DIVISION PERFORMANCE COMMITMENT AND REVIEW (DPCR) TARGET

I, IMELDA L. BIYOYO, RN,Nurse II/Supervising Nurse of Malimono District Hospital, commits to deliver and agree to be rated on the attainment of the following target in
accordance with the indicated measures for the period July to December, 2017.

IMELDA L. BIYOYO, RN
Nurse II/Supervising Nurse
Date:
Reviewed by: Date: Approved By: Date:

MARIA KAREEN G. PEPITO, RMT, MD MARIA KAREEN G. PEPITO, RMT, MD

Medical Officer IV Medical Officer IV

5-Outstanding R
4-Very Satisfactory A
3-Satisfactory T
2-Unsatisfactory I
1-Poor N
G
Rating
DIVISION/
SUCCESS INDICATOR Alloted INDIVIDUAL Q1 E2 T3 A4
PPA/MFO /OUTPUTS ACTUAL ACCOMPLISHMENT Remarks
(MEASURES + TARGETS) Budget ACCOUNTABLE
PERSON

PPA: MEDICAL SERVICES

CORE FUNCTIONS:
MFO 1- EMERGENCY SERVICES
Output 1 10 treated patient who needs immediate Php250.00 I. L. Biyoyo
care with complete data information M. B.
Emergency Room including the disposition and treatments
Registration Book (Emergency given/rendered based on the Hospital Mula
Patients) Policies and Procedures within the rating A. M. Datso
period.
J. V. Lumancas
E.
R. Senados

I. F.
Orias
Output 2
Emergency Room Registration Book
(Non-Emergency Patient)
200 ambulatory patients treated during Php 500.00 I. L. Biyoyo
non office hours with complete data M. B.
information including disposition and
intervention like minor operation assisted, Mula
dressing and etc. within the rating period. A. M. Datso

J. V. Lumancas
E.
R. Senados

I. F.
Output 3 10 attended/treated OB-Gyne patients Php 250.00 Orias
I. L. Biyoyo
with complete data informations including C. Q. M. B.
BEMONC interventions and treatment given based
Emergency Logbook on the Hospital Policies and Procedures Macaranas
Mula
within the rating period. C. O.
A. M. Datso
Botardo
L. A.
J. V. Lumancas
Ga E.
R. Senados

I. F.
MFO 2: OUTPATIENT DEPARTMENT SERVICES Orias
Output 1 800 filled up ITRs with complete Php 3,500.00 I.C.
L. Q.
Biyoyo
demographic and baseline data, including Macaranas M. B.
Individual Treatment nursing assessment based on the policies
Mula C. O.
Record and procedures done within the rating A. M. Datso
period. Botardo
L. J.
A.V.
Lumancas
Ga
E. R.
Senados

I. F. Orias
C. Q.
Macaranas
C. O.
Output 2 20 Patients given with Tetanus Prophylaxis Php 30.00 I. L. Biyoyo
Botardo
Tetanus Prophylaxis Registration per Doctor's order with complete data L. A.M.
GaB.
information based on Hospital Policies and Mula
Logbook Procedures A. S.
Boc A. M. Datso
V. P. Llamera
J. V. Lumancas
E.
R. Senados
Output 3 1000 ambulatory patients recorded in Php 1,000 J. V. Lumancas
OPD Registration Book (Pedia, the logbook according to their
classification within the rating period.
Medical, OB-Gyne, Surgical) Eye Care
Patients
Output 4 2 confirmed or suspected TB patients with Php 50.00 J. V. Lumancas
TB Case Registration Book complete and correct information referred
to RHU TB DOTS.

Output 5 10 patients referred with eye problem Php 150.00 Jesserie V.

