Provincial and District Hospitals
external services

Patient is provided with emergency treatment and/or admitted for management of chief complaint(s).

Office or Division: Medical And Nursing Services
Classification: Simple
Type of Transaction: G2C – Government to Citizens
Who May Avail: Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patient's card Admitting Clerk
2. Patient's Chart Admitting Clerk
3. Charge slip ER Nurse/Nursing Attendant
4. Official receipt of ER service or procedure. Cashier/Designated Collecting Officer
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Arrives at the hospital ER. 1.1 Conducts patients to ER. None 5 Minutes Administrative Aide/ Security Guard/any designated personnel
2. Submits for vital signs check and thorough assessment 2.1 Takes vital signs and conducts initial assessment of patient. None 1 Hour
 ER Nurse/ Nursing Attendant
2.2 Interviews patient None   OPD Clerk/Admitting Clerk
2.3 Takes patient's data; issues card to folks (if new, gives chart to ER Nurse). None   Admitting clerk
2.4 Examines and manages patient accordingly. None 2 Hours Physician (medical officer on Duty), Nurse and Nursing Attendant.
3. Receives charge slip and pays to the cashier or designated collecting officer 3.1 Issues charge slip. Fees based on the Revenue Code of the Province of Iloilo. 10 minutes ER Nurse/ Nursing Attendant
4. Submits for admission. 4.1 Admits patient. None 5 minutes Medical Technologist or Laboratory Aide
4. Claim Test Result(s) 4.1 Issue Test Result(s) 15 minutes Physician (Medical Officer on Duty) and ER Nurse
TOTAL NONE

3 Hours

30 Minutes

Note: Rates as per Provincial. Ordinance. No. 2017-145 otherwise known as the 2017 Revised Revenue Code of Iloilo

Out-patient consultation is sought by a patient for management of medical, surgical, obstetricgynecological or pediatric conditions.

Office or Division: Medical And Nursing Services
Classification: Simple
Type of Transaction: G2C – Government to Citizens
Who May Avail: Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. OPD Chart Information Clerk
2. Charge Slip Information Clerk
3. Official Receipt Cashier
. Prescription for treatment and advice. OPD Doctor and Nurse
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Old patient: Registers and presents old number 1.1 Old patient: Retrieves OPD Chart on file. None 10 Minutes Information clerk
New patient: Requests for new OPD chart New patient: Prepares OPD chart. None
 
2. Submits for vital signs check and initial assessment 2. 1. Takes vital signs and initial assessment None 15 Minutes Nursing attendant/ Nurse
3. Receives charge slip 3.1 Gives charge slip and instructs client to pay at the Cashier's Office and presents slip with Official Receipt. Dependent upon patient classification and total cost of service and diagnostic procedure sought based on Local Government Code of Iloilo 10 Minutes Information Clerk/ Nurse/Nursing Attendant
3.2 Instructs client to proceed to OPD Personnel.
4. Submits for consultation, physical examination and case management, including referral to specific service/program 4.1 Examines patient. 50 minutes Physician/Dentist
4.2 Gives request for diagnostic examination
TOTAL See above

1 Hour

25 Minutes

Patient is discharged upon doctor’s order after completing required forms, issued discharge clearance and given going home instructions.

Office or Division: Medical And Nursing Services
Classification: Simple
Type of Transaction: G2C – Government to Citizens
Who May Avail: Patients and Patients' Folks
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Discharge clearance form. Nurse's Station
2. Discharge clearance form Concerned Department
3. Hospital bill Billing Section
4. Official Receipt of hospital bill paymenture. Cashier
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Presents request for discharge clearance form from the Nurse's Station. 1.1 Issues discharge clearance form. None 5 Minutes Nurse on Duty at the Nurse's Station
2. Gets discharge clearance from concerned personnel. 2.1 Signs discharge clearance and attaches charge slip for payment. None 10 Minutes
 Concerned Department Incharge
3. Presents discharge clearance form. 3.1 Summarizes bill None 1 Hour Billing clerk
4. Presents bill to Social Welfare Officer. 4.1 Assesses, evaluates and recommends total cost of hospitalization to Chief of Hospital. None 1 Hour Social Welfare Officer
5. Pays bill and receives Official Receipt (OR) and discharge clearance form. 5.1 Receives payment; issues OR and discharge clearance form. None 30 minutes Cashier
6. Presents approved discharge clearance. 6.2 Checks form, gives doctor's advice and signs discharge clearance. None 30 minutes Nurse on Duty at the Nurse's Station
7. Submits discharge clearance form 7.1 Receives the form; inspects patient's belongings; releases patient. None 5 minutes Security Guard
TOTAL NONE

3 Hours

20 Minutes

Philhealth Section verifies patient’s eligibility to avail insurance benefits from Philippine Health Insurance Corp. and assesses completeness of supporting documents

Office or Division: Philhealth Section
Classification: Simple
Type of Transaction: G2C – Government to Citizens
Who May Avail: All patients or their representatives
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Government issued ID or any competent proof of identification of PhilHealth member PhilHealth
2. Member Data Record
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Presents ID or competent proof of identity and Member Data Records 1.1 Interviews patient or representative and checks eligibility of PhilHealth member through PhilHealth portal

1.2 If not eligible – instructs patient’s representative to proceed to Social Service Section as for classification as Point-of-Service Financially capable/ Financially incapable

1.3 If eligible-issues Claim Signature Form and requires submission of updated Member Data Record 		None 30 Minutes Administrative Aide III
2. Submits accomplished Claim Signature Form and updated Member Data Record 2.1 Verifies PhilHealth Case Rate Package and completeness of papers None 30 Minutes
 Administrative Aide III
TOTAL NONE

1 Hour

To identify indigent patients in the health facility in order to avail of medical social service assistance.

