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MUNICIPAL HEALTH OFFICE

MHO

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RAUL V. MANANSALA, MD

Municipal Health Officer

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APPLICATION FORM

NAME POSITION

DAISY L. GEPILANO, DMD Dentist II
IMEE E. INSULAR, RN Nurse III
SHIRLEY P. CASPE, RN Nurse II
LESTER C. DEFENSOR, RN Nurse I
JENNELYN I. ABELARDE, RN Nurse I
  Midwife II
  Midwife II
  Midwife II
  Midwife II
  Midwife II
  Midwife II
  Midwife II
  Midwife II
  Midwife II
  Midwife
  Midwife
  Midwife
  Midwife
  Midwife
  Midwife
  Midwife
  Midwife
MA. RIZA DIONELA, RMT Medical Technologist II
VIDELYN C. BOTACION, RMT Medical Technologist I
RAY E. MAGTULIS, RN, RM Sanitary Inspector
RODRIGO B. RIVERA Dental Aide
  Utility
  Asst. Lab. Tech.
  Data Encoder
  Nurse
  Nurse
  Midwife
  Janitress
  Janitor
  Health Aide
  Field Asst. Worker

VISION:

“Quality Health Care Services to All.”

MISSION:

“To provide preventive, promotive, curative and rehabilitative healthcare regardless of race,

culture, social status, religion, and political affiliation.”

Out-Patient Medical Consultation and/or Issuance of Medical Certificate if Necessary

STEP CLIENT SERVICE PROVIDER DURATION FEES PERSON/S RESPONSIBLE FORM  
1 Out-Patient Show/present documents. (Note: Emergency cases, Senior’s Citizen, Persons with Disability and Pregnant Women has SPECIAL LANE). Scrutinize requirements. Give client a priority number and instruct him/her to wait. 1-2 mins (excluding waiting time depending on the number of clients) None Action Officer Lester C. Defensor, RN Priority Number  
2   Call priority number and get the notebook or referral slip. Look for medical records.Assess client.Interview client.Obtain vital signs and present history of medical condition. 3-5 mins None Action Officer Lester C. Defensor, RN Individual Treatment Record (ITR)  
3   Consultation and physical examination 3-5 mins None Raul V. Manansala, MD ITR    
4 Get prescribed medicines. Dispense medicines as ordered/prescribed, record and give home instructions. 1-3 mins None Action Officer Shiela I. Erfe, RPh ITR  
STEP CLIENT SERVICE PROVIDER DURATION FEES PERSON/S RESPONSIBLE FORM  
If client is for laboratory procedure:
1 Secure laboratory request form from the OPD staff. Record and issue laboratory request. 1-2 mins None Action Officer Lester C. Defensor, RN Lab Request Form
2 Proceed to RHU-Bagumbayan Clinical Laboratory and present ITR and Laboratory Request Form. Admission and registration. Instruct client for submission of required specimen. (Note: Blood chemistry is done every Tuesday and Thursday. Clients are given instructions to fast 8-10 hours prior to given schedule.) 3-5 mins None Action Officer Lera D. Faunillon   Lab Request Form
3 Submission and receiving of required specimen (feces, urine, etc.) Receive required specimen and/or blood extraction. 3-5 mins None Action Officer Lera D. Faunillon    
STEP CLIENT SERVICE PROVIDER DURATION FEES PERSON/S RESPONSIBLE FORM
4   Laboratory examination procedure: FecalysisUrinalysisBlood ChemistryCBC, Platelet Count, Hemoglobin and HematocritAcid Fast Bacilli/Sputum ExamSyphilis and HBsAgGram Staining and Skin SlitRapid Diagnostic TestBSMP   30 mins 30 mins 3 hrs 1 hr   3 hrs 1 hr 2 hrs 1 hr 3 hrs None Ma. Riza R. Dionela, RMT Videlyne C. Botacion, RMT Elizabeth D. Insular    
5   Release results. 3-5 hrs after Lab Exam None Action Officer Lera D. Faunillon   Lab Result Form
6   Read/interpret results. 5-10 mins None Raul V. Manansala, MD Lab Result Form and ITR
7 Get prescribed medicines. Dispense medicines as ordered/prescribed, record and give home instructions. 1-3 mins None Action Officer Shiela I. Erfe, RPh ITR
STEP CLIENT SERVICE PROVIDER DURATION FEES PERSON/S RESPONSIBLE FORM
If client  needs further medical treatment and management to a higher facility:
1 Present Individual Treatment Record with doctor’s order for referral to the OPD staff. Type/fill-up the Referral Slip.   1-2 mins None Action Officer Lester C. Defensor, RN Referral Slip
2   Log and release Referral Slip, and give of instructions to the client. 2-3 mins None Action Officer Lester C. Defensor, RN Referral Slip
If client is for nebulization:
1 Present Individual Treatment Record to the OPD staff. Prepare medication and nebulize client.   3-5 mins None Action Officer Lester C. Defensor, RN ITR
If client is for wound dressing and suturing:
1 Present Individual Treatment Record to the OPD staff. Prepare medical supplies and wound dress the client. 5-10 mins None Action Officer Lester C. Defensor, RN ITR
If client is Anti-Tetanus Serum (ATS) and Tetanus Toxoid (TT) vaccination:
1 Present Individual Treatment Record to the OPD staff. Prepare medicines and medical supplies and give vaccine to the client.   45 mins- 1 hr None Action Officer Lester C. Defensor, RN ITR

