PCPAccFrm E-4A1F1 Rev2014

Hospital:

East Avenue Medical Center

Admissions:

Ward Census

the Month
Case-load (case census per year) and results of care Enter
and Year

Month/Year:

OCTOBER 2014
283

Total IM Admissions:

CARDIOLOGY

ICD 10

1 NSTEMI
2 STEMI
3 DCM
4 Arrythmia
5 PAOD
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26

I21.4
I21.0
I42.0
I47.0
I73

TOTAL

INFECTIOUS DISEASES
1 Leptospirosis
2 UTI
3 Cellulitis
4 Dengue Fever
5 Laryngeal TB
6 Septic Shock
7
8
9
10
11
12
13
14
We attest to the truthfulness of the above documentation:
Chairman, Dept. of Medicine

Enter Total IM
Admisssions (Patient
person count) for
the Month

# of
Cases

5
6
3
1
1

16

ICD 10
A27
N39
L03.1
A91
A18
R65.21

# of
Cases

10
3
4
4
1
1

% of Total
Admissions
(# of
cases/ Total
IM
admissions)

1.77%
2.12%
1.06%
0.35%
0.35%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
5.65%
% of Total
Admissions
(# of
cases/ Total
IM
admissions)

3.53%
1.06%
1.41%
1.41%
0.35%
0.35%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

# of
Mortality

1
2
0
0
0

# of
Mortality

% of
Mortality
(# of
deaths/ #
of Cases)

20.00%
33.33%
0.00%
0.00%
0.00%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
18.75%
% of
Mortality
(# of
deaths/ #
of Cases)

0.00%
0.00%
0.00%
0.00%
0.00%
100.00%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
Page 1 of 32

PCPAccFrm E-4A1F1 Rev2014

15
16
17
18
19
20
21
22
23
24
25
TOTAL

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

23

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
8.13%

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
4.35%

Page 2 of 32

PCPAccFrm E-4A1F1 Rev2014

PULMONARY MEDICINE

ICD 10

1 Pleural Effusion
2 COPD in acute exacerbation
3 Pneumothorax
4 Pneumonia
5 VAP
6 ARF
7 Mediastinal Mass
8 Asthma
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

J90
J44.1
J93.11
J18
J15.4
J96
C85.2
J45

TOTAL

GASTROENTEROLOGY

K83.1
K31.1
K75.0
A18.3
K92.2
C25.1
K85
K31.5
K757.33

K50
K72.91
K31.1
C77.1

C18.0
C16.0
K74.64
K80.5
C22.1

T50
T54.2x2
C20
K64

TOTAL

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

10
5
3
17
1
2
1
1

40

ICD 10

1 Bile Duct Obstruction

2 pyloric Stricture
3 Liver Abscess
4 GI TB
5 UGIB
6 Pancreatic Mass
7 Acute Pancreatitis
8 SBO
9 Diverticulitis
10 Chron's disease
11 Hepatic encephalopathy
12 Gastric outlet obstruction
13 Esophageal mass
14 Colon Mass
15 Gastric mass
16 Chronic Liver Disease
17 Choledocholithiasis
18 Cholangiocarcinoma
19 Ferrous sulfate ingestion, intentional
20 Toxic effects of corrosive acids
21 Rectal mass
22 Internal hermorrhoids
23
24
25

# of
Cases

# of
Cases

1
1
2
3
27
2
2
1
1
2
1
1
1
2
3
1
2
1
1
2
1
1

59

% of Total
Admissions
(# of
cases/ Total
IM
admissions)

3.53%
1.77%
1.06%
6.01%
0.35%
0.71%
0.35%
0.35%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
14.13%
% of Total
Admissions
(# of
cases/ Total
IM
admissions)

0.35%
0.35%
0.71%
1.06%
9.54%
0.71%
0.71%
0.35%
0.35%
0.71%
0.35%
0.35%
0.35%
0.71%
1.06%
0.35%
0.71%
0.35%
0.35%
0.71%
0.35%
0.35%
0.00%
0.00%
0.00%
20.85%

# of
Mortality

1
0
0
1
0
1
0
0

# of
Mortality

0
0
0
0
2
0
0
1
0
0
1
1
0
0
0
0
0
0
0
0
0
0

% of
Mortality
(# of
deaths/ #
of Cases)

