Jose-C.-Payumo-Jr.-Memorial-Hospital-Services-2024

1.
Patient Triage
Early identification and separation of suspected COVID-19 patients to prevent transmission and
contamination of clean (non-COVID) areas.
Office or Division: Jose C. Payumo Jr. Memorial Hospital/ Triage Area
Classification: Simple
Type of Transaction: G2C - Government to Citizen
Who may avail: ALL
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Health Declaration Checklist Triage Area
Hospital Card
Patient Medical Record Records Section
PRO-
FEES TO PERSON
CLIENTS STEPS AGENCY ACTION CESSING
BE PAID RESPONSIBLE
TIME
1. Proceeds to Triage 1.1 Interviews the purpose of
visit.
1.2 If for consultation, catego-

rizes patient condition (non-
emergent, emergent, urgent)
along with COVID-like symp-
toms
Nurse I
None 3 minutes Triage Area
1.3 If emergent/urgent case,
directs to the Emergency
Room as endorsed by the
nurse.
1.4 If non-emergent, follow

the next step.
2.1 Interviews the patient/ rel-
ative/ guest/ staff for signs
and symptoms, exposure and
travel history and completes
the health declaration.
2. Submits information Nurse I
None 3 minutes
on Health Declaration 2.2 Signs the health declara- Triage Area
tion form.
2.3 If NOT for consultation,

assists to identified concern
department.
3. Provides information
Out Patient Nurse I Triage Ar-
on the creation of new 3. Creates medical record of
Card- PHP 2 minutes ea /
medical record. (New the patient. Cashier
20.00
Patient)
4. Proceeds to Records
4. Retrieves old patient rec- Loss Card/
section and presents Medical Records
ord of the previous consulta- Penalty-
the hospital card for the 4 minutes Clerk /
tion and treatment manage- PHP Cashier
retrieval of old patient
ment done. 100.00
record. (Old Patient)
467
5. Conducts initial assess-
ment, vital signs
5. Waits for the assess- Nurse I
(temperature, pulse, oxygen None 3 minutes
ment of the nurse. Triage Area
saturation, blood pressure,
weight) and history taking.
6. Endorses the patient to
6. Waits for endorse- Nurse I
Out Patient Department or None 2 minutes
ment. Triage Area
Consultant clinic.
PHP 20.00
TOTAL: 17 minutes
-100.00
2. Emergency Room: Consultation & Treatment

Area specializing in the acute care of patient who present without prior appointment; either by
their own means or ambulance. The department provide initial treatment and immediate attention
for a broad spectrum of illnesses and injuries .
Office or Division: Jose C. Payumo Jr. Memorial Hospital/ Emergency Department
Who may avail: Patients

Health Declaration Checklist, Patient Medical Triage Area
Record (New) Medical Records Section
Patient Medical Record (Old) RHU or other hospital/clinic
Referral Form/ Hospital Chart
PRO-
FEES TO BE PERSON RE-
PAID SPONSIBLE
TIME
1. Assesses the patient'
condition as emergent/ Nurse I
1. Arrives in the Triage None 3 minutes
urgent and COVID and Triage Area
non-COVID case.
2.1 Interviews the pa-

tients' complaint and
2. Proceeds to the past medical history. Nurse I
Emergency room and None 7 minutes Emergency
approaches the nurse. 2.2 Takes initial vital Department
signs and refers to the
doctor.
3. Conducts thorough
Medical Officer I
3. Waits for the doctor's assessment and sug-
None 20 minutes Emergency
initial assessment. gests appropriate treat- Department
ment management.
468
PRO-
PERSON RE-
CLIENTS STEPS AGENCY ACTION FEES TO BE PAID CESSING
SPONSIBLE
TIME
4. Receives initial 4. Provides prompt and ECG tracing- PHP 1 hour Nurse II
treatment/ manage- appropriate medical 200.00 Emergency De-
ment management and treat- ECG Tracing with inter- partment
ment to stabilize patient pretation- PHP 250.00
condition Suturing Fee- PHP 500-
1,500
Wound Dressing- 50-
100
Circumcision, Incision
and drainage, Excision-
PHP 1,000-2,000
Nebulization (excluding
meds)- PHP 50.00
Injection Fee- PHP
50.00
NGT insertion/ Catheter
insertion- PHP 50.00
Oxygen Fee- PHP 100
per hour
5. Explains the patients'
5. Waits for the ad- condition and advises Medical Officer I
vised plan of care/ patient to be admitted/ None 15 minutes Emergency De-
treatment discharge/ referred to a partment
higher facility.
6. Decides on com- 6. Admits, discharges,or
Medical Officer I
pliance on the ap- refers the patient to a
None 15 minutes Emergency De-
propriate treatment higher facility as need- partment
options presented. ed.
TOTAL: Varies depending on 2 hours
all incurred charges
3. Emergency Room: Consultation, Diagnostics and Treatment

Area specializing in the acute care of patient who present without prior appointment; either by
their own means or ambulance. The department provide initial treatment and immediate attention
for a broad spectrum of illnesses and injuries .
Health Declaration Checklist, Patient Medical
Triage Area
Record (New)
Medical Records Section
Patient Medical Record (Old)
RHU or other hospital/clinic
Referral Form/ Hospital Chart
FEES TO PROCESSI PERSON
CLIENTS STEPS AGENCY ACTION
BE PAID NG TIME RESPONSIBLE
1. Assesses the patient'
condition as emergent/ Nurse I
urgent and COVID and Triage Area
non-COVID case.
469
2.1 Interviews the
patients' complaint and
2. Proceeds to the Nurse II
past medical history.
Emergency room and None 7 minutes Emergency
approaches the nurse. Department
2.2 Takes initial vital signs
and refers to the doctor.
3.1 Conducts thorough
assessment and suggests
appropriate treatment
Medical Officer III
3. Waits for the doctor's management.
initial assessment. Department
3.2 Requests diagnostic
examination for
differential diagnosis.
4.1 Completes and
forwards request to Nurse I
4. Waits for the appropriate department. Medical Technologist
and/or
diagnostic procedure to None 40 minutes Radiologic
be done 4.2 Collects blood Emergency
sample; performs x-ray Department
procedure.
5. Retrieves old medical
record/chart of patient by Medical Records Clerk
5. None None 10 minutes
the relative to the Medical Records Section
Record Section.
6. Provides prompt and
appropriate medical Medical Officer III
6. Receives initial Nurse II
management and None 1 hour
treatment/ management Emergency
treatment to stabilize Department
patient condition.
7. Gathers and interprets

result of diagnostic tests, Medical Officer III
7. Waits for diagnostic
makes diagnosis and Nurse II
findings and/or effect of None 1 hour
monitors the response of Emergency
initial treatment Department
the patient to the initial
treatment.
8. Explains the patients'
condition and advises Medical Officer III
8. Waits for the advised
patient to be admitted/ None 15 minutes Emergency
plan of care/treatment Department
discharge/ referred to a
higher facility.
9. Decides on
9. Admits, discharges,or Medical Officer III
compliance on the
refers the patient to a None 15 mins Emergency
appropriate treatment Department
higher facility as needed.
options presented.
3 hours, 45
TOTAL: None minutes
470
4. Out Patient Department: Consultation
Area that provides non-urgent diagnosis and care, and follow-up for patients.
Office or Division: Jose C. Payumo Jr. Memorial Hospital/ Out Patient Department
Health Declaration Form Triage Area
Patient Medical Record, Old Medical Records Section
Laboratory and X-ray Results Laboratory and Radiology Department
FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Proceeds to Out
Patient Department, 1. Receives the medical Nurse I
submits the medical record, arrange the None 2 minutes Out Patient
record and waits to be patients by number. Department
called by the nurse.
2. Waits for secondary 2. Conducts secondary Nurse I
assessment and history assessment, vital signs, None 8 minutes Out Patient
taking. and history taking. Department
3. Conducts medical
Medical Officer III
3. Waits for consultation assessment and
None 20 minutes Out Patient
to the doctor. provide plan of care for Department
the patient.
4. Waits for the 4. Issues prescription of
Medical Officer III
prescribed medications needed medications
None 10 minutes Out Patient
and other instructions of and explain to the Department
treatment plan. patient and relative.
Nurse I
5. Provides health
5. None None 5 minutes Out Patient
teachings. Department
TOTAL None 45 minutes
5. Out Patient Department: Consultation with Diagnostic Procedures

Area that provides non-urgent diagnosis and care, and follow-up for patients.
Office or Division: Jose C. Payumo Jr. Memorial Hospital/ Out-Patient Department
Health Declaration Form Triage Area
FEES TO PROCESSIN PERSON
BE PAID G TIME RESPONSIBLE
1. Proceeds to Out Patient
1. Receives the medical Nurse I
Department, submits the
record, arrange the None 2 minutes Out-Patient
medical record and waits Department
patients by number.
to be called by the nurse.
471
2. Waits for secondary 2. Conducts secondary Nurse I
assessment and history assessment, vital signs, None 8 minutes Out-Patient
taking. and history taking. Department
3. Conducts medical Medical Officer I/
3. Waits for consultation to assessment and provide Medical Officer III
None 20 minutes Out-Patient
the doctor. plan of care for the
patient. Department
4. Takes the laboratory Medical Technologist

Varies
request and proceeds to and/or
4. Collects blood sam- depend-
the Laboratory for blood 1 hour, 30 Radiologic Technolo-
ple; performs x-ray pro- ing on all gist
tests and to Radiology de- minutes
cedure incurred Laboratory/Radiology
partment for x-ray proce-
charges Department
dures.
5. Brings the laboratory 5. Interprets the diag-

results or x-ray findings to nostic results and pro- Medical Officer I/
Medical Officer III
OPD department for inter- vide treatment plan as None 15 minutes Out-Patient Depart-
pretation and manage- based on the patients' ment
ment. diagnosis.
6. Issues prescription of
6. Waits for the prescribed needed medications and Medical Officer I/
Medical Officer III
medications and other in- explain to the patient
None 10 minutes Nurse I
structions of treatment and relative. Out-Patient Depart-
plan. Provides health teach- ment
ings.
7. May go home if ad-

vised. 7. Advises patient to be Medical Officer I/
Transfers to Emergency admitted/ discharge/ re- Medical Officer III
None 10 minutes Out-Patient Depart-
Room assisted by nurse if ferred to a higher facility
for admission or transfer if necessary. ment
to higher facility.
Varies
depend-
2 hours, 35
TOTAL ing on all
minutes
incurred
charges
472
6. Out Patient Department: Consultation and Follow -up with Specialist
Area that provides non-urgent diagnosis and care, and follow-up for patients referred to specialist.
Office or Division: Jose C. Payumo Jr. Memorial Hospital/ Out Patient Department
Triage Area
PERSON
FEES TO PROCESSING
CLIENTS STEPS AGENCY ACTION RESPONSI-
BE PAID TIME
BLE
1.1 Assesses the patient'
condition as emergent/ ur-
gent and COVID and non-
COVID case.
1.2 Checks the HCI number-

on the Hospital Card.
Nurse I
1.3 Interviews the patients' Triage Area
complaint and past medical
history and encodes in the
DCI e-Med electronic health
record system.
1.4 Takes initial vital signs