Office or Division: Medical Social Service
Classification: Simple
Type of Transaction: G2C – Government to Citizens
Who May Avail: Admitted patient
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Referral Form no. 1 Emergency Room (ER) Nurse/ Out-Patient Department Nurse/ Ward Nurse
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Brings the Medical Social Service Referral Form no. 1 and submits self to intake interview 1.1 Conducts intake interview and social work counseling None 2 days Social Welfare Officer
1.2 Classifies patient in accordance to DOH A.O. 51-A None
1.3 Provides orientation on hospital policies, available social services, scope and limitation of hospital assistance None
1.4 Registers the name of patients in General Registry Logbook and file for future reference None 30 minutes.
TOTAL NONE

2 Days

30 Minutes

Provides financial assistance to qualified indigent patients.

Office or Division: Medical Social Service
Classification: Simple
Type of Transaction: G2C – Government to Citizens
Who May Avail: All patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
In-Patient
1. Certificate of Indigency (1 original and 1 photo copy) 1. Municipal Social Welfare and Development Office
2. Statement of Accounts(1 original and 1 photo copies) 2. Billing Section
Out-Patient / ER
1. Certificate of Indigency (1 original and 1 photo copy) 1. Municipal Social Welfare and Development Office
2. Prescriptions, diagnostic test requests(1 original and 2 photo copies) 2. Attending Physician
3. Medical Abstract or Medical Certificate (1 original and 1 photocopy) 3. Hospital Medical Records Section
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Directly requests/seeks assistance 1.1 Identifies patients qualified to avail MAIPDOH

1.2 Orients clients re: coverage of assistance 		None 1 Day Social Welfare Officer
2. Secures necessary requirements and submit to the Social Service office. 2.1 Checks and verifies all requirements submitted

2.2 Recommends the amount to be granted by the chief of hospital

2.3 Records name of patient and amount granted. 		None 1 Day
TOTAL NONE

2 Days

Provides Health Care Insurance to Non-PhilHealth/In-active member admitted patients

Office or Division: Medical Social Service
Classification: Simple
Type of Transaction: G2C – Government to Citizens
Who May Avail: Admitted patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Any of the Primary Documents:
1. Birth Certificate or baptismal certificate (minor/ single) (2 photo copies)
2. Married certificate (for parents/ married)(2 photo copies)
3. Any government issued ID 		Local civil registrar/ Philippine statistics Authority/ local church
Local Civil Registrar/ Philippine Statistics Authority

BIR, COMELEC, POST office, LTO, Philhealth Office
Any of the Secondary Documents:  
4. Affidavit of guardianship ( 1 original 2 photo copies ( minor/abandoned patients)
5. Affidavit of two disinterested person ( 1 original 1 photo copies)
 Public Attorney’s Office or Any Law Offices
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Directly requests/seeks assistance 1.1 Identifies patients qualified to avail POS-FI 1.2 Orients clients re: coverage of assistance and requirements None 1 Hour Social Welfare Officer
2. Fill –up PMRF and Secures necessary requirements and brings these to the Social Service office. 2.1 Receives copy of Philhealth Member Registration Form (PMRF.)
2.2 Checks and verifies all requirements submitted
2.3 Online Enrolment to Institutional Health Care Provider(IHCP)
2.4 Filing of Philhealth Member Data Record (PMRF 		None 2 Days Social Welfare Officer
TOTAL NONE

2 Days

1 Hour

Provides Health Care Insurance to Non-PhilHealth/In-active member admitted patients

Office or Division: Medical Social Service
Classification: Simple
Type of Transaction: G2C – Government to Citizens
Who May Avail: Admitted patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Any of the Primary Documents:
1. Birth Certificate or baptismal certificate (minor/ single) (2 photo copies)
2. Married certificate (for parents/ married)(2 photo copies)
3. Any government issued ID 		Local civil registrar/ Philippine statistics Authority/ local church
Local Civil Registrar/ Philippine Statistics Authority

BIR, COMELEC, POST office, LTO, Philhealth Office
Any of the Secondary Documents:  
4. Affidavit of guardianship ( 1 original 2 photo copies ( minor/abandoned patients)
5. Affidavit of two disinterested person ( 1 original 1 photo copies)
 Public Attorney’s Office or Any Law Offices
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Directly requests/seeks assistance 1.1 Identifies patients qualified to avail POS-FC None 30 Minutes Social Welfare Officer
1.2 Orients clients re: coverage of assistance None
2. Fills –up Philhealth Member Registration Form (PMRF) and secures necessary requirements and brings these to the Social Service office. 2.1 Receives copy of PMRF None 1 hour Social Welfare Officer
2.2 Checks and verifies all requirements submitted None
2.3 Online Enrolment to Institutional Health Care Provider(IHCP) None
2.4 Instructs client to bring PPMRF to PhilHealth Office for payment None
3. Submits photocopy of Official Receipt issued by PhilHealth 3. Receives photocopy of Official Receipt as proof of payment and updated Member Data Record (MDR) for Posting and Filing None 2 days from the date of admission Social Welfare Officer
TOTAL NONE

2 Days

1 Hour

30 Minutes 

Provides assistance to indigent admitted patients.

Office or Division: Medical Social Service
Classification: Simple
Type of Transaction: G2C – Government to Citizens
Who May Avail: Admitted patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Certificate of Indigency (1 original and 1 photo copy) 1. Municipal Social Welfare and Development Office
2. Statement of Account (1 original and 1 photo copies)
 2. Billing Section
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Directly requests/seeks assistance 1.1 Identifies patients qualified to avail MAPHMO None 1 Hour Social Welfare Officer
1.2 Orients clients re: coverage of assistance and requirements None
2. Secures necessary requirements and submit to the Social Service office 2.1 Receives and checks all requirements submitted None 2 Days Social Welfare Officer
2.2 Recommends the amount to be granted to the chief of hospital None
2.3 Records name of patient and amount granted. None
TOTAL NONE

2 Days

1 Hour

The Iloilo Provincial and District Hospitals provide basic dental services such as extraction, filling, oral prophylaxis and consultation.