Eye referral Registration Logbook with complete data information based on Lumancas
DOH memo Margie B.
Mula
MFO 3: ADMISSION/WARD SERVICES
Output 1 200 patient's charts completed with Php I. L. Biyoyo
patient's information and intervention 8,000.00 M. B.
Patient's Chart rendered by the attending
(admission sheet, Physician/Nurses/nursing attendant within Mula
informed consent, history and the rating period. A. M. Datso
physical examination, doctors order,
J. V. Lumancas
progress notes, lab,ivf sheet,tpr
E.
sheet, I and O sheet, Nurses notes, R. Senados
Medication Sheet, Discharge
Summary, Discharge slip) I. F.
Output 2 180 24 hour census report updated for Php Orias
I. L. Biyoyo
every admission and discharges of 1000.00 C. Q. M. B.
24- hour Census patients within the rating period. Macaranas
Mula
report
C. O.
A. M. Datso
Botardo
L. A.
J. V. Lumancas
Ga E.
R. Senados

I. F.
Orias
C. Q.
Macaranas
Output 3 200 admitted patients duly recorded with Php I. L. Biyoyo
complete data in the Admission 1000.00 M. B.
Admission Registration Book based on the Hospital
Registration Book policies and procedures within rating Mula
period. A. M. Datso

J. V. Lumancas
E.
R. Senados

MFO 4: DELIVERY SERVICES I. F.

Output 1 20 Recorded OB patients in active labor Orias
Php 30.00 I. L. Biyoyo
with complete data and intervention C. Q. M. B.
Labor rendered based on DOH BEMONC Policies Macaranas
Mula
Watch Partograph Sheet and Procedures
A. M. Datso

J. V. Lumancas
E.
R. Senados

I. F.
Output 2 20 of recorded mothers and newborn Orias
Php 60.00 I. L. Biyoyo
information after delivery which includes C. Q. M. B.
Parturation Form interventions provided based on Hospital
Policies and Procedures. Macaranas
Mula
C. O.
A. M. Datso
Botardo
L. A.
J. V. Lumancas
Output 3 20 of recorded newborn given with hepa-B Php 30.00 I.
GaL. Biyoyo E.
vaccine within 24 hours after birth based
Hepa-B on DOH memo. R. SenadosM. B.
Logbook Mula
A. M. Datso

J. V. Lumancas
E.
R. Senados

I. F.
Orias
C. Q.
Macaranas
Output 4 20 deliveries recorded with complete data Php 30.00 I. L. Biyoyo
based on the Nursing policies and M. B.
Delivery procedures within the rating period.
Logbook (Maternal Mula
and Newborn) A. M. Datso

J. V. Lumancas
E.
R. Senados

I. F.
Output 5 20 newborns taken with blood samples Php M. B. Mula
24-72hrs. for screening After birth in Orias
Newborn Screening Samples/Slips 11,000.00 V.
C.Lumancas
Q.
accordance to NBS Central policies and
Procedures within the rating period. MacaranasE. R.
Senados C. O.
Botardo
Output 6 20 NBS report submitted Free Mailing M. B. MulaL. A.
quarterly/annually with complete data
Newborn Screening Report information based on NBS Central Policies Ga
and Procedures within the rating period.

Output 7 20 newborn screened recorded with Php 300.00 M. B. Mula

complete data, based on the NBS Central
Newborn policies and procedures within the rating
Screening Register Book period.

MFO 5: PRIMARY NURSING CARE SERVICES

Output 1 200 actual admitted patients data verified Php 7500.00 I. L. Biyoyo
in all pages of the chart within the rating M. B.
Demographic Data and Clinical History period.
Record on Chart (Chronoligically Mula
arranged) A. M. Datso

J. V. Lumancas
E.
R. Senados

I. F.
Orias
C. Q.
Macaranas
C. O.
Output 2 200 informed consent obtained from Php350.00 I. L. Biyoyo
Informed Consent patients prior to initiation of care. M. B.
Mula
A. M. Datso

J. V. Lumancas
E.
R. Senados

I. F.
Output 3 200 patients vital signs checked and Orias
Php 350.00 I. L. Biyoyo
recorded within the rating period. C. Q. M. B.
Vital Signs/Temperature Pulse
Respiration (TPR) Sheet Macaranas
Mula
C. O.
A. M. Datso
Botardo
L. A.
J. V. Lumancas
Ga E.
R. Senados

I. F.
Output 4 200 patient's fluid intake and output Php 350.00 I. L. Biyoyo
monitored within the rating period. Orias
Intake and Output Sheet C. Q. M. B.
Mula
Macaranas
A. M. Datso
C. O.
Botardo
J. V. Lumancas
L. A.
Ga E.
R. Senados