Issuance of Referral Slip

(Note: Follow the process presented hereunder, unless emergency cases wherein the Municipal Health Officer will immediately issue the Referral Slip.)

STEP CLIENT SERVICE PROVIDER DURATION FEES PERSON/S RESPONSIBLE FORM
1 Present Individual Treatment Record with doctor’s order for referral to the OPD staff. Type/fill-up the Referral Slip.   1-2 mins None Action Officer Lester C. Defensor, RN Referral Slip
2   Log and release Referral Slip, and give instructions to the client. 2-3 mins None Action Officer Lester C. Defensor, RN Referral Slip and Log Book

Issuance of Medical Certificate

STEP CLIENT SERVICE PROVIDER DURATION FEES PERSON/S RESPONSIBLE FORM
1 Fill-up request for Medical Certificate.   Give instructions for filling-up the request form, obtain vital signs and prepare/type the Medical Certificate. (Note: Look medical records for out-patient clients 3-5 mins None Action Officer Lester C. Defensor, RN Request Form
2   Consultation, do physical examination and sign the Medical Certificate. 3-5 mins None Raul V. Manansala, MD Medical Certificate
3   Log and release signed Medical Certificate.   1-2 mins None Action Officer Lester C. Defensor, RN Logbook

Issuance of Medico-Legal Certificate

STEP CLIENT SERVICE PROVIDER DURATION FEES PERSON/S RESPONSIBLE FORM
1 Complainant/s Show/present documents. Check requirements, get basic information and obtain vital signs. 2-3 mins None Action Officer Lester C. Defensor, RN Medico-Legal Form
2   Consultation and physical examination. 2 mins None Raul V. Manansala, MD Medico-Legal Form
3   Prepare/type Medico-Legal Certificate. 1 min None Action Officer Lester C. Defensor, RN Medico-Legal Form
4   Sign Medico-Legal Certificate. 1 min None Raul V. Manansala, MD Medico-Legal Form
5   Log and release signed Medico-Legal Certificate. 1 min None Action Officer Lester C. Defensor, RN Logbook

Issuance of Sanitary Permit, Health Certificate and Health Card for Employment, Food Handlers and Operators

