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Department of Health
BUREAU OF HEALTH FACILITIES AND SERVICES
ANNEX – E A.O. No. 2012-0012
ANNUAL HOSPITAL STATISTICAL REPORT
YEAR 2014
Name of Hospital: DR.JOSE FABELLA MEMORIAL HOSPITAL Street Address : Lope De Vega Sta Cruz ,Manila
Municipality: __________________ Province ____________________ Region: National Capital Region___________
Contact No.: 7345561 Fax Number: __________________________________
Email Address: ____________________________________________________________________________________
(PLEASE FILL OUT ALL ITEMS. PUT N/A IF NOT APPLICABLE.)
I. GENERAL INFORMATION
A. Classification
1. Service Capability
Service capability: Capability of a hospital/other health facility to render administrative, clinical,
ancillary and other services
General: Specialty: (Specify)
[ ] Level 1 Hospital [ ] Treats a particular disease (Specify):___________
[ ] Level 2 Hospital [ ] Treats a particular organ (Specify):_____________
[ ∕ ] Level 3 Hospital (Teaching/ Training) [ ] Treats a particular class of patients (Specify):_____
[ ] Others (Specify):____________
Trauma Capability: [ ] Trauma Capable [ ] Trauma Receiving
2. Nature of Ownership
Government: Private:
[ / ] National –DOH Retained/ Renationalized [ ] Single Proprietorship/Partnership/Corp.
[ ] Local (Specify): [ ] Religious
[ ] Province [ ] Civic Organization
[ ] City [ ] Foundation
[ ] District [ ] Others (Specify):________________
[ ] Municipality
[ ] DND/ DOJ
[ ] State Universities and Colleges (SUCs)
[ ] Others (Specify):_________________
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Department of Health
BUREAU OF HEALTH FACILITIES AND SERVICES
ANNEX – E A.O. No. 2012-0012
B. Quality Management
Quality Management/ Quality Assurance Program: Organized set of activities designed to
demonstrate on-going assessment of important aspects of patient care and services
[ ] ISO Certified (Specify ISO Certifying Body and
area(s) of the hospital with Certification) Validity Period ____________
[ ] International Accreditation Validity Period ____________
[ ] PhilHealth Accreditation Validity Period: December 31, 2015
[ / ] Basic Participation
[ ] Advanced Participation
[ ] PCAHO Validity Period ____________
C. Bed Capacity/Occupancy
1. Authorized Bed Capacity: 700 beds
Authorized bed: Approved number of beds issued by BHFS, the licensing agency of DOH.
2. Implementing Beds: 496 beds
Implementing beds: Actual beds used (based on hospital management decision)
3. Bed Occupancy Rate (BOR) Based on Authorized Beds: _______%
(Total Inpatient service days for the period)**
(Total number of Authorized beds) x (Total days in the period) X 100
Bed Occupancy Rate: The percentage of inpatient beds occupied over a period of time. It is a
measure of the intensity of hospital resources utilized by in-patients.
Inpatient Service days: Unit of measure denoting the services received by one in-patient in one 24
hour period.
**Inpatient Service days (Bed days) = [(Inpatients remaining at midnight + Total admissions) – Total
discharges/deaths) + (number of admissions and discharges on the same day)].
Bed Occupancy Rate (BOR)
A. Based on Authorized Bed
Including Newborn = 167.96%
Excluding Newborn=73.24%
B. Based on Implementing Bed
Including Newborn = 237.03%
Excluding Newborn=103.36%
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Department of Health
BUREAU OF HEALTH FACILITIES AND SERVICES
ANNEX – E A.O. No. 2012-0012
II. HOSPITAL OPERATIONS
A. Summary of Patients in the Hospital
For each category listed below, please report the total volume of services or procedures performed.
*Inpatient: A patient who stays in a health facility while under treatment.
*Bed day: Bed used for a continuous 24 hours by an inpatient.
