NCHFD Hosp Stat Form 1
NCHFD Hosp Stat Form 1
NCHFD Hosp Stat Form 1
Number of Patients
Pay Service
% of
Districts Non PHIC HMO Non PHIC Grand
PHIC Member/Dep Indigent w/ PHIC w/o PHIC OWWA PHIC Member/Dep Indigent OWWA Total Total
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
Grand Total 0 0 0 0 0 0 0 0 0 0 0
1
2
1.2 Congressional districts outside the province but within the region
Number of Patients
Pay Service
% of
Districts Non PHIC HMO Non PHIC Grand
PHIC Member/Dep Indigent w/ PHIC w/o PHIC OWWA PHIC Member/Dep Indigent OWWA Total Total
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
Grand Total 0 0 0 0 0 0 0 0 0 0 0
Number of Patients
Pay Service
% of
Districts Non PHIC HMO Non PHIC Grand
PHIC Member/Dep Indigent w/ PHIC w/o PHIC OWWA PHIC Member/Dep Indigent OWWA Total Total
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
Grand Total 0 0 ###
0 0 0 0 0 0 0 0 0
3
Medicine 0 0 0 0
Obstetrics 0 0 0 0
Gynecology 0 0 0 0
Pediatrics 0 0 0 0
Surgery 0 0 0
Adult 0 0 0 0
Pedia 0 0 0 0
Others 0 0 0 0
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Newborn(born alive)
Pathologic
Non Pathologic xxx xxx xxx xxx xxx xxx xxx xxx xxx
* Bed Days (In-Patient Service Days) = [(In-patients remaining at midnight+Total Admissions)-Total Discharges/Deaths]
+ [Admitted and discharged on the same day]
* Srvc= Service FT= Full time PT= Part time
2.6 Average Daily Census of Admitted Patients
* Ave. daily census of admitted patients = Total in -patient service days for the period
Total days in the period
2.7 Percentage of Occupancy/Bed Occupancy Rate (BOR)
3.2 Discharges
Type of Accomodations
Pay Service
Type of Service PHIC HMO PHIC
Non- Total
OWWA Non-PHIC OWWA
PHIC Member / Member / Length
Dep Indigent W/ PHIC W/O PHIC Dep Indigent Total of Stay
Medicine 0
Obstetrics 0
Gynecology 0
Pediatrics 0
Surgery 0
Adult 0
Pedia 0
Others (specify) 0
Total 0 0 0 0 0 0 0 0 0 0 0 0
Newborn (born alive)
Pathologic 0
Non-Pathologic 0
Grand Total 0 0 0 0 0 0 0 0 0 0 0 0
* Average Length of Stay = Total length of stay of discharged patients (incl.deaths) in the period
Total discharges and deaths in the period
* Average Length of Stay = Total length of stay of newborns (incl.deaths) in the period
Total discharges and deaths newborns in the period
Medicine 0 0 0 0 0
Obstetrics 0 0 0 0 0
Gynecology 0 0 0 0 0
Pediatrics 0 0 0 0 0
Surgery 0 0 0 0 0
Adult 0 0 0 0 0
Pedia 0 0 0 0 0
Others (specify) 0 0 0 0 0
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Newborn (born alive)
Pathologic 0 0 0 0 0
Non-Pathologic 0 0 0 0 0
Grand Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5
Disch = Discharged Trans = Trasferred Hama = Home Against Medical Advise Abs = Absconded
5
3 HOSPITAL OPERATIONS
2. 0 0 0 #DIV/0!
3. 0 0 0 #DIV/0!
4. 0 0 0 #DIV/0!
5. 0 0 0 #DIV/0!
6. 0 0 0 #DIV/0!
7. 0 0 0 #DIV/0!
8 0 0 0 #DIV/0!
9. 0 0 0 #DIV/0!
10. 0 0 0 #DIV/0!
11 0 0 0 #DIV/0!
12 0 0 0 #DIV/0!
13 0 0 0 #DIV/0!
14 0 0 0 #DIV/0!
15 0 0 0 #DIV/0!
16 0 0 0 #DIV/0!
17 0 0 0 #DIV/0!
18 0 0 0 #DIV/0!
19 0 0 0 #DIV/0!
20. 0 0 0 #DIV/0!