STEP CLIENT SERVICE PROVIDER DURATION FEES PERSON/S RESPONSIBLE FORM
1 Fill-up request form. Give instructions for filling-up the request form and obtain vital signs. 3-5 mins None Action Officer Lester C. Defensor, RN Request Form
2 Submit laboratory request form. Admission and registration.   1 min None Action Officer Lera D. Faunillon Lab Request Form
3   Give  instructions to client for submission of required specimen (urine, feces and sputum) to the Clinical Laboratory staff. 3-5 mins None Action Officer Lera D. Faunillon  
4 Payment of laboratory procedures, permit and health certificate.   3-5 mins a. Sanitary Permit for Food Establishments b. Sanitary Permit for Non-Food Establishments c. Health Card/Certificate d. For Gov’t Employees and Applicants   P425.00     P285.00      P225.00   P165.00   Accountable Officer  Official Receipt
5   Laboratory examination procedure: FecalysisUrinalysisBlood TypingAcid Fast Bacilli/Sputum ExamSyphilis and HBsAg   30 mins 30 mins 3-5 mins 2-3 hrs 1 hr   Ma. Riza R. Dionela, RMT Videlyne C. Botacion, RMT Elizabeth D. Insular    
6   Prepare/type laboratory results, permit, medical and health certificate and ID.   5 mins None Ma. Riza R. Dionela, RMT Videlyne C. Botacion, RMT Lab Result Forms, Medical and Health Cert and ID
7   Sign permit, medical and health certificate and ID. 2 mins None Raul V. Manansala, MD Lab Result Forms, Medical and Health Cert and ID
8   Log and release the signed permit, medical and health certificate and ID. 2  mins None Action Officer Lera D. Faunillon Lab Result Forms, Medical and Health Cert and ID
If client needs medication, he/she will proceed to RHU-Dispensary/Pharmacy.

Issuance of Permit to Embalm Certificate, Death Certificate, Transfer of Cadaver and Post-Mortem Certificate

STEP CLIENT SERVICE PROVIDER DURATION FEES PERSON/S RESPONSIBLE FORM
PERMIT TO EMBALM CERTIFICATE
1 Family Member or Immediate Relative Show/present documents. Scrutinize requirements. Prepare the permit. 3 mins None Videlyne C. Botacion, RMT Lester C. Defensor, RN Birthing Home Staff-on-Duty Permit to Embalm Certificate
2   Sign Permit to Embalm Certificate 1 min None Raul V. Manansala, MD Or Authorized Signatories as per Memorandum Permit to Embalm Certificate
3   Log and release signed Permit to Embalm Certificate. 1 min None Videlyne C. Botacion, RMT Lester C. Defensor, RN Birthing Home Staff-on-Duty Logbook
STEP CLIENT SERVICE PROVIDER DURATION FEES PERSON/S RESPONSIBLE FORM
DEATH CERTIFICATE
1 Family Member or Immediate Relative Show/present documents. Issue checklist of requirements and Death Information Sheet. Scrutinize completeness of requirements. 3 mins None Action Officer Lera D. Faunillon Checklist and Death Information Sheet
2   Determination of the Cause of Death. 2 mins None Raul V. Manansala, MD Death Information Sheet
3   Prepare and type Death Certificate. 1 min None Videlyne C. Botacion, RMT Lester C. Defensor, RN Death Certificate
4   Sign Death Certificate. 1 min None Raul V. Manansala, MD Death Certificate
5   Log and issue signed Death Certificate and give instructions to the client. 1 min None Videlyne C. Botacion, RMT Lester C. Defensor, RN  Logbook
STEP CLIENT SERVICE PROVIDER DURATION FEES PERSON/S RESPONSIBLE FORM
TRANSFER OF CADAVER CERTIFICATE (FOR THOSE BE TRAVELED AND BURIED OUTSIDE BAGUMBAYAN)
1 Family Member or Immediate Relative Show/present documents. Prepare and type Transfer of Cadaver Certificate. 1 min None Videlyne C. Botacion, RMT Lester C. Defensor, RN Transfer of Cadaver Certificate
2   Sign Transfer of Cadaver Certificate. 1 min None Raul V. Manansala, MD Transfer of Cadaver Certificate
3   Log and issue signed Transfer of Cadaver Certificate. 1 min None Videlyne C. Botacion, RMT Lester C. Defensor, RN Logbook
STEP CLIENT SERVICE PROVIDER DURATION FEES PERSON/S RESPONSIBLE FORM
POSTMORTEM CERTIFICATE (AUTOPSY)
1 Family Member or Immediate Relative Show/present documents. Scrutinize requirements. 3 mins None Videlyne C. Botacion, RMT Lester C. Defensor, RN
2 Conduct postmortem examination and sign Postmortem Certificate. 45 mins None Raul V. Manansala, MD Postmortem Certificate
3   Log and issue signed Postmortem Certificate. 1 min None Videlyne C. Botacion, RMT Lester C. Defensor, RN Logbook

