[YEAR] LIST OF CERTIFIED PRIMARY CARE WORKERS

Instruction: The template for PCF shall be used in the listing of the certified primary care workers (physicians, nurses,
midwives) in the facilities.

FOR PRIMARY CARE FACILITY UNDER A MUNICIPALITY/COMPONENT CITY

1. The template for PCF shall be used in the listing of the certified primary care workers (physicians, nurses, midwives).
2. The primary care facility shall submit the list to the Provincial Health Office.

FOR PRIMARY CARE FACILITY UNDER INDEPENDENT COMPONENT CITY (ICC)/ HIGHLY URBANIZED
CITY (HUC)
1. The template for PCF shall be used in the listing of the certified primary care workers (physicians, nurses, midwives).
2. The primary care facility shall submit the list to the City Health Office.

Note: The list to be submitted to MHO/ICC/HUC should be in Excel form. Please make an Excel form copy of this template.

CC / Municipality:

Province / HUC / ICC:

Region:

0 FALSE
UIS NON-UIS

Number of PCW Teams

Name of Primary Care Workers of [Name of Primary Care
No. Health Pofession (one Physician, one Nurse,
Facility as registered in the National Health Facility Registry]
one Midwife)

e.g JUAN L. DELA CRUZ Physician

4
 5

10

please add rows if necessary

Total for the [ Facility Name ]

APPROVED:

[Name & Signature of the Head of the Facility]

[Position]
 SUMMARY REPORT OF CERTIFIED PRIMARY CARE WORKES

Instruction:

FOR THE PROVINCIAL HEALTH OFFICE

1. The template shalll be used to consolidate the list of the certified care workers submitted by the primary care facilities
2. The Provincial Health Office shall directly submit to the Center of Health Development.

Region:

Province:

0 FALSE
UIS Non-UIS

Number of PCW per Profession

Name of Primary Care Facilities (as registered in the National Number of PCW
Health Facility Registry) Teams
Physician Nurse Midwife

8
 9

10

please add rows if necessary

Total

APPROVED: Date Signed:

[Name & Signature of the Head of the Offce]

[Position]