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LGU Physician Data Collection Form - MOISES PADILLA
LGU Physician Data Collection Form - MOISES PADILLA
POSITION TITLE
(e.g., MHO, RHP, MO I, MO III) LGU-RETAINED DTTB Batch NUMBER OF ACTUAL MONTHLY
NATURE OF NUMBER FUNDING VACANCY DTTB Key in the DTTB Batch OVERTIME PAY /
PROVISION OF HONORARIUM NIGHT SHIFT HAZARD
NO.
Indicate titles of LGU-created
APPOINTMENT/ OF MONTHS STATUS STATUS Select "Yes" if post number if post is MONTHS VACANT SALARY BASIC SALARY
MAGNA CARTA
COMPENSATORY
PER MEDICO- DIFFERENTATIAL PAY
positions for physicians in if UNFILLED (excluding benefits)
filled by a DTTB, GRADE-STEP OVERTIME
EMPLOYMENT EMPLOYED
PRIMARY CARE facilities whether funded whether filled is filled by a former DTTB. BENEFITS LEGAL SERVICE (NSD) (HP)
PERMANENT post. Indicate ACTUAL basic
(MHO/CHO/RHU/Urban Health Centers). for FY 2022 or unfunded or unfilled If unfilled, indicate otherwise indicate CREDITS
"Not Applicable" Indicate N/A if otherwise. salary being provided
For multiple items of the same position, "Not Applicable"
input them in separate rows.
a b c d e f g h r. j k l m n o p
All benefits provided at full
1 Municipal Health Officer Permanent Funded Unfilled No 24-1 86,742.00 No No No Yes
rate
10
11
12
13
14
15
16
CERTIFICATION CERTIFICATION
This is to certify that the above information and the supporting documents, as attached, are true and accurate. Any form of misrepresentation may
render the request of the local government unit for physician augmentation under the Doctors to the Barrios Program invalid
GRACE B. OCAG, CPA JOJI L. CONSENCINO ELLA CELESTINA D. GARCIA-YULO STEPHANY GRACE C. YU
Mun. Accountant/ HRMO Designate Municipal Budget Officer MUNICIPAL MAYOR HRMO Designate
LGU MOISES PADILLA LGU MOISES PADILLA LGU MOISES PADILLA LGU BINDOY
MAGNA CARTA BENEFITS
Select "Yes" if the corresponding benefit is provided. Otherwise, indicate either No or Not Applicable
SALARY STEP
FREE LIVING INCREMENT REPRESENTATION
SUBSISTENCE LONGEVITY LAUNDRY REMOTE OTHER
QUARTERS / FOR POST- AND TRAVEL LIST OF OTHER
ALLOWANCE PAY ALLOWANCE
QUARTERS GRADUATE ALLOWANCE
ASSIGNMENT BONUSES &
BENEFITS
REMARKS
(SA) (LP) (LA) ALLOWANCE BENEFITS
ALLOWANCE DEGREE (RATA)
COMPLETION
q r s t u v w x y
PERA, MIDYEAR, z
CLOTHING, YEAR-
Yes No Yes No No Yes No Yes END, CASH GIFT, PEI,
SRI