Office or Division: HMO - Hospital Operations Division
Classification: Simple
Type of Transaction: G2C – Government to Citizens
Who May Avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. For all patients, secure Out-Patient Department (OPD) chart Out-Patient Department (OPD) Station
2. Consent Form
 Out-Patient Department (OPD) Station
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Requests for the procedure 1.1 For old client: Retrieves dental chart on file.

For new client: Prepares new dental record 		None 10 minutes Dental Aide
1.2 Interviews patient, reviews vital signs, examines and records in the dental chart None 20 minutes Dentist III / II Dental Aide
1.3 Performs dental procedure None 1 Hour
15 Minutes 		Dentist III/II
1.4 Issues charge slip and instructs client to pay to the cashier Refer to Schedule of Dental Fees based on the Local Revenue Code of Iloilo 5 Minutes Dentist III/II
2. Pays required fee 2.1 Receives payment, issues Official Receipt and instructs client to return to the Dental Clinic 30 minutes Cashier
3. Presents Official Receipt to Dental Clinic 3.1 Records proof of payment 10 minutes Dental Aide
3.2 Gives post-dental operation instructions None 5 minutes Dentist III/II
TOTAL See reference of rates

2 Hours

35 Minutes

The Iloilo Provincial and District Hospitals also perform PHIC Dental cases such as operculectomy, excision of fibrous tuberosity, tooth lesion and hyperplastic mass, drainage of cyst and abscess, removal of foreign body and closed treatment of TMJ dislocation, as well as management of dry socket, pulpitis, pulp degeneration, acute and chronic periodontitis, peri-apical and dental abscess, radicular and peri-apical cyst, and suturing of post-extraction wounds.

Office or Division: HMO - Hospital Operations Division
Classification: Simple
Type of Transaction: G2C – Government to Citizens
Who May Avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. For all patients, secure OPD Chart and consent form OPD Station
2. For members and beneficiaries, secure PhilHealth Benefit Eligibility Form (PBEF)
 PHIC Office
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Requests for the procedure 1.1 For old client: Retrieves dental chart on file.

For new client: Prepares new dental record 		None 10 minutes Dental Aide
1.2 Interviews patient, reviews vital signs, examines and records in the dental chart None 30 minutes Dentist III / II Dental Aide
1.3 Performs dental procedure None 1 Hour
30 Minutes 		Dentist III/II
1.4 Gives prescription, issues charge slip and instructs client to proceed to pharmacy None 30 Minutes Dentist III/II
2. Proceeds to pharmacy and gets medicines 2.1 Gives medicines and instructs client to get Statement of Account (SOA) from Billing Station None 10 Minutes Pharmacist
3. Presents Official Receipt to Dental Clinic 3.1 Prints and issues Statement of Account (SOA) Refer to Schedule of Dental Fees for PHIC Cases 20 minutes Billing Clerk
4. Pays required fees 4.1 Receives payment, issues O.R. and instructs client to return to the Dental clinic 30 minutes Cashier
5. Presents O.R. to Dental Clinic 5.1 Records proof of payment 5 Minutes Dental Aide
5.2 Gives post-dental operation instruction None 10 minutes Dentist III or II
TOTAL See reference of rates

3 Hours

25 Minutes

Drugs and medicines are dispensed in cash basis to non-PhilHealth patients who are not hospitalized and visit the hospital for diagnosis and treatment.

Office or Division: Pharmacy
Classification: Simple
Type of Transaction: G2C – Government to Citizens
Who May Avail: All Clients/Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Prescription/Charge slip Doctor on duty- Out-Patient Department
2. Official Receipt
 Cashier
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Presents prescription and receives charge slip 1.1 Receives and checks prescription.

1.2 If Senior Citizen or Person with Disability, ask for Identification Card to avail of the 20% discount

1.3 Informs drug cost, issues charge slip and instructs the clients to pay at the cashier 		None 10 minutes Pharmacist III or Pharmacist II
2. Pay medicines 2.1. Receives payment and issues official receipt None 30 minutes Cashier
3. Presents official receipt 3.1 Verifies official receipt number

3.2. Dispenses the medicines to the client
 None 5 Minutes Pharmacist III or Pharmacist II
4. Receives medicines 4.1. Patient Counseling None 5 Minutes Pharmacist III or Pharmacist II
TOTAL None

50 Minutes

Drugs and medicines are dispensed in cash basis to non-PhilHealth patients who are not hospitalized and visit the hospital for diagnosis and treatment.

Office or Division: Pharmacy
Classification: Simple
Type of Transaction: G2C – Government to Citizens
Who May Avail: All Clients/Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Prescription/Charge slip Doctor on duty- Out-Patient Department
2. Official Receipt
 Cashier
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Presents prescription / charge slip 1.1 Receives and checks prescription.

1.2 Instructs the client to proceed to Philhealth-incharge for approval 		None 5 Minutes Pharmacist III or Pharmacist II
2. Presents approved prescription/ charge slip 2.1. Prepares and dispenses medicines None 5 Minutes Pharmacist III/ Pharmacist II/
3. Receives medicines 3.1 Patient Counseling

3.2 Encodes charged medicines
 None 5 Minutes Pharmacist III or Pharmacist II
TOTAL None

15 Minutes

Drugs and medicines are dispensed to PhilHealth-paying and Non-PhilHealth patients admitted in the hospital receiving medical care by a particular doctor.

Office or Division: Pharmacy
Classification: Simple
Type of Transaction: G2C – Government to Citizens
Who May Avail: All Clients/Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Prescription/Charge slip Doctor on duty, Nurse
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CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Presents prescription / charge slip 1.1 Receives prescriptions/ charge slips and checks availability None 10 Minutes Pharmacist III or Pharmacist II
2. Receives medicines 2.1. Prepares and dispenses medicines None 10 Minutes Pharmacist III or Pharmacist II
2.2. Provides follow-up instructions to client
 None
2.3. Encodes the charged medicines None
TOTAL None

20 Minutes

Drugs and medicines are dispensed to No Balance Billing patients and indigents admitted in the hospital receiving medical care.