10.00%
0.00%
0.00%
5.88%
0.00%
50.00%
0.00%
0.00%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
7.50%
% of
Mortality
(# of
deaths/ #
of Cases)

0.00%
0.00%
0.00%
0.00%
7.41%
0.00%
0.00%
100.00%
0.00%
0.00%
100.00%
100.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
#DIV/0!
#DIV/0!
#DIV/0!
8.47%

Page 3 of 32

PCPAccFrm E-4A1F1 Rev2014

NEPHROLOGY

ICD 10

1 CKD
2 Hypokalemia
3 Nephritic syndrome
4 Hyponatremia
5 Female genital proplapse, unspecified
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

N18.9
E87.6
N00.9
E87.6
N81.9

TOTAL

ENDOCRINOLOGY

E11.621
E10.1
E11.2
E05

TOTAL

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

18
3
1
1
1

24

ICD 10

1 Neuropathic foot
2 DKA
3 Type 2 DM with diabetic kidney disease
4 Thyroid storm
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

# of
Cases

# of
Cases

6
2
1
2

11

% of Total
Admissions
(# of
cases/ Total
IM
admissions)

6.36%
1.06%
0.35%
0.35%
0.35%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
8.48%
% of Total
Admissions
(# of
cases/ Total
IM
admissions)

2.12%
0.71%
0.35%
0.71%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
3.89%

# of
Mortality

# of
Mortality

% of
Mortality
(# of
deaths/ #
of Cases)

11.11%
0.00%
0.00%
0.00%
0.00%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
8.33%
% of
Mortality
(# of
deaths/ #
of Cases)

0.00%
0.00%
0.00%
0.00%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
0.00%

Page 4 of 32

PCPAccFrm E-4A1F1 Rev2014

HEMATOLOGY

ICD 10

1 ITP
2 AIHA
3 Aplastic anemia
4 Nutritional anemia
5 Polycythemia vera
6 Anemia secondary to chronic disease
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

D69.3
D59.1
D61.9
D50
D45
D63

TOTAL

NEUROLOGY

I63.9
I61
I60
G00.9
A17.1

TOTAL

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

1
2
1
1
2
1

ICD 10

1 Cerebral Infarction
2 CVA bleed
3 SAH
4 Bacterial Meningitis
5 TB meningitis
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

# of
Cases

# of
Cases

39
37
8
2
1

87

% of Total
Admissions
(# of
cases/ Total
IM
admissions)

0.35%
0.71%
0.35%
0.35%
0.71%
0.35%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
2.83%
% of Total
Admissions
(# of
cases/ Total
IM
admissions)

13.78%
13.07%
2.83%
0.71%
0.35%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
30.74%

# of
Mortality

% of
Mortality
(# of
deaths/ #
of Cases)

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

# of
Mortality

2
9
0
2
1

14

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
0.00%
% of
Mortality
(# of
deaths/ #
of Cases)

5.13%
24.32%
0.00%
100.00%
100.00%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
16.09%

Page 5 of 32

PCPAccFrm E-4A1F1 Rev2014

ONCOLOGY

ICD 10

1 Rectal Ca
2 Anterior neck mass
3 Germ cell tumor testis
4 Esophageal adenocarcinoma
5 Rhabdomyosarcoma
6 Breast CA
7 NPCA
8 Colon CA
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

C20
R22
C62.9
C15.9
C48.2
C50.9
C30
C18.9

TOTAL

DERMATOLOGY

# of
Cases

2
1
1
2
1
3
2
1

13

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

% of Total
Admissions
(# of
cases/ Total
IM
admissions)

0.71%
0.35%
0.35%
0.71%
0.35%
1.06%
0.71%
0.35%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
4.59%
% of Total
Admissions
(# of
cases/ Total
IM
admissions)

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

# of
Mortality

0
0
0
0
0
2
0
0

# of
Mortality

% of
Mortality
(# of
deaths/ #
of Cases)

0.00%
0.00%
0.00%
0.00%
0.00%
66.67%
0.00%
0.00%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
15.38%
% of
Mortality
(# of
deaths/ #
of Cases)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

