Dr. Jose Rizal Memorial Hospital Citizen's Charter Handbook

DR. JOSE RIZAL MEMORIAL HOSPITAL
CITIZEN’S CHARTER

2019 (1ST Edition)

DR. JOSE RIZAL MEMORIAL HOSPITAL

CITIZEN’S CHARTER 1|Page

2019 (1ST Edition)

I. Mandate:

Republic Act (RA) 8200:
 This is an Act approved on July 30, 1996 converting the Rizal Memorial District Hospital

in Dapitan City into a tertiary Hospital, under the full administrative and technical
supervision of the Department of Health (DOH), which shall be known as the Dr. Jose
Rizal Memorial Hospital and appropriating funds therefore.

 States that the said general hospital shall have the capabilities of a tertiary hospital,
increasing its bed capacity to two hundred (200) beds.

 Further states that the DOH shall formulate the necessary guidelines for its operation as
a tertiary hospital and that the amount necessary to carry out the provisions of this Act
shall be included in the General Appropriations Act of the year following its enactment
into law and thereafter

 DOH-Administrative Order No. 2015-0041 dated September 15, 2015 defined its
Implementing Rules and Regulations (IRR) with the following seven (7) implementing
mechanisms involving the following areas:

 Redirection and Expansion of Services
 Health Human Resource
 Assets and Liabilities
 Equipment
 Infrastructure
 Systems Development
 Quality Management

II. Vision:

The Dr. Jose Rizal Memorial Hospital (DJRMH), an enabler in the attainment of Filipinos as
among the healthiest people in Southeast Asia by 2022, and by Asia by 2040.

III. Mission:

As part of the Department of Health, the DJRMH shall lead in the hospital and community
based development of people-centered, resilient, and equitable health system for its target
population.

IV. Service Pledge:

We, The members of the Management and Staff of Dr. Jose Rizal Memorial Hospital, do
pledge and commit to deliver quality services as provided in our Citizen’s Charter.
We commit to:
1. UPHOLD our values of PROFESSIONALISM, RESPONSIVENESS, INTEGRITY,

COMPASSION, EXCELLENCE in dealing with our clients
2. WEAR OUR IDENTIFICATION CARDS AND UNIFORMS with PRIDE & DIGNITY
3. APPLY and IMPLEMENT consistently applicable Rules And Policies
4. LISTEN and ACT Appropriately to our client’s feedback
5. CONSCIOUSLY AIM for our client’s satisfaction

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LIST OF SERVICES 7
9
I. HOSPITAL OPERATIONS AND PATIENT SUPPORT SERVICE 10
External Services 12
1 Issuance of Certificate of Employment 13
2 Issuance of Official Receipt and/or Clearance 14
3 Issuance of Service Record 15
4 Issuance of Statement of Account (SOA) 17
5 Processing of Receipt of Deliveries of Supplies/Equipment 18
6 Purchase of Bidding Documents
7 Releasing of Checks to External Creditors 20
8 Request of Data/Information under EO No. 2 21
9 Verification of PHIC Eligibility Status 26

Internal Services 31
1 Issuance of Requested Supplies/Equipment 32
2 Leave of Absence Application 33
3 Leave of Absence Application – For Travel Abroad, Maternity 34
Leave and Leave of Absence for more than 30 days 35
4 Liquidation f Cash Advance – Travel or Training 36
5 Production of Linen Supplies Based on Approved Job Order
6 Releasing of Checks to Internal Creditors 39
7 Request for Budget Obligation of Financial Transaction 41
8 Request for Corrective Maintenance (CM)
9 Request for Linen Supplies 43

II. NURSING SERVICE 44
External Services 51
1 Availment of Animal Bite Services – Follow up Vaccination 52
2 Availment of Animal Bite Services – New Animal Bite Clients 53
(Category II & Category III bite exposure without PhilHealth 54
3 Availment of Animal Bite Services – New Animal Bite Clients
(Category III bite exposure) with PhilHealth 55
4 Availment of Medical and Surgical Supplies
5 Availment of Out-Patient Department Consultation 56
6 Availment of TB-DOTS Service – New TB DOTS Clients 57
7 Availment of TB-DOTS – Patient follow-up for Enrolled TB Clients 59
8 Availment of TB-DOTS Service – Patient follow-up for continuation 60
of treatment at the Hospital 62
9 Availment of TB-DOTS Service – Patient follow-up for continuation 67
of treatment at the RHU / CHO
10 Issuance of Patients Identification Card
11 Issuance of Triage Pass
12 Patient’s Registration at the Emergency Room
13 Patient’s Triage at the Emergency Room
14 Patient’s Post Triage Disposition at the Emergency Room
15 Triaging and Admission of Suspect, Probable and Confirmed COVID-19

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Internal Services 69
1 Discharge Process/Discharging a Patient from Clinical Areas 71
2 Issuance of Medical Supplies
74
III. MEDICAL AND ANCILLARY SERVICE 76
External Services 77
1 Availment of Blood Units 81
2 Availment of In-Patient Registration 82
3 Availment of Laboratory Services for Out-Patients 84
4 Availment of Dental Services
5 Availment of Medical Assistance 86
6 Availment of Medico-Legal Examination at the Women 87
and Child Protection Unit 88
7 Availment of MSS Classification/Re-Classification of Patient 89
8 Availment of Nutritional and Dietetics Service 90
9 Availment of Patient’s Data Correction
10 Availment of Patients Hospital Identification Card 92
11 Availment of Philhealth Enrolment through Point
Of Service (POS) 94
12 Availment of Services at Malasakit Center 97
(Medical/Financial Assistance & Verification of PHIC Status
13 Availment of X-ray Services for Out-Patient 99
14 Conduct of Procedure and Releasing of Result
for Out-Patient (X-Ray Special Procedure, Ultrasound and 2D Echo) 101
15 Conduct of Procedure and Releasing of Result 105
for Out-Patient (CT-Scan and Mammogram) 107
16 Issuance of Drugs and Medicines 109
17 Issuance of Duplicated Copies of Health Records
18 Issuance of Unregistered Death Certificate 112
19 Issuance of Various Certificates and Completed
Insurance Forms 117
20 Processing for Payment of Radiology Services
– For Special Procedures 120
21 Processing of Unregistered Certificate of Live Birth 122

Internal Services 124
1 Availment of Laboratory Services for In-Patient
2 Availment of Imaging Services for COVID Related Patients
– For X-Ray Procedure and Ultrasound
3 Availment of CT-Scan Procedure for COVID Related Patients
– For CT Scan

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HOSPITAL OPERATION AND
PATIENT SUPPORT SERVICE

(HOPPS)

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External Services

6|Page

1. Issuance of Certificate of Employment

This certificate is issued to a requesting client relative to their services rendered as an employee of Dr.

Jose Rizal Memorial Hospital

Office/Division: Human Resource Management Section

Classification: Simple

Type of Transaction: G2G - Government to Government , G2C – Government to Client

Who May Avail: All Dr. Jose Rizal Memorial Hospital employees including those who are
already separated in the service

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Principal: Cashier
1. Official receipt HR Office
2. Charge Slip
Authorized representative: Any Government-issued IDs
1.Proof of Identification of the principal and authorized
Requesting party (principal)
representative Cashier / HR Office
2. Authorization letter
3. Official receipt / Charge Slip

CLIENT STEPS AGENCY ACTION FEES PROCESSING PERSON
TO TIME RESPONSIBLE
1. Fills-out the logbook 1. Entertains client’s request and BE
and secures the advise to fill-out the Logbook PAID 2 minutes Administrative
Document Request and provides Document None Assistant II
Form Request Form

1.1 Receives and fill up the 1.1 Issues Charge Slip and None 2 minutes Administrative
Document Request advice the client to proceed to Assistant II
Form the HR head

1.2 Presents the Document 1.2 Signs the Charge Slip and None 2 minutes Administrative
Request Form and countersigns the Document 20 minutes Officer V/ HRMO
Charge Slip to the HR Request Form Php 5 minutes
head 15.00 Cashier’s office
None 1 minute staff
1.3 Proceeds to the 1.3 Issues official receipt 2 minutes
Cashier’s office for None Medical Center
payment and pays the None Chief
corresponding amount
Administrative
1.4 Proceeds to the office 1.4 Approves the Document Assistant II
of the Medical Center Request Form
Chief for the approval Administrative
of the Document 1.5 Receives the approved Assistant II
Request Form Document Request Form 7|Page

1.5 Returns to the HR office 1.5.1 Advices the client of the
and presents Official scheduled Date of release
Receipt then submits (Next working day after
the approved request is done) of the
Document Request
Form

Certificate of Employment None 5 minutes Administrative
1.5.2 Verifies the employment Officer IV

2.1 Returns on the record of the client from None 2 day Administrative
scheduled date his/her 201 File None 5 minutes Officer IV
None 5 minutes
1.5.3 Prepares and print the None 1 minute Administrative
Certificate of Employment Officer V/ HRMO
None 1 minute
1.5.4 Reviews and signs the Medical Center
Certificate of Employment Chief

1.5.5 Signs the Certificate of Administrative
Employment Assistant II

2.1 Gives Document Releasing Administrative
Logbook Assistant II

2.2 Signs the Document 2.2 Releases the Certificate of
Releasing Logbook Employment

TOTAL: Php 2 days & 51
15.00 minutes

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2. Issuance of Official Receipt and/or Clearance

The Cashier is in charge with the collection of payment for hospital fees, sales from pharmacy and

medical/surgical supplies, professional fees of agency-credentialled physicians and billed through

charge slips, statement of accounts, order slips and professional fee.