Office or Division: Pharmacy
Classification: Simple
Type of Transaction: G2C – Government to Citizens
Who May Avail: All Patients and Indigents
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
2. Statement of Account (1 original and 1 photo copies)
 2. Billing Section
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Presents prescription / charge slip 1.1 Receives prescriptions/ charge slips None 2 Minutes Pharmacist III or Pharmacist II
2. Receives medicines 2.1. Prepares and dispenses medicines

2.2. Encodes the charged medicines 		None 10 Minutes
TOTAL None

12 Minutes

Approves clearance to admitted patients before hospital discharge

Office or Division: Pharmacy
Classification: Simple
Type of Transaction: G2C – Government to Citizens
Who May Avail: Admitted Patients/Representatives
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Discharge Clearance
 Nurse’s Station
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Patient or Representative presents clearance for signature of the Pharmacist 1.1 Receives and signs clearance

1.2 Processes returned medicines 		None 5 Minutes Pharmacist III or Pharmacist II
TOTAL None

5 Minutes

Provides PhilHealth benefit package to qualified patients for discharge.

Office or Division: Provincial And District Hospitals
Classification: Simple
Type of Transaction: G2C – Government to Citizens
Who May Avail: Admitted Patients/Representatives
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Discharge Clearance
 Nurse’s Station
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Member or Representative presents clearance 1.1 Receives and signs clearance

1.2 Processes returned medicines 		None 30 Minutes Administrative Aide III
TOTAL None

30 Minutes

Cashiering service includes acceptance of payments and issuance of corresponding receipts

Office or Division: Provincial And District Hospitals
Classification: Simple
Type of Transaction: G2C – Government to Citizens
Who May Avail: Patients or their representatives
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Charge Slip or billing statement
 Charge Slip – specific unit where service is availed Billing Statement- Billing Section
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Presents charge slip or billing statement, and pays amount due 1.1 Accepts payment and issues Official Receipt Variable 30 Minutes Administrative Aide III (Cashier)
TOTAL None

30 Minutes

Cashiering service includes disbursement of fund as payment of claims such as claim of suppliers, reimbursements, salaries, allowances and other benefits of employees

Office or Division: Provincial And District Hospitals
Classification: Simple
Type of Transaction: G2C – Government to Citizen, G2G - Government to Government
Who May Avail: Patients or their representatives
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Competent proof of identity of the Payee or
 Any government agency, company, school
2. Special Power of Attorney of the representative Payee
3. Competent proof of identity of the representative, if applicable Any government agency, company, school
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Presents identification and/or Special Power of Attorney 1. Validates claim None 10 Minutes Administrative Aide III (Cashier)
2. Signs voucher and receives payment 2. Disburses cash or issues check None 10 Minutes Administrative Officer III (Cashier)
TOTAL None

20 Minutes

Provides preparation of Birth Certificate prior to discharge

Office or Division: Hospital Records Section
Classification: Complex
Type of Transaction: G2C – Government to Citizen
Who May Avail: OB patients who gave birth at the hospital, or nearest kin or guardian of the child
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Accomplished Information Sheet
 Records Section
If married
 • One (1) machine copy of Marriage Certificate
 • One (1) machine copy of valid Identification
   Card of the parent present 		Local Civil Registrar/Philippine Statistics Authority BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID if not working
If not married
• One (1) machine copy of Valid Identification Cards of parents present 		BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID if not working
If single mother
• One (1) photocopy of Birth Certificate of the mother or any valid
 Identification card 		Local Civil Registrar/Philippine Statistics Authority / BIR/GSIS/Post Office/HDMF/ SSS/LGU/DFA/ PSA/ School ID if not working
For Late registration less than one (1) year from date of birth
If married
• One (1) machine copy of Marriage Certificate of parents
• One (1) machine copy of valid Identification Cards of parents
• One (1) machine copy of the Certificate of NonRegistration 		Local Civil Registrar/Philippine Statistics Authority BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID if not working

Philippine Statistics Authority
If not married:
• One (1) machine copy of valid Identification
  Cards of requesting parent
• One (1) machine copy of the Certificate of NonRegistration 		BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID if not working

Philippine Statistics Authority
For more than one (1) year delayed registration:
If married
• One (1) machine copy of Marriage Certificate
• Original and one (1) machine copy of Negative Result of
  Registration of Birth
• One (1) machine copy of valid Identification
  Cards of requesting parent 		Local Civil Registrar/Philippine Statistics Authority Philippine Statistics Authority

BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
Barangay/Municipal Treasurer’s Office
If single mother
• Original and one (1) machine copy of Negative Result of
  Registration of Birth from PSA
• One (1) machine copy of valid Identification Card 		Philippine Statistics Authority

BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
If informant is other than the parents (nearest kin)If informant is other than the parents (nearest kin)
• One (1) copy of original Authorization Letter duly signed by any of
   the parents of the child
• One (1) machine copy of valid Identification Card of the
   requesting parent
• One (1) machine copy of valid Identification Card of
   authorized person 		Parents of the child

BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
If informant is the guardian of the child
• One (1) original copy of duly notarized Affidavit of Guardianship
• One (1) machine copy of valid Identification Card of guardian
• Certificate of Non-Registration by the PSA 		Barangay/Lawyer

BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA Philippine Statistics Authority
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Fills up, signs Information Sheet and attaches supporting documents and submits to Records Section 1.1. Receives Information Sheet and checks completeness of attached documents. As provided in the Revenue Code 10 Minutes Administrative Aide I or Administrative Officer III (Records Officer II)
  1.2 Verifies data on the Delivery Logbook based on the supporting documents submitted and advises client if there is discrepancy. None 30 Minutes Administrative Aide I or Administrative Officer III (Records Officer II)
1.3 Prepares Birth Certificate None 25 Minutes Administrative Aide I or Administrative Officer III (Records Officer II)
2. Receives, checks and verifies data entered on the Birth Certificate and other documents 2.1 Gives the documents to the informant for verification of entries on the Birth Certificate None 30 minutes Administrative Aide I or Administrative Officer III (Records Officer II)
2.2 Corrects entry if there are corrections and prepares final copies of Birth Certificate and other supporting documents for signature of the informant/requesting party None 20 minutes Administrative Aide I or Administrative Officer III (Records Officer II)
3. Receives and signs the final copies of Birth Certificate, checks and verifies if corrections are made 3.1. Receives and checks Birth Certificates if properly signed by the informant/requesting party. None 30 minutes Administrative Aide I or Administrative Officer III (Records Officer II)
3.2 Signs the Birth Certificates None 3 Days Attending Physician, or Medical Officer on duty in case of absence of Attending Physician
4. Logs out Birth Certificate for signing of the Private Attending Physician 4. Instructs informant to bring the Birth Certificate and have it signed by the Private Attending Physician and return the Birth Certificate to Records Section as soon as it is signed. None 30 minutes Administrative Aide I or Administrative Officer III (Records Officer II)
5. Informant receives instructions and fills up Waiver Form if opts to personally submit Birth Certificates to the Office of the Local Civil Registrar 5. Instructs informant/ requesting party to get the copy of the Birth Certificate from the Office of the Local Civil Registrar after 10 working days None 10 minutes Administrative Aide I or Administrative Officer III (Records Officer II)
6. Authorized Informant receives copies of Birth Certificates 6. Releases copies of Birth Certificates None 5 Minutes Administrative Officer III (Records Officer II)
TOTAL As provided in the Revenue Code

3 days

3 hours

10 minutes

Provides issuance of Death Certificate

Office or Division: Hospital Records Section
Classification: Complex
Type of Transaction: G2C – Government to Citizen
Who May Avail: Nearest Kin of the Deceased /Folks/Guardians/
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Accomplished Information Sheet
 Records Section
 2.a. If admitted
 • One (1) machine copy of valid Identification Card of the deceased
 • One (1) machine copy of valid Identification Card of informant 		BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID if not working
BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
2.b. If ER death
• One (1) machine copy of valid Identification Card of the deceased
• One (1) machine copy of valid Identification Card of the informant 		BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID if not working
BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
2.c. If informant is other than the nearest kin
• Duly signed Authorization Letter
• One (1) machine copy of valid Identification Card of nearest kin
• One (1) machine copy of valid Identification Card of representative 		Nearest kin
BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID if not working
BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
2.d. Late registration less than one (1) year
d.1. If informant is nearest kin
• One (1) machine copy of valid Identification Card of the deceased 		BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
d.2. If informant is other than the nearest kin
• Duly signed Authorization Letter
• One (1) machine copy of valid Identification Card of nearest kin
• One (1) machine copy of valid Identification Card of representative 		Nearest kin
BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School
e. For late registration more than one (1) year
• Original and one (1) machine copy of Negative Result of Registration of Death
• All the required documents if informant falls under category 2.a, 2.b, 2.c or 2.d. 		Philippine Statistics Authority
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Submits requests for issuance of Death Certificate 1.1. Receives request and retrieves In-Patient chart with the draft of Death Certificate As provided in the Revenue Code 5 Minutes Administrative Aide I or Administrative Officer III (Records Officer II)
  1.2 Retrieves draft Death Certificate from the floor. None 2 Hours 2. Provides/Answers/ Gives data of the deceased Aide I or Administrative Officer III (Records Officer II) Nurse I or Nursing Attendant (Ward Station/ Emergency Room)
2. Provides/Answers/ Gives data of the deceased 2.1 Interviews client to verify data entered in the draft of Death Certificate None 30 Minutes Administrative Aide I or Administrative Officer III (Records Officer II)
2.2 Prepares Death Certificate None 20 Minutes
3. Receives and reviews the correctness of data in the draft Death Certificate 3.1 Gives the Death Certificate for verification of the informant/ requesting party. None 20 Minutes
4. Receives, checks and reviews if corrections are made and signs the Death Certificate 4.1. Receives and checks Death Certificate if properly signed by the informant/ requesting party and instruct client to return after 3 days. None 20 Minutes
4.2 Reviews entries and signs the Death Certificate None 3 Days Attending Physician, or Medical Officer
5. Fills up Waiver Form if opts to submit personally the Death Certificate to the Local Civil Registrar and signs Logbook for logout documents 5.1 Receives and files filled up Waiver Form and checks if informant/ requesting party have signed the Logbook None 10 minutes Administrative Aide I or Administrative Officer III (Records Officer II)
6. Receives the Death Certificate 6.1 Releases the Death Certificate and advises client to process the Death Certificate and have it signed by the embalmer, Municipal Health Officer and Local Civil Registrar None 5 minutes Administrative Aide I or Administrative Officer III (Records Officer II)
TOTAL As provided in the Revenue Code

3 days 1 Hour and 50 Minutes

Provides issuance of Medical Certificates for In-Patient in the hospital

Office or Division: Hospital Records Section
Classification: Complex
Type of Transaction: G2C – Government to Citizen
Who May Avail: Patients/Guardian/Folks or Nearest Kin of Patient
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Accomplished Information Sheet
  
 a. For In-Patients and Out-Patients
• One (1) machine copy of valid Identification Card of the patient 		BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
b. For Guardian
• One (1) copy of Certification from the issued by the Punong Barangay stating that the claimant is
   the true guardian of the patient or duly notarized Affidavit of Guardianship
• One (1) machine copy of valid Identification Card of the guardian
• One (1) machine copy of valid Identification Card of the patient
 Office of the Punong Barangay where the Guardian resides/Lawyer

BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
c.. For claimant other than patient/Parent or Guardian of the patient
• Duly signed Authorization Letter