Inpatient Care
Number
Total number of inpatients (admissions, including newborns)
54,322
Total Discharges (Alive)
52,089
Total patients admitted and discharged on the same day
96
Total number of inpatient bed days (service days)
429,128
Total number of inpatients transferred TO THIS FACILITY from another
facility for inpatient care
2,457
Total number of inpatients transferred FROM THIS FACILITY to another
facility for inpatient care
31
Total number of patients remaining in the hospital as of midnight last day of
previous year 563
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Department of Health
BUREAU OF HEALTH FACILITIES AND SERVICES
ANNEX – E A.O. No. 2012-0012
B. Discharges
Kindly accomplish the “Type of Service and Total Discharges According to Specialty” in the table
below.
Type
of
Service
No of
Pts
Total
Length
of
Stay/ Total No. of
Days Stay
Type of Accomodation
Non- Philhealth
Philhealth
H
M
O
O
W
W
A
Pay
Service
Charity
Total
Pay
Service
Total
Member
/
Depend
ent
Indi-
gent
Obstetrics 23,736 131,423 236 20,146 20,382 754 2,227 350 3,331 - 23
Gynecology 786 14,938 30 - 30 98 562 80 740 - 16
Pediatrics 1,321 9,645 - 714 714 - 523 81 604 - 3
Surgery: 11 74 - 11 11 - - - - - -
Pedia
Adult
Others, Specify
TOTAL 25,854 156,080 266 20,871 21,137 852 3.312 511 4,675 - 42
Total Newborn
-Pathologic 8,738 31,051 - 3,366 3,366 - 4,613 731 5,344 - 28
-Non-Pathologic 18,383 242,005 - 13,758 13,758 - 4,061 537 4,598 - 27
Grand Total 52,975 429,136 266 37,995 38,261 852 11,986 1,779 14,617 - 97
CONDITION ON DISCHARGE
Type
of
Service
R/I
T
H
A
U Deaths
Discharges
< 48 hrs > 48 hrs Total
Obstetrics 23,630 13 30 51 - 7 5 12 23,736
Gynecology 780 1 - 1 - 0 4 4 786
Pediatrics 1,231 5 6 - - 36 43 79 1,321
Surgery: 11 - - - - 11
Pedia
Adult
Others, Specify
TOTAL 25,652 19 36 52 - 43 52 95 25,854
Total Newborn
-Pathologic 6,531 - 614 - - 318 469 787 7,932
-Non-Pathologic 19,185 - - - - 2 2 4 19,189
Grand Total 51,368 19 650 52 - 363 523 886 52,975
* R/I – Recovered/Improved T- Transferred U – Unimproved
H- Home Against Medical Advice A – Absconded D – Died (died upon admission)
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Department of Health
BUREAU OF HEALTH FACILITIES AND SERVICES
ANNEX – E A.O. No. 2012-0012
1. Average Length of Stay (ALOS) of Admitted Patients
Total length of stay of discharged patients (including Deaths) in the period = _________________
Total discharges and deaths in the period
Average length of stay: Average number of days each inpatient stays in the hospital for each episode
of care.
Including Newborn = 7.92 days
Excluding Newborn =5.47 days
2. Ten Leading causes of Morbidity based on final discharge diagnosis
For each category listed below, please report the total number of cases for the top 10 illnesses/injury.
Cause of Morbidity/Illness/Injury Number ICD-10 Code
(Individual)
1. Spontaneous Delivery by Low Risk
10,166 O80.0
2. Delivery by Cesarean Section
6,296 O82.0
3. Spontaneous Delivery by High Risk
3,504 O90.0
4. Complete Abortion ( all types )
1,247 O03.9
5. Neonatal Pneumonia
1,227 P23.1
6. Potentially Septic
873 P36.9
7. Sepsis all forms
724 P36.0
8. Pneumonia 519 J18.9
9. Pediatric Community Acquired Pneumonia
423 J18.9
10. Septic Shock
403 A41.9
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Department of Health
BUREAU OF HEALTH FACILITIES AND SERVICES
ANNEX – E A.O. No. 2012-0012
Kindly accomplish the “Ten Leading Causes of Morbidity/Diseases Disaggregated as to Age and Sex” in the table below.