Office/Division: Cash Operations

Classification: Simple

Type of Transaction: Government-to-Citizen (G2C), Government-to-Business (G2B),
Who May Avail: Government-to-Government (G2G)

Patients or their representatives, employees, government agencies

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Any of the following: Cost center where service was rendered
Charge slip/ Order of Payment – 1 copy
Professional Fee Slip – 2 copies (1 original and 1 Attending physician or his authorized
photocopy)
Statement of Account or Billing Statement – 3 copies representative

Billing and Claims Section

CLIENT STEPS AGENCY ACTION FEES PROCESSING PERSON
TO BE TIME RESPONSIBLE
PAID

1. Gets queuing number 1. Calls the number of the None 5 minutes Collecting

and waits for number transaction to be Officer

to be called accommodated

Note: Special priority for 2. Receives document, such None 5 minute Collecting
Senior Citizens, Pregnant as: charge slip / statement None 3 minutes Officer
women and PWDs. of account (SOA)/
2. Approaches the MSS Stamped SOA/Order Collecting
of Payment Officer
window when called
and presents required 3.1 Receives cash / check
document from clients /creditors.

3.1 Gives cash/ checks
payment and
pays corresponding
amount.

3.2 Receives Official 3.2 Issues Official Receipt/s None 7 minutes Collecting
Receipt and/or (OR) and/or clearance None 20 minutes Officer
clearance then gives instruction to
the
client as needed

TOTAL

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3. Issuance of Service Record

A service record is issued to clients relative to their services as an employee of the Dr. Jose Rizal

Memorial Hospital.

Office/Division: Human Resource Management Section

Classification: Complex

Type of Transaction: Government to Government

Who May Avail: All active human resource

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Principal: Cashier / HR Office
1. Official receipt / Charge Slip
Authorized representative: Any Government-issued IDs
1.Proof of Identification of the principal and authorized
Requesting party (principal)
representative
2. Authorization letter Cashier / HR Office
3. Official receipt / Charge Slip

FEES

CLIENT STEPS AGENCY ACTION TO PROCESSING PERSON

BE TIME RESPONSIBLE

PAID

1. Fills-out the logbook and 1. Entertains client’s request None 2 minutes Administrative
secures the Document and advise to fill-out the
Request Form Logbook and provides Assistant II
Document Request Form

2. Receives and fill up the 2. Issues Charge Slip and None 2 minutes Administrative
Document Request Form advice the client to proceed None 2 minutes Assistant II
to the HR head
3. Present the Document Administrative
Request Form and Charge 3. Signs the Charge Slip and Officer V/ HRMO
Slip to the HR head countersigns the Document
Request Form

4. Proceeds to the Cashier’s 4. Accepts payment and issues Php 20 minutes Cashier’s office
office for payment official receipt 15.00 5 minutes staff

5. Proceeds to the office of 5. Approves the Document None Medical Center
the Medical Center Chief Request Form Chief
for the approval of the
Document Request Form

6. Returns to the HR office 6.1 Receives the approved None 1 minute Administrative
and presents Official Document Request Form None 2 minutes Assistant II
Receipt and submits the
approved Document 6.2 Advices the client of the Administrative
Request Form scheduled Assistant II
release of the Service
Record

6.3 Verifies the employment None 5 minutes Administrative
record of the client from Officer IV
his/her 201 File None 4 days
Administrative
6.4 Prepares and print the Officer IV
Service Record
Administrative

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6.5 Reviews and signs the None 10 minutes Officer V/ HRMO
Service Record None 1 minute Medical Center
None 1 minute Chief
7.1 Returns on the scheduled 7.1 Gives Document Administrative
Assistant II
date Releasing Logbook
Administrative
7.2 Signs the Document 7.2 Releases the Service Assistant II
Releasing Logbook Record

TOTAL: Php 4 days & 51

15.00 minutes

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4. Issuance of Statement of Accounts (SOA)

The Billing and Claims Unit is incharge for the issuance of Statement of Account (Billing Statement) for

all patients managed in the hospital for purposes of use for discharge process and to avail external

financial assistance such as insurance companies, SSS, PCSO and others.

Office/Division: Billing and Claims

Classification: Simple

Type of Transaction: G2C – Government to Citizen

Who May Avail: All Patients

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

None AGENCY ACTION None PROCESSING PERSON
TIME RESPONSIBLE
CLIENT STEPS 1.1 Receives request for Billing FEES
and SOA. TO 2 minutes Billing and
1. Request for Billing and BE Claims Frontline
SOA PAID
None Staff

2. Receives SOA and 1.2 Generates and prints SOA None 8 minutes Billing and
signs receipt thereto. to include PHIC benefits None 13 minutes Claims Frontline
and other related benefits/
discounts as applicable Staff

2. Releases the printed SOA Billing and
and have the Claims Frontline
client/authorized
representative sign receipt Staff
thereto.

TOTAL None 23 minutes

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5. Processing of Receipt of deliveries of supplies/equipment

The Materials Management Office has the sole authority to receive deliveries from all legitimate
suppliers. The MMO ensures that all deliveries are in accordance to the specifications stipulated in the
Purchase Order. Any deliveries that are not in compliance to the specifications shall be rejected and
shall be returned to the suppliers.

Office or Division: Materials Management Section
Classification: Simple
Type of Transaction: G2C – Government to Client
Who may avail: Supplier

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Approved P.O./Sales Invoice /Delivery Receipt MMO / Supplier

CLIENT STEPS AGENCY ACTIONS FEES TO PROCESSING PERSON
BE PAID TIME RESPONSIBLE
1. Presents documentary 1. Receives documentary 1 hour
requirements of requirements presented. None MMO staff
supplies/equipment for Checks if delivery are in 5 minutes
delivery conformity with the None End-Users/CSR
specifications stipulated
2. Receives copy of receipt in the purchase order
of supplies/equipment
delivered 2. Signs when in order and
gives a copy of the
receipt to the client

TOTAL None 35 minutes

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6. Purchase of Bidding Documents

This process shows the process on how the suppliers/bidders can avail for the bidding documents.

Office/Division: Procurement

Classification: Simple

Type of Transaction: G2C – Government to Citizen

Who May Avail: Bidders / Suppliers

CHECKLIST OF REQUIREMENTS WHERE TO SECURE
- Supplier
- Letter of Intent (LOI) - (1 copy)
- Valid ID - (1 copy) - Cashier
Official Receipt - (1 copy)

CLIENT STEPS AGENCY ACTION FEES PROCESSING PERSON
TO BE TIME RESPONSIBLE
PAID
Procurement
1.Signs in the Visitor’s 1. Gives the Visitor’s Logbook to Staff/BAC
Secretariat
Logbook the Supplier/Bidder None 5 minutes
Procurement
2. Presents Letter of Intent 2.1 Receives and reviews LOI None 10 minutes Staff/BAC
Secretariat
(LOI) and Valid ID and ID

1.1 Issues Charge Slip to None 2 minutes Procurement
Supplier/Bidder Staff/BAC
Secretariat

1.2 Directs bidder/suppliers to None 3 minutes Procurement
Cashier for payment Staff/BAC
*Please 20 minutes Secretariat
3. Presents charge slip 3. Issues Official Receipt refer to 25 minutes
45 minutes Cashier
and pays corresponding table
below Procurement
amount Staff/BAC
None Secretariat
4. Presents Issued Official 4. Receives Official Receipt and
Receipt from the Issues bidding documents None
Cashier

TOTAL

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7. Releasing of Checks to External Creditors

The Cash Operations is tasked with the releasing of checks to external creditors through issuance of
processed and approved checks or through Authority to Debit Advice System. It ensures that
payments are duly acknowledged by mentioned creditors through the issuance of valid official or
collection receipts whichever is appropriate, with the corresponding acknowledgment on the approved
disbursement or payroll vouchers and withholding tax certificates

Office or Division: Cash Operations

Classification: Simple

Type of Transaction: Government-to-Citizen (G2C), Government-to-Business (G2B),

Government-to-Government (G2G)