• One (1) machine copy of valid Identification Card of authorized person
• One (1) machine copy of valid Identification Card patient/Parent or Guardian of the patient 		Patient/Parent of the patient if minor/Guardian of the patient
BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Requests for Medical Certificate 1.1. Prepares, signs and issues request for Medical Certificate None 5 Minutes Nursing Attendant/ Nurse on Duty
  1.2 Brings and present the request to the Records Section None 20 Minutes Nursing Attendant/ Nurse on Duty
  1.3 Receives and reviews completeness of the data. None 20 Minutes Administrative Aide I or Administrative Officer III (Records Officer II)
2. Proceeds to Records Section and receives charge slip 2. Issues charge slip and advises client to pay to the Cashier As provided in the Revenue Code 10 Minutes Administrative Aide I or Administrative Officer III (Records Officer II)
3. Pays to the Cashier 3. Receives payment and issues Official Receipt 30 Minutes Administrative Officer III (Cashier)
4. Returns charge slip with Official Receipt Number to the Records Section 4.1 Receives charge slip with Official Receipt Number and advises client to return adter 4 hours None 5 Minutes Administrative Aide I or Administrative Officer III (Records Officer II)
4.2 Prepares the Medical Certificate None 4 Hours Administrative Aide I or Administrative Officer III (Records Officer II) Attending Physician, in case of his/her absence, Medical Officer on Duty
5. Receives the original copy of the Medical Certificate 5. Releases complete Medical Certificate None 30 minutes Administrative Aide I or Administrative Officer III (Records Officer II)
TOTAL As provided in the Revenue Code 6 Hours

Issuance of Medical Certificates for In-Patient and Out-Patient for insurance and other legal purpose.

Office or Division: Hospital Records Section
Classification: Complex
Type of Transaction: G2C – Government to Citizen
Who May Avail: Patients/Guardian/Folks or Nearest Kin of Patient
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Accomplished Information Sheet
 Nurse’s Station
For In-Patients and Out-Patients
• One (1) machine copy of valid Identification Card of patient 		BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
For Guardian
• One (1) copy of Certification from the issued by the Punong Barangay stating that the claimant is
   the true guardian of the patient or duly notarized Affidavit of Guardianship
• One (1) machine copy of valid Identification Card of the guardian
• One (1) machine copy of valid Identification Card of the patient
 Office of the Punong Barangay where the Guardian resides/Lawyer

BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
For claimant other than patient/Parent or Guardian of the patient
• Duly signed Authorization Letter

• One (1) machine copy of valid Identification Card of authorized person
• One (1) machine copy of valid Identification Card patient/Parent or Guardian of the patient 		Patient/Parent of the patient if minor/Guardian of the patient
BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Requests for Medical Certificate 1.1 Prepares/bring request to Records Section None 2 Hours Nurse on Duty
  1.2. Receives and reviews completeness of data None 1 Hour Administrative Aide I or Administrative Officer III (Rec
2. Proceeds to Records Section and receives charge slip 2.1 Issues charge slip and advises client to pay to the cashier None 10 Minutes Administrative Aide I or Administrative Officer III (Records Officer II)
3. Pays to the Cashier 3. Receives payment and issues Official Receipt As provided in the Revenue Code 30 Minutes Administrative Officer III (Cashier)
4. Returns charge slip with Official Receipt Number to the Records Section 4. Receives charge slip with Official Receipt Number and advises client to return after 3 working days 5 Minutes Administrative Aide I or Administrative Officer III (Records Officer II)
  4.2 Prepares the Medical Certificate None 3 Days Administrative Aide I or Administrative Officer III (Records Officer II)

Attending Physician, in case of his/her absence, Medical Officer on Duty
5. Receives the original copy of the Medical Certificate 5.1 Releases complete Medical Certificate None 30 Minutes Administrative Aide I or Administrative Officer III (Records Officer II)
TOTAL None 3 Days
4 Hours
15 Minutes

Issuance of Medico-Legal Certificate which will be used by the requesting party in filing of case in court.

Office or Division: Hospital Records Section
Classification: Complex
Type of Transaction: G2C – Government to Citizen
Who May Avail: Patients/Guardian/Folks or Nearest Kin of Patient
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. One (1) of accomplished Request Form
 Records Section
For In-Patients and Out-Patients
• One (1) machine copy of valid Identification Card of patient
 • One (1) copy of request from the Philippine National Police with written consent of the patient
 BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
Office of the Municipal Police Station (as to where the incident happened)
For Guardian
• One (1) copy of Certification from the issued by the Punong Barangay stating that the claimant is
   the true guardian of the patient or duly notarized Affidavit of Guardianship
• One (1) machine copy of valid Identification Card of the guardian
• One (1) machine copy of valid Identification Card of the patient
• One (1) copy of request from the Philippine National Police with written consent of the patient
 Office of the Punong Barangay where the Guardian resides/Lawyer

BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
Office of the Municipal Police Station (as to where the incident happened)
For claimant other than patient/Parent or Guardian of the patient
• Duly signed Authorization Letter

• One (1) machine copy of valid Identification Card of authorized person
• One (1) machine copy of valid Identification Card patient/Parent or Guardian of the patient
• One (1) copy of request from the Philippine national Police with written consent of the patient
Patient/Parent of the patient if minor/Guardian of the patient
BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
Office of the Municipal Police Station (as to where the incident happened)
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Submits complete request form 1. Receives and reviews completeness of request None 30 Minutes Administrative Aide I or Administrative Officer III (Records Officer II)
2. Receives charge slip 2. Issues charge slip and advises client to pay to the Cashier None 5 Minutes
3. Pays to the Cashier 3. Receives payment and issues Official Receipt None 30 Minutes Administrative Officer III (Cashier)
4. Returns charge slip with Official Receipt Number to the Records Section 4.1 Receives charge slip with Official Receipt Number and advises client to return after 4 days None 5 Minutes Administrative Officer III (Cashier)
4. Returns charge slip with Official Receipt Number to the Records Section 4.1 Receives charge slip with Official Receipt Number and advises client to return after 4 days None 5 Minutes Administrative Aide I or Administrative Officer III (Records Officer II)
  4.2 Prepares the document None 30 Minutes
  4.3 Checks correctness and signs the document None 4 Days Attending Physician, in case of his/her absence, Medical Officer on Duty
5. Receives the MedicoLegal Certificate 5. Releases the original copy of Medico-Legal Certificate None 5 Minutes Administrative Aide I or Administrative Officer III (Records Officer II)
TOTAL None 4 Days
1 Hour
45 Minutes