Page 6 of 32

PCPAccFrm E-4A1F1 Rev2014

RHEUMATOLOGY

ICD 10

1 SLE
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

M32.10

TOTAL

ALLERGOLOGY & IMMUNOLOGY

1 Anaphylactic shock
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

ICD 10
T88.6

TOTAL

# of
Cases

# of
Cases

% of Total
Admissions
(# of
cases/ Total
IM
admissions)

0.35%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.35%
% of Total
Admissions
(# of
cases/ Total
IM
admissions)

0.35%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.35%

# of
Mortality

# of
Mortality

% of
Mortality
(# of
deaths/ #
of Cases)

100.00%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
100.00%
% of
Mortality
(# of
deaths/ #
of Cases)

0.00%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
0.00%

Page 7 of 32

PCPAccFrm E-4A1F1 Rev2014

Enter Name
of Hospital

Enter the place

of census i.e.
Ward, ICU, ER, or
OPD

Yellow boxes
automatically
computed from data
entered in the
shaded boxes. DO
NOT WRITE
ANYTHING ON THE
YELLOW BOXES.

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

Page 8 of 32

PCPAccFrm E-4A1F1 Rev2014

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

Page 9 of 32

PCPAccFrm E-4A1F1 Rev2014

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

Page 10 of 32

PCPAccFrm E-4A1F1 Rev2014

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

Page 11 of 32

PCPAccFrm E-4A1F1 Rev2014

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

Page 12 of 32

PCPAccFrm E-4A1F1 Rev2014

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

Page 13 of 32

PCPAccFrm E-4A1F1 Rev2014

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

Page 14 of 32

PCPAccFrm E-4A1F1 Rev2014

The Premier Medical General Hospital

Hospital:

Admissions:

Ward Census
Enter the Month

Case-load (case census per year) and results of care and Year
Month/Year: NOVEMBER 2012
Total IM Admissions:

CARDIOLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

INFECTIOUS DISEASES
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
We attest to the truthfulness of the above documentation:
Chairman, Dept. of Medicine

ICD 10

# of
Cases

Enter Total IM
Admisssions
(Patient person
count) for the
Month

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
Page 15 of 32

PCPAccFrm E-4A1F1 Rev2014

16
17
18
19
20
21
22
23
24
25
TOTAL

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

Page 16 of 32

PCPAccFrm E-4A1F1 Rev2014

PULMONARY MEDICINE

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

GASTROENTEROLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

Page 17 of 32

PCPAccFrm E-4A1F1 Rev2014

NEPHROLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

ENDOCRINOLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

Page 18 of 32

PCPAccFrm E-4A1F1 Rev2014

HEMATOLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

NEUROLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

Page 19 of 32

PCPAccFrm E-4A1F1 Rev2014

ONCOLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

DERMATOLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

Page 20 of 32

PCPAccFrm E-4A1F1 Rev2014

RHEUMATOLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

ALLERGOLOGY & IMMUNOLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

Page 21 of 32

PCPAccFrm E-4A1F1 Rev2014

The Premier Medical General Hospital

Hospital:

Admissions:

Ward Census

Case-load (case census per year) and results of care

Month/Year: DECEMBER 2012
Total IM Admissions:

CARDIOLOGY

ICD 10

# of
Cases

0
0

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

INFECTIOUS DISEASES
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
We attest to the truthfulness of the above documentation:
Chairman, Dept. of Medicine

ICD 10

# of
Cases

Enter the Month

and Year
Enter Total IM
Admisssions
(Patient person
count) for the
Month

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

0
0

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
Page 22 of 32

PCPAccFrm E-4A1F1 Rev2014

16
17
18
19
20
21
22
23
24
25
TOTAL

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

Page 23 of 32

PCPAccFrm E-4A1F1 Rev2014

PULMONARY MEDICINE

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

GASTROENTEROLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

Page 24 of 32

PCPAccFrm E-4A1F1 Rev2014

NEPHROLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

ENDOCRINOLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

Page 25 of 32

PCPAccFrm E-4A1F1 Rev2014

HEMATOLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

NEUROLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

Page 26 of 32

PCPAccFrm E-4A1F1 Rev2014

ONCOLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

DERMATOLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

Page 27 of 32

PCPAccFrm E-4A1F1 Rev2014

RHEUMATOLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

ALLERGOLOGY & IMMUNOLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

Page 28 of 32

Philippine College of Physicians

PCPAccFrm E-4A1F2 Rev2014

Ward Census

SUMMARY OF CENSUS

East Avenue Medical Center

HOSPITAL
Month/Year

OCTOBER 2014

% of Total Admissions
(# of cases/total IM
# of Cases
Cases)