I. F.
Output 5 30 referral forms duly filled-up within the Php 50.00 I. L. Biyoyo
rating period. Orias
Referral Forms C. Q. M. B.
Mula
Macaranas
A. M. Datso
C. O.
Botardo
J. V. Lumancas
L. A.
Ga E.
R. Senados

I. F.
Orias
C. Q.
Output 6 200 discharge instruction sheet given to Php 50.00 I. L. Biyoyo
patients/watchers for proper M. B.
Discharge Instruction Sheet instruction/health teaching within the
rating period. Mula
A. M. Datso

J. V. Lumancas
E.
R. Senados

I. F.
Output 7 200 discharge slips prepared for outgoing Php 50.00 I. L. Biyoyo
patients within the rating period Orias
Discharge Slip C. Q. M. B.
Mula
Macaranas
A. M. Datso
C. O.
Botardo
J. V. Lumancas
L. A.
Ga E.
R. Senados

I. F.
200 Kardexes of patients updated per shift Php 50.00 Orias
Output 8 I. L. Biyoyo
C. Q.
within the rating period M. B.
Kardex Macaranas
Mula
C. O.
A. M. Datso
Botardo
L. A.
J. V. Lumancas
Ga
E.
R. Senados

I. F.
Output 9 400 Diagnostic exams requested for Php 100.00 I. L. Biyoyo
patients submitted, and charged based on Orias
Diagnostic Tests Request C. Q. M. B.
the attending Physicians order within the
rating period. Mula
Macaranas
A. M. Datso
C. O.
Botardo
J. V. Lumancas
L. A.
Ga E.
R. Senados

I. F.
Orias
Ouput 10 prescription/supply requisition Php I. L. Biyoyo
encoded, submitted, and charged M. B.
Medication and Supply requests/ prescriptions within the rating
Requisition/Prescription period Mula
A. M. Datso

J. V. Lumancas
E.
R. Senados

I. F.
600 administered medications Orias
Output 11 I.C.
L. Q.
Biyoyo
intravenously or orally to admitted patients
Medication Administration prepared within the rating period Macaranas M. B.
Mula C. O.
A.
Botardo M. Datso
L. A.
J.
GaV. Lumancas
E.
R. Senados
Output 12 200 patient inserted with Intravenous Php 350.00 I. L. Biyoyo
Fluid and documented within the rating
Intravenous Fluid Sheet period I.M.
F. B.
Mula
Orias
A. M. Datso
C. Q.
Macaranas
J. V. Lumancas
Output 13 400 Nurse's Notes accomplished by the Php 800.00 I. L. Biyoyo E.
Nurses Notes actual number of patients per shift R. SenadosM. B.
within the rating period. Mula
A. M. Datso

J. V. Lumancas
E.
R. Senados
Output 14 400 Doctor's orders carried out and duly Php 800.00 I. L. Biyoyo
recorded within the rating period
Carried out Doctor's Order I.M.
F. B.
Mula
Orias
A. M. Datso
C. Q.
Macaranas
J. V. Lumancas
E.
R. Senados

I. F.
MFO 6: OTHER RECORDS/SUPPORTING DOCUMENTS
Output 1 600 recorded list of therapeutic/routine Php150.00 I. L. Biyoyo
Diet list diet patients as prescribed by the physician M. B.
facilatated to dietary sectionwithin the
rating period. Mula
A. M. Datso

J. V. Lumancas
E.
R. Senados

I. F.
Output 2 20 referral forms issued containing Php30.00 I. L. Biyoyo
Orias
Referral Forms accurate data of patients referred to higher M. B.
facility based on the instruction of the C. Q.
Attending Physician within the rating Mula
Macaranas
period. A. M. Datso
C. O.
Botardo
J. V. Lumancas
L. A.
Ga E.
R. Senados

I. F.
Output 3 Master 200 listed patients catered in the facility Php100.00 J. V.
Orias Lumancas
Patients Index (MPI) with complete profile data carefully
indexed per Hospital Policies. C. Q. I. L.
Biyoyo
Macaranas
M. B.C.Mula
O.
Botardo
A. M. Datso
L. A.
Ga E. R.
3 death (ER, WARD,DOA Cases) recorded Senados
Output 4 Php 100.00 J. V. Lumancas
Other in the Logbook with correct and complete I. L.
information based on Hospital Policies.
Logbooks (Death Registration Book) Biyoyo
M. B. Mula
Ouput 5 1 patients recorded with allergic reaction Php 50.00 J. V. Lumancas `
Drug Allergy Registration Book after taking prescribed meds by the
Physician on duty in the facility within the
rating period.