Who may avail: External creditors or suppliers

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

1. Valid identification card with signature of the claimant (1 Company affiliation, Land Transportation

ID) Office, or Professional Regulation

Commission, GSIS, SSS, OSCA or

OWWA, COMELEC

2. For company representative: Legitimate payee company

a. Authorization letter using company stationary (1

original document) The authorizing person of the company

b. Photocopy of valid identification of authorizing

person with signature as shown in the identification

for comparison purposes (1 copy)

3. If representing a person: Special Power of Attorney (1 Notary public

original document)

4. If representing a deceased payee: Extrajudicial Lawyer or judicial court

Settlement of Estate where name of representative of

the claimant is included or Affidavit of Self-Adjudication

(1 original document)

5. Additional requirement for suppliers: Valid Official or Bureau of Internal Revenue authorized

Collection Receipt print

FEES

CLIENT STEPS AGENCY ACTIONS TO PROCESSING PERSON

BE TIME RESPONSIBLE

PAID

If not given permission to transact inside after assessment at designated area for COVID-19 triage area:

Waits for the cashier’s staff to transact outside

If given permission to transact inside after assessment at designated area for COVID-19 triage area:
Proceeds to Cashier’s Office

1. Presents required 1.1 Verifies documents None 3 minutes Disbursing
documents Officer

2. Acknowledges the 1.2 If identification is appropriate, None 2 minutes Disbursing
disbursement documents logs out documents to be None 3 minutes Officer
by affixing signature issued out
Disbursing
2. Retrieves the check or Officer
Authority to Debit Account

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3. Issues Official or 3. Issues the check or Authority to None 3 minutes Disbursing
Collection Receipt and Debit Account None 2 minutes Officer
acknowledges BIR forms None 13 minutes
2306 and 2307 4. Inspects the documents for Disbursing
completeness and propriety of Officer
4. Returns the signed acknowledgment
disbursement
documents

TOTAL

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8. Request for Data/Information under EO No. 2

The Office of the Supervising Administrative Officer is in charged in receiving request for information

under EO no. 2 which pertains to Freedom of Information (FOI). The service rendered is open to all

Filipino Citizen that wants to access/asks for records/information

Office/Division: Office of the Supervising Administrative Officer (SAO)

Classification: Highly Technical

Type of Transaction: Government-to-Citizen (G2C)

Who May Avail: Any Filipino Citizen

CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Any valid government-issued identification card – 1 copy
Land Transportation Office, Professional
FOI Request Form Regulation Commission, GSIS, SSS,
OSCA, OWWA, COMELEC
Office of the SAO

CLIENT STEPS AGENCY ACTION FEES PROCESSING PERSON
TO
BE TIME RESPONSIBLE
PAID
1. Fills up a request form 1. Receives, evaluates and None 15 working days FOI Receiving
and submits to the FOI classifies the information Officer (FRO)
Receiving Officer with being requested and transmit None (maybe
the copy of valid ID. it to the FOI Decision Maker extended with 5 FOI Decision
for proper assessment. working days of Maker (FDM)

1.1 Checks if the agency holds processing
the information requested, if it period as the
is already accessible, or if the need arises)
request is a repeat of any
previous request. Forwards None Concerned
request to the officials Official
involved to locate the
requested information.

1.2 Retrieves all relevant
information, checks if any
exemptions apply and
recommends appropriate
response to the request.

1.3 Approves or denies the None FOI Decision
Maker (FDM)
request and notifies the FRO.

2. Receives the 2. If approved, releases None FOI Receiving
information/ Records Information/ Records on the Officer (FRO)
on the desired format. desired format.

Receives notice of If denied, informs of denial.
denial. TOTAL

None 15 working days
( 20 working days if with 5
working days extension)

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9. Verification of PHIC Eligibility Status

The Billing and Claims Unit is incharge for the verification of the patient’s PHIC eligibility prior to patien
t’s availment of the PHIC Benefits/Package.

Office/Division: Billing and Claims
Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who May Avail: All Patients with PhilHealth

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

* Any of listed documentary requirements, as applicable: - Philippine Statistics Authority (PSA)
- Birth Certificate with Registry Number for undeclared - Philippine Statistics Authority (PSA)
- PhilHealth Office
child - (1 copy) - Public Attorneys’ Office
- Marriage Contract with Registry Number for undeclared
- Employer
spouse - (1 copy) - BIR, Post Office, DFA, PSA, SSS,
- MDR - (1 copy)
- Notarized Affidavit of Guardianship if patient is a Minor GSIS,
PAG-IBIG, LTO, COMELEC
or the Member is absent - (1 copy)
- CSF duly filled and signed if the member is employed -

(1 copy)
- Valid ID(Government Issued I.D.) - (1 copy)

CLIENT STEPS AGENCY ACTION FEES PROCESSING PERSON
TO TIME RESPONSIBLE
1. Requests for PHIC 1. Asks client some key point BE
Eligibility Status and Information and any PAID 3 minutes Billing and
presents documentary documentary requirements None Claims Frontline
requirements as as necessary for searching
necessary and verification of PHIC Staff
Eligibility Status in PHIC
2. Receives PHIC Portal/eClaims None 3 minutes Billing and
Eligibility Status Claims Frontline
2. Informs client’s PHIC
Eligibility Status Staff

if Not Eligible:
Instructs clients to submit
pertinent
documents as applicable

TOTAL None 6 minutes

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Internal Services

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1. Issuance of Requested Supplies/Equipment

The Materials Management Office has the sole authority in the issuance of an approved Requisition
and Issuance Slip of supplies and equipment. The MMO ensures that the issuance are duly
acknowledged and received by the requesting end users.

Office/Division: Materials Management Section

Classification: Simple

Type of Transaction: G2C

Who May Avail: End-users, CSR

CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Approved RIS
End-users, CSR

FEES

CLIENT STEPS AGENCY ACTION TO PROCESSING PERSON
RESPONSIBLE
BE TIME
MMS staff
PAID

1. Submits approved 1. Receives request None 5 minutes
Requisition and
Issuance Slip (RIS) 2.1 Prepares requested None 1 hour MMS staff
supplies/equipment None 30 minutes MMS staff
2. Waits for the requested
supplies/equipment 2.2 Prepares Property None 1 hour MMS staff
Acknowledgment Receipt End-users/CSR
3. Receives and signs (PAR) for equipment and None 5 minutes
requested supplies/ Inventory Custodian Slip (ICS)
equipment for semi
expendable items

2.3 Issues requested supplies/
equipment

3. Signs the portion issued and let
the end users/CSR sign the
received portion

TOTAL: None 2 hours & 40
minutes

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2. Leave of Absence Application

Leave of absence is generally defined as a right granted to officials and employees not to report for

work with or without pay as may be provided by law and as the rules prescribe in Rule XVI hereof.

Leave application refers to the application of an employee to avail leave of absence.

Office/Division: Human Resource Management Section

Classification: Simple

Type of Transaction: Government to Government

Who May Avail: All employees holding plantilla position

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Please refer to Table of Requirements for the Specific Please refer to Table of Requirements for
Type of Leave Applied
the Specific Type of Leave Applied

FEES

CLIENT STEPS AGENCY ACTION TO PROCESSING PERSON

BE TIME RESPONSIBLE

PAID

1. Secures Application for 1. Provides Application for Leave None 2 minutes Administrative

Leave Form Form Assistant II

2. Submits the Application 2. Receives the duly None 2 minutes Administrative
for Leave Form with the accomplished None 5 minutes Assistant II
required documents for Application for Leave and
the specific type of validates the required Administrative
leave applied and fill up documents/ attachments Assistant II
the Application for
Leave Logbook 2.1. Verifies the Leave Balance(s)
of the employee

If the employee has no leave None 2 minutes Administrative
balance: Assistant II
2.1.a Informs the employee that

he/she may avail the
desired leave without pay
subject for the approval of
the head of the agency.