Cardiology
Infectious Diseases
Pulmonary Medicine
Gastroenterology
Nephrology
Endocrinology
Hematology
Neurology
Oncology
Dermatology
Rheumatology
Allergology & Immunology

Total IM Cases
Total IM Admissions

# of Mortality

% Mortality
(# of deaths/ #
of cases)

3
1
3
5
2
0
0
14
2
0
1
0

18.75%
4.35%
7.50%
8.47%
8.33%
0.00%
0.00%
16.09%
15.38%
#DIV/0!
100.00%
0.00%

16
23
40
59
24
11
8
87
13
0
1
1

5.65%
8.13%
14.13%
20.85%
8.48%
3.89%
2.83%
30.74%
4.59%
0.00%
0.35%
0.35%

283
283

Total Mortality
Total Mortality/Total Admissions

31
10.95%

Ward Census

SUMMARY OF CENSUS

The Premier Medical General Hospital

HOSPITAL
Month/Year

NOVEMBER 2012
Cardiology
Infectious Diseases
Pulmonary Medicine
Gastroenterology
Nephrology
Endocrinology
Hematology
Neurology
Oncology
Dermatology
Rheumatology
Allergology & Immunology

Total IM Cases
Total IM Admissions

% of Total Admissions
(# of cases/total IM
# of Cases
Cases)

# of Mortality

% Mortality
(# of deaths/ #
of cases)

0
0
0
0
0
0
0
0
0
0
0
0

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

0
0
0
0
0
0
0
0
0
0
0
0

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

0
0

Total Mortality
Total Mortality/Total Admissions

0
#DIV/0!

Philippine College of Physicians

PCPAccFrm E-4A1F2 Rev2014

Ward Census

SUMMARY OF CENSUS

The Premier Medical General Hospital

HOSPITAL
Month/Year

DECEMBER 2012

% of Total Admissions
(# of cases/total IM
# of Cases
Cases)

Cardiology
Infectious Diseases
Pulmonary Medicine
Gastroenterology
Nephrology
Endocrinology
Hematology
Neurology
Oncology
Dermatology
Rheumatology
Allergology & Immunology

Total IM Cases
Total IM Admissions

Total IM Cases
Total IM Admissions

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

0
0

Total Mortality
Total Mortality/Total Admissions

0
#DIV/0!

Ward Census
The Premier Medical General Hospital

HOSPITAL

Cardiology
Infectious Diseases
Pulmonary Medicine
Gastroenterology
Nephrology
Endocrinology
Hematology
Neurology
Oncology
Dermatology
Rheumatology
Allergology & Immunology

0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0

SUMMARY OF CENSUS

Months/Year
OCTOBER 2014
NOVEMBER 2012
DECEMBER 2012

# of Mortality

% Mortality
(# of deaths/ #
of cases)

# of Cases % of Total Admissions

(# of cases/total IM
Cases)

# of Mortality

% Mortality
(# of deaths/ #
of cases)

3
1
3
5
2
0
0
14
2
0
1
0

18.75%
4.35%
7.50%
8.47%
8.33%
0.00%
0.00%
16.09%
15.38%
#DIV/0!
100.00%
0.00%

16
23
40
59
24
11
8
87
13
0
1
1

5.65%
8.13%
14.13%
20.85%
8.48%
3.89%
2.83%
30.74%
4.59%
0.00%
0.35%
0.35%

283
283

Total Mortality
Total Mortality/Total Admissions

31
10.95%

Philippine College of Physicians

PCPAccFrm E-4A1F2 Rev2014

Philippine College of Physicians

PCPAccFrm E-4A1F2 Rev2014