Spell out. Do not
AbbreviateM F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F
1. Spontaneous
Delivery by Low Risk0 0 0 0 0 0 0 0 0 2012 0 3192 0 2304 0 1820 0 832 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 10166 10166 243
2. Delivery by
Ceasarean Section0 0 0 0 0 0 0 15 0 536 0 1503 0 1434 0 1478 0 989 0 325 0 16 0 0 0 0 0 0 0 0 0 0 0 6296 6296 242
3. Spontaneous
Delivery by High Risk0 0 0 0 0 0 0 78 0 831 0 358 0 244 0 323 0 871 0 762 0 37 0 0 0 0 0 0 0 0 0 0 0 3504 3504
4. Complete Abortion
(all types)0 0 0 0 0 0 0 1 0 143 0 298 0 284 0 239 0 171 0 101 0 10 0 0 0 0 0 0 0 0 0 0 0 1247 1247 236
5. Neonatal
Pneumonia539 688 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 539 688 1227 249
6. Potentially Septic 463 410 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 463 410 873 245
7. Sepsis (all forms) 389 335 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 389 335 724 250
8. Pneumonia 287 225 2 3 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 290 229 519 169
9. Pediatric
Community Acquired
Pneumonia
260 163 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 260 163 423 169
10. Septic Shock 235 163 1 0 0 0 0 0 0 0 0 2 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 236 167 403 017
65 - 69 70 & Over Subtotal
TOTALICD-10
CODE /
TABULA
R LIST
Age Distribution of Patients
35 - 39 40 - 44 45 - 49 55 - 5950 - 54 60 - 6415 - 19 20 -24 25 - 29 30 - 34
Cause of Morbidity
(Underlying)Under 1 1 - 4 5 - 9 10 -14
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Department of Health
BUREAU OF HEALTH FACILITIES AND SERVICES
ANNEX – E A.O. No. 2012-0012
11. Total Number of Deliveries
For each category of delivery listed below, please report the total number of deliveries.
Deliveries
Number ICD-10 Code
Total number of in-facility deliveries 20,344 Z38.0
Total number of live-birth vaginal deliveries (normal)
13,670 O80.0
Total number of live-birth C-section deliveries (Caesarians)
6,261 O82.0
Total number of other deliveries
Breech Extraction
Delivery by Forceps Extraction
292
86
O83.0
O81.0
12. Outpatient Visits, including Emergency Care, Testing and Other Services
For each category of visit of service listed below, please report the total number of patients receiving the care.
Outpatient visits
Number
Number of outpatient visits, new patient
35,223
Number of outpatient visits, re-visit
52,289
Number of outpatient visits, adult
67,146
Number of outpatient visits, pediatric
20,366
Number of adult general medicine outpatient visits
4,724
Number of specialty (non-surgical) outpatient visits
1,328
Number of surgical outpatient visits
143
Number of antenatal care visits
35,473
Number of postnatal care visits
4,112
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Department of Health
BUREAU OF HEALTH FACILITIES AND SERVICES
ANNEX – E A.O. No. 2012-0012
Emergency visits
Number
Total number of emergency department visits
9,129
Total number of emergency department visits, adult
7,948
Total number of emergency department visits, pediatric
1,181
Total number of patients transported FROM THIS FACILITY’S
EMERGENCY DEPARTMENT to another facility for inpatient care
5
Testing
Number
Total number of medical imaging tests (all types including x-rays, ultrasound,
CT scans, etc.)
26,660
Total number of laboratory and diagnostic tests (all types, excluding medical
imaging)
269,505
Other services and diseases seen
Number
Total number of outreach or home visits
10
Total number of immunization doses administered to children 0-59 months at
this facility or during outreach or home visits. Include immunizations
administered during child health weeks.
45,621
Total number of newly diagnosed cases of TB
( OPD cases )
13
Total number of confirmed cases of dengue
27
C. Deaths
For each category of death listed below, please report the total number of deaths.