If the employee has leave None 5 minutes Administrative
balance: Assistant II
2.1.b Made the necessary

computation and reflects in
the Leave Card

2.2 Entries the computation in the

Application for Leave Form None 5 minutes Administrative
Assistant II

2.3 Forwards the Application for None 2 minutes Administrative
Leave Form to the HR Head Assistant II
for certification of Leave
Credits balance

2.4 Certifies the Leave Credit None 5 minutes Administrative
Balance as reflected in the Officer V/ HRMO
Application for Leave

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3. Claims the approved/ 2.5 Forwards the Application for None 4 hours Administrative
disapproved leave and Leave Form to the respective None 2 minutes Assistant II
sign the released division head
logbook for leave None 1 day, 4 hours In-charge of the
application for 3. Releases the Approved & 30 minutes respective
employee’s copy Leave
Application Form and give division concern
the Released Logbook for
Employees copy

TOTAL:

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TYPE OF CHECKLIST OF REQUIREMENTS WHERE TO SECURE
LEAVE
CSC form No. 6 -Application for Leave Human Resource
For Vacation Form (2, Original Copy) Management Section
Leave: (HRMS)

For one (1) month and above, additional Human Resource
requirements: Management Section
(HRMS)
 Hospital Clearance Form (4,
Original Copy) Human Resource
Management Section
Additional Documentary Requirements (HRMS)
(for Travel Abroad)
Requesting party
Travel Authority Form (1, Original Copy) Human Resource
Management Section
For Sick Leave: Letter of Intent approved by the Head of (HRMS)
the Agency (1, Original Copy)
CSC form No. 6 -Application for Leave Issued by the Attending
Form (2, Original Copy) Physician

For infectious disease:
Medical Certificate (Fit to Work status
upon returned to work, 1 photocopy)

Additional Documentary Requirements: Issued by the Attending
For five (5) days above attached the ff: Physician

 Medical Certificate (1, Original Issued by the Attending
Copy) Physician

 Medical Certificate (Fit to Work
status upon returned to work, 1
photocopy)

For one (1) month and above

 Medical Certificate (1,Original
Copy)

 Medical Certificate (Fit to Work
status upon returned to work, 1
photocopy)

 Hospital Clearance Form (4,
Original Copy)

TYPE OF CHECKLIST OF REQUIREMENTS WHERE TO
LEAVE SECURE
For Maternity Medical Certificate (CSC Form 41, 3
Leave: Original copies) Human Resource
Management Section
For Maternity Hospital Clearance (4, Original Copy) (HRMS)
Leave:
For Paternity CSC form No. 6 -Application for Leave Sign by the Attending
Leave: Form Physician

MHuamnaagneRmeesnotuSrceection23 | P a g e
(HRMS)
CSC form No. 6
(Application for Leave

(2, Original Copy) Form)

Marriage Contract (1, Photocopy) Local Civil Registrar

For Paternity Birth certificate of the child (1, Photocopy) Local Civil Registrar
Leave: or Medical Certificate for Miscarriages (1,
For Solo Photocopy) Human Resource
Parent Leave: CSC form No. 6 -Application for Leave Management Section
Form (HRMS)
For Solo (2, Original Copy) Department of Social
Parent Leave: Solo Parent ID or Certificate from DSWD Welfare and
For (1, photocopy) Development (DSWD)
Rehabilitation Human Resource
Leave: (for CSC form No. 6 -Application for Leave Management Section
wounds and/or Form (HRMS)
injuries (2, Original Copy)
sustained while
in the CSC form No. 6 -Application for Leave Issued by the Attending
performance of Form Physician
official duties.) (2, Original Copy)
Medical Certificate (2, Original and
Photocopy)

For Approved Incident Report or Police Agency or Philippine
Rehabilitation Report (2, Original and Photocopy) National Police
Leave: (for Approved Hospital Order / Department Human Resource
wounds and/or Order / Travel Order for Official Business Management Section
injuries or Official Time (HRMS)
sustained while (1, Original Copy)
in the Holds a permanent appointment Employees concerned
performance of
official duties.)

For Study
Leave
Application:

For Study Holds a Degree that requires passing of Employees concerned
Leave bar/board examination School attended
Application: Field of study pursued must be relevant to
the agency’s mandate, or to the duties 24 | P a g e
and responsibilities of the concerned
official or employee, as determined by the
agency head:
School Certification (1, Original copy) to
wit:

 For Bachelors Degree –
Qualified for Board/Bar
Examination

 Completion For Master’s

Degree Human Resource
Completion For Doctoral Degree Management Section
With at least two (2) years of continuous (HRMS)
service in DRMC: Employees concerned

 Latest Service Record (1, Employees concerned
Original copy)

Individual Performance Commitment and
Review (IPCR) Form for the last 2 rating
period with at least Very Satisfactory
Rating immediately preceding the
application (1 Certified True Copy of each
rating period)
Letter of Intent (1 Original copy)

No Pending administrative and / or City Trial Court
criminal case: Human Resource
Court Clearance (1 Original copy) Management Section
Must not have any current foreign or local (HRMS)
scholarship grant:
Certificate of No Current Foreign or Local Human Resource
Scholarship Grant (1 Original copy) Management Section
Clearance (4 Original copies) (HRMS)

The employee must have fulfilled the
service obligation of any previous
training/scholarship/study grant
Study Leave Agreement for the Service
obligation

25 | P a g e

3. Leave of Absence Application – For travel abroad, Maternity

Leave and Leave of absence for more than 30 days

Leave of absence is generally defined as a right granted to officials and employees not to report for

work with or without pay as may be provided by law and as the rules prescribe in Rule XVI hereof.

Leave application refers to the application of an employee to avail leave of absence.

Office/Division: Human Resource Management Section

Classification: Simple

Type of Government to Government

Transaction:

Who May Avail: All employees holding plantilla position

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Please refer to Table of Requirements for the Specific Please refer to Table of Requirements for
Type of Leave Applied
the Specific Type of Leave Applied

FEES

CLIENT STEPS AGENCY ACTION TO PROCESSING PERSON

BE TIME RESPONSIBLE

PAID

1. Presents clearance as 1. Receives the clearance None 1 minute Administrative
an attachment for filing
of leave application 2. Provides Application for Leave Assistant II
Form
2. Secures Application for None 2 minutes Administrative
Leave Form Assistant II

3. Submits the Application 3. Receives the duly None 2 minutes Administrative
for Leave Form with the accomplished Application None 5 minutes Assistant II
required documents for for Leave and validates the
the specific type of required documents/ Administrative
leave applied and fill up attachments Assistant II
the Application for
Leave Logbook 3.1 Verifies the Leave Balance(s)
of the employee

If the employee has no leave None 2 minutes Administrative
balance: Assistant II
3.1.a Informs the employee that

he/she may avail the
desired leave without pay
subject for the approval of
the head of the agency.
(except for maternity leave)

If the employee has leave None 5 minutes Administrative
balance: Assistant II
3.1.b Made the necessary

computation and reflects in
the Leave Card

3.2 Entries the computation in the None 5 minutes Administrative
Application for Leave Form Assistant II

3.3 Forwards the Application for None 2 minutes Administrative
Leave Form to the HR Head Assistant II

26 | P a g e

for certification Leave Credits None 5 minutes Administrative
balance Officer V/ HRMO
3.4 Certifies the Leave Credit
Balance as reflected in the
Application for Leave

3.5 Forwards the Application for None 5 minutes Administrative
Leave Form to the respective Assistant II
division head for
recommending approval

3.6 Recommends approval of the None 1 hour Division Head
Application for leave and
forwards to Head of the
Agency for approval

4. Claims the approved/ 3.7 Approves the Application for None 1 day Head of Agency
disapproved leave and Leave None 2 minutes
sign the released In-charge of the
logbook for leave 4. Releases the Approved respective
application for Leave Application Form and
employee’s copy give the Released Logbook division concern
for Employees copy

TOTAL: 1 day, 1 hour &
34 minutes

27 | P a g e

TYPE OF CHECKLIST OF REQUIREMENTS WHERE TO SECURE
LEAVE
CSC form No. 6 -Application for Leave Human Resource
For Vacation Form (2, Original Copy) Management Section
Leave: (HRMS)

For one (1) month and above, additional Human Resource
requirements: Management Section
(HRMS)
 Hospital Clearance Form (4,
Original Copy) Human Resource
Management Section
Additional Documentary Requirements (HRMS)
(for Travel Abroad)
Requesting party
Travel Authority Form (1, Original Copy) Human Resource
Management Section
For Sick Leave: Letter of Intent approved by the Head of (HRMS)
the Agency (1, Original Copy)
CSC form No. 6 -Application for Leave Issued by the Attending
Form (2, Original Copy) Physician

For infectious disease:
Medical Certificate (Fit to Work status
upon returned to work, 1 photocopy)

Additional Documentary Requirements: Issued by the Attending
For five (5) days above attached the ff: Physician

 Medical Certificate (1, Original Issued by the Attending
Copy) Physician

 Medical Certificate (Fit to Work
status upon returned to work, 1
photocopy)

For one (1) month and above

 Medical Certificate (1,Original
Copy)

 Medical Certificate (Fit to Work
status upon returned to work, 1
photocopy)

 Hospital Clearance Form (4,
Original Copy)

TYPE OF CHECKLIST OF REQUIREMENTS WHERE TO
LEAVE SECURE
For Maternity Medical Certificate (CSC Form 41, 3
Leave: Original copies) Human Resource
Management Section
For Maternity Hospital Clearance (4, Original Copy) (HRMS)
Leave:
For Paternity CSC form No. 6 -Application for Leave Sign by the Attending
Leave: Form Physician