Provides issuance of Dead on Arrival Certificate

Office or Division: Hospital Records Section
Classification: Complex
Type of Transaction: G2C – Government to Citizen
Who May Avail: Nearest Kin of the deceased or Guardian/Folks
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. One copy (1) of accomplished Request Form from the nearest of kin/authorized representative
 Records Section
For Folks/ /Nearest Kin of the Deceased
• One (1) machine copy of valid Identification Card of the deceased
• One (1) machine copy of valid Identification Card of the claimant
 BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
For representative of the Nearest Kin of the Deceased
• Duly signed Authorization Letter
• One (1) machine copy of valid Identification Cards of nearest kin of the deceased
• One (1) machine copy of valid Identification Card of the representative of the nearest kin
 Nearest kin of the deceased
BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
For Guardian
• One (1) copy of Certification from the issued by the Punong Barangay stating that
   the claimant is the true guardian of the patient
   or duly notarized Affidavit of Guardianship
• One (1) machine copy of valid Identification Card of the guardian
• One (1) machine copy of valid Identification Card of the deceased
 Office of the Punong Barangay where the Guardian resides/Lawyer

BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Submits accomplished request form to Records Office 1. Receives Patient’s Chart of the deceased from the floor None 1 Hour Administrative Aide I or Administrative Officer III (Records Officer II) Emergency Room Nurse/Nursing Attendant
2. Provides/answers/ gives data of the deceased 2. Interviews client to verify data of the deceased None 30 Minutes Administrative Aide I or Administrative Officer III (Records Officer II
3. Receives charge slip 3. Issues charge slip and advises client to pay to the cashier NoAs provided in the Revenue Code 5 Minutes
4. Pays to the Cashier 4. Receives payment and issues Official Receipt 30 Minutes Administrative Officer III (Cashier)
5. Returns charge slip with Official Receipt Number to the Records Section 5.1 Receives charge slip with Official Receipt Number and advises client to return and get the Dead on Arrival Certificate after one (1) hour None 5 Minutes Administrative Aide I or Administrative Officer III (Records Officer II)
  5.2 Prepares the Dead on Arrival Certificate None 5 Minutes
6. Receives the original copy of the Dead on Arrival Certificate and receives instruction 6.1 Releases the original copy of Dead on Arrival Certificate and instructs client to proceed to Rural Health Unit for the preparation of Death Certificate None 5 Minutes Administrative Aide I or Administrative Officer III (Rec
TOTAL As provided in the Revenue Code 3 Hours
15 Minutes

Completes the forms required by the Social Security System, Social Service Commission and other insurance forms of the In and Out-Patients.

Office or Division: Hospital Records Section
Classification: Complex
Type of Transaction: G2C – Government to Citizen
Who May Avail: Patients admitted/consulted with SSS/CSC/Insurance claims
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. One copy (1) of accomplished Request Form
Records Section
a. For Patients admitted/consulted
• SSS/CSC/Insurance Forms (number of copies depend on the request)
• One (1) machine copy of valid Identification Card of the requesting party
 Social Security System/Civil Service Commission/ Insurance Company concerned
BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
b. For representative of the Nearest Kin of the Deceased
 • SSS/CSC/Insurance Forms (number of copies depend on the request)
• Duly signed Authorization Letter
• One (1) machine copy of valid Identification Cards of nearest kin of the deceased
• One (1) machine copy of valid Identification Card of the representative of the nearest kin
 Social Security System/Civil Service Commission/ Insurance Company concerned
Nearest kin of the deceased
BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
c. For Guardian
 • SSS/CSC/Insurance Forms (number of copies depend on the request)
• One (1) copy of Certification from the issued by the Punong Barangay stating that
   the claimant is the true guardian of the patient
   or duly notarized Affidavit of Guardianship
• One (1) machine copy of valid Identification Card of the guardian
• One (1) machine copy of valid Identification Card of the deceased
 Social Security System/Civil Service Commission/ Insurance Company concerned
Office of the Punong Barangay where the Guardian resides/Lawyer

BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA
BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID if not working
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Submits accomplished request form and SSS/ CSC/Insurance forms 1. Receives request form and checks documents for completion by the Attending Physician None 20 Minutes Administrative Aide I or Administrative Officer III (Records Officer II)
2. Receives charge slip 2. Issues charge slip As provided in the Revenue Code 5 Minutes Administrative Aide I or Administrative Officer III (Records Officer II
3. Pays to the Cashier 3. Receives payment and issues Official Receipt 30 Minutes Administrative Officer III (Cashier)
4. Returns charge slip with Official Receipt Number to the Records Section 4.1 Receives charge slip with Official Receipt Number and advises client to return after five (5) days None 5 Minutes Attending Physician, in case of his/her absence, Medical Officer on Duty
  4.2 Reviews and evaluates records of the patient and fills up and accomplishes the forms submitted by the client None 5 Days Attending Physician, in case of his/her absence, Medical Officer on Duty
5. Receives the documents 5. Releases the documents and instructs the claimant to provide one (1) machine copy of the documents for Record Section’s file None 5 Minutes Administrative Aide I or Administrative Officer III (Records Officer II)
TOTAL None 5 Days
1 Hour
5 Minutes

Issues request for certified machine copy of laboratory and diagnostic results, medical abstract, technique and discharge summary for the use of the clients in his/her insurance claims and other purposes.