Types of deaths
Number
Total deaths
886
Total number of inpatient deaths
Total deaths < 48 hours 363
Total deaths > 48 hours 523
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Department of Health
BUREAU OF HEALTH FACILITIES AND SERVICES
ANNEX – E A.O. No. 2012-0012
Total number of emergency room deaths
1
Total number of cases declared ‘dead on arrival’
1
Total number of stillbirths
395
Total number of neonatal deaths
791
Total number of maternal deaths
12
1. Gross Death Rate= 1.67%
Gross Death Rate = Total Deaths (including newborn for a given period)
Total Discharges and Deaths for the same period x 100
2. Net Death Rate= 1.00%
Net Death Rate = Total Death (including newborn for a given period) – death <48 hours for the period
Total Discharges (including deaths and newborn) – death<48 hours for the period x 100
3. Ten Leading Causes of Mortality/Deaths and Total Number of Mortality/Deaths.
Mortality/Deaths
Number ICD-10 Code
(Individual)
1. Septic Shock
403 A41.9
2. Respiratory Distress Syndrome
123 P22.0
3. Respiratory Failure
70 P28.5
4. Birth Asphyxia
49 P21.9
5. Disseminated Intravascular Coagulopathy
47 P60.0
6. Sepsis ( all forms )
19 P36.9
7. Persistent Pulmonary Hypertension
18 P29.2
8. Prematurity
15 P07.0
9. Multiple Congenital Anomaly
15 Q89.7
10.Anencephaly
14 Q00.0
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Department of Health
BUREAU OF HEALTH FACILITIES AND SERVICES
ANNEX – E A.O. No. 2012-0012
Kindly accomplish the “Ten Leading Causes of Mortality/Deaths Disaggregated as to Age and Sex” in the table below.
Cause of
Death (Underlying) Age Distribution of Patients
T O T A L
ICD-10 CODE/ TABULAR LIST Under 1 1 – 4 5 – 9 10 -14 15 –19 20 – 24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70 &
over Subtotal
Spell out. Do not abbreviate.
M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F
1.Septic Shock 235 163 1 0 0 0 0 0 0 0 0 2 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 236 167 403 3-009
2.Respiratory Distress Syndrome
76 47 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 76 47 123 3-042
3.Respiratory Failure 44 26 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 44 26 70 3-044
4.Birth Asphyxia 27 22 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 27 22 49 3-041
5.Disseminated Intravascular Coagulopathy 24 23 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 24 23 47 3-047
24 23 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 24 23 47 3-047
6. Sepsis all forms 9 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9 10 19 3-045
7. Persistent Pulmonary Hypertension
9 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9 9 18 3-048
8.Prematurity 8 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 7 15 3-039
9.Multiple Congenital Anomaly
5 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 9 15 3-055
10..Anencephaly 5 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 9 14 3-051
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Department of Health
BUREAU OF HEALTH FACILITIES AND SERVICES
ANNEX – E A.O. No. 2012-0012
D. Healthcare Associated Infections (HAI)
HAI are infections that patients acquire as a result of healthcare interventions. For purposes of Licensing, the
four (4) major HAI would suffice.
For All Hospitals (Levels 1, 2, 3 General and Specialty)
INFECTION RATE = Number of Healthcare Associated Infections x 100
Number of Discharges
853 x 100
52,974
= 1.61 %
a. Device Related Infections
1. Ventilator Acquired Pneumonia (VAP) = Number of Patients with VAP x 1000
Total Number of Ventilator Days
147 x 1000
3,880
= 37.89 VAP/1,000 Ventilator days
2. Blood Stream Infection (BSI) = Number of Patients with BSI x 1000
Total Number of Central Line
622 x 1000
2,980
= 208.72 BSI/1,000 Central Lines
3. Urinary Tract Infection (UTI) = Number of Patients with UTI x 1000
Total Number of Catheter Days
9 x 1000
6,668
= 1.35 UTI/1,000 Catheter days
b. Non-Device Related Infections
Surgical Site Infections (SSI) = Number of Surgical Site Infections x 100
Total number of Procedures
49 x 1000
11,300
= 4.34 %
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Department of Health
BUREAU OF HEALTH FACILITIES AND SERVICES
ANNEX – E A.O. No. 2012-0012
E. Surgical Operations
1. Major Operation refers to surgical procedures requiring anesthesia / spinal anesthesia to be performed in an
operating theatre. (The definition of a major operation shall be based on the definitions of the different cutting
specialties ).
