Republi pines Dep: ith HEALTH FACILITIES AND SERVICES REGULATORY BUREAU (CHECKLIST FOR REVIEW OF FLOOR PLANS MEDICAL FACILITY FOR OVERSEAS WORKERS AND SEAFARERS Name of Health Facity. Adress Date Review. it a Bie 1. PHYSICAL PLANT. 141 Medical Facity ‘Woating'Reception Area Popcologeal Testing Room Intoriew Are ‘Audiometry Room 0 Dental Cio Optcal Room let (Separate for male and female) 7 ‘cea with Sink (minimum of 20 square meters in floor logit Area (may be part of or separate from the Clinical Work rea) Access to Todet WalingyRecepion Area Extraction Area (Separate fom Clinical Work Area) X-Ray Room with Contre! Booth and Dressing Area ‘Access to Toset ‘Area fr Digtal Film Processing Equipment Radiologist Area 2 PLANNING AND DESIGN 21 Floorplans property identified and completly labeled 22 Meets prescribed functional programs ‘COMMENTS:Republic ofthe Philippines Department of Health HEALTH FACILITIES AND SERVICES REGULATORY BUREAU Name of Health Facility Adress ‘COMMENTS: HEALTH FACILITIES EVALUATION AND REVIEW COMMITTEE (HFERC) T 1Aperoved ——[_] Disapproved ‘Chargers, HFERC ENGR. RODELIO A. PINEDA ‘ice Chaepereon, FERC Member Member Member alt |