proficient)
Types of Reports Submitted (Multiple responses are expected)
REPORTS SUBMITTED
M1 Report PIDSR Reports
TCL KRA and EO 12 Reports
Non-Com Reports Maternal Death Report
COVID Reports Other reports submitted:
HEMS

Outstanding Very Satisfactory Satisfactory Unsatisfactory Poor

Criteria
(5) (4) (3) (2) (1)
1. Quality
Reports were submitted
(consistent, validated, minimal error)

2. Timeliness
Reports were submitted
(ahead of deadline, on-time)

Types of Coordination Conducted (Multiple responses are expected)

COORDINATION TO DOH/LGU PERSONNEL
RHU Personnel (CHO/MHO) NGO Personnel
DOH Personnel (PDOHO/RO IVA) LGU Personnel (Mayor, Other Dept.)
LGU Personnel (Barangay) PHO Personnel
Other Health Personnel: _____________________

Outstanding Very Satisfactory Satisfactory Unsatisfactory Poor

Criteria
(5) (4) (3) (2) (1)
1. Quality
Coordination was done
concise, clear, consistent)

2. Timeliness
Coordination was done efficiently

EVALUATOR:
MHO/CHO/ PHN