2. Minor Operation refers to surgical procedures requiring only local anesthesia /no OR needed, example suturing .
10 Leading Major Operations (
excluding Caesarian Sections )
Number
ICD-10 Code
1. Abdominal Hysterectomy 202 5-683
2. Salpingectomy 193 5-665
3. Salpingoophorectomy 80 5-653
4. Myomectomy 35 5-681
5. Oophorectomy 31 5-652
6. Cystectomy 21 5-575
7. Vaginal Hysterectomy 14 5-684
8. Laparotomy 14 5-541
9. Oophorocystectomy 4 5-651
10. Radical Hysterectomy 3 5-685
10 Leading Minor Operations
Number
ICD-10 Code
1. Laceration 5,006 O70.9
2. Episiotomy 4,698 5-738
3. Bilateral Tubal Ligation 4,328 Z30.2
4. Completion Curettage 915 5-690
5. Delivery by Breech Extraction 292 O80.1
6. Dilatation and Curettage 184 5-690
7. Delivery by Forceps Extraction 86 O81.0
8. Endometrial Curettage 78 5-690
9. Suction Curettage 57 5-690
10. Polypectomy 21 5-684
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Department of Health
BUREAU OF HEALTH FACILITIES AND SERVICES
ANNEX – E A.O. No. 2012-0012
2 STAFFING PATTERN (Total Staff Complement)
Profession/ Position/
Designation
Total staff working full time
(at least 40 hours/week)
Total staff working part time
(at least 20 hours/week)
Active
Rotating
or
Visiting/
Affiliate
(For
Private
Facilities)
Out-
sourced
Number of
permanent
staff
Number of
contractual
staff
Number of
volunteer
staff
Number of
permanent
staff
Number of
contractual
staff
Number of
volunteer
staff
A. Medical
1. Consultants (indicate One-
Peso consultant)
1.1. Internal Medicine
a. Generalist 1
b. Nephrologist 1
c. Surgery 1
1.2. Obstetrics/ Gynecology
(and subspecialty)
a.Reproductive
/Endocrinology/Infertility
2 1
b.Perinatology 1
c.Infectious Disease 1
d.Generalist 12
e.Ultrasound 1 2
f.Gynecologic Oncology 1 1
g.Trophoblastic Disease 1
h.Perinatology & Ultrasound 1
i.Maternal & Fetal Medicine 1
j.Perinatology/Maternal & Fetal
Medicine
1
1.3. Pediatrics
a.Generalist 4
b.Pediatric Intensive Care 1
c.Pedia Cardiology 1
d.Pediatric Infectious Disease 1
e.Nephrology 1
f.Pediatric Surgery 1
g.Developmental Pediatrics 1
h.Pediatric Gastroenterolog y&
Nutrition
1
i.Child Neurology 1
1.4 Surgery None None
1. 5 Anesthesiologist
a.Generalist 11 2
b.Pediatric Anesthesiology 1
1. 6 Radiologist
a.Generalist 1 1
b.Sonologist 1
1. 7 Pathologist
a.Generalist 2 3
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Department of Health
BUREAU OF HEALTH FACILITIES AND SERVICES
ANNEX – E A.O. No. 2012-0012
1. 8 Neonatologist
a.Neonatology 1 5
b.Post Graduate Fellows none none
c.Residents/Post Residents All residents and post residents are temporary
1.1 Internal Medicine
1.2 Obstetrical/Gynecology
1.3 Pediatrics
1.4 Surgery
B. Allied Medical
1. Nurses 174
2. Midwives 122
3. Nursing Aides 33
4. Nutritionist 8
5. Physical Therapist None
6. Pharmacists 23
7. Medical Technologist 22
8. Dentists 7
9. Midwifery School Pricipal 1
10. Chemists 2
11. Dental Aides 2
12. Laboratory Aides 8
C. Non-Medical
1. Social Workers 11
2. Medical Records Officer/
Hospital Health Information
Officer with formal training
in medical records
management
6
3. Laboratory Technicians 1
4. X-Ray Technicians 10
5. Administrative Officer 36
6. Accounting/ Finance Officer 3
7. General Support Staff
(maintenance, janitorial,
secretarial) – indicate if
outsourced
8. Medical Center Chief II 1
9. Chief,Medical Professional
Staff II
1
10. Engineers 2
11. Training Specialist 1
12. Health Education and
Promotion Officer
1
13. Statisticians 3
14. Computer Maintenance
technologist
2
15. Security Officer 1
16. Legal Assistants 1
17. Presidential Staff Assistant 1
18. Administrative Assistants 74
19. Hospital Housekeepers 3
20. Master Tailor 2
21. Training Assistants 2
22. Social Welfare Assistants 1
23. Administrative Aides 147
24. Laundry Workers 8
25. Cook 6
26. Security Guard 9
27. Seamstress 3
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Department of Health
BUREAU OF HEALTH FACILITIES AND SERVICES
ANNEX – E A.O. No. 2012-0012
3 EXPENSES
Report all money spent by the facility on each category.