MHuamnaagneRmeesnotuSrceection28 | P a g e
(HRMS)
CSC form No. 6
(Application for Leave

(2, Original Copy) Form)

Marriage Contract (1, Photocopy) Local Civil Registrar

For Paternity Birth certificate of the child (1, Photocopy) Local Civil Registrar
Leave: or Medical Certificate for Miscarriages (1,
For Solo Photocopy) Human Resource
Parent Leave: CSC form No. 6 -Application for Leave Management Section
Form (HRMS)
For Solo (2, Original Copy) Department of Social
Parent Leave: Solo Parent ID or Certificate from DSWD Welfare and
For (1, photocopy) Development (DSWD)
Rehabilitation Human Resource
Leave: (for CSC form No. 6 -Application for Leave Management Section
wounds and/or Form (HRMS)
injuries (2, Original Copy)
sustained while
in the CSC form No. 6 -Application for Leave Issued by the Attending
performance of Form Physician
official duties.) (2, Original Copy)
Medical Certificate (2, Original and
Photocopy)

For Approved Incident Report or Police Agency or Philippine
Rehabilitation Report (2, Original and Photocopy) National Police
Leave: (for Approved Hospital Order / Department Human Resource
wounds and/or Order / Travel Order for Official Business Management Section
injuries or Official Time (HRMS)
sustained while (1, Original Copy)
in the Holds a permanent appointment Employees concerned
performance of
official duties.)

For Study
Leave
Application:

For Study Holds a Degree that requires passing of Employees concerned
Leave bar/board examination School attended
Application: Field of study pursued must be relevant to
the agency’s mandate, or to the duties 29 | P a g e
and responsibilities of the concerned
official or employee, as determined by the
agency head:
School Certification (1, Original copy) to
wit:

 For Bachelors Degree –
Qualified for Board/Bar
Examination

 Completion For Master’s

Degree Human Resource
Completion For Doctoral Degree Management Section
With at least two (2) years of continuous (HRMS)
service in DRMC: Employees concerned

 Latest Service Record (1, Employees concerned
Original copy)

Individual Performance Commitment and
Review (IPCR) Form for the last 2 rating
period with at least Very Satisfactory
Rating immediately preceding the
application (1 Certified True Copy of each
rating period)
Letter of Intent (1 Original copy)

No Pending administrative and / or City Trial Court
criminal case: Human Resource
Court Clearance (1 Original copy) Management Section
Must not have any current foreign or local (HRMS)
scholarship grant:
Certificate of No Current Foreign or Local Human Resource
Scholarship Grant (1 Original copy) Management Section
Clearance (4 Original copies) (HRMS)

The employee must have fulfilled the
service obligation of any previous
training/scholarship/study grant
Study Leave Agreement for the Service
obligation

30 | P a g e

4. Liquidation of Cash Advance - Travel or Training

The Accounting Section is in-charged in the checking of the completeness of the supporting documents for

liquidation of cash advances being submitted by the employees of the hospital. The Accounting Section is open

for official transactions from Monday to Friday (8:00AM to 5:00PM).

Office/Division: Accounting

Classification: Simple

Type of Transaction: Government to Government

Who May Avail: All employees of DJRMH

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Liquidation Report End-User
Mandatory Supporting Documents: (3 copies each)
a. Revised Itinerary of Travel
b. Certificate of Travel Completed
c. Paper/Electronic Receipt, boat or bus tickets, boarding pass,

terminal fees
d. Certificate of Appearance/Attendance
e. Post Activity Report
f. Travel Order
g. Letter of Invitation addressed to the agency
h. Revised or Supplemental office order or any proof supporting

the change of schedule
i. Copy of the previously approved itinerary of travel
j. Certificate of not requiring receipt, in case refund of excess of

cash advance
k. Copy of Disbursement voucher upon cash advance

CLIENT STEPS AGENCY ACTION FEES PROCESSING PERSON
TO BE TIME RESPONSIBLE
1. Submits required 1. Checks the completeness and PAID
documents accuracy of the documents 6 hours Accountant
None
2. Receives documents for If complete: Accounting
compliance and/or 1.1 The In-Charge signs the None 2 hours Personnel/
payment of excess Accountant
approval None 30 minutes Accountant
3. Submits Liquidation If incomplete:
Report with Official 1.2 Proceed to Step 2.
Receipt 2. Returns documents to the

client and issues Order of
Payment in case of excess of
cash advance
3. Receives Liquidation Report
and signs it.

TOTAL None 1 day & 30
minutes

31 | P a g e

5. Production of Linen Supplies Based On Approved Job Order

Manufacturing of special requested linen supplies.

Office/Division: Linen and Laundry Service (HOPSS-General Services)

Classification: Complex

Type of Government-to-Government

Transaction:

Who May Avail: Nursing, Ancillary & HOPSS Service Supervisors and/or equivalent

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Approved Job Request Form – 1 copy Engineering & Facilities Management

Section-

EFMS Engineer In charged/Housekeeper

FEES

CLIENT STEPS AGENCY ACTION TO PROCESSING PERSON

BE TIME RESPONSIBLE

PAID

1. Submits approved Job 1.Receives approved Job None 5 minutes Linen & Laundry

Request Form Request staff

2. Waits for notice when 2.1 Fills out Job Order Logbook None 5 minutes Linen & Laundry
to pick up the finished None 4 days staff
items 2.2 Starts the manufacturing None
process 40 minutes Linen & Laundry
3. Receives notice from staff
Linen & Laundry 3. Informs the client for pick-up
Linen & Laundry
staff

4. Accepts Items and 4. Gives items and asks the None 5 minutes Linen & Laundry
affixes signature in the client to sign in the Job staff
Job Request Form/ Request Form/Acceptance of
Acceptance of Work & Work & Logbook
log book

TOTAL: None 4 days & 55
minutes

32 | P a g e

6. Releasing of Checks to Internal Creditors

The Cashier is tasked with the releasing of checks to internal creditors through issuance of processed
and approved checks or through Authority to Debit Advice System, while ensuring that payments are
duly acknowledged by mentioned creditors with the corresponding acknowledgment on the approved
disbursement or payroll vouchers.

Office or Division: Cash Operations

Classification: Simple

Type of Transaction: Government-to-Citizen (G2C), Government-to-Business (G2B),

Government-to-Government (G2G)

Who may avail: Hospital personnel

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Valid identification card of the claimant (1 ID) Company affiliation, Land Transportation

Office, or Professional Regulation

Commission, GSIS, SSS, OSCA or

OWWA, COMELEC

If representing a person:

Notary public
Special Power of Attorney. (1 original document)

If representing a deceased payee:

Extrajudicial Settlement of Estate where name of Lawyer or judicial court
representative of the claimant is included or Affidavit of
Self-Adjudication (1 original document)

CLIENT STEPS AGENCY ACTIONS FEES PROCESSING PERSON
1. Verifies documents TO BE
1. Presents identifying PAID TIME RESPONSIBLE
documents None
3 minutes Disbursing
Officer

2. Acknowledges the 1.1 If identification is None 2 minutes Disbursing
disbursement appropriate, log out None 5 minutes Officer
documents by affixing documents to be issued out
signature None 2 minutes Disbursing
2. Retrieves the check or Officer
3. Returns the signed Authority to Debit
disbursement Account and Issues the Disbursing
documents check or Authority to Debit Officer
Account

3. Inspects the documents for

completeness and propriety

of acknowledgment

TOTAL None 10 minutes

33 | P a g e

7. Request for Budget Obligation of Financial Transaction

Budget Section is tasked to perform budget execution, monitoring and reporting of all obligatory
expenses for the implementation of programs, activities and projects of DJRMH in accordance with the
agency’s current year approved General Appropriation Act (GAA) and Approved Budgeted Revenue
(Hospital Income/HI).

Office/Division: Budget
Classification: Simple

Type of Transaction: Obligation of Financial Transaction

Who May Avail: Different DJRMH Sections/Employees / External Clients

CHECKLIST OF REQUIREMENTS WHERE TO SECURE
End User
Obligation Request Status (ObRS) / Budget Utilization Request
Status (BURS) End user
Supporting Documents (May vary upon the type of transaction)

CLIENT STEPS AGENCY ACTION FEES PROCESSING PERSON
TO TIME RESPONSIBLE
BE
PAID Budget
Personnel
1. Submits ObRS/BURS 1.1 Receives the ObRS/BURS None 3 minutes
duly signed by the and supporting documents Budget
Division Head with None 7 minutes Personnel
attached supporting 1.2 Checks the completeness
documents to and accuracy of the None 5 minutes Budget
Accounting Section supporting documents. Personnel

1.3 Processes for Budget
Obligation

2. Receives ObRS/BURS if found incomplete. None 15 minutes Budget
with incomplete Proceed to step 2 Personnel
documents 2. Returns ObRS/BURS with

incomplete documents to
concerned Section and inform
the client of the deficiency.