and refers to the doctor.
2.1 Cheks the record on the
system, receives the medical
2. Proceeds to the Con- record and conduct initial Nurse I
sultants' Clinic and ap- assessment of patient. None 7 minutes Consultants'
proaches the nurse. Clinic
2.2 Arrange patients by num-
ber.
3. Conducts medical assess- Specialist
3. Waits for consultation
ment and provide plan of None 20 minutes Consultants'
to the specialist. Clinic
care for the patient.
4.1 Issues prescription of
needed medications and ex-
4. Waits for the pre-
plain to the patient and rela- Specialist
scribed medications and
tive. None 10 minutes Consultants'
other instructions of treat- Clinic
ment plan.
4.2 Advises schedule of fol-
low-up.
5. Provides health teachings Nurse I
5. None and importance of compli- None 5 minutes Consultants'
ance and follow-up of care. Clinic
Total None 45 minutes
473
7. Admission
Admission of patient to a facility as an In-Patient for continuity of medically necessary and appro-
priate care and treatment of an illness or injury.
Medical Record with endorsement for admission Out Patient Department/ Consultant Clinic
Laboratory and/or Radiology Results Laboartory/ Radiology Department
Referral form RHU/ other clinics
Valid Identification Card Government Agencies
FEES PRO-
PERSON RESPON-
CLIENTS STEPS AGENCY ACTION TO BE CESSING
SIBLE
PAID TIME
1. Proceeds in the
1. Receives all the necessary
Emergency Room and
medical records from the pa- Nurse I
willing to comply with
tient. Takes vital signs, as- None 10 minutes Emergency
the treatment plan and Department
sesses, and refers the patient
be admitted. Submits
to the doctor.
the medical records.
2. Explains to the patient and/
or immediate relative/ legal
2. Wait for the doctor's
guardian the diagnosis and Medical Officer III
explanation of treament
treatment plan of and ask None 10 minutes Emergency
plan and sign the in- Department
them to sign the informed
formed consent.
consent as a proof of approv-
al and understanding.
3. Occupies bed and
3. Accomplishes the patient
waits for the nurse to Medical Officer III
chart. Completes the Doctor's
carry out the doctors' None 20 minutes Emergency
Order Sheet for the medical Department
orders on the plan of
care and treatment plan.
care.
4. Provides accurate 4. Completes all other per-
Nurse I
personal information; sonal information for encod-
present valid identifica- ing in iHOMIS Database and Department
tion card if available. Patient Chart.
5. Cooperates with ad-
5. Performs initial venoclysis, Nurse II
ministration of medi-
administer medications and None 30 minutes Emergency
cines and other needed Department
other nursing procedures.
procedures.
6. Completes patient chart Nurse II
6. Waits for the comple-
and documents all treatment None 10 minutes Emergency
tion of patients chart. Department
and management done.
Utility Worker
7.1 Transports patient via Emergency
stretcher/ wheelchair. Department
7. Awaits transfer to
None 10 minutes
designated ward. Nurse I
7.2 Endorses patient to Ward
Nurse for continuity of care. Emergency
Department
TOTAL: None 1 hour ,35 minutes
474
8. Discharge
Discharge procedure for may go home (MGH), home against medical advice (HAMA), and/or
transfer.
Jose C. Payumo Jr. Memorial Hospital/ Covid Isolation Ward/OB-GYNE
Office or Division: Ward/Surgey Ward/Medical-Pedia Ward
Type of Transac-
tion: G2C - Government to Citizen
Discharge Clearance
Itemized Billing Statement Nurse Station
CSF, CF1 Billing Section
Summarized Statement of Account PhilHealth Office
Official Receipt/ Guarantee Letter/ Discharge Clear- Billing Section
ance Cashier/ Social Services/ Billing Section
FEES TO PRO- PERSON
BE PAID CESSING RESPONSIBLE
1. Waits for the doc- 1. Examines by the resident on
tors' advise of may duty and orders May Go Home
go home. with home medications and in-
structions. Medical Officer
Covid Isolation
1.1 Insists on going 1.1 Orders Home Against Medi- None 15 minutes Ward/OB-GYNE
home against medical Advise (HAMA) if the patient Ward/Surgey Ward/
cal advise; must and relative still insist to go Medical-Pedia Ward
sign the waiver. home after doctors' explanation
and signs on the chart and
2. Waits for the 2. Carries out doctor's order

nurse to process and updates disposition of pa- Nurse I
discharge. tient on iHOMIS database. Pre- Covid Isolation
pares the discharge clearance None 10 minutes Ward/OB-GYNE
form and client satisfaction sur- Ward/Surgey Ward/
vey form, then distributes to pa- Medical-Pedia Ward
3. Goes to Nursing 3.1 Receives and document the

Station to return the returned linen; signs the dis-
linen ang get un- charge clearance. Nursing Attendant
used medicines or Tallies all oxygen consumption Nurse I
supplies. report and attaches in the clear- Covid Isolation
ance. None 10 minutes Ward/OB-GYNE
3.2 Checks the medication box Ward/Surgey Ward/
for any unused medicines and Medical-Pedia Ward
medical supplies to be given to
patients' relatives.
4. Proceeds to 4. Receives the unused medi-
Pharmacy to return cine and supplies, verify in- Pharmacist
the unused medi- curred charges and signs the None 10 minutes Pharmacy
cines and supplies. discharge clearance. Department
475
PRO-
FEES TO PERSON
BE PAID RESPONSIBLE
TIME
5. Proceeds to Labora- 5. Verifies incurred charges
tory to check incurred for blood tests, newborn Medical Technologist/
Laboratory Aide
charges for blood tests, screening/ blood consump- None 10 minutes Laboratory
newborn screening/ tion and signs the discharge Department
blood consumption. clearance.
6. Proceeds to Billing 6. Makes a copy of the item-
Billing Clerk
Section for initial billing ized billing statement and None 10 minutes Billing Section
procedure. gives it to patients' relative.
7. Proceeds to Phil- 7. Validates eligibility of pa-
PhilHealth Clerk
Health to check Phil- tient to avail PhilHealth bene- None 10 minutes Philhealth Section
health eligibility. fits.
8. Proceeds to Social 8. Validates eligibility of pa-
Social Welfare Officer
Worker to check eligibil- tient to avail social assis- None 10 minutes Medical Social Work
ity for social assistance. tance.
9. Proceeds to Billing 9. Validates if payment is still
for issuance of Final needed and issues the final
Billing Clerk
Statement of Account. statement of account. Signs None 10 minutes Billing Section
the discharge clearance.
10.Proceeds to Cashier 10. Collects the prescribed Varies

to pay the prescribed amount and issues official depend-
Cashier
amount noted in clear- receipt. ing on all 8 minutes Cashier Section
ance incurred
charges
11. Returns to Nurse
Station and give one 11.1 Validates the complete-
copy of the discharge ness of Discharge Clearance.
clearance. 11.2 Instructs patient and/or
relative on medications and Nurse I / Nursing At-
follow-up consultation. tendant
11.3 Removes patient's con- Covid Isolation Ward/
None 12 minutes OB-GYNE Ward/
traptions and collects the cli-
ent satisfaction survey. Surgey Ward/Medical
11.4 Collects the completed -Pedia Ward
discharge clearance and cuts
the patient ID band prior to
exit.
12. None 12.1 Transports the patient

for discharge via wheelchair Utility Worker
to be sent home. Security Guard
Covid Isolation Ward/
12.2 Collects the completed None 10 minutes OB-GYNE Ward/
discharge clearance and cuts Surgey Ward/Medical
the patient ID band prior to -Pedia Ward
exit.
Varies
depend-
2 hours, 5
TOTAL: ing on all
minutes
incurred
charges
476
9. Surgery, Emergency
This procedure covers from the initial contact (consultation), performance of diagnostic exams
and swab, clearance, admission, and actual performance of surgery to recovery room.
Health Declaration, Patient Medical Record (Old) Triage
Diagnostic Exam Results Laboratory and Radiology
FEES
PROCESSI PERSON
CLIENTS STEPS AGENCY ACTION TO BE
NG TIME RESPONSIBLE
PAID
1. Categorizes patient as
1. Arrives in the non-COVID, non-urgent case Nurse I
None 10 minutes
Triage. and creates patient medical Triage Area
record
2. Conducts assessment and
2. Proceeds to Medical Specialist
history taking and advises None 30 minutes Out-patient Department
Consultation Clinic.
patient the need to undergo
3. Explains the procedure to

3. Decides to continue Medical Specialist
the patient and relative, None 30 minutes Out-patient Department
with surgery.
completes the history and
4. Performs admission
4. Transfers to procedure and notifies Nurse II
Emergency Room for Operating Room, Surgeon, None 30 minutes Emergency
admission. and Anesthesiologist for the Department
surgery case
5. Performs pre operative
5. Occupies bed in the protocols and procedure, and Nurse II
None 30 minutes
ward. administers pre operative Surgery Ward
medications.
6. Endorses the patient to Nurse I
Operating room. Surgery Ward
None 15 minutes
operating Room.
6.1 Tranports the patient to Utility Worker
Operating Room after proper Surgery Ward
Surgeon,
7. Performs surgery in strict Anesthesiologist,
7. Occupies the OR Assistant Surgeon, Scrub
infection control protocol None 4 hours Nurse, Circulating Nurse
table.
wearing level 3/4 PPE. (Nurse I/ Nurse II)
Emergency Department
Utility Worker
8. Awaits transfer to 8. Transports to Post
Nurse I
Post Anesthesia Care Anesthesia Care unit. None 3 hours
Operating Room
Unit Monitors patient condition.
Department
TOTAL: None 9 hours, 25
minutes
477
10. Surgery, Elective
This procedure covers from the initial contact (consultation), performance of diagnostic exams
and swab, clearance, admission, and actual performance of surgery to recovery room.
Jose C. Payumo Jr. Memorial Hospital/Out-Patient Department /
Office or Division:
Emergency Room
Health Declaration, Patient Medical Record
Triage
(Old)
Laboratory and Radiology
Diagnostic Exam Results
1. Categorizes
patient as non-
Nurse I
1. Arrives in the Triage. COVID, non-urgent None 10 minutes
Triage Area
case and creates
patient medical record
2. Conducts
assessment and Medical Specialist
2. Proceeds to history taking and Nurse I
None 30 minutes
Consultation Clinic. advises patient the Out-Patient
need to undergo Department
surgery
3. Waits for the Swab: PHP

3. Schedules patient
schedule of swab test 2,800 (may Medical Specialist
to undergo NPS/OPS
or rapid antigen test be covered 2 days Out-Patient
and other diagnostic
and other laboratory by Department
exams for clearance.
tests. PhilHealth)
4. Provides
4. Returns to the
secondary Medical Specialist
Consultant Clinic with
consultation for CP None 30 minutes Out-Patient
complete laboratory
Clearance and Department
results.
schedules for surgery.
5. Performs
admission procedure
5. Proceeds to Nurse I
and notifies Operating
emergency Room for None 45 minutes Emergency
Room, Surgeon, and
admission. Department
Anesthesiologist for
the surgery case
Utility Worker
6.1 Transports the
Emergency
patient to ward via
Department
6. Awaits transfer to wheelchair.
None 15 minutes
surgery ward.
Nurse I
6.2 Endorses the
Emergency
patient to ward.
Department
478
7. Performs pre operative
7. Occupies bed in protocols and procedure, and Nurse I
None 1 day
the ward. administers pre operative Surgery Ward
medications
8. Waits for the
8. Performs pre-anesthetic Anesthesiologist
assessment of the None 25 minutes
assessment prior to surgery
anesthesiologist.
Nurse I
9. Endorses the patient to
Emergency
Operating room.
Department
None 25 minutes
operating Room. 9.1 Tranports the patient to
Utility Worker
Operating Room after proper
Emergency
coordination.
Department
Surgeon,
Anesthesiologist,
Assistant Surgeon,
10. Performs surgery in strict
10. Occupies the OR Scrub Nurse,
infection control protocol None 4 hours
table. Circulating Nurse
wearing level 3/4 PPE.
(Nurse I/ Nurse II)
Emergency
Department
Utility Worker
11. Awaits transfer 11. Transports to Post
Nurse I
to Post Anesthesia Anesthesia Care unit. None 3 hours
Emergency
Care Unit Monitors patient condition.
Department
3 days, 10
TOTAL: PHP 2800
hours
11. Normal Spontaneous Vaginal Delivery