Expenses
Amount in
Pesos
Amount spent on personnel salaries and wages
₱260,022,213.97
Amount spent on benefits for employees (benefits are in addition to wages/salaries.
Benefits include for example: social security contributions, health insurance)
36,257,406.60
Allowances provided to employees at this facility (Allowances are in addition to
wages/salaries. Allowances include for example: clothing allowance, PERA, vehicle
maintenance allowance and hazard pay.)
215,289,603.76
TOTAL amount spent on all personnel including wages, salaries, benefits and
allowances for last year (PS)
₱511,569,224.33
Total amount spent on medicines funded by the Revolving Fund
15,185,338.92
Total amount spent on medicines funded by the Government of the Philippines (from
any level of government, including the central, provincial and municipal
governments)
5,567,708.38
Total amount spent on medical supplies (i.e. syringe, gauze, etc.; exclude
pharmaceuticals)
45,462,032.63
Total amount spent on utilities
30,657,999.01
Total amount spent on non-medical services (For example: security, food service,
laundry, waste management)
31,267,116.24
TOTAL amount spent on maintenance and other operating expenditures
(MOOE)
₱128,140,195.18
Amount spent on infrastructure (i.e., new hospital wing, installation of ramps)
568,315.80
Amount spent on equipment (i.e. x-ray machine, CT scan) 7,123,656.16
TOTAL amount spent on capital outlay (CO) ₱ 7,691,291.96
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Department of Health
BUREAU OF HEALTH FACILITIES AND SERVICES
ANNEX – E A.O. No. 2012-0012
4 REVENUES
Please report the total revenue this facility collected last year. This includes all monetary resources acquired by this
facility from all sources, and for all purposes.
Revenues
Amount in
Pesos
Total amount of money received from the Department of Health None
Total amount of money received from the local government
None
Total amount of money received from donor agencies (for example JICA, USAID,
and others)
None
Total amount of money received from private organizations (donations from
businesses, NGOs, etc.)
None
Total amount of money received from Phil Health
137,380,956.15
Total amount of money received from direct patient/out-of-pocket charges/fees
53,082,722.33
Total amount of money received from reimbursement from private insurance/HMOs
None
Total amount of money received from other sources (PDAF, PCSO, etc.)
5,000,000.00
TOTAL Revenue
₱195,463,678.48
Report Prepared by : Emelita F. Sanchez
Designation/Section/Department : Statistician III Date: _______
Report Approved and Certified by : ____________________________ Date: _______
Chief of Hospital/Medical Director
_________________________________________________________________________________________________
PREPARED BY:
STANDARDS DEVELOPMENT DIVISION (SDD)
BUREAU OF HEALTH FACILITIES AND SERVICES (BHFS)
DEPARTMENT OF HEALTH (DOH)
APPROVED BY:
ATTY. NICOLAS B. LUTERO III, CESO III
ASSISTANT SECRETARY
DOH
HOS-Stat Report Form Revision:02
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