Republic of the Philippines

PHILIPPINE HEALTH INSURANCE CORPORATION

12/Floor City State Center, 709 show Blvd.brngy.orando Pasig city
MANDATORY MONTHLY HOSPITAL REPORT

For the month of: January 2008

Accreditation No 780329-P Region: IX
Name of Hospital: Redoble medical clinic Category: Primary
Add.no.of Street: Poblacion Buug Zamboanga sibugay PHIC Accredited bed: 8
Municipality: Buug DOH authorized bed: 8
Province: Zamboanga sibugay
Zip code 7009
1. DAILY CENSUS OF NHIP PATIENTS (EVERY 12:00MN) CENSUS FOR THE DAY= (CENSUS OF THE PREVIOUS DAY plus ADMISSION OF THE

DAY minus DISCHARGES OF THE DAY

1 2 1 2
DATE CENSUS DATE CENSUS
a.NHP b.NON-NHP c. TOTAL a.NHP b.NON-NHP c. TOTAL
1 0 5 5 1 0 5 5
2 0 1 1 2 0 2 2
3 0 3 3 3 0 1 1
4 0 4 4 4 0 3 3
5 0 1 1 5 0 3 3
6 0 1 1 6 0 1 1
7 0 4 4 7 0 4 4
8 0 2 2 8 0 1 1
9 0 1 1 9 0 2 2
10 0 1 1 10 0 2 2
11 0 5 5 11 0 1 1
12 0 3 3 12 0 6 6
13 0 5 5 13 0 2 2
14 0 1 1 14 0 6 6
15 0 2 2 15 0 0 0
16 0 2 2 16 0 3 3
17 0 4 4 17 0 1 1
18 0 0 0 18 0 3 3
19 0 3 3 19 0 1 1
20 0 6 6 20 0 3 3
21 0 4 4 21 0 7 7
22 0 1 1 22 0 3 3
23 0 0 0 23 0 1 1
24 0 2 2 24 0 0 0
25 0 4 4 25 0 2 2
26 0 4 4 26 0 4 4
27 0 2 2 27 0 4 4
28 0 4 4 28 0 1 1
29 0 3 3 29 0 4 4
30 0 3 3 30 0 3 3
31 0 0 0 31 0 3 3
TOTAL 0 81 81 TOTAL 0 82 82

B.QUALITY ASSURANCE INDICATOR

1. Monthly bed occupancy Rate (MBOR) =3.1 % 3.Average length of stay per NHIP patient

Total of NHIP CENSUS plus Total of NON-NHIP CENSUS (ALSP) = Zero

MBOR=--------------------------------------------------------------------X 100
Number of days per month indicated multiplied by Number of DOH authorized beds Total of NHIP CENSUS

2. Monthly NHIP Beneficiary occupancy rate (MNHIPBOR) = Zero ALSP =-------------------

Total of NHIP CENSUS Total NHIP DISCHARGES

MNHIPBOR= ---------------------------------------------------------------X 100

C.NEW BORN CENSUS

PARENT
NHIP NON-NHIP TOTAL
TOTAL OF NEW BBORN

DATE RECIEPT: PRO/S _____________________________ RECORDS SECTION_________________ ACCREDITATION______________

Note: This is a mandatory Hospital record to be submitted within the e first 10 days of the following month
D. MOST COMMON CAUSES OF CONFINEMENT
TOTAL
SURGICAL PROCEDURES
NHIP NON-NHIP
1. Acute Gastroenteritis 0 35
2 Enteric Fever 0 5
3. Influenza 0 5
4. Pneumonia 0 3
5.Typhoid Fever 0 2
6.URTI 0 2
7.Renal Colic 0 1
8.Bronchial Asthma 0 1
9.CVA 0 1
10.Dizziness 0 1

E.SURGICAL OUTPUT
TOTAL
SURGICAL PROCEDURES
NHIP NON-NHIP

E.1TOTAL SURGICAL STERILAZATION

TOTAL
SURGICAL SREILIZATION PROCEDURES
NHIP NON-NHIP
1.BILATERAL TUBAL LIGATION
2.VASECTOMY
TOTAL

F.OBSTETRICAL PROCEDURES
TOTAL
NHIP NON-NHIP
F1.TOTAL NO.OF DELIVERIES(NSD PLUS CAESARIAN SECTION
F2.TOTAL NO.OFCAESARIAN CASES

G.MONTHLY MORALITY CENSUS (ALL CASES)

TOTAL
DIAGNOSIS
NHIP NON-NHIP

2
3
4
5

H.REFERRALS
TOTAL
MOST COMMON REASONS FOR REFERRAL
NHIP NON-NHIP
1 AGE 1

PREPARED BY: CERTIFIED CORRECT:

Zandro Redoble Rosendo C.Redoble M.D

Name of Position of Person filling up the form Chief of hospital/ Medical director
(Signature over printed name) (Signature over printed name)