Covers from the period when patient experienced her first labor pains, admission, delivery of the
newborn and placenta.
Office or Division: Jose C. Payumo Jr. Memorial Hospital/ Delivery Room
Health Declaration Checklist, Patient Medical Record
Triage
(Old)
Labor/Delivery Room
Patient Chart
Labor Room
Partograph
Delivery Room
Delivery Room Record

1.1 Categorizes patient as non

-COVID case and creates
patient medical record. Nurse I
1. Proceeds to Triage None 7 minutes
Triage Area
1.2 Retrieves old patient
record to the Records section.
479
2. Endorses the patient and

her vital signs to the Delivery Nurse I
2. Waits for transport to
Room nurse and midwife. None 8 minutes Utility Worker
Delivery Room (DR).
Transports to Delivery Room Delivery Room
via wheelchair.
3. Re-assesses blood
3. Arrives in the Delivery Nurse I
pressure of patient and verifies None 8 minutes
Room. Delivery Room
complaint and history.
4. Performs initial internal
examination (IE) and
assessment.
4.1 For patient under active

phase of labor (cervical Obstetrician
dilatation of 4cm and above), Delivery Room
proceeds to admission
procedure.
4. Position to the DR Nurse I
None 10 minutes
table. 4.2 For patient under latent Delivery Room
phase of labor (cervical
dilatation of less than 4cm)
sents home or in the waiting Midwife
area with proper instructions. Delivery Room
4.3 Conducts secondary

assessment and cervical
dilatation, vital signs, and
history taking.
5. Signs the informed

5. Completes patients' chart Obstetrician
consent for admission
with doctors orders. Carries None 15 minutes Nurse I
and transfer to Labor
out doctors orders. Delivery Room
Room assisted by nurse.
6. Monitors feeling of 6. Monitors progress of labor,

contractions and report if fetal heart tone, fetal Nurse I
None 4 hours
contractions become movement, and vital signs Delivery Room
stronger and persistent. every 30 mins or as needed.
7. Verbalizes strong and 7. Performs internal

regular contractions, or examination. If fully dilated, Midwife
None 7 minutes
feeling of rupture of bag patient is transported to Delivery Room
of water. Delivery Room.
8. Occupies the DR 8. Assists patient in positioning Nurse I

None 5 minutes
table. to DR table. Delivery Room
480
9.1 Assists patient on the
delivery of the newborn
following strict infection Nurse I
9. Follows the control wearing level 3/4 Delivery Room
instructions given by PPE. None 1 hour
nurse/ midwife. Midwife
9.2 Assists on the delivery of Delivery Room
the placenta and assesses
its completeness and
10.1 Administers prescribed Nurse I
10. Cooperates with
medication and treatment. Delivery Room
the administration of 20
None
medications and other minutes
10.2 Assesses for perineal Midwife
procedures.
laceration and repairs it. Delivery Room
11. Transfers to bed
and reports if there is 11. Monitors vitals signs and Nurse I
None 2 hours
profuse vaginal signs of profuse bleeding. Delivery Room
bleeding.
12. Documents all
12. Awaits completion
procedures, completes 15 Nurse
of monitoring and None
monitoring and endorses to minutes Delivery Room
transfer to ward.
ward for continuity of care.
8 hours,
TOTAL: None 35
minutes
12. Essential Newborn Care

Essential newborn care is the care provided to the newborn after birth within the delivery room by
skilled personnel which includes drying and stimulating, assessing breathing, cord care, skin-to-
skin contact, inititating exclusive breastfeeding, eye care, vitamin K provision, place of identifica-
tion band and weighing.
Office or Division: Jose C. Payumo Jr. Memorial Hospital/ Delivery Room
Type of Transac-
Patient Chart, Patient Medical Record Delivery Room
Maturity Rating
NBS and NBHST Request
FEES PRO-
PERSON
RESPONSIBLE
PAID TIME
1. Catches the baby and places Nurse I
1. Awaits for the baby. None 1 minute Delivery Room
under the mother's abdomen
2. Dries the newborn thoroughly
2. Receives and holds
using a clean cloth by wiping the Nurse I
the baby well maintain- None 1 minute
eyes, face, head, front and back, Delivery Room
ing skin to skin contact.
arms, and legs
481
FEES PRO- PERSON
TO BE CESSING RESPONSIBLE
3. Assesses newborn if breath-
3. Observes her baby's Nurse I
ing, if not, may perform ventila- None 1 minute Delivery Room
cry.
tion or suctioning
4. If newborn is breathing and
crying, places the newborn in
4. Maintains skin to
prone position on mother's abdo- Nurse I
skin contact with the None 3 minutes
men and covers with dry blanket Delivery Room
baby.
and bonnet and places identifica-
tion band on ankle.
5. Cooperates with the 5. Assesses umbilical pulsations
Nurse I
care being provided to and may clamp and cut the cord None 5 minutes Delivery Room
her newborn. using strict sterile technique.
6. Offers her breast to
6. Observes for feeding cues and 90 Nurse I
the newborn to initiate None Delivery Room
initiate breastfeeding. minutes
breastfeeding.
7. Measures anthropometric
7. The mother awaits
measurements, performs eye
for completion of ad- 10 Nurse I
care, and administers None
ministration of vac- minutes Delivery Room
BCG,Hepatitis B vaccine and Vit-
cines.
amin K injections.
8. Documents all procedure done
and fills-in request for newborn
8. Awaits transfer to 15 Nurse I
screening and hearing screening None
ward. minutes Delivery Room
test and forwards to appropriate
area.
TOTAL: None 2 hours, 5
minutes
13. Hemodialysis (New Patients)

Hemodialysis is a treatment to filter wastes and water from a patient's blood.
Office or Division: Jose C. Payumo Jr. Memorial Hospital/ Dialysis Department
Health Declaration Checklist Triage Nurse
Patient Medical Record, Treatment Sheet Dialysis
Government or Non-Government Nephrolo-

Medical Abstract, Prescription and HD gist, Hospital and Hemodialysis Center
Treatment Sheet Hospital and Hemodialysis Center
Laboratory and Chest X-ray Government or Non-Government Diagnostic
Results Center
PhilHealth MDR ( Member Data Record), Phil- PhilHealth, PhilHealth Online, Hospital and
health Dialysis Database (PDD), Philhealth Jour- Hemodialysis Center
nal, Certificate of Philhealth used -PhilHealth, PhilHealth Online
Senior Citizens ID Senior Citizens Office
Persons with Disability (PWD) ID DSWD Office
482
PRO-
FEES TO PERSON RESPON-
BE PAID SIBLE
TIME
1. Categorizes patient as non-

1. Proceeds in the Tri- Nurse I
COVID case and creates pa- None 8 minutes Triage Area
age.
tient medical record.
2.1 Conduct physical examina-

2. Submit all require-
tion and evaluation of require-
ment needed (medical
ment 20
abstract, latest labora- None Physician on Duty
2.2 Ask patient for referral letter minutes
tory result, referral
from other dialysis center/ hos-
form)
pital
3.1 Secure and complete pa-

tient's chart 3.2 Patient/
3. Completion of Pa- relatives will sign informed con- 20 HD Nurse / Physician
None
tient's Chart sent and conduct orientation of minutes on Duty
Hemodialysis units' rules and
regulations
4.1 Conduct pre dialysis as- Dialysis Nurse/ Dialy-
4. Preparation for He- sessment 4.2 Prepare 20 sis Technician / Phy-
None
modialysis Treatment designated dialysis machine for minutes sician on Duty
initial treatment Dialysis Department
5. Cleaning and assessment for

15 Dialysis Nurse
5. Pre- dialysis care patency of hemodialysis vascu- None
minutes Dialysis Department
lar access and cannulation.
6. Provide Hemodialysis treat- Dialysis Nurse/ Dialy-

6. Hemodialysis Treat- sis Technician / Phy-
ment and monitoring for intradi- None 4 hours
ment sician on Duty
alytic complications. Dialysis Department
7. Conduct termination, deccan- Dialysis Nurse/ Dialy-

15 sis Technician / Phy-
7. Post dialysis care ulation and post dialysis as- None
minutes sician on Duty
sessment and home advised. Dialysis Department
8. Patient /relative will sign

8. Philhealth package
CSF, PBEF, Text BPN, CF2 15 Dialysis Clerk
claim, Statement of Ac- None
Philhealth forms and Statement minutes Dialysis Department
count and Discharge
of Account.
5 hours,
TOTAL: None 53
minutes
483
14. Hemodialysis (Old Patients with Philhealth)
Government or Non-Government Nephrolo-
Medical Abstract, Prescription and HD gist, Hospital and Hemodialysis Center
Results Center
PhilHealth MDR ( Member Data Record), Philhealth PhilHealth, PhilHealth Online, Hospital and
Dialysis Database (PDD), Philhealth Journal, Certifi- Hemodialysis Center
cate of Philhealth used -PhilHealth, PhilHealth Online
PRO-
FEES TO PERSON RE-
BE PAID SPONSIBLE
TIME
1. Proceeds in the Tri- Nurse I
non-COVID case and cre- None 8 minutes
age. Triage Area
ates patient medical record.
2. Retrieve and secure pa- Dialysis Nurse

2. Retrieval of Charts None 5 minutes Dialysis Department
tients record
3.1 Conduct pre dialysis as-
sessment 3.2
Cleaning and assessment Dialysis Nurse/ Dialy-
sis Technician / Phy-
3. Pre- dialysis care for patency of hemodialysis None 20 minutes sician on Duty
vascular access and cannu- Dialysis Department
lation. 3.3 Preparation of Di-
alysis Machine
4. Provide Hemodialysis Dialysis Nurse/ Dialy-

4. Hemodialysis Treat- sis Technician / Phy-
treatment and monitoring for None 4 hours
ment sician on Duty
intradialytic complications. Dialysis Department
5. Conduct termination, dec- Dialysis Nurse/ Dialy-
canulation and post dialysis sis Technician / Phy-
5. Post dialysis care None 15 minutes sician on Duty
assessment and home ad-
vised. Dialysis Department
6. Patient /relative will sign