TOTAL None 30 minutes

34 | P a g e

8. Request for Corrective Maintenance (CM)

This process shows on how the Dr. Jose Rizal Memorial Hospital Employee can request for a

corrective maintenance for their equipment. This covers from the time that the request is done up to

the acknowledgement of the work performed by signing the acceptance report.

Office/Division: Engineering and Facilities Management Section (EFMS)

Classification: Simple

Type of Government-to-Government
Transaction:

Who May Avail: DJRMH Staff/Unit End-User

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Approved Job Request Form – 1 copy - EFMS Office
Supplemental – 1 copy - End-User
Letter Request – 1 copy
Purchase Request – 1 copy - MMO
- Requisition Issuance Slip (RIS) – 1 copy

FEES

CLIENT STEPS AGENCY ACTION TO PROCESSING PERSON
RESPONSIBLE
BE TIME
EFMS Staff on
PAID duty

1. Proceeds to EFMS 1. Receives the filled out form, None 5 minutes Head of
Job Request Desk and verify and checks its accuracy EFMS/Authorized
fills out the Job and completeness, and None 5 minutes
Request Form and determines nature of the Staff
submits to on duty work. None 2 hours Assigned Staff
staff
1.1 Assigns to maintenance staff None 2 hours Assigned Staff
2. Assists the EFMS to do the job request
maintenance staff None For Simple Assigned Staff
during the conduct of 2.1 Conducts visual inspection Repair/CM
assessment of the job immediately after receipt of (2 hours)
request and presents assigned job request.
needed requirements
as necessary 2.2 Request for materials if
necessary and instructs to
secure documentary
requirements as necessary

2.3 Performs the corrective For complex Assigned Staff
maintenance (CM) repair/CM Assigned Staff
(3 days)
3. Acknowledges the 3. Asks the requestor to sign the None 5 minutes
work performed by Acceptance Report
signing theAcceptance
Report after the
conduct of corrective
maintenance

TOTAL: For Simple:
2 hours & 15

minutes

For Complex:
3 days, 2 hours
& 15 minutes

35 | P a g e

9. Request For Linen Supplies

Release and replenishment of soiled linen for admitted patients.

Office/Division: Linen and Laundry Service (HOPSS-General Services)

Classification: Simple

Type of Government-to-Government

Transaction:

Who May Avail: Hospital Employees from Various Wards

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Linen Issuance Slip From CSR/Nursing issued to patients
Soiled Linen
Various Wards/CSR Linen room

FEES

CLIENT STEPS AGENCY ACTION TO PROCESSING PERSON

BE TIME RESPONSIBLE

PAID

1.1 Submits the issued 1.1 Accepts Linen Issuance Slip None 5 minutes Laundry Worker
Linen Issuance Slip (LIS)
(LIS) None 15 minutes Laundry Worker
1.2 Sorts, counts and checks
1.2 Returns soiled linen per soiled linen and instructs None 10 minutes Laundry Worker
LIS and signs the client to signs the collection
collection logbook logbook

2.1 Waits for the delivery of 2.1 Prepares linen for delivery
clean linens

2.2 Receives delivery of 2.2 Delivers the processed clean None 10 minutes Laundry Worker

clean linens and signs Linens and asks client to sign

the clean linen logbook the clean linen logbook.

TOTAL None 40 minutes

36 | P a g e

NURSING SERVICE

37 | P a g e

External Services

38 | P a g e

1. Availment of Animal Bite Services – Follow-up Vaccination

Treatment protocols for Animal Bite treatment clients require follow-up vaccination. To promote
efficient services, the following steps must be followed:

Office/Division: Animal Bite Treatment Center (ABTC)
Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who May Avail: Animal Bite Clients for Follow-up Vaccination

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Rabies Post-Exposure Prophylaxis Card ABTC

Order of Payment and/or Charge Slip ABTC

CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON

PAID TIME RESPONSIBLE

1. Presents Rabies Post- 1. Receives Rabies None 3 minutes ABTC Manager
Exposure Prophylaxis Post-Exposure
Card Prophylaxis Card

For Free Vaccine:
Proceeds to Step 5

2.a Receives prescription 2.a Issues prescription None 3 minutes ABTC Manager
and proceeds to and instructs client
Pharmacy then to to proceed to 17 minutes MSS
Cashier for payment Pharmacy then to Cashier
cashier for payment 20 minutes Pharmacy
*If patient will avail for ABTC Manager
medical assistance 2.b Processes None 3 minutes ABTC Manager
availment of ABTC Manager
2.b Proceeds to MSS for medical_assistance *Please refer 2 minutes
Availment of medical to table below 5 minutes 39 | P a g e
assistance 3.1 Issues Official 3 minutes
Receipt For Non-Free
3. Presents order of Vaccine
payment and pays 3.2 Dispenses Vaccine None 39 minutes
corresponding amount For Free
then proceeds to 4. Receives the vaccine None Vaccine:
Pharmacy to get the 8 minutes
vaccine 5. Administers vaccine None
to client/patient
4. Returns to ABTC and
gives the vaccine 6. Instructs client/patient

5. Receives vaccination for follow-up doses None

6. Receives further indicated in the card
instructions
*Please refer to table
TOTAL
below

*If patient will avail for
medical assistance
Amount to be paid

depends on the discount
given

DEPARTMENT OF HEALTH

DR. JOSE RIZAL MEMORIAL HOSPITAL

LAWAAN, DAPITAN CITY
TELEFAX: (065) 213-6421

Website: www.djrmh.doh.gov.ph
Email: [email protected]

PRICE LIST FOR ANIMAL BITE TREATMENT SERVICE

MEDICAL SUPPLIES PRICE

Insulin syringe (1cc) 3.10

3cc syringe 2.25

1cc syringe 2.20

Alcohol pad 0.60

Cotton balls 1.00

Disposable needle (G26) 1.40

VACCINE 1,220.70
Active rabies vaccine 1,180.40
Passive rabies vaccine

40 | P a g e

2. Availment of Animal Bite Services - New Animal Bite Clients

(Category II & Category III bite exposure without PhilHealth)

Dr. Jose Rizal Memorial Hospital’s Animal Bite Treatment Center aims to deliver quality service among
animal bite clients. Clients with category II and III bite exposures without PhilHealth can avail the
ABTC service by following these steps:

Office/Division: Animal Bite Treatment Center (ABTC)

Classification: Simple

Type of Transaction: G2C – Government to Citizen

Who May Avail: New Animal Bite Clients (Category II & Category III bite exposure without
PhilHealth)

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Rabies Post-Exposure Prophylaxis Card ABTC

CLIENT STEPS AGENCY ACTION FEES PROCESSING PERSON
TO BE
1. Presents self and waits 1. Receives client/patient and PAID TIME RESPONSIBLE
for instructions. gives instructions. None
3 minutes ABTC Manager

2.a Receives charge slip 2.a Issues charge slip and None 26 minutes ABTC Manager/
and proceeds to instructs client to proceed Pharmacy/
Pharmacy and Central to Pharmacy and CSR then CSR
Supply Room (CSR) to cashier for payment
then to Cashier for
payment 2.b Processes availment of None 17 minutes MSS
medical assistance
*If patient will avail for
medical assistance 3. Issues official receipt *Please 20 minutes Cashier
refer to
2.b Proceeds to MSS for 4. Receives supplies and 1 hour ABTC Manager
Availment of medical administers vaccines table
assistance below
None
3. Presents charge
slip/order of payment 5. Provides Rabies Post- None 5 minutes ABTC Manager
and pays corresponding Exposure Prophylaxis Card
amount indicating the dates of
follow up doses
4. Returns to ABTC and
gives supplies and
vaccines for
administration

5. Receives Rabies Post-
Exposure Prophylaxis
Card and waits for further
instructions including
follow-up schedules.

* Please refer to table 1 hour & 54 minutes
below for applicable fees

TOTAL *If patient will avail for *If patient will avail for medical
medical assistance assistance
Amount to be paid
= 2 hours & 11 minutes
depends on the discount
given

41 | P a g e

DEPARTMENT OF HEALTH

DR. JOSE RIZAL MEMORIAL HOSPITAL

LAWAAN, DAPITAN CITY
TELEFAX: (065) 213-6421

Website: www.djrmh.doh.gov.ph
Email: [email protected]

PRICE LIST FOR ANIMAL BITE TREATMENT SERVICE

MEDICAL SUPPLIES PRICE

Insulin syringe (1cc) 3.10

3cc syringe 2.25

1cc syringe 2.20

Alcohol pad 0.60

Cotton balls 1.00

Disposable needle (G26) 1.40

VACCINE 1,220.70
Active rabies vaccine 1,180.40
Passive rabies vaccine

42 | P a g e

3. Availment of Animal Bite Services - New Animal Bite Clients

(Category III bite exposure) with PhilHealth

Located in the Out Patient Department is the PhilHealth Accredited Animal Bite Treatment Center of

the Dr. Jose Rizal Memorial Hospital. The following steps must be followed for the availment of the

Animal Bite Package among clients with Category III bite exposure.