Output 6 10 referral/return Slips filed every after Php15.00 J. V. Lumancas

Referral Return Slips escort/transport of patient according to I. L.
the date of referrals within the rating
period. Biyoyo
M. B. Mula

A. M. Datso
E. R.
Senados
MFO 7: SUPERVISORY SERVICES
Output 1 500 endorsement recorded in the Php500.00 I. L. Biyoyo
I. F. Orias
Nursing logbook, for continuity of supervision by M.C.B.
the next shift based on the Nursing
Endorsement Logbook policies and procedures within the rating Mula
Q. Macaranas
period. A. M. Datso

J. V. Lumancas
E.
R. Senados

I. F.
Output 2 1 Approved policy(s) by the Chief of Orias
I. L. Biyoyo
Nursing Policy and Standards Hospital for compliance of department's C. Q.
operation's flow acted and implemented Macaranas
(to include Policy per area) within the rating period. C. O.
Botardo
L. A. Ga
Output 3 50 rounds conducted to different areas Php500.00 I. L. Biyoyo
Daily Rounds Logbook and checked equal staffing, census, M. B.
cleanliness and attended the issues and
concern based on the Hospital standard Mula
requirement within the rating period. A. M. Datso

J. V. Lumancas
E.
R. Senados

I. F.
Orias
C. Q.
Output 4 1 manual accomplished submitted for Php30.00 I. L. Biyoyo
Macaranas
Nursing Work Instruction Manual corrections and revisions within the rating
period. C. O.
Botardo
L. A. Ga
MFO 8: TRAININGS/ORIENTATION AND SEMINARS
Output 1 5 certificates obtained/filed in every I. L. Biyoyo
employee who attended seminars and M. B.
Certificate of trainings per memo order of requesting
attendance/appearance of trainings agency. Mula
and seminars A. M. Datso

J. V. Lumancas
MFO 9: RECORDS/REPORTORIAL AND COMMUNICATION SERVICES E.
Output 1 8 announcements, scheduled activities Php50.00 R. L.
I. Senados
Biyoyo
received by the office, posted for M. B. Mula
information and attendance of the same
Documents/reports / announcements by the conduct of such activities within A. M.
posted the rating period. Datso
J. V.
Lumancas
Output 2 10 meetings attended instructed by the Php50.00 I. L. Biyoyo
Chief of Hospital within the rating period. M. B.
Attendance to
meetings Mula
A. M. Datso

J. V. Lumancas
E.
R. Senados

I. F.
Output 3 8 approved accomplishment report Php50.00 Orias
I. L. Biyoyo
submitted to the requesting office C. Q.J. V.
Validated concerned within seven (7) working days Macaranas
Lumancas M.
Accomplishment Report / Soft and upon receipt of the letter/memo sent by
hard copies of official documents the requesting office. B. MulaC. O.
Botardo
L. A. Ga
Output 4 200 listed philhealth and non-philhealth Php50.00 I. L. Biyoyo
patients admitted/discharged daily ended
Monthly Mandatory Report at midnight per philhealth memo.

Output 5 3 of recorded suspected or confirmed TB Php30.00 J. V. Lumancas

patients referred to TB-DOTS Facility
Hospital TB Referral Registration following the mandated referral system
Logbook based on DOH memo within the rating
period.

Output 6 2 recorded filed statistical Reports Php60.00 I. L. Biyoyo

submitted quarterly and semi-annually to
Statistical Report Files PHO/DOH/CHD per DOH Memo.