6. Philhealth package
CSF, PBEF, Text BPN, CF2 Dialysis Clerk
claim, Statement of Ac- None 15 minutes Dialysis Department
Philhealth forms and State-
count and Discharge
ment of Account.
5 hours, 3
TOTAL: None
minutes
484
15. Hemodialysis ( Patients without Philhealth)
Government or Non-Government Nephrologist,
Medical Abstract, Prescription and HD Hospital and Hemodialysis Center
Results Center
PhilHealth MDR ( Member Data Record), Phil- PhilHealth, PhilHealth Online, Hospital and He-
health Dialysis Database (PDD), Philhealth Jour- modialysis Center
nal, Certificate of Philhealth used -PhilHealth, PhilHealth Online
1. Proceeds in the Tri- non-COVID case and Nurse I
None 8 minutes
age. creates patient medical Triage Area
record.
2. Retrieve and secure Dialysis Nurse
2. Retrieval of Charts None 5 minutes
patients record Dialysis Department
3.1 Conduct pre dialysis

assessment
3.2 Cleaning and assess- Dialysis Nurse/ Dial-
ment for patency of he- ysis Technician /
3. Pre- dialysis care None 20 minutes Physician on Duty
modialysis vascular ac-
cess and cannulation. Dialysis Department
3.3 Preparation of Dialy-
sis Machine
4. Provide Hemodialysis Dialysis Nurse/ Dial-
4. Hemodialysis Treat- treatment and monitoring ysis Technician /
None 4 hours Physician on Duty
ment for intradialytic complica-
tions. Dialysis Department
5. Conduct termination, Dialysis Nurse/ Dial-
deccanulation and post ysis Technician /
5. Post dialysis care None 15 minutes Physician on Duty
dialysis assessment and
home advised. Dialysis Department
6. Patient /relative will
6. Statement of Account Dialysis Clerk
sign Statement of Ac- None 5 minutes Dialysis Department
and Discharge
count.
4 hours, 53
TOTAL: None
minutes
485
16. Dental
This department primarily focus on the dental health of patient. It provide dental consultation and
tooth extraction.
Office or Division: Jose C. Payumo Jr. Memorial Hospital/ Dental Department
Type of Transaction:
G2C - Government to Citizen
Health Declaration Checklist Triage
Dental Record Dental Clinic
PRO-
PERSON
TIME RESPONSIBLE
1. Categorizes pa-
tient as non-COVID
Nurse I
1. Arrives to Triage. case and creates None 7 minutes Triage Area
patient medical rec-
ord
2. Arranges the pa-

2. Receives number tient by number and
Security Guard
and proceeds to Den- assists them to the None 3 minutes Admin
tal Clinic. waiting area in the
Dental Clinic.
3. Registers patient
in the logsheet and
3. Awaits for your creates/ retrieves Dental Aide
number to be called dental record. Also, None 10 minutes Dental De-
for initial assessment. interviews patient partment
history and takes
vital signs.
4. Performs dental
assessment and Dentist
4. Awaits for your turn Dental Consultation/
consultation and 25 minutes Dental De-
for consultation. Check-up PHP 50.00 partment
may send patient for
tooth extraction.
486
5. If for tooth extrac- 5. Instructs the pa- Dental Extraction Fee 10 minutes
tion: Buys dental sup- tient /relative to -Anterior teeth/ Root frag-
plies in the pharmacy buy dental supplies ments PHP 250.00
and pay dental fee in in the pharmacy - Posterior Teeth /Severely
the Cashier. and pays dental broken down teeth (normal
extraction)- PHP 300.00
fee. Local Anesthesia
(additional)- PHP 50.00
Suturing (additional)- PHP
400.00
Complicated extraction Cashier
(surgical extraction) - PHP
600.00
Glass Ionomer Permanent
restoration (Class V -
Anterior/Posterior teeth)-
PHP 400.00
Glass Ionomer Permanent
Restoration PHP 500.00-
+ 100 per deep restora-
6. Performs tooth
6. Occupies the dental Dentist
extraction and
chair and cooperates None 60 minutes Dental
check for signs of Department
with tooth extraction.
complication.
7. Instructs pa-
Dentist
tients for home
7.None None 5 minutes Dental Depart-
medications and ment
instructions.
Varies depending on all 2 hours
TOTAL:
incurred charges
17. ARV Refill

This covers the refill of Antiretroviral (ARV) Treatment for HIV & Hepa B Treatment Hub patient.
Office or Division: Jose C. Payumo Jr. Memorial Hospital / HIV & Hepa B Treatment Hub
Patient Medical Record HEARTH Unit
ARV Treatment Card
487
FEES TO PROCESSING PERSON RE-
BE PAID TIME SPONSIBLE
1. Categorizes patient
Nurse I
as non-COVID case and
1. Arrives in the Triage. None 7 minutes HIV & Hepa B
creates patient medical
Treatment Hub
record.
2.1 Retrieves patient
Nursing attendant
2. Proceeds to HEARTH medical record.
I / Nurse I
Unit. Present ARV Treat- 2.2 Takes vital signs None 15 minutes
HIV & Hepa B
ment Card. and perform brief physi-
Treatment Hub
cal assessment.
3. Performs adherence
3. Cooperates with ad- counseling and assess- Nurse I
herence counselling and es patient current medi- None 30 minutes HIV & Hepa B
verbalizes concerns. cal condition and com- Treatment Hub
pliance.
4. Cooperates with la- 4.1 Collects blood sam- 15 minutes Medical Technolo-
boratory and x-ray pro- ple for monitoring of Varies de- gists (HIV & Hepa
cedure; if requested. CD4 count. pending on B Treatment Hub) /
4.2 Performs chest x- incurred Radiologic Tech-
ray. charges nologist
Nurse I
5. Awaits for the ARV 4. Refills pill bottle and
None 15 minutes HIV & Hepa B
refill. other medications.
Treatment Hub
5. Fills up and signs Nurse I

6. Out Patient HIV/ AIDS
documents for philhealth None 5 minutes HIV & Hepa B
Treatment Package
Claims Treatment Hub
5. Advises follow-up as
Nurse I
prescribed on the date
6. None None 5 minutes HIV & Hepa B
written on Treatment
Treatment Hub
Card.
Varies de-
pending on 1 hour, 5
TOTAL: incurred
minutes
charges
18. Pre-exposure Prophylaxis Initiation (PrEP)

It is an HIV preventive service and treatment that is continuing to evolve.
ARV Treatment Card
488
PRO-
FEES TO PERSON
BE PAID RESPONSIBLE
TIME
Nurse I
non-COVID case and cre-
1. Arrives in the Triage. None 7 minutes HIV & Hepa B Treat-
ates patient medical rec-
ment Hub
ord.
2.1 Retrieves patient med-

Nursing Attendant I /
2. Proceeds to ical record.
Nurse I
HEARTH Unit. Present 2.2 Takes vital signs and None 10 minutes
HIV & Hepa B Treat-
ARV Treatment Card. perform brief physical as-
ment Hub
sessment.
3. Provides an overview
Nurse I
3. Cooperates STI Di- and definition of HIV/
None 30 minutes HIV & Hepa B Treat-
agnostics Counselling AIDS, STI and Viral Hepa-
ment Hub
titis
4. Cooperates with 4. Collects blood sample None 10 minutes Medical Technolo-
specimen collection for STI/ HIV/ Hepa B Diag- gists
(blood). nostic test and for Creati- (HIV & Hepa B Treat-
nine level. ment Hub) /
Radiologic Technolo-
5. Receives the results 5. Releases official result. None 45 minutes Medical Technolo-
of STI Diagnostics. If Non-reactive to HIV, gists
proceed with PrEP Initia- (HIV & Hepa B
tion. If reactive, may pro- Treatment Hub) /
ceed Antiretroviral Treat- Radiologic Technolo-
ment Initiation counselling. gist
Medical Officer III/

6. Cooperates with 6. Provides thorough dis-
Nurse I
PrEP Initiation Coun- cussion on ways how to None 45 minutes
HIV & Hepa B
selling use PrEP.
Treatment Hub
5. Perform brief physical Medical Officer III/
examination to rule out Nurse I
7. None None 10 minutes
any possible Sexually HIV & Hepa B
Transmitted Infection. Treatment Hub
Nurse I
8. Waits for the release 5. Gives the PrEP pill bot-
of PrEP pill. tle.
Treatment Hub
5. Advises follow-up as
Nurse I
9. Receives the Treat- prescribed on the date
ment card. written on Treatment
Treatment Hub
Card.
2 hours, 47
TOTAL: None
minutes
489
19. Antiretroviral Treatment Initiation (HIV/Hepa B)
It is he start of HIV treatment after the dianosis of HIV infection.
ARV Treatment Card
FEES TO PROCESSING PERSON RESPONSI-
BE PAID TIME BLE
1. Categorizes patient
Nurse I
1. Arrives in the Tri- as non-COVID case
age. and creates patient
Treatment Hub
medical record.
2.1 Retrieves patient
Nurse I/ Nursing At-
medical record.
2. Proceeds to tendant
2.2 Takes vital signs None 10 minutes
HEARTH Unit. HIV & Hepa B
and perform brief physi-
Treatment Hub
cal assessment.
3. Listens and under- 3. provides a thorough None 45 minutes Medical Officer III/
standsto what is being discussion on how to Nurse I
discussed in counsel- take ARV and what to HIV & Hepa B
ling on treatment initia- avoid during initiation Treatment Hub
tion. phase and what are the
general side effects to
expect upon treatment
initiation.
4. Receives the medi- 4.1 Releases medica- None 13 minutes Nurse I/ Nursing At-
cations and Treatment tions (ARV, Prophylax- tendant
Card. is) with brief discussion HIV & Hepa B Treat-
of treatment card. ment Hub
4.2 Advises follow-up

as prescribed on the
date written on Treat-
1 hours, 15
TOTAL: None
minutes
490
20. Dispensing of Medicines and Supplies
Covers the issuance of medicines and medical supplies of pharmacy.
Office or Division: Jose C. Payumo Jr. Memorial Hospital / Pharmacy
Type of Transaction: G2C - PHP Government to Citizen
Who may avail: ALL
Prescription Physician/ Dentist/ Nurse
Charge Slip Pharmacy
PRO-
BE PAID SIBLE
TIME
1.1 Issues prescription of
medicines and supplies.
1. Receives the Prescrip- Medical Officer/Dentist/
Nurse
tion for the needed medi- 1.2 Instructs to proceed to None 5 minutes Emergency or Out Pa-
cines and supplies. Pharmacy to buy/collect tient Department
medicines and medical
supplies.
2. Verifies and collects

2. Awaits for verification if Pharmacist
available medicines and None 5 minutes
medicines are available. Pharmacy
supplies.
3. Logs patient in the