Tooth Extraction and Dental Examination/Consultation

STEP CLIENT SERVICE PROVIDER DURATION FEES PERSON/S RESPONSIBLE FORM
1 Out-patient clients Show/present documents.   Check requirements. Give client a priority number, admit and register client, and get blood pressure. 3 mins None Rodrigo B. Rivera Dental Record
2   Tooth extraction and dental examination/consultation, dispense medicines and give home care instructions. 15-30 mins None Daisy L. Gepilano, DMD Dental Record

Oral Prophylaxis for Pregnant Women

STEP CLIENT SERVICE PROVIDER DURATION FEES PERSON/S RESPONSIBLE FORM
1 Submit Mother and Child Booklet for admission and registration. Admit and register pregnant client.   3 mins None Rodrigo B. Rivera Dental Record
2   Tooth scaling and polishing procedure, application of tooth mouse or fluoride, and give home care instructions. 15 mins None Daisy L. Gepilano, DMD Dental Record

Hematology and Blood Chemistry, Microscopy and Parasitology, and Program- Based and Miscellaneous Services

STEP CLIENT SERVICE PROVIDER DURATION FEES PERSON/S RESPONSIBLE FORM  
If client after medical consultation is for laboratory procedure:  
1 Secure laboratory request form from the OPD staff. Record and issue laboratory request. 2 mins None Action Officer Lester C. Defensor, RN Lab Request Form  
2 Proceed to RHU-Clinical Laboratory and present ITR and Lab Request Form. Admission and registration Instruct client for submission of required specimen. (Note: Blood chemistry is done every Tuesday and Thursday. Clients are given instructions to fast 8-10 hours prior to given schedule.) 3 mins None Action Officer Lera D. Faunillon   Lab Request Form  
3 Submission and receiving of required specimen (feces, urine, etc.) Receive required specimen and/or blood extraction. 3-5 mins None Action Officer Lera D. Faunillon      
4   Laboratory examination procedure: FecalysisUrinalysisBlood ChemistryCBC, Platelet Count, Hemoglobin and HematocritAcid Fast Bacilli/Sputum ExamSyphilis and HBsAgGram Staining and Skin SlitRapid Diagnostic TestBSMP   30 mins 30 mins 3 hrs 1 hr   3 hrs 1 hr 2 hrs 1 hr 3 hrs None Ma. Riza R. Dionela, RMT Videlyne C. Botacion, RMT Elizabeth D. Insular    
5   Read/interpret results. 5 mins None Raul V. Manansala, MD Lab Result Form and ITR
6 Get prescribed medicines. Dispense medicines as ordered/prescribed, record and give home instructions. 3 mins None Action Officer Shiela I. Erfe, RPh ITR
If client needs medication, he/she will proceed to RHU-Dispensary/Pharmacy.