Output 7 100 of recorded OPD/Admitted patients Php50.00 J. V. Lumancas

with notifiable diseases followimg R.A
Patients Surveillance Registration 3573(Report of notifiable disease to local
Logbook and national health facilitator)
Output 8 2 approved communication by the Chief Php50.00 I. L. Biyoyo
of Hospital depnding on the nature of the M. B. Mula
letter- request acted within the rating
Incoming/Outgoing Communications period. A. M.
Acted Datso
J. V. Lumancas
E. R.
SUPPORT FUNCTIONS 1: SUPPORTING SERVICES Senados

MFO 1: MEDICAL RECORDS

Output 1 50 approved medical certificates recorded Php100.00 I. L. Biyoyo
and released to requesting patients within M. B.
Medical Certificate logbook the rating period.
Mula
A. M. Datso

J. V. Lumancas
E.
R. Senados
Output 2 20 approved birth certificates recorded Php100.00 I. L. Biyoyo
and released to requesting patients within
Birth Certificate logbook the rating period. I.M.
F. B.
Mula
Orias
A. M. Datso
C. Q.
Macaranas
J. V. Lumancas
E.
R. Senados

I. F.
Output 3 5 approved medico-legal certificates Php50.00 I. L. Biyoyo
recorded and released to requesting Orias
Medico-Legal Certificate logbook C. Q. M. B.
patients within the rating period.
Mula
Macaranas
A. M. Datso

J. V. Lumancas
E.
R. Senados

MFO 2: MEDICAL ASSISTANCE PROGRAM I. F.

Orias
C. Q.
Macaranas
Output 1 25 documents per patient prepared with Php100.00 A. Datso, RN;
Approved MAP Documents complete pertaining datas and M. Mula, RN,
attachments for medical assistance per
DOH instructions and rules. MSN, MAN

Output 2 10 approved transmittal sent Php100.00 A. Datso, RN; M.

electronically with complete data Mula, RN, MSN,
Approved Transmittal informations per DOH memo rules and
instructions. MAN

MFO 3: CENTRAL SUPPLY SERVICES

Output 1 50 requests slips filed which were Php15.00 J. V. Lumancas
Request Slips supplied to requesting patient and/or I. L.
personnel in 10 minutes per request.
Biyoyo
M. B. Mula

A. M. Datso
E. R.
Senados
T. P.
Output 2 300 patients charts filed and organized Php I. L. Biyoyo
Senados
chronologically according to hospital 10,000.00
Patients Admission Chart policies within the rating period. I. F. M. B.
Orias
Mula C.
A. M. Datso
Q. Macaranas

J. V. Lumancas
E.
R. Senados

I. F.
Orias
C. Q.
Macaranas
C. O.
Botardo
L. A.
Ga
Output 3 1,000 medication tickets prepared, made Php200.00 I. L. Biyoyo
ready for use and distributed accordingly M. B.
Medication within the rating period.
Tickets(different colors) Mula
A. M. Datso

J. V. Lumancas
E.
R. Senados

I. F.
Output 4 200 of times autoclaving of instruments Php500.00 Orias
C. O. Botardo
conducted and always ready for use within L.C.A.Q.
Ga
Autoclaved the rating period.
Instruments Macaranas
200 sterilized and packed intruments/sets, C. O.
Output 5 M. B. Mula
conducted and always available and ready Botardo
Sterilized Packs A. M.
for use within the rating period. L. A.
and Sets, and Repacked OS, IE gloves, Datso
Ga
cotton and cherry balls and many others J. V.
Lumancas
E. R.
Senados

I. F. Orias
MFO 4: PHARMACY SERVICES C.
300 prescriptions dispensed and recorded Php50.00 Q. Macaranas
Output 1 M. B. Mula
C.
to in- and out-patients within the rating A. M.
Prescription Logbook period. O. Botardo
Datso
L.
J. V.
A. Ga
Lumancas
E. R.
Senados

I. F. Orias
C.
Output 2 50 prescriptions recorded and filed based Php50.00 A.
on daily tally sheet within 2 hours per Q. M Datso
Macaranas
Daily Stock Card/Tally Sheet week within the rating period. C.
O. Botardo
L.
A. Ga
Output 4 1 of transactions in monitoring inventory Php50.00 A. M Datso
of drugs and medicines based on
Inventory Logbook Pharmacy policies within the rating period.

Output 5 2 dangerous drug prescriptions recorded, Php50.00 A. M Datso

reviewed, and updated based on
Narcotic Drug Book Comprehensive Dangerous Drug Act of
2002 within the rating period.

Output 6 2 requested drugs and medicines checked Php50.00 A. M Datso

and recorded, based on Pharmacy policies
Purchase Request Book and procedures within the rating period.