3. Awaits for the charge Pharmacist
iHOMIS database and is- None 5 minutes Pharmacy
slip.
sues charge slip.
4. Proceeds to Cashier for 4. Collects the prescribed Depends 7 minutes Cashier

payment. amount and issues official on Medi-
receipt. cine Price
LIST OF FEES
Medicines:
0.9% Saline, 50 ml. - PHP 78.00 Amoxicillin 250 mg/5ml.,60ml. - PHP 34.78
0.9% Sodium Chloride for irrigation, 1 lit - PHP Amoxicillin 500 mg tab - PHP 3.00
107.00 Ampicillin+Sulbactam 500/250 mg.- PHP226.00
A.T.S. 1,500 I.U. - PHP 182.00 Ampicillin 1g (IM,IV) - PHP 26.00
A.T.S. 3,000 I.U. - PHP 185.00 Ampicillin 250 mg. - PHP 24.00
Acetylcysteine 600mg tab - PHP 46.00 Ampicillin 500 mg. - PHP 16.00
Activated Charcoal Sachet 100g - PHP 256.00 Anti- PHPRabies Serum, (equine)
Acyclovir 200mg - PHP 13.00 Ascorbic Acid (Vitamin C) 500 mg Tab- PHP2.00
Adenosine 3mg/ml - PHP 1,389.00 Ascorbic Acid (Vitamin C) syrup, 60 ml. - PHP
Allopurinol 300 mgt ab - PHP 18.00 143.00
Al (Mg OH) 225 mg tab - PHP 3.00 Ascorbic Acid (Vit. C) 250 mg/m amp - PHP 52.00
Amikacin 250mg/ml., 2ml. - PHP 150.00 Aspirin 80 mg. Tablet - PHP 2.00
Amino Acid + Sorbitol amp - PHP 543 Atenolol 50 mg tab - PHP 5.00
Aminophylline 25 mg./ ml. 10 ml. - PHP 54.00 Atorvastatin 40 mg tab. - PHP 7.00
Amiodarone 200 mg - PHP 48.00Amlodipine Besyl- Atorvastatin 80mg tab - PHP 30.00
ate 10 mg. - PHP 2.00 Atropine Sulfate 1mg/ml. - PHP 130.00
Amlodipine Besylate 5 mg. - PHP 1.50 Azithromycin 200 mg/5 ml, 15 ml. - PHP 700.00
Amoxicillin 250 mg. cap. - PHP 2.00 Azithromycin 500 mg - PHP 54.00
491
Benzyl Penicillin Sodium 1M unit - PHP 20.00 Distilled Water for inj. 50 ml. - PHP 78.00
Benzyl Penicillin Sodium 5M unit - PHP 35.95 Dobutamine 12.5mg/ml., 20 ml. (IV) - PHP 771.00
Betahistine tab. 16 mg. - PHP 20.00 Dobutamine 12.5mg/ml., premixed - PHP 1234.00
Betahistine tab. 24 mg. - PHP 71.50 Dopamine 40 mg/ml.,5ml. - PHP 100.00
Bisacodyl 10 mg. supp. - PHP 98.00 Doxycycline 100 mg cag (as Hydrate) - PHP 19.50
Bisacodyl 5 mg. supp. - PHP 52.00 Dydrogesterone 10 MG TAB - PHP 5.3.00
Budesonide 250mcg/ml., 2 ml. resp - PHP 100.00 Enoxaparin 4,000 iu - PHP 660.00
Bupivacaine hcl. Heavy, 5 mg/ml. 4 ml. - Enoxaparin 6,000 iu- PHP 990.00
PHP987.00 Ephedrine 50mg/ml. 1 ml. - PHP108.00
Butamirate citrate 500mg - PHP 25.00 Epinephrine amp.1 mg/ml., 1 ml - PHP 85.00
Calcium Gluconate 10% 10 ml. - PHP 100.00 Epoetin Alfa 4000 IU/0.4 ml. - PHP 845.00
Captopril 25 mg. tablet - PHP 4.00 Famotidine 20 mg tab - PHP 26.00
Carbociestine 250 mg. syrup - PHP 67.00 Fenofibrate 200 mg. cap. - PHP 23.00
Carboprost 125 mg - PHP 715.00 Fentanyl 50 mcg, 2 ml. amp - PHP 139.00F
Castor oil 120 ml- PHP 200.00 Fluticasone + Salmeterol 50 mcg + 25 mcg.
Carvedilol 6.25 mg. tab. - PHP 13.00 Fluticasone Propionate 25mcg inhaler- PHP 216.00
Cefalexin 250 mg/5ml. Susp., 60 ml. - PHP 42.90 Furosemide 10 mg. / ml. 2 ml. - PHP
Cefazolin 1 g ( as soldium salt) - PHP 143.00 Furosemide 40 mg. tablet
Cefixime 200mg/100ml drops - PHP 250.00 Gabapentin 300 mg. - PHP 32.00
Ceftazidime 1 gram vial - PHP 93.00 Gentamycin 40 mg/mL,2ml. - PHP 34.00
Ceftriaxone 1g vial - PHP 41.00 Gliclazide 80 mg tab - PHP 6.00
Cefuroxime 500 mg. tablet - PHP 42.00 Heparin Sodium 1000 IU/ml. 5 ml. - PHP83.00
Cefuroxime 750 mg vial - PHP 53.00 Hexitidine 60 ml.
Celecoxib 200 mg. capsule - PHP 23.00 Hydralazine 20mg/ml., 1` ml. - PHP 339.00
Cetirizine drop 10 ml- PHP 71.00 hydrochlorthiazide 25 mg.- PHP 4.00
Chloramphenicol 1 gram vial - PHP 63.00 Hydrocortisone 100mg. Vial- PHP 91.00
Chlorphenamine 10mg/ml., 1 ml. (IM/IV) - PHP Hydrocortisone 250 mg vial - PHP 120.00
34.00. Hydroxyzine 10mg tab - PHP 31.00
Chlorpromazine 200 mg. tab. - PHP 65.00 Hydroxyethyl starch 6% sol. 500 ml.- PHP 900.00
Chlorpromazine 25 mg./ ml. - PHP 136.00 Hyoscine 10 mg tab - PHP 8.00
Cinnarizine 75 mg, oral - PHP 164.00 Hyoscine N- PHPButyl Bromide 20mg/ml - PHP
Ciprofloxacin 2 mg/ml. sol. 100 ml. - PHP 267.00 75.00
Ciprofloxacin 500 mg tab - PHP 5.00 Ibuprofen 200 mg/5 ml., 60 ml. - PHP 130.00
Clarithromycin 125 mg/5ml., 60 ml.- PHP156.00 Ibuprofen 400 mg. - PHP 10.00
Clindamycin 150 mg/ ml. 4 ml. - PHP 228.00 Ipratropium + Salbutamol 500mcg /2.5mg/2.5ml
Clonidine 150 mcg. Tab - PHP 16.00 Isoflurane 100%inhalation - PHP 99.00
Clopidogrel 75 mg. - PHP 18.00 Isosorbide Dinitrate 1 mg./ml. 10 ml. - PHP 862.00
Cloxacillin 250 mg/5 ml. Syrup, 60 ml.- PHP 54.00 Isosorbide Dinitrate 5 mg. SL Tablet - PHP 27.00
Cloxacillin 500 mg (as sodium salt) - PHP 48.00 Isosorbide- PHP5- PHPMononitrate 30 mg - PHP
Co- PHPAmoxiclav 250 mg.5 ml. susp. 60ml. 44.00
350.00 Isoxsupine Hcl. 10 mg. - PHP 33.00
Co- PHPAmoxiclav 625 mg. - PHP 24.00 Isoxsuprine Hcl. 5mg/2ml. - PHP 285.00
D10% Water 1 liter - PHP 102.00 Ketamine Hcl. 50 mg/ml., 10 ml. - PHP 289.00
D10% Water 500 ml. - PHP 99.00 Ketorolac 30 mg/ml. 1 ml.- PHP 86.00
D5% 0.3% Nacl. 500 ml. - PHP 93.00 Lactulose 3.3g/5 ml. syrup 120 ml. - PHP 174.00
D5% IMB 500 ml. - PHP 93.00 Lagundi tab. 300 mg. - PHP 3.00
D5% LRS 1 liter - PHP 104.00 Levofloxacin 500 mg - PHP 63.00
D5% Normosol M 1 liter - PHP 104.00 Levothyroxine 50mcg - PHP 11.00
D5% Normosol R 1 liter - PHP 99.00 Lidocaine 2%, 5 mL - PHP 40.00
D5% NSS 1 liter - PHP 86.00 Lidocaine 2% 50 ml. vial - PHP 130.00
D5% Water 1 liter - PHP 96.00 Losartan 100 mg. tablet - PHP 13.00
D5% Water 250 ml. - PHP 219.00 Losartan 50 mg. tablet - PHP 7.00
D5% Water 500 ml. - PHP 91.00 Losartan HCTZ 50 mg. + 125 mg. - PHP 20.00
Dexamethasone 4mg/ml., 2 ml. (amp/vial) - PHP
60.00
Dextran 70% Water, 500 ml. - PHP 974.00
Diazepam 10 mg/ 2 ml. amp. - PHP 187.00
Digoxin 250 mcg/mL, 2 ml. - PHP 323.00
Diphenhydramine 50mg/ml. amp - PHP 74.00
492
Magnesium Sulfate 5 g vial- PHP 102.00 Paracetamol 100 mg/5ml. Drops, 15 ml.- PHP
Magnesium Sulfate 500 mg. / 2 ml. amp.- PHP 54.00 63.00
Mannitol 500 ml. - PHP 257.00 Paracetamol 125 mg (rectal) supp - PHP 58.00
Mebendazole 100 mg/5ml. Susp., 60 ml.- PHP Paracetamol 125mg/5ml,60ml syrup- PHP 65.00
170.00 Paracetamol 150mg/ml., 2 ml. (IM/IV) - PHP 33.00
Mebendazole 500 mg tab. - PHP 141.00 Paracetamol 250 mg. supp- PHP 24.00
Mefenamic Acid 250 mg cap - PHP 3.00 Paracetamol 250mg/5ml,60ml syrup- PHP 80.00
Mefenamic Acid 500 mg cap - PHP 3.00 Paracetamol 500 mg/tab. - PHP 2.00
Meperidine Hcl. 50 mg/ml., 2 ml. - PHP 387.00 Phenobarbital 30 mg/bot,- PHP 8.00
Metformin 500 mg tab- PHP 3.00 Phenytoin 100 mg. IV- PHP 384.00
Methyldopa 250 mg tab.- PHP 27.00 Phytomenadione 10mg/ml. - PHP 29.00
Methylergometrine 200 mcg 1 ml.amp - PHP 59.00 Plain LRS 1 liter - PHP 111.00
Methylergometrine Maleate 125 mcg.tab - PHP Plain NSS 1 liter - PHP111.00
20.00 Plain NSS 500 ml. - PHP 104.00
Methylprednisolone 4 mg/tab - PHP 13.00 Potassium Chloride 2 mEq/mL, 20 mL Vial - PHP
Metoclopramide 5 mg./2 ml. ampule- PHP 17.00 53.00
Metoclopramide 10mg tab - PHP 7.00 Potassium Chloride 750 mg. (as durules)- PHP
Metoprolol 100 mg 59.00
Metoprolol 50 mg Prednisone 10 mg./ml., 60 ml.- PHP 364.00
Metronidazole 500 mg IV - PHP 144.00 Prednisone 20 mg tab - PHP 20.00
Metronidazole 500 mg. tablet - PHP 2.00 Propofol 10mg/ml, 20 ml. - PHP 691.00
Midazolam 5mg/ml. 1 ml - PHP 137.00 Promethazine Hcl. amp - PHP 21.00
Montelukast 4mg tab - PHP 15.00 Prophylthiouracil 50mg tab - PHP 15.00
Morphine SO4, 10 mg/ml., 1 ml. - PHP 162.00 Propranolol 10mg - PHP 16.00
Mupirocin Ointment 2%, 15 g - PHP Pyrantel + Oxantel Suspension- PHP 220.00
Multi Vitamin + dextrose 550 ml. Ranitidine 150 mg tab - PHP 5.00
N- PHPAcetyl Cysteine 200 mg. Ranitidine 25 mg/mL, 2ml. - PHP 25.00
N- PHPAcetyl Cysteine 600 mg. Rebamipide 25 mg / ml. 2 ml.
Nalbuphine Hcl. 10 mg/ml. 1 ml Regular Insulin 100 IU/ml. 10 ml. - PHP 845.00
Naloxone 400 mcg/mL, 1 mL Ampule - PHP 650.00 Rosuvastatin 20mg - PHP 42.00
Nicardepine 1mg/ml. 2 ml.- PHP 207.00 Salbutamol 2 mg/ml,2.5 mg neb - PHP 36.00
Nicardepine ampule 1mg/ ml., 10 ml.- PHP 350.00 Salbutamol 100 mcg. / dose x 200 MDI- PHP
Nifedipine 10 mg cap - PHP 20.00 201.00
Norepinephrine 2 mg amp. - PHP 728.00 Salbutamol 2 mg/5 ml. 60 ml. syrup - PHP 40.00t
Ofloxacin 200 mg. - PHP 27.00
Omeprazole 20 mg. tablet - PHP 13.00
Omeprazole 40 mg, 10 ml. with diluent- PHP 173.00
Omeprazole 40 mg. tablet - PHP 33.00
Oresol Sachet 20.5 g - PHP 26.00
Oxytocin 10 I.U/ml, 1 ml. - PHP 25.00
5. Presents the Official Re-