Office or Division: Hospital Records Section
Classification: Complex
Type of Transaction: G2C – Government to Citizen
Who May Avail: Patients admitted or consulted/ folks/guardian/nearest kin
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. One copy (1) of accomplished Request Form
Records Section
a. For Patients admitted/consulted
• One (1) machine copy of valid Identification Card of the requesting party
 BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
b. For representative of the Nearest Kin of the Deceased
• Duly signed Authorization Letter
• One (1) machine copy of valid Identification Cards of nearest kin of the deceased
• One (1) machine copy of valid Identification Card of the representative of the nearest kin
  Nearest kin of the deceased

BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID
c. For Guardian
• One (1) copy of Certification from the issued by the Punong Barangay stating that
   the claimant is the true guardian of the patient
   or duly notarized Affidavit of Guardianship
• One (1) machine copy of valid Identification Card of the guardian
• One (1) machine copy of valid Identification Card of the deceased
 Office of the Punong Barangay where the Guardian resides/Lawyer

BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA

BIR/GSIS/Post Office/HDMF/SSS/LGU/DFA/ PSA/ School ID if not working
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Submits accomplished request form 1. Receives request form and checks documents for completion by the Attending Physician None 10 Minutes Administrative Aide I or Administrative Officer III (Records Officer II)
  1.2. Retrieves patient’s records None 30 Minutes
1.3 Checks for completeness of the records None 10 Minutes  
  1.4 Sorts out requested documents for reproduction None 10 Minutes  
2. Reproduce the requested documents 2. Gives the documents to the claimant for reproduction and issues charge slip As provided in the Revenue Code 20 Minutes Administrative Aide I or Administrative Officer III (Records Officer II)
3. Pays to the Cashier 3. Receives payment and issues Official Receipt 30 Minutes Administrative Officer III (Cashier)
4. Returns charge slip with Official Receipt Number to the Records Section 4.1 Receives charge slip with Official Receipt Number None 10 Minutes Administrative Officer III (Records Officer II)
4.2. Signs and certifies that the machine copies are true reproduction of the original copy on file. None
5. Receives the documents 6.1 Releases the documents None 5 Minutes Administrative Aide I or Administrative Officer III (Records Officer II)
TOTAL None 2 Hours
5 Minutes

Performs hematology, chemistry, urinalysis/parasitology and other special laboratory examinations.

Office or Division: Hospital Records Section
Classification: Simple
Type of Transaction: G2C – Government to Client
Who May Avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Laboratory requests with patient’s data (1 copy)
Attending Physician
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Presents laboratory request 1.1 Receives request None 5 Minutes Medical Technologist
  1.2 Issues charge slip and instructs client to proceed to the Cashier None 5 Minutes Medical Technologist
2. Pays required fees 2.1 Receives payment & instructs client to present Charge Slip with Official Receipt to the Laboratory Station As provided in the Local Revenue Code 30 Minutes Cashier
3. Presents charge slip and Official Receipt to Laboratory Station 3.1 Extracts, processes and examines specimen None 5 Hours Medical Technologist
3.2 Records result
4. Receives results 4.1 Releases results None 5 Minutes Medical Technologist
TOTAL None 5 Hours
45 Minutes

Performs blood cross-matching and compatibility testing for available blood units in the blood station.

Office or Division: Laboratory Services
Classification: Simple
Type of Transaction: G2C – Government to Client
Who May Avail: All Admitted patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Blood Request Form (1 copy)
 Nursing Station
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Submits blood request form to Blood Station 1.1 Receives and records blood request None 10 Minutes Medical Technologist
  1.2 Performs blood typing and records result None 30 Minutes
  1.3 Checks the availability of blood unit None 20 Minutes
1.4 Informs the client and nurse on duty of the blood availability None 5 Minutes
  1.5 Extracts blood from patient for cross-matching and compatibility testing As provided in the Local Revenue Code (included in patient’s bill upon discharge 3 Hours Medical Technologist
1.6 Records result and indorses blood unit/s to the Nursing Station for blood transfusion.
TOTAL None 5 Hours
45 Minutes

Performs blood cross-matching and compatibility testing for blood units from Philippine National Red Cross or Western Visayas Medical Center Blood Bank

Office or Division: Laboratory Services
Classification: Simple
Type of Transaction: G2C – Government to Client
Who May Avail: All Admitted patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Blood Unit/s (depending on amount of blood required for transfusion)
 Philippine National Red Cross or Western Visayas Medical Center Blood Bank
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Submits blood unit/s to Blood Station 1.1 Receives and records blood unit None 20 Minutes Medical Technologist
  1.2 Extracts blood from patient for cross-matching and compatibility testing None 3 Hours
  1.3 Records result and Informs the nurse on duty of the blood availability As provided in the Local Revenue Code (included in patient’s bill upon discharge)
1.4 Indorses blood unit to the Nursing Station for blood transfusion.
TOTAL None 3 Hours
20 Minutes

Blood request form for Philippine National Red Cross or Western Visayas Medical Center is issued to clients in case of unavailability of blood units in the hospital’s Blood Station.

Office or Division: Laboratory Services
Classification: Simple
Type of Transaction: G2C – Government to Client
Who May Avail: All Admitted patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Blood Request Form (1 copy)
 Nursing Station
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Forwards request form to Blood Station for indorsement to Philippine National Red Cross/ Western Visayas Medical Center 1.1 Receives request None 10 Minutes Medical Technologist
1.2. Performs blood typing and records result None 20 Minutes
2. Receives blood request form 2.1 Issues validated blood request form As provided in the Local Revenue Code (included in patient’s bill upon discharge) 20 Minutes
2.2 Instructs client to proceed to Philippine National Red Cross or Western Visayas Medical Center 5 Minutes
  2.3 If patient is indigent, instructs client to secure Certificate of Indigency from respective municipality to avail free blood processing fee. 5 Minutes
TOTAL None 1 Hour