Output 8 1 of Approved policies by the Chief of Php50.00 A. M Datso

Policy Recommendations
Hospital for compliance to FDA rules and
regulations within the set timeframe for
the purpose of smooth flow of hospital
pharmacy operation within the rating
period.

Output 9 1 Pest prevention applied and recorded as Php100.00 E. R. Senados

part of good sanitation practice within the
Sanitation and Pest Control Logbook rating period.

MFO 5: FINANCIAL/SUPPLY MANAGEMENT SERVICES

Output 1 100 times cashiering services performed at Php J. V. Lumancas
the Admission section within the rating I. L.
Cashiering period.
Biyoyo
M. B. Mula

A. M. Datso
E. R.
Senados
C. O.
Botardo
I. F. Orias
C.
MFO 6: HUMAN RESOURCE MANAGEMENT SERVICES
Output 1 1 Approved Citizens Charter implemented Php I. L. Biyoyo
and posted in ER, WARD and OPD sections
in compliance to RA 9485, the Anti Red
Citizens Charter Prepared and Posted Tape Act of 2007 within the rating period.

Output 2 50 Off duties requests recorded in the Php50.00 A. M. Datso

logbook, checked and deliberated within
Request for OFF Duties the rating period.
Logbook

Output 3 20 Approved weekly schedule of duties Php40.00 I. L. Biyoyo

and posted in ER and Wards unit based on A. M. Datso
Schedule of the Nursing standard requirements.
Duties
Output 4 10 leave application request approved, Php50.00 E. R. Senados
submitted to the Administrative Section for
Staff's Leave preparation and transmitted to the
Application Request PHRMDO for approval.

Output 5 120 filed DTR'S prepared and Php100.00 I. L. Biyoyo

accomplished submitted to administrative M. B.
DTR office per Hospital Policies.
Mula
A. M. Datso

J. V. Lumancas
E.
R. Senados

I. F.
Output 6 1 Completed/Updated the worksforce of Php100.00 I. L. Biyoyo
Orias
Office Organizaional Structure in M.C.B.Q.Mula
Nursing compliance to the Department of Health
Organizational Structure licensing requirements within the rating J. V. Lumancas
Macaranas
period. C. O.
Botardo
L. A. Ga
Output 7 1 Success indicators/Performance Php50.00 I. L. Biyoyo
measures prepared, based on the
Table CSC/PGSDN/SPMS standards and
of Success Indicators submitted to the PHRMDO for review
within the rating period.

Output 8 1/10 DPCR/IPCR's Approved by the Chief Php300.00 I. L. Biyoyo

of Hospital and submitted to the PHRMDO M. B.
SPMS-DPCR's/IPCR's for Checking and validation.
Rating and Targets Mula
A. M. Datso

J. V. Lumancas
E.
R. Senados

I. F.
Orias
MFO 7: RECORDS MANAGEMENT AND COMMUNICATION/REPORTORIAL SERVICES C. Q.

Output 1 200 clients Satisfactory Form given and Php. 400.00 Macaranas
I. L. Biyoyo
collected to patient/significant others C. O.M. B.
Consolidated Patient's Survey before discharge within the rating period Botardo
Mula
per hospital policies.
L. A.
A. Ga
M. Datso

J. V. Lumancas
E.
R. Senados

C. O.
Output 2 20 Birth Certificate encoded and verified Php Botardo
M. Mula, RN,
PHILCRIS (Birth Cert. System) for registration at LCR within the rating L. A.MAN
MSN, Ga
period I.F.Orias
C.Q.Macaranas
Output 3 Number patients diseases registered Php A. Datso, RN
Philhealth Claims Case Rates according to Philhealth case rates
withing the rating period.
Output 2 10 types of diseases coded based I. L. Biyoyo
Diseases Coded on rules/guidelines on ICD-10
coding of specific conditions within
the rating period.

MFO 8: CASH MANAGEMENT SERVICES

Output 1 400 official receipts issued with the Php600.00 M. B. Mula
Payments Collected and Official corresponding amount collected facilitated
within the rating period.
Receipt Issued

Output 2 6 official stubs remittance reported with Php M. B. Mula

Cash Collection Report corresponding amount collected, within
the set timeframe.