Office/Division: Animal Bite Treatment Center (ABTC)

Classification: Simple

Type of Transaction: G2C – Government to Citizen

Who May Avail: New Animal Bite Clients (Category III bite exposure) with PhilHealth

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Rabies Post-Exposure Prophylaxis Card ABTC

PHIC Note Billing and Claims

CLIENT STEPS AGENCY ACTION FEES PROCESSING PERSON
TO BE
1. Presents self and waits 1. Receives client/patient and PAID TIME RESPONSIBLE
for instructions. gives instructions. None
3 minutes ABTC Manager
2. Receives charge slip and 1.1 Issues charge slip None
proceeds to Billing and 3 minutes ABTC Manager
Claims to ask for PHIC
Confirmation Note then to 1.2 Issues PHIC Confirmation 6 minutes Billing & Claims
Pharmacy and Central Note
Supply Room(CSR) to get
vaccines and supplies 10 minutes Pharmacy

2. Returns to ABTC, 1.3 Dispenses Vaccine
presents PHIC
Confirmation Note and 13 minutes CSR
endorses supplies and
vaccines 1.4 Dispenses Supplies None 1 hour ABTC Manager
3. Receives PHIC Confirmation
3. Receives Rabies Post-
Exposure Prophylaxis Note, supplies and administers
Card and waits for vaccine
further instructions
including follow-up 4. Provides Rabies Post- None 5 minutes ABTC Manager
schedules. Exposure Prophylaxis Card
indicating the dates of follow
up doses

* Please refer to table
below for applicable fees

TOTAL *If patient will avail for 1 hour & 40
medical assistance minutes
Amount to be paid

depends on the discount
given

43 | P a g e

4. Availment of Medical and Surgical Supplies

The Central Supply Room under the supervision of the Nursing Service plays an essential role for the
entire hospital service operation. It serves OPD- Patients and provides necessary supplies for their
treatment at home or in other health facilities.

Office/Division: Central Supply Room

Classification: Simple

Type of Transaction: G2C – Government to Citizen

Who May Avail: Patients managed as Out-Patients

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Charge Slip - (1 copy) ER/OPD

Official Receipt / MSS Stamped Charge Slip - (1 copy) Cashier/MSS

CLIENT STEPS AGENCY ACTION FEES PROCESSING PERSON
TO BE TIME RESPONSIBLE
PAID

1. Presents charge slip 1.1 Reviews charge slip/s and None 2 minutes CSR Staff on

and receives affixes corresponding Duty

instruction/s if any. amount and provides

instruction if any None 3 minutes

1.2 Directs to cashier for CSR Staff on

payment Duty

2.a Presents charge slip 2.a Issues official receipt Please 20 minutes Cashier staff on
and pays corresponding refer to duty
amount the table
below for
*If patient will avail for applicable

fees

medical assistance 2.b Processes Availment of None 17 minutes MSS Staff on
2.b Proceeds to MSS for

Availment of medical medical assistance duty

assistance

3. Returns to CSR and 3. Receives Official Receipt or None 3 minutes CSR Staff on

presents Official MSS Stamped Charge Slip Duty

Receipt or MSS

Stamped charge slip

4. Checks dispensed 4. Dispenses supplies and None 5 minutes CSR Staff on

supplies and receives gives Duty

instructions if any instructions if any

Please refer to the table

below for applicable fees 33 minutes

TOTAL *If patient will avail for *If patient will avail for medical
medical assistance assistance
Amount to be paid 50 minutes

depends on the discount
given

44 | P a g e

DEPARTMENT OF HEALTH

DR. JOSE RIZAL MEMORIAL HOSPITAL

LAWAAN, DAPITAN CITY
TELEFAX: (065) 213-6421

Website: www.djrmh.doh.gov.ph
Email: [email protected]

PRICE LIST OF MEDICAL AND SURGICAL SUPPLIES

as of June 30, 2020

RATE

ITEM UNIT Standard Senior
Citizen

Absorbent cotton, Sterile Small Pack ₱5.00 ₱4.00

Adhesive Plaster Big Pack ₱15.00 ₱12.00
Alcohol, 70% Isoprophyl, 500 ml Roll
₱108.80 ₱87.04
Bot. Not for Not for
Sale
Sale

Alcohol pad Piece ₱0.60 ₱0.48
Piece ₱361.40 ₱289.12
Anesthesia Face Mask #1 Infant Piece ₱416.00 ₱332.80
Piece ₱689.00 ₱551.20
Pedia Small Piece ₱416.00 ₱332.80
Piece ₱361.40 ₱289.12
Pedia Large Piece ₱361.40 ₱289.12
Piece
Adult-Small Piece ₱62.40 ₱49.92
Piece ₱72.80 ₱58.24
Adult-Medium Piece ₱1,904.50 ₱1,523.60
Piece ₱1,544.00 ₱1,235.20
Adult-Large Piece ₱1,935.00 ₱1,548.00
Piece ₱81.90 ₱65.52
Armsling Adult Piece ₱117.00 ₱93.60
Piece ₱603.20 ₱482.56
Pedia Piece ₱513.50 ₱410.80
Piece ₱676.00 ₱540.80
Bag Vave Mask Adult Piece ₱513.50 ₱410.80
Piece ₱1,014.00 ₱811.20
Chidl/Pedia Piece ₱806.00 ₱644.80
Piece ₱3,640.00 ₱2,912.00
Infant/Neonate Piece ₱647.40 ₱517.92
Piece ₱570.00 ₱456.00
BedPan Piece ₱1,436.50 ₱1,149.20
Piece ₱2,600.00 ₱2,080.00
Blood Administration Set Piece ₱42.25 ₱33.80
Piece ₱42.25 ₱33.80
Bone Wax, 2.5 Piece ₱22.75 ₱18.20
₱32.15 ₱25.72
BP rubber arm cuff Adult
45 | P a g e
with cloth Pedia

Infant

Breathing Circuit/System Adult

Pedia

Jackson Rees

Cervical Collar Adult

Pedia

Chest Tube Thoracostomy Bottle

Closed wound Suction Drainage Sytem

Colostomy Bag Adult, 24x15 cm

Pedia, 20x14 cm

Condom Catheter Small

Medium

Cotton Applicator Stick Large Piece ₱22.75 ₱18.20
CTG Recording Paper Box ₱43.25 ₱34.60
ECG Cream Sterile Pack
ECG Suction Cap Pack ₱5.00 ₱4.00
ECG Tracing paper 50mmX30m Tube ₱747.50 ₱598.00
ECG Tracing paper 80mmX20m Piece ₱361.40 ₱289.12
Elastic Bandage Welch Allyn Roll ₱650.00 ₱520.00
Roll
Electrocautery grounding pad 2"X5yards Roll ₱52.00 ₱41.60
Electrocautery pencil with tip 4"X5yards Roll ₱83.00 ₱66.40
Endotracheal tube 6"X5yards Roll ₱715.00 ₱572.00
Roll ₱23.80 ₱19.04
Epidural set G18 2 Piece ₱29.25 ₱23.40
2.5 Piece ₱36.40 ₱29.12
Piece ₱676.00 ₱540.80
3 Piece ₱624.00 ₱499.20
3.5 Piece ₱57.20 ₱45.76
Piece ₱32.50 ₱26.00
4 Piece ₱40.30 ₱32.24
4.5 Piece ₱42.10 ₱33.68
Piece ₱42.10 ₱33.68
5 Piece ₱35.10 ₱28.08
5.5 Piece ₱53.30 ₱42.64
Piece ₱63.03 ₱50.42
6 Piece ₱49.40 ₱39.52
6.5 Piece ₱44.20 ₱35.36
Piece ₱98.80 ₱79.04
7 Piece ₱44.20 ₱35.36
7.5 ₱42.90 ₱34.32
₱1,040.00 ₱832.00
8 Not for Not for
Sale
Face Mask Respirator N95 Piece Not for Sale
Sale Not for
Respirator KN95 Piece
Feeding Tube with eye Shield Piece ₱273.00 Sale
earloop Piece ₱1.25 ₱218.40
Foley Balloon Catheter, Piece ₱7.45
2-way Fr. 5 Piece ₱1.00
Fr. 8 Piece ₱14.95 ₱5.96
Fr. 10 Piece ₱10.40 ₱11.96
Fr. 12 Piece
Fr. 14 Piece ₱15.40 ₱8.32
Fr. 16 Piece ₱22.95 ₱12.32
Fr. 18 Piece ₱12.35 ₱18.36
Fr. 8 Piece ₱34.45
Fr. 10 Piece ₱33.80 ₱9.88
Fr. 12 Piece ₱32.85 ₱27.56
Fr. 14 Piece ₱32.45 ₱27.04
Fr. 16 Piece ₱30.42 ₱26.28
Fr. 18 ₱37.05 ₱25.96
₱37.05 ₱24.34
₱29.64
₱29.64