Maternity and Newborn Care Package

  1. Normal Spontaneous Vaginal Delivery
  2. Postpartum Intra-Uterine Device (PPIUD) Insertion
  3. Registration of Live Birth                              
  4. Newborn Screening Test
  5. G6PD Confirmatory Test
STEP CLIENT SERVICE PROVIDER DURATION FEES PERSON/S RESPONSIBLE FORM  
NORMAL SPONTANEOUS VAGINAL DELIVERY (NSVD)  
1 Expectant Mother Show/present documents. Admit and secure consent from the client. Health and obstetrical history and vital signs takingInternal Examination (IE), fundic height and fetal heart beat ausculatation (Note: If in latent phase of labor or “waiting” for Expected Date of Confinement (EDC), usher to Balay Palahuwayan.) 10 mins None Staff-on-Duty Chart  
2   If in active labor, monitoring of the progress of labor up to full dilatation of cervix.   None Staff-on-Duty Chart, Labor and Partograph Form  
3   Handle normal spontaneous vaginal delivery (NSVD). From delivery of the baby to expulsion of placenta (5-10 minutes) None Staff-on-Duty Chart  
STEP CLIENT SERVICE PROVIDER DURATION FEES PERSON/S RESPONSIBLE FORM  
4   Monitor newborn and postpartum mother from transfer to Recovery Room up to day of discharge. within 24-48 hours after delivery None Staff-on-Duty Chart  
5   Give health education and home care/discharge instructions. 10 mins None Staff-on-Duty    
If couple decides for PPIUD INSERTION:
1 Postpartum woman Prepare instruments and medical supplies, insert IUD, and give instructions when to come back for follow-up check-up. 10 mins None Trained PPIUD Provider FP Form 1
If couple decides for any Family Planning Method:
1 Postpartum woman Give health education, counselling and instructions. 10 mins None Staff-on-Duty FP Form 1
STEP CLIENT SERVICE PROVIDER DURATION FEES PERSON/S RESPONSIBLE FORM  
REGISTRATION OF LIVE BIRTH (MARRIED PARENTS)  
1 Mother or father of the newborn   Instruct client or any family member  to : Fill-up the Certificate of Live Birth (COLB) Information Sheet, andPay corresponding amount to Municipal Treasurer’s Office.Check for correctness of the entries, and 10 mins P50.00 Staff-on-Duty COLB Info Sheet and Official Receipt  
2 Prepare/type the Certificate of Live Birth and give instructions to the client. 3 mins None Staff-on-Duty COLB  
3 Check for the correctness of the entries, affix signature and submit the Certificate of Live Birth to the Municipal Civil Registrar’s Office. None MCRO Staff COLB  
STEP CLIENT SERVICE PROVIDER DURATION FEES PERSON/S RESPONSIBLE FORM  
REGISTRATION OF LIVE BIRTH (NOT MARRIED PARENTS, NEWBORN WILL BE ACKNOWLEDGED BY FATHER)
1 Mother or father of the newborn   Instruct client or any family member  to : Fill-up the Certificate of Live Birth (COLB) Information Sheet, andPay corresponding amount to Municipal Treasurer’s Office.Check for correctness of the entries, and 10 mins P50.00 Staff-on-Duty COLB Info Sheet and Official Receipt
2 Prepare/type the Certificate of Live Birth and the Affidavit to Use the Surname of the Father (AUSF) and give instructions to the client. 3 mins None Staff-on-Duty COLB, AUSF Form
3 Check for the correctness of the entries, affix signatures, have the AUSF Form notarized and submit the Certificate of Live Birth to the Municipal Civil Registrar’s Office. None MCRO Staff COLB, AUSF Form
STEP CLIENT SERVICE PROVIDER DURATION FEES PERSON/S RESPONSIBLE FORM
NEWBORN SCREENING TEST (NBS)
1  Newborn Infant (24-72 hours) Fill-up NBS kit, do test and give home care instructions. After 24 hours from time of delivery None NBS Collectors NBS Kit
2   Release NBS result. After 1 month from NBS Testing None Shirley P. Caspe, RN NBS Result Form
G6PD CONFIRMATORY TEST
1 Infant Fill-up Laboratory Request Form, do confirmatory test and give home care instructions. 15 mins P600.00 Ma. Riza R. Dionela, RMT Videlyne C. Botacion, RMT Lab Request Form
2 Prepare and send out blood sample. 15 mins None Shirley P. Caspe, RN G6PD Form
3 Release NBS result. After 1 month from G6PD Testing None Shirley P. Caspe, RN G6PD Result Form

Admission to Halfway Home

STEP CLIENT SERVICE PROVIDER DURATION FEES PERSON/S RESPONSIBLE FORM
IF IN LATENT PHASE OF LABOR OR “WAITING” FOR EXPECTED DATE OF CONFINEMENT (EDC);
1 Expectant Mother Register client to Monitoring Sheet.Monitor blood pressure (BP) and FHB daily.Distribute daily ration.Give instructions to client. 10 mins None Staff-on-Duty Monitoring Sheet

Availment of Blood

STEP CLIENT SERVICE PROVIDER DURATION FEES PERSON/S RESPONSIBLE FORM
1 Family Member or Immediate Relative Show/present documents. Scrutinize requirements, log-in request for blood availment and prepare the Referral Slip and BITES ILHZ Yellow Card. 1-2 mins None Videlyne C. Botacion, RMT Referral Form and BITES ILHZ Yelllow Card
2   Sign Referral Slip.   1 min None Raul V. Manansala, MD Referral Form
3 Sign BITES ILHZ Yellow Card. 1 min None Jonalette E. De Pedro BITES ILHZ Yellow Card
4   Log and release Referral Slip  and BITES ILHZ Yellow Card and give of instructions to the client. 2 mins None Videlyne C. Botacion, RMT Logbook