Output 3 6 remitted collections and deposits M. B. Mula

Report on Collections and Deposits encoded via ETRACS with complete and
exact informations and figures within the
rating period

Output 4 6 official stubs checked and monitored M. B. Mula

Official Receipts Control within the rating period.
Checked and Monitored

Output 5 1 Facilitated Philhealth sharing released to Php A. M. Datso

PHILHEALTH Sharing Payroll all employees who rendered services
within the period January-June 2017 with
100% accuracy.

Output 6 2 Facilitated salaries/wages releases to Php A. M. Datso

JOB-ORDER SALARIES/ WAGES the Job-Order employees within the
period of January to June 2017 with 100%
accuracy.

Output 7 2 cash advance entered in the cash book Php M.B.Mula

Cash Advance Cash Book within the rating period.

MFO 9: BILLING/PHILHEALTH SERVICES REMITTANCES

Output 1 200 checked and reviewed patients bill Php M. B Mula
Checked and reviewed Patient's Bill cleared within the rating period. J. V. Lumancas
within the rating period E. R. Senados

Output 2 12 computed and printed statement of Php M. B Mula

Computed and Printed Patients accounts released to the discharge patient J. V. Lumancas
for payment of their bills within the period E. R. Senados
Statement of Account of time.
A. M. Datso

Output 3 15 Patient's PBEF generated and printed Php300.00 M. B Mula

PHIC Claims Enrolled Transmittal in accordance with PHIC rules and J. V. Lumancas
regulations within the rating period. E. R. Senados

Output 4 30 of PHIC Patients Supporting Php I. L. Biyoyo

PHIC Patients Supporting Documents Documents collected/received within the M. B Mula
rating period. J. V. Lumancas
E. R. Senados
A. M. Datso
C. Q. Macaranas
I. F. Orias

Output 5 50 patients diseases registered according Php A. M. Datso

to Philhealth case rates within the rating
Philhealth Claims Case Rates period.

Output 6 8 SPA generated and printed in M. B. Mula

Approved PHIC Remittance accordance with PHIC rules and
regulations within the rating period.

MFO 10: PROPERTY AND SUPPLY MANAGEMENT

Output 1 1 assisted revised PPMP as mandated by Php M. B. Mula
PPMP Revised Budget Office within the rating period.

MFO 11: PROCUREMENT SERVICES

Output 1 16 assisted Prswithin the rating period Php M. B. Mula
Approved PR
MFO 12: ACCREDITATION/LICENSING
Output 1 1 complied the Nursing Instruction Php
Licensing Documents Prepared Manuals, Policies and Infection Control
Standards based on the Department of
Health licensing requiremnets within the
rating period

MFO 13: ADDITIONAL OUTPUTS

Output 1 1 conducted counselling to all nursing staff Php250.00 I. L. Biyoyo
pertaining on the incident reported
Incident recorded within the rating period.
Reporting Counselling Logbook

Output 2 1 prepared inspection report on the Php20.00 M.B.Mula

delivered medical supplies as to the
Inspectorate accuracy on the listed against the actual
Report number of items within the rating period.

Output 3 100 Checked and countersigned Daily Php10.00 I. L. Biyoyo

Time Record (DTR) with supporting
Checked documents within the rating period.
and Countersigned Nursing Staff Daily
Time Record
Output 4 6 posted communications, memorandum Php50.00 I. L. Biyoyo
orders, posters, announcements updated M. B.
within the rating period.
Updated Bulletin Board Mula
A. M. Datso

J. V. Lumancas
E.
R. Senados
Output 5 20 conducted/facilitated ward lecture to Php300.00 I. L. Biyoyo
patients and watchers the effect of their
Ward lifestyle and the probable remedies that I. M.
F. B.
Audience Lecture Logbook could be used in their home treatment Mula
Orias
recorded within the rating period. A. M. Datso
C. Q.
Macaranas
J. V. Lumancas
E.
R. Senados
Final Average Rating
I. F.
Adjectival Rating Orias
C. Q.
Macaranas
Comments and Recommendation for Development Purposes

Assessed By:
Discussed with Date I certify that I Date Final Rating By: Date
assessed he targets of the
performance with the employee.

MARIA KAREEN G. PEPITO, RMT, MD MARIA KAREEN G. PEPITO, RMT, MD

MEDICAL OFFICER IV Medical Officer IV
Legend: 1 - Qualiity 2 - Efficiency 3 - Timeliness 4 - Average