46 | P a g e

Foley Ballon Catheter, 3-way Fr. 18 Piece ₱143.00 ₱114.40
Piece ₱143.00 ₱114.40
Fr. 22 Piece ₱143.00 ₱114.40
Pair
Foley Ballon Catheter, 3-way Fr. 24 Pair ₱3.25 ₱2.60
Pair ₱3.10 ₱2.48
Gloves Examination Small Pair ₱3.25 ₱2.60
Pair ₱145.50 ₱116.40
Medium Pair ₱145.50 ₱116.40
Pair ₱145.50 ₱116.40
Large Pair ₱21.00 ₱16.80
Pair ₱21.00 ₱16.80
Elbow Length 6 Pair ₱21.00 ₱16.80
Pair ₱21.00 ₱16.80
7 Piece ₱21.00 ₱16.80
Piece ₱11.05 ₱8.84
7.5 Bot ₱97.50 ₱78.00
Roll ₱32.50 ₱26.00
Surgical 6 Piece ₱27.00 ₱21.60
Piece ₱125.30 ₱100.24
6.5 Piece ₱3.85 ₱3.08
Piece ₱3.85 ₱3.08
7 Piece ₱3.85 ₱3.08
Piece ₱17.65 ₱14.12
7.5 Piece ₱182.00 ₱145.60
Piece ₱14.30 ₱11.44
8 ₱182.00 ₱145.60
Piece
Heparin lock ₱115.70 ₱92.56
Piece ₱327.60
Hot water bag Piece ₱409.50 ₱416.00
Piece ₱520.00 ₱416.00
Hydrogen peroxide Piece ₱520.00
Piece ₱12.56
Hypoallergenic Plaster Piece ₱15.70 ₱12.27
Piece ₱15.34 ₱12.24
Ice Bag Piece ₱15.30 ₱12.24
Piece ₱15.30 ₱14.64
ID Wrist Band Adult/ White Piece ₱18.30 ₱19.76
Piece ₱24.70
Child/ Pink Piece ₱2.40
Piece ₱3.00 ₱156.00
Child/ Blue Piece ₱195.00
Piece ₱100.60 ₱80.48
Infusion Set Macroset Piece ₱54.08
Piece ₱67.60 ₱44.72
Macroset, Needleless Tube ₱55.90 ₱31.20
Piece ₱39.00 ₱416.00
Microset ₱520.00 ₱11.96
₱14.95 ₱124.80
Intubation Stylet Microset, Needleless ₱31.72
With ₱156.00
₱39.65 47 | P a g e
Burette/Soluset
Fr. 8

Fr. 12

Fr. 14

IV Cannula G. 16

G. 18

G. 20

G. 22

G. 24

G. 26

IV Dressing

IV Extension Set

IV Starter Kit

IV Wrist Splint Adult

Pedia

Infant/Neonate

Kelly Pad

Kidney Basin

Lubricating Jelly

Nebulizing kit

Nebulizing kit with Mask Adult Piece ₱49.40 ₱39.52
Needle Pedia Piece ₱50.40 ₱40.32
G 18 Piece
Oral Airway G 19 Piece ₱1.45 ₱1.16
G 21 Piece ₱1.45 ₱1.16
Oxygen Face Mask G 22 Piece ₱1.40 ₱1.12
G 23 Piece ₱1.40 ₱1.12
Oxygen Nasal Cannula G 26 Piece ₱1.40 ₱1.12
#0, 60mm, Black Piece ₱1.40 ₱1.12
Penrose drainage tube #1, 70mm, ₱27.30 ₱21.84
White Piece
Pill Crusher #2, 80mm, ₱32.50 ₱26.00
Pill Cutter Green Piece
Plaster of Paris #3, 90mm, ₱32.50 ₱26.00
Polypropylene mesh Yellow Piece
Povidone Iodine per cc #4, 100mm, Red Piece ₱43.90 ₱35.12
Scub Brush #5, 110mm, ₱41.60
Skin Stapler Piece ₱33.28
Specimen Cup Blue Piece ₱41.60
Spinal needle Adult Piece ₱50.70 ₱33.28
Stockinette Pedia Piece ₱43.45
Suction Catheter Neonate/Infant ₱67.60 ₱40.56
with Reservoir, Piece ₱34.76
Adult Piece ₱84.50 ₱54.08
Adult Piece ₱19.50
Pedia Piece ₱19.50 ₱67.60
Infant Piece ₱21.45
1/4 inches Piece ₱18.20 ₱15.60
1/2 inches Piece ₱20.80 ₱15.60
1 inches Piece ₱29.50 ₱17.16
Piece ₱195.00 ₱14.56
4 inches Piece ₱387.00 ₱16.64
6 inches Piece ₱91.00 ₱23.60
Piece ₱130.00 ₱156.00
40 cc in cup* cc ₱2,340.00 ₱309.60
cup ₱72.80
Stool Piece ₱0.25 ₱104.00
Urine/Sputum Piece ₱20.00 ₱1,872.00
Piece ₱65.00
G. 23 Piece ₱247.00 ₱0.20
G. 25 Piece ₱16.00
Piece ₱7.20 ₱52.00
Fr. 5 Roll ₱5.85 ₱197.60
Fr. 8 Piece ₱102.95
Fr. 10 Piece ₱68.25 ₱5.76
Fr. 12 Piece ₱3,250.00 ₱4.68
Fr. 14 Piece ₱9.00 ₱82.36
Piece ₱9.35 ₱54.60
₱11.70 ₱2,600.00
₱9.00 ₱7.20
₱9.35 ₱7.48
₱9.36
₱7.20
₱7.48

48 | P a g e

Suction Poole Drain Fr. 16 Piece ₱9.35 ₱7.48
Suction Bottle Fr. 18 Piece ₱8.20 ₱6.56
Surgical Blade Piece ₱156.00 ₱124.80
#10 Piece ₱3,900.00 ₱3,120.00
Suture, Chromic #11 Piece ₱3.80 ₱3.04
#15 Piece ₱3.64 ₱2.91
Novosyn #20 Piece ₱4.30 ₱3.44
Polypropylene #21 Piece ₱3.80 ₱3.04
#22 Piece ₱3.35 ₱2.68
Suture, Mersilk O Cutting Piece ₱4.65
Vicryl O Round Piece ₱47.65 ₱3.72
1 Cutting Piece ₱48.75 ₱38.12
Syringe 1 Round Piece ₱47.65 ₱39.00
Syringe 2/O Cutting Piece ₱33.55 ₱38.12
2/O Round Piece ₱34.65 ₱26.84
3/O Cutting Piece ₱34.65 ₱27.72
3/O Round Piece ₱34.65 ₱27.72
4/O Cutting Piece ₱33.55 ₱27.72
4/O Round Piece ₱46.00 ₱26.84
5/O Round Piece ₱37.90 ₱36.80
3/O Round Piece ₱48.75 ₱30.32
Mono Piece ₱353.50 ₱39.00
O Round Piece ₱252.75 ₱282.80
2/O Cutting Piece ₱530.75 ₱202.20
2/O Round Piece ₱487.50 ₱424.60
3/O Cutting Piece ₱487.50 ₱390.00
3/O Round Piece ₱595.75 ₱390.00
4/O Cutting Piece ₱577.75 ₱476.60
4/O Round Piece ₱476.50 ₱462.20
4/O w/o Needle Piece ₱48.75 ₱381.20
5/O Cutting Piece ₱54.15 ₱39.00
Piece ₱54.15 ₱43.32
O Piece ₱147.40 ₱43.32
2/O Piece ₱183.00 ₱117.92
3/O Piece ₱183.00 ₱146.40
4/O Piece ₱162.25 ₱146.40
O Round Piece ₱593.35 ₱129.80
1 Round Piece ₱484.60 ₱474.68
2/O Round Piece ₱497.90 ₱387.68
3/O Cutting Piece ₱314.15 ₱398.32
3/o Round Piece ₱303.30 ₱251.32
4/O Cutiing Piece ₱455.00 ₱242.64
O.5 mL Insulin Piece ₱364.00
1 mL Insulin Piece ₱12.70 ₱10.16
1 cc Piece ₱3.10
3 cc ₱2.48
Piece ₱2.20 ₱1.76
₱2.25 ₱1.80

49 | P a g e