5, Gives the medicines
ceipt and receives the pro- Pharmacist
and supplies after presen- None 3minutes
cured medicines and sup- Pharmacy
tation of Official Receipt.
plies.
Varies de-
pending on all
TOTAL: 25 minutes
incurred
charges
493
21. Radiology - X-ray
X-ray, form of medical imaging, assists in the diagnosis and treatment of medical conditions.
Office or Division: Jose C. Payumo Jr. Memorial Hospital/ Radiology Department

Who may avail: ALL
Radiology Request Form Physician/ Nurse

Charge Slip Radiology
Official Receipt/ Acknowledgement Receipt Cashier
PRO-
FEES TO BE PERSON RE-
PAID SPONSIBLE
TIME
1. Issues request for

imaging procedure
and instructs/ assissts Medical Officer I/
1. Receives the x-ray re- Nurse
to Radiology Depart- None 7 minutes Emergency or Out
quest.
ment depending on Patient Department
the case of the pa-
tient.
2. Verifies patient's
2. Proceeds to Radiology identity and complete- Radiologic Technol-
ogist
department and presents ness of data and logs None 8 minutes Radiology
the request. in the iHOMIS data- Department
base.
3. Performs appropri- Radiologic Technol-

3. Awaits for the x-ray ate imaging proce- ogist
None 40 minutes
procedure. dure and processes Radiology
the film. Department
494
4. Receives 4. Issues charge "*Chest PA - PHP 160.00 10 minutes Radiologic Technologist
the charge slip and instructs *Ankle APL - PHP 160.00 Radiology Department
slip and pro- to pay to the Cash- *Knee Bilateral AP only - PHP
ceeds to ier. 160.00
Cashier for *Apicolordotic View - PHP
160.00 Cashier
payment. *Chest AP - PHP 160.00 Cashier Section
*Chest AP Sitting -PHP
160.00
*Arm (Humerus) APL - PHP
200.00
*Clavicle AP - PHP 200.00
* Elbow AP - PHP 200.00
*Scapula AP - PHP 200.00
*Shoulder AP - PHP 200.00
*Towne’s View - PHP 180.00
* Water’s View - PHP 180.00
* Wrist APL - PHP 200.00
*KUB - PHP 200.00
*Forearm APL -PHP 200.00
*Foot APL - PHP 200.00
*Foot APO - PHP 200.00
*Hand/Digit APL -PHP 200.00
*Hand/Digit APO - PHP
200.00
*Hip/Pelvic AP - PHP 200.00
* Knee APL - PHP 200.00
*Leg APL - PHP 200.00
*Mandible APL - PHP 320.00
*Nasal Bone (R&L) - PHP
180.00
*Oscalsis view - PHP 200.00
*Pelvic (Frog Leg View) -
PHP 200.00
*Femur/Thigh APL - PHP
200.00
*Thoracic Cage AP - PHP
170.00
*Zygomatic View -PHP 160.00
*Abdomen Lateral -PHP
185.00
*Abdomen Upright - PHP
185.00
*Babygram/ Fetus Gram -PHP
320.00
*Elbow Bilateral -PHP 400.00
*Clavicle Bilateral - PHP
340.00
*Forearm Bilateral - PHP
400.00
*Hand Bilateral - PHP 400.00
*Knee Bilateral - PHP 400.00
*Foot Bilateral - PHP 400.00
*Leg Bilateral - PHP 400.00
*Sacrum APL - PHP 320.00
*Shoulder APL - PHP 400.00
*Wrist Bilateral - PHP 400.00
*Chest Lateral Decubitus -PHP
495
5. Presents the Official 5. Verifies the Official
receipt and inform the receipt and temporari-
nurse that the x-ray film ly gives the x-ray film Radiologic Technolo-
can now be borrowed to to the Emergency de- None 5 minutes gist
the Radiology section for partment nurse with Radiology Department
initial reading of the re- instruction to return it
questing physician. for official reading.
6. Sends film to Radi-
6. Returns the x-ray films ologist for official Radiologic Technolo-
and waits for the Official reading of result then None 5 minutes gist
result. issues it to the pa- Radiology Department
tient.
Varies depend-
1 hour, 5
TOTAL: ing on all in-
minutes
curred charges
22. Clinical Laboratory

Clinical area focus on collection and processing of blood, serum, urine and stool for various diag-
nostic examinations
Office or Division: Jose C. Payumo Jr. Memorial Hospital / Laboratory Department
Who may avail: ALL
Laboratory Request Form Physician/ Nurse
Charge Slip Laboratory
Official Receipt/ Acknowledgement Receipt Cashier
Laboratory Result Laboratory
PRO-
FEES TO PERSON RESPONSI-
CLIENTS STEPS AGENCY ACTION CESSIN
BE PAID BLE
G TIME
1. Issues request for la- Physician/ Nurse
1. Receives the labor- 5
boratory tests and sends None Emergency or Out Patient
atory request. minutes Department
to Laboratory Department.
2. Proceeds to Labora- 2. Verifies patient's identi-
Medical Technologist
tory department and ty and completeness of 8
None Clinical Laboratory Depart-
present the laboratory data and logs in the minutes ment
request. iHOMIS database.
3.1 Collects specimen
(blood).
3. Awaits for specimen 3.2 Instructs the patient to Medical Technologist

collection and pro- properly collect specimen None 4 hours Clinical Laboratory Depart-
cessing. like urine and stool. ment
3.3 Processes the sample/

specimen appropriately.
496
4. Receives 4. Issues "A. All Stat Procedures - Depends on the 10 Cashier
the charge charge slip procedure minutes
slip and pro- and instructs B. Clinical Microscopy
ceeds to to pay to the * Routine Urinalysis - PHP 80.00
Cashier for Cashier. * Routine Fecalysis -PHP 80.00
* Occult Blood -300.00
payment. * Pregnancy Test -150.00
C. Hematology
*CBC - 230.00
* CBC withPlatelet Count -275.00
* CT BT - 100.00
* Protime (PT) - 750.00
* Activated Partial
Thromboplastine Time (APTT) -750.00
* Malarial Smear - Non-Charge
D. Blood Chemistry
*RBS (Capillary Blood - 150.00
Glucose)
* FBS -150.00
* BUN - 150.00
* Creatinine - 150.00
* Cholesterol - 150.00
* Blood Uric Acid - 150.00
* Tryglycerides - 250.00
* HDL/LDL - 500.00
* SGOT - 230.00
* SGPT - 230.00
* Na, K, Cl package - 600.00
E. Microbiology
* AFB Staining (Sputum) / Trugnat - Non-Charge
* GRAM Staining - 150.00
* Wet Smear/ KOH - 150.00
F. Serology/ Blood Banking
* ABO-Rh Typing - 200.00
* Hepa B Surface Ag - 160.00
* VDRL/ Syphilis - 250.00
* Rapid Screen Testing - Non-Charge
* Dengue NS1 - 1,200
* Dengue Duo -PHP 1,200.00
* Typhidot - PHP 600.00
* Cross Matching - PHP 700.00
G. COVID Ag Test - PHP 850.00
H. Special Examinations
* Troponin I - PHP 1,000.00
* CK-MB - PHP 1,000.00
* PSA - PHP 950.00
* TSH - PHP 650.00
* T3 - PHP 600.00
* T4 - PHP 450.00
* fT3- PHP 600.00
* fT4 - PHP 650.00
* HbA1c - PHP 700.00
I. Newborn Screening
* Newborn Screening Test
(Expanded) - PHP 1,800.00- Depends on the
procedure
497
5. 5. Presents the Offi- Medical Technolo-
Verifies the Official re-
cial receipt and ob- 7 gist
ceipt and release the re- None
tains the results on minutes Clinical Laboratory
sults. Department
the instructed time.
Varies depending 4 hours
TOTAL: on all incurred and 30
charges minutes
23. Swabbing
Detection of COVID-19 Disease can only be seen by performing OPS and NPS and submit for RT
-PCR testing in a molecular laboratory.
Office or Division: Jose C. Payumo Jr. Memorial Hospital/ Clinical Laboratory Department
Who may avail: Patients, Staff
Case Investigation Form COVID-19, Laboratory
Request Form Laboratory
PhilHealth Forms PhilHealth
Valid ID and Birth or Marriage Certificate (1 Government Agencies
photocopy)
1. Interviews the patiet
and fills-in the Case
Nurse I
1. Submits information that Investigation Form
None 20 minutes Emergency or Out
are required. COVID-19, Laboratory Patient Department
Test Request Form, and
other PhilHealth Forms
2. Submits the forms for

2. Awaits for the schedule scheduling of patient of Nurse
of swab test. for swab test. Emergency or Out
Patient Department
None 5 minutes Medical
2.1 Returns to the 2.1 Verifies the Technologist
Laboratory on the completeness of forms Clinical Laboratory
scheduled date and time. and attachments; then Department
provide schedule.
3. Attaches unique
barcode on the forms Medical
Technologist
3. None and encodes all data in None 10 minutes Clinical Laboratory
the Bataan - BGHMC Department
Online Referral System.
498
4. Verifies the
PHP 2800
4. None completeness of all 1 day BGHMC
(1)
forms.
5. Proceed to 5. Performs OPS and
Laboratory's NPS following strict Medical Technologist
designated swabbing infection control None 15 minutes Clinical Laboratory
area on the scheduled procedure wearing a Department
date and time. level 3/4 PPE.
6. Submits the samples Clerk/ Medical

and all documentary Technologist
6. None None 1 hour
requirements to BGHMC Clinical Laboratory
Molecular Laboratory. Department
7. Updates the system for

the status of the result.
7. Collects the result Nurse
on the specified date None 1 day Emergency or Out Patient
Validates the result prior
and time. Department
to official release and
printing of result.
TOTAL: 2,800 2 days, 1
hour, 50
minutes
24. Hospital Certificates: Issuance of Certificates
Covers the interview, encoding and releasing of requested hospital certificate.
Office or Division: Jose C. Payumo Jr. Memorial Hospital/ Records Section
Who may avail: ALL
Hospital Card
Valid Identification Card of Patient and In- Government Agencies
formant or ( 1 photocopy)
499
PRO-
PERSON RE-
SPONSIBLE
TIME
1.1 Proceeds to Record 1.1 Get the hospital
Section and request for card and asks to fill
the certificate/s needed. up on the logbook
1.2 Present the hospital indicating the re-
Medical Records
card and valid identifi- quested certificate.
None 8 minutes Clerk
cation card. 1.2 Retrieves pa- Records Section
tient record.
1.3 Issues charge
slip.
2.1 Presents the charge 2. 3. Collects pay- Medical Certificate- Php 7 minutes Cashier
slip to the cashier. ment for requested 120.00 Cashier Section
certificate. Medico-Legal Certificate-
2.2 Pay the amount in- Php 150.00
Certificate of Confinement
dicated. - Php 120.00
Medical Abstract- Php
200.00
Discharge Summary- Php
120.00
Operation Report- Php
120.00
Surgical Memorandun-
Php 120.00
Additional copy of Certifi-
cates- Php 30.00
Certified True Copy- Php
100.00 for every docu-
ment, additional Php
20.00 for second page
and every succeeding
pages
2.1 Encodes the
requested certifi-
cate. Medical Records
3. Awaits for the issu- 10
2.2 Facilitates sign- None Clerk
ance of certificate. minutes Records Section
ing of attending
physician on the
certificate.
4.1 Presents the Official