Ambulance Conduction

STEP CLIENT SERVICE PROVIDER DURATION FEES PERSON/S RESPONSIBLE FORM
1 Family Member or Immediate Relative Show/present documents. Scrutinize requirements and availability of ambulance vehicles, log-in request for ambulance conduction and prepare the Driver’s Trip Ticket. 1-2 mins None Elena O. Grande, RM Driver’s Trip Ticket
2   Sign Driver’s Trip Ticket   1 min None Raul V. Manansala, MD Or Authorized Signatories as per Memorandum Driver’s Trip Ticket
3   Log, release Driver’s Trip Ticket and give instructions to the client. 2 mins None Elena O. Grande, RM Logbook

Enrollment to LGU-Sponsored PHIC

STEP CLIENT SERVICE PROVIDER DURATION FEES PERSON/S RESPONSIBLE FORM
1 Any family member/relative or representative Show/present documents. Check masterlist and portal, scrutinize requirements and prepare Endorsement Letter. 3 mins None Action Officer Imee E. Insular, RN Checklist
2 Sign Endorsement Letter. 3 mins None Raul V. Manansala, MD Jonalette E. De Pedro Endorse ment Letter
3   Profile, log, give instructions to client and release Endorsement Letter. 5 mins None Action Officer Imee E. Insular, RN Profiling Form

Animal Bite Treatment Center (ABTC)

STEP CLIENT SERVICE PROVIDER DURATION FEES PERSON/S RESPONSIBLE FORM
1 Out-Patient Show/present documents. (Note: Emergency cases, Senior’s Citizen, Persons with Disability and Pregnant Women has SPECIAL LANE). Scrutinize requirements. Give client a priority number and instruct him/her to wait. 1-2 mins (excluding waiting time depending on the number of clients) None Action Officer Lester C. Defensor, RN Priority Number
2   Call priority number and get the notebook or referral slip. Look for medical records.Assess client.Interview client.Obtain vital signs and present history of medical condition. 5 mins None Action Officer Lester C. Defensor, RN Individual Treatment Record (ITR)
3   Consultation and physical examination 3 mins None Raul V. Manansala, MD ITR  
4 Get prescribed medicines. Dispense medicines as ordered/prescribed, record and give home instructions. 3 mins None Action Officer Shiela I. Erfe, RPh ITR
STEP CLIENT SERVICE PROVIDER DURATION FEES PERSON/S RESPONSIBLE FORM
5 Present Individual Treatment Record to the ABTC staff. Prepare medicines and medical supplies and give vaccine to the client. 45 mins None Action Officer Imee E. Insular, RN ITR
6 Give instructions to client when to come back for follow-up. 2 mins None Action Officer Imee E. Insular, RN  

TB-DOTS

STEP CLIENT SERVICE PROVIDER DURATION FEES PERSON/S RESPONSIBLE FORM
1 Out-Patient Show/present documents. (Note: Emergency cases, Senior’s Citizen, Persons with Disability and Pregnant Women has SPECIAL LANE). Scrutinize requirements. Give client a priority number and instruct him/her to wait. 1-2 mins (excluding waiting time depending on the number of clients) None Action Officer Lester C. Defensor, RN Priority Number
2   Call priority number and get the notebook or referral slip. Look for medical records.Assess client.Interview client.Obtain vital signs and present history of medical condition. 5 mins None Action Officer Lester C. Defensor, RN Individual Treatment Record (ITR)
3   Consultation and physical examination 3 mins None Raul V. Manansala, MD ITR  
4 Get prescribed medicines. Dispense medicines as ordered/prescribed, record and give home instructions. 3 mins None Action Officer Shiela I. Erfe, RPh ITR
STEP CLIENT SERVICE PROVIDER DURATION FEES PERSON/S RESPONSIBLE FORM
5 Present Individual Treatment Record to the TB-DOTS staff. Prepare medicines and medical supplies. 15 mins None Action Officer Jennylen I. Abelarde, RN ITR
6 Give instructions to client when to come back for follow-up. 2 mins None Action Officer Jennylen I. Abelarde, RN  

                                                                    EVENTS AND UPDATES FOR THE MONTH