Receipt.
Medical Records
4.2 Receives the re- 4. Issues the re-
quested certificate, ver- quested certificate. Records Section
ifies the details and
signs the logbook upon
receipt.
Varies depending on 30
TOTAL:
incurred charges minutes
500
25. Hospital Certificate: Birth Certificate
Covers the interview, encoding and releasing of birth certificate.
Type of Transac-
Who may avail: ALL
Valid Identification Card of Patient and Informant or ( 1
photocopy)
Any two supporting documents of patients' identifica-
Government Agencies
tion. (1 photocopy)
Marriage Contract (1 photocopy)
CEDULA (1 original and 1 photocopy)
PRO-
FEES TO PERSON RE-
BE PAID SPONSIBLE
TIME
1.1 Verifies the information
written in the Birth certificate
1. Proceeds to Records template collected daily from
Medical Records
Section and checks the the wards.
information of patient 1.2 Signs the form. Records Section
and informant. (The initial information for birth
certificate is obtained from
mothers.)
2.1 Checks for the Cedula and
2. Presents Cedula and Valid I.D. Asks the father to
Medical Records
Valid Identification sign the template.
Card then signs on the 2.2 Issues charge slip and in- Records Section
birth certificate. struct the relative to pay to the
Cashier.
3. Receives the charge

3. Collects payment for Birth PHP Cashier
slip and proceed to 5 minutes Cashier Section
Certificate. 50.00
Cashier for payment.
4. Awaits for the issu- Medical Records

4. Encodes the information as
ance of Birth Certifi- None 10 minutes Clerk
verified. Records Section
cate.
5.1 Present the Official5.1 Issues the Birth certificate
Receipt. and instructs the informant to
proceed to Local Civil Regis-
Medical Records
5.2 Receives the Birth trar in the Municipal Office.
Certificate then pro- Records Section
ceed to Local Civil 5.2 Signs the logbook and
Registrar for Registra- waiver form as a proof of re-
tion. ceipt and details verification.
PHP 30
TOTAL:
50.00 minutes
501
26. Hospital Certificate: Death Certificate
Covers the interview, encoding and releasing of death certificate.
Who may avail: ALL
Valid Identification Card of Patient and Informant Government Agencies
or
Any two supporting documents of patients' identi-
fication (for verification purposes)
PRO-
BE PAID SIBLE
TIME
1. Verifies the infor-
1. Proceeds to Records mation written in the
Section and checks the Death certificate tem- Medical Records Clerk
None 10 minutes
information of patient and plate collected daily Records Section
informant. from the wards. Signs
the form.
2. Presents a Valid I.D. 2.1 Verifies details of

or any supporting docu- patient.
Medical Records Clerk
ment for patients' identifi- 2.2 Issues charge slip None 5 minutes Records Section
cation and that of the in- and instruct the relative
formant. to pay to the Cashier.
3. Receives the charge

3. Collects payment for Cashier
slip and proceed to cash- PHP 50.00 5 minutes
death Certificate. Cashier Section
ier for payment.
4. Awaits for the issu- 3. Encodes the infor- Medical Records Clerk
None 10 minutes
ance of Death Certificate. mation as verified. Records Section
5.1 Present the Official

4.1 Issues the Death
Receipt.
Certificate and instructs
5.2 Receives theDeath
the informant to pro-
Certificate then proceed
ceed to Local Civil
to Local Civil Registrar
Registrar in the Munici-
for Registration. Medical Records Clerk
pal Office. None 5 minutes Records Section
4.2 Signs the logbook
and waiver form as a
proof of receipt and de-
tails verification.
TOTAL: PHP 50.00 30 minutes
502
27. Outgoing Referrals to Bataan General Hospital
Process of proper coordination and referral through use of service delivery network to Batan
General Hospital (BGH).
Type of
Transaction: G2C - Government to Citizen
Referral Form Ward/ Emergency Room/ Delivery Room
Discharge Clearance
1. Decides on the
advise of patients' 1. Orders transfer to a
transfer to higher higher facility and explains Medical Officer I
None 30 minutes
facility. Signs the the need for referral. Emergency Department
consent for transfer
to hospital.
2. Coordinates the referral
2. Waits for the either by accomplishing a
approval of the higher written Referral Form, Medical Officer I
None 3 hours
facility to proceed telephone call or use of Emergency Department
with transfer. Bataan-BGHMC Online
Referral Form.
3. Carries out the doctor's
3. Awaits transfer of
order and notify the Nurse
patient to higher None 10 minutes
Ambulance Driver once Emergency Department
facility.
approved.
4. Instructs the relative on Nurse, Medical

4. Proceeds to Technologist, Radiologic
the discharge process or if
discharge process Ambulanc Technologist,
needs immediate transfer,
until the discharge e Fee- 15 minutes Pharmacist,
the nurse assists the Billing Clerk, Cashier
clearance is signed PHP 500
relative for discharge Emergency Department/
and released.
clearance ADMIN Section
5. Transports the patient

via ambulance.
5. Proceeds with Monitors the patient during Ambulance Driver
transfer to the referral conduction and endorses None 30 minutes Nurse
facility. all medical treatment and Emergency Department
management to the
referral facility.
4 hours, 25
TOTAL: PHP 500
minutes
503
28. Outgoing Referrals to Jose B Lingad Memorial Hospital
Process of proper coordination and referral through use of service delivery network to Jose B.
Lingad Memorial Hospital (JBLMH)
Type of
Referral Form Ward/ Emergency Room/ Delivery Room
Discharge Clearance
PROCES
FEES TO PERSON
CLIENTS STEPS AGENCY ACTION SING
BE PAID RESPONSIBLE
TIME
1. Decides on the
advise of patients'
1. Orders transfer to a higher
transfer to higher 30 Medical Officer I
facility and explains the need None
facility. Signs the minutes Emergency Department
for referral.
consent for transfer to
hospital.
2. Coordinates the referral
either by accomplishing a
2. Waits for the approval
written Referral Form, Medical Officer I
of the higher facility to None 3 hours Emergency Department
telephone call or use of
proceed with transfer.
Bataan-BGHMC Online
Referral Form.
3. Carries out the doctor's
3. Awaits transfer of order and notify the 10 Nurse
None
patient to higher facility. Ambulance Driver once minutes Emergency Department
approved.
Nurse, Medical
4. Instructs the relative on the Technologist,
4. Proceeds to
discharge process or if needs Ambulanc Radiologic
discharge process until
immediate transfer, the nurse e Fee- 15minutes Technologist,
the discharge clearance Pharmacist,
assists the relative for 1,000
is signed and released. Billing Clerk, Cashier
discharge clearance
ADMIN Section
5. Transports the patient via

ambulance.
5. Proceeds with Monitors the patient during Ambulance Driver
transfer to the referral conduction and endorses all None 1 hour Nurse
facility. medical treatment and Emergency Department
management to the referral
facility.
4 hours,
TOTAL: PHP 1000 55
minutes
504
29. Billing (For NBB Patients)
Covers and verifies all the incurred charges and prints the statement of account.
Office or Division: Jose C. Payumo Jr. Memorial Hospital/ Billing Section
Type of
Discharge Clearance ER/Ward
FEES
PROCESSIN PERSON
G TIME RESPONSIBLE
PAID
1. Verifies the
completeness of all
1. Presents the Discharge Billing Clerk
incurred charges from None 5 minutes
clearance. Billing Section
the Discharge
Clearance
2. Applies applicable
benefit based on the
case rate of the final PhilHealth Clerk
2. Proceeds to Philhealth None 10 minutes
diagnosis and checks Philhealth Section
eligibility for Philhealth
benefits.
3. Logs final diagnosis
and ICD Code,
3. Returns to Billing
professional fee, and
section and waits for the Billing Clerk
hospital stay in the None 10 minutes
statement of account and Billing Section
iHOMIS database.
discharge clearance.
Prints Itemized Billing
Statement
4. Logs benefit package
PhilHealth Clerk
4. None in the iHOMIS database None 5 minutes Billing Section
and prints CSF and CF1
5. Verifies the
completeness of all
documents and prints
5. Waits for the final Billing Clerk
the Final Statement of None 5 minutes
statement of account. Billing Section
Account. If Philhealth
eligible, no fee shall be
collected.
6. Receives the discharge 6. Receives the

clearance and submits discharge clearance Billing Clerk
None 5 minutes
one copy to the Nursing with sign and noted for Billing Section
Station. release.
TOTAL: None 40 minutes
505
30. Billing ( Philhealth or non-Philhealth patients with excess bill)
Covers and verifies all the incurred charges and prints the statement of account.
Office or Division: Jose C. Payumo Jr. Memorial Hospital/ Billing Section
Type of Transac-
Discharge Clearance ER/Ward
Statement of Account Billing Section
FEES
PROCESSING PERSON
TIME RESPONSIBLE
PAID
1. Verifies the complete-
1. Presents the Dis- ness of all incurred charg- Billing Clerk
None 5 minutes
charge clearance. es from the Discharge Billing Section
Clearance
2. Applies applicable ben-

efit based on the case
2. Proceeds to Phil- PhilHealth Clerk
rate of the final diagnosis None 10 minutes
health PhilHealth Section
and checks eligibility for
Philhealth benefits.
3. Logs final diagnosis

3. Returns to Billing
and ICD Code, profes-
section and waits for
sional fee, and hospital Billing Clerk
the statement of ac- None 10 minutes
stay in the iHOMIS data- Billing Section
count and discharge
base. Prints Itemized Bill-
clearance.
ing Statement
4. Logs benefit package

PhilHealth Clerk
4. None in the iHOMIS database None 5 minutes Billing Section
and prints CSF and CF1
5.1 Verifies the complete-

ness of all documents and
prints the Final Statement
of Account.
5. Waits for the final 5.2 Instructs the relative Billing Clerk
None 5 minutes
statement of account. to bring the Statement of Billing Section
account to Social Worker
to be advised on how to
augment the excess in
hospital bill.
506
6.1 Proceeds to Social
Worker then to Cashier as
instructed if with excess bill.
6. Checks the Official Billing Clerk/ Cash-
ier/ Social Welfare
6.2 Presents the Official Receipt and signs the Varies 10 minutes Officer
Receipt to Billing section. discharge clearance. ADMIN Section
6. Receives the discharge
clearance and submits one
TOTAL: Varies de- 45 minutes
pending
on all in-
curred
charges
31. Claims Benefits

PhilHealth office processes philhealth claims and packages, benefits eligibility verification, and
updating of membership status.
Office or Division: Jose C. Payumo Jr. Memorial Hospital/ Philhealth Section
Valid Identification Card of Patient and Informant or (1 Government Agencies
photocopy)
Any two supporting documents of patients' identification PhilHealth Office
(1 photocopy)
MDR (Members Data Record)/Philhealth I.D.
PBEF
FEES TO PROCES PERSON
BE PAID SING RESPONSIBLE
1. Proceeds to Philhealth 1. Asks the patient/ relative
10 PhilHealth Clerk
and presents your fills in the PhilHealth None
minutes Philhealth Section
documents. Member Registration Form.
2. Waits for verification of 2. Verifies the patient/ 10 PhilHealth Clerk
None
eligibility. member's eligibility minutes Philhealth Section
3. Advises patient/relative to
submit other documents
3. Waits for other (birth certificate, marriage 10 PhilHealth Clerk
None
documents to be checked. certificate, valid ID) to minutes Philhealth Section
update membership status
using PLINKS
4. Advises patient/relative to
sign and submits other
4. Submits other PhilHealth Clerk
documents (PBEF, Text None 5 minutes
requirements needed. Philhealth Section
BPN, PMRF) to avail benefit
package.
35
TOTAL: None
minutes
507
32. Social Service Assistance
Responsible to various referral and social assistance to financially incapable patients.
Office or Division: Jose C. Payumo Jr. Memorial Hospital/ Medical Social Work Deparment
Social Worker Classification Form Social Service
Patient Benefit Elegibility Form PhilHealth Office
POS Certification Social Service
Referral/ Recommendation Form
1. Assesses and classifies Social Worker
1. Proceeds to Social
patient according to social None 10 minutes Medical Social
Worker office Work
status.
2. Verifies if there is an PhilHealth Clerk
2. None active PhilHealth None 5 minutes Medical Social
membership. Work
3. Enrolls qualified patient
3. Waits for the signed to POS FI and refers Social Worker
or approved discharge unqualified to other None 10 minutes Medical Social
clearance or charge slip. government and non- Work
government organization
TOTAL: None 25 minutes
33. Cash Collection

Section that receives cash payment from various departments
Office or Division: Jose C. Payumo Jr. Memorial Hospital/ Cashier Section
Who may avail: ALL
Charge Slip/ Statement of Account Pharmacy/ Laboratory/ Radiology
Billing Section
FEES TO BE PROCESSI PERSON
PAID NG TIME RESPONSIBLE
1. Receives the
charge slip or
1. Presents charge slip/ Cashier
statement of None 2 minutes
statement of account. Cashier Section
account and states
the amount to pay.
2. Pays the amount 2. Collects cash Cashier
Varies 3 minutes
stated. payment. Cashier Section
3. Issues official
3. Receives the Official Cashier
receipt and records None 2 minutes
receipt. Cashier Section
the transaction.
Varies
depending on
TOTAL: 7 minutes
all incurred
charges
508
34. Newborn Screening
Set of special tests that is use to identify conditions that can affect a child's ;ong-term health or
survival.
Office or Division: Jose C. Payumo Jr. Memorial Hospital/ Laboratory Department
NBS Request Form Laboratory
1.1 Forwards NBS
Request Form to
laboratory. Medical
Technologist schedules
Nurse I
1. Waits for the the time of collection 24
None 10 minutes Clinical Laboratory
schedule of NBS. hrs after birth. Department
1.2 Logs the data in the
NBS Collection
Logbook.
2. Verifies patients'
2. Submits patients' information and Medical Technologist
information by the charges into the PHP 1800 5 minutes Clinical Laboratory
mother. iHOMIS database. Fill Department
up the filter card.
3. Collects blood in the
3. Proceeds to heel of the newborn
laboratory on the and drop it in the filter Medical Technologist
scheduled date and card and advises None 20 minutes Clinical Laboratory
time for collectio of mother to apply Department
blood sample pressure on the
puncture site.
TOTAL: PHP 1800 35 minutes
35. Newborn Hearing Screening Test
Test designated to detect hearing loss for newborn as early as possible.

Office or Division: Jose C. Payumo Jr. Memorial Hospital/ OB Ward
Type of
NBHST Request Form Hearing Screening Nurse/Ward Nurse
509
1. Waits for the 1. Prepares NBHST Request
schedule of Newborn and logs in to the NBHST Nurse I
None 5 minutes
Hearing Screening Request Logbook. OB Ward
Test.
2.Submits patients' 2. Verifies patients'
Nurse I
information by the information and charges into None 5 minutes
OB Ward
mother. the iHOMIS database.
PHP 200
(may be
3. Hold the baby well
3. Performs hearing covered Nurse I
for the newborn 20 minutes
screening on both ears. by OB Ward
hearing screening test.
philhealth
)
4. Relays information
correctly regarding the
screening and implication of
4. Listens and
results, next steps (what to Nurse I
understands health None 10 minutes
do in case of deviations, OB Ward
teachings.
where to refer when
diagnostic test is needed),
use of flyer/brochure for
5. Waits for the result
5. Fills in the Registry Form
of the Newborn Nurse I
for parents, hospital and None 5 minutes
Hearing Screening OB Ward
PhilHealth claim copy.
Test.
6.1 Issues and prints official
result to parent and submits
PhilHealth claim copy to
6. Gets the official Philhealth Office Nurse I
None 5 minutes
result. OB Ward
6.2 Signs the NBHST Result
Logbook to claim the Official
Result.
TOTAL: PHP 200 50 minutes
510
36. HEARTH Counseling and Testing
Counseling and testing for high-risk individuals and key populations.
Office or Division:
Jose C. Payumo Jr. Memorial Hospital/ HIV & Hepa B Treatment Hub
Form 1
HEARTH Request Form
PRO-
FEES TO PERSON RE-
BE PAID SPONSIBLE
TIME
non-COVID case and cre- Nurse I
1. Proceeds to Triage. None 7 minutes
ates patient medical rec- Triage Area
ord.
2. Submits information for Nursing Attendant
2. Retrieves patient medi-
the retrieval of patient None 8 minutes HIV & Hepa B
cal record Treatment Hub
medical record.
3. Listens and under- 4. Provides a quick over-
Nurse I
stands to what is being view and definition of what
discussed in counselling STI, HIV, AIDS and Viral Treatment Hub
before testing for HIV. Hepatits
4. Signs the informed con- Nurse I
3. Asks patient to sign the
sent as proof of under- None 10 minutes HIV & Hepa B
informed consent. Treatment Hub
standing.
5. Cooperate with collect- Nurse I / Medical
5. Collects sample and Technologist
ing blood sample for test- None 5 minutes
performs screening/ testing HIV & Hepa B
ing. Treatment Hub
6.1 Releases official result
and conduct risk assess-
ment and behavioral
6. Receives the result and change management Nurse I
understands the counsel- 6.2 If reactive; proceed None 45 minutes HIV & Hepa B
ling after testing. with Risk Reduction man- Treatment Hub
agement and counselling
on possible Antiretroviral
Treatment Initiation
TOTAL: None 1 hour, 35
511
37. Animal Bite Treatment Center
Provide treatment to patients who have been bitten by potentially rabid animals
Office or Division: Jose C. Payumo Jr. Memorial Hospital/ Animal Bite Treatment Center

Health Declaration Checklist
Triage
Patient Medical Record
Animal Bite Treatment Center
Antirabies Vaccine (ARV) Treatment Card
FEES PRO-
PERSON RESPON-
SIBLE
PAID TIME
Nurse I
non-COVID case and
1. Proceeds to Triage. None 7 minutes Animal Bite Treatment
creates patient medical Center
record.
2.1 Conducts secondary
assessment, vital signs, Nurse I
2. Proceeds to Animal
and history taking. None 10 minutes Animal Bite Treatment
Bite Treatment Area. Center
2.2 Performs wound care.
3. Conducts medical as-
3. Waits for the doctor for sessment and consulta- Medical Officer III
consultation and treat- tion and issues prescrip- None 30 minutes Animal Bite Treatment
ment. tion if antibiotic and teta- Center
nus treatment is needed
4.1 Checks the prescrip-

tion and issues charge
slip.
4. Proceed to Pharmacy 4.2 If the patient is with
Pharmacist I
to buy anti-tetanus vac- Category III animal bite, None 30 minutes Pharmacy
cines he/she is instructed to
proceed to Philhealth to
check eligibility with phil-
health claim
5.1 Administers anti-

5. Waits for the admin- tetanus and/or antirabies Nurse I
istration of antirabies and vaccine (ARV) and issues None 45 minutes Animal Bite Treatment
antitetanus vacines. vaccination schedule. Center
5.2 Advises on follow-up.
TOTAL: None 1 hour, 32
minutes
512

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1.

1.2 If for consultation, catego-

1.4 If non-emergent, follow

2.3 If NOT for consultation,

2. Emergency Room: Consultation & Treatment

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

2.1 Interviews the pa-

3. Emergency Room: Consultation, Diagnostics and Treatment

7. Gathers and interprets

5. Out Patient Department: Consultation with Diagnostic Procedures

4. Takes the laboratory Medical Technologist

5. Brings the laboratory 5. Interprets the diag-

7. May go home if ad-

1.2 Checks the HCI number-

1.4 Takes initial vital signs

2. Waits for the 2. Carries out doctor's order

3. Goes to Nursing 3.1 Receives and document the

10.Proceeds to Cashier 10. Collects the prescribed Varies

12. None 12.1 Transports the patient

3. Explains the procedure to

3. Waits for the Swab: PHP

11. Normal Spontaneous Vaginal Delivery

FEES TO PROCESSI PERSON

1.1 Categorizes patient as non

2. Endorses the patient and

4.1 For patient under active

4.3 Conducts secondary

5. Signs the informed

6. Monitors feeling of 6. Monitors progress of labor,

7. Verbalizes strong and 7. Performs internal

8. Occupies the DR 8. Assists patient in positioning Nurse I

12. Essential Newborn Care

13. Hemodialysis (New Patients)

Government or Non-Government Nephrolo-

1. Categorizes patient as non-

2.1 Conduct physical examina-

3.1 Secure and complete pa-

5. Cleaning and assessment for

6. Provide Hemodialysis treat- Dialysis Nurse/ Dialy-

7. Conduct termination, deccan- Dialysis Nurse/ Dialy-

8. Patient /relative will sign

2. Retrieve and secure pa- Dialysis Nurse

4. Provide Hemodialysis Dialysis Nurse/ Dialy-

6. Patient /relative will sign

3.1 Conduct pre dialysis

2. Arranges the pa-

17. ARV Refill

5. Fills up and signs Nurse I

18. Pre-exposure Prophylaxis Initiation (PrEP)

2.1 Retrieves patient med-

Medical Officer III/

4.2 Advises follow-up

2. Verifies and collects

3. Logs patient in the

4. Proceeds to Cashier for 4. Collects the prescribed Depends 7 minutes Cashier

5. Presents the Official Re-

Office or Division: Jose C. Payumo Jr. Memorial Hospital/ Radiology Department

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Radiology Request Form Physician/ Nurse

1. Issues request for

3. Performs appropri- Radiologic Technol-

22. Clinical Laboratory

3. Awaits for specimen 3.2 Instructs the patient to Medical Technologist

3.3 Processes the sample/