21 Others 0 0 0 #DIV/0!
Total xxx
6
Condition on Discharge
Discharged Diagnosis (Primary) Imroved Unimproved Total ICD-10 Code
M F Total M F Total M F
1. 0 0 0 0
2. 0 0 0 0
3. 0 0 0 0
4. 0 0 0 0
5. 0 0 0 0
6. 0 0 0 0
7. 0 0 0 0
8. 0 0 0 0
9. 0 0 0 0
10. 0 0 0 0
11. 0 0 0 0
12. 0 0 0 0
13. 0 0 0 0
14. 0 0 0 0
15. 0 0 0 0
16. 0 0 0 0
17. 0 0 0 0
18. 0 0 0 0
19. 0 0 0 0
20 0 0 0 0
21. Others 0 0 0 0
Total 0 0 0 0 0 0 0 0
3.5.2 Surgery
Condition on Discharge
Discharged Diagnosis (Primary) Recovered Improved Unimproved Total ICD-10 Code
M F Total M F Total M F Total M F
1. 0 0 0 0 0
2. 0 0 0 0 0
3. 0 0 0 0 0
4. 0 0 0 0 0
5. 0 0 0 0 0
6. 0 0 0 0 0
7. 0 0 0 0 0
8. 0 0 0 0 0
9. 0 0 0 0 0
10. 0 0 0 0 0
11. 0 0 0 0 0
12. 0 0 0 0 0
13. 0 0 0 0 0
14. 0 0 0 0 0
15. 0 0 0 0 0
16. 0 0 0 0 0
17. 0 0 0 0 0
18. 0 0 0 0 0
19. 0 0 0 0 0
20 0 0 0 0 0
21. Others 0 0 0 0 0
Total 0 0 0 0 0 0 0 0 0 0 0
7
8
3.5.3 Obstetrics
Condition on Discharge
Discharged Diagnosis (Primary) ICD-10 Code
Recovered Improved Unimproved Total
1. 0
2. 0
3. 0
4. 0
5. 0
6. 0
7. 0
8. 0
9. 0
10. 0
11. 0
12. 0
13. 0
14. 0
15. 0
16. 0
17. 0
18. 0
19. 0
20 0
21. Others 0
Total 0 0 0 0
3.5.4 Gynecology
Condition on Discharge
Discharged Diagnosis (Primary) Recovered Improved Unimproved Total ICD-10 Code
M F Total M F Total M F Total M F
1. 0 0 0 0 0
2. 0 0 0 0 0
3. 0 0 0 0 0
4. 0 0 0 0 0
5. 0 0 0 0 0
6. 0 0 0 0 0
7. 0 0 0 0 0
8. 0 0 0 0 0
9. 0 0 0 0 0
10. 0 0 0 0 0
11. 0 0 0 0 0
12. 0 0 0 0 0
13. 0 0 0 0 0
14. 0 0 0 0 0
15. 0 0 0 0 0
16. 0 0 0 0 0
17. 0 0 0 0 0
18. 0 0 0 0 0
19. 0 0 0 0 0
20 0 0 0 0 0
21. Others 0 0 0 0 0
Total 0 0 0 0 0 0 0 0 0 0 0
9
3.5.5 Pediatric
Condition on Discharge
Unimproved Total
Discharged Diagnosis (Primary) ICD-10 Code
Imroved
M F Total M F Total M F
1. 0 0 0 0
2. 0 0 0 0
3. 0 0 0 0
4. 0 0 0 0
5. 0 0 0 0
6. 0 0 0 0
7. 0 0 0 0
8. 0 0 0 0
9. 0 0 0 0
10. 0 0 0 0
11. 0 0 0 0
12. 0 0 0 0
13. 0 0 0 0
14. 0 0 0 0
15. 0 0 0 0
16. 0 0 0 0
17. 0 0 0 0
18. 0 0 0 0
19. 0 0 0 0
20 0 0 0 0
21. Others 0 0 0 0
Total 0 0 0 0 0 0 0 0
9
3.7 Abortion
Category of Abortion
Type
Spontaneous Induced Total
1. Non-Septic
a. Complete 0
b. Imminent 0
c. Inevitable 0
d. Incomplete 0
2. Septic
a. Complete 0
b. Imminent 0
c. Inevitable 0
d. Incomplete 0
Sub-Total
3. Threatened 0
4. Blighted Ovum 0
5. Missed Abortion 0
Total 0 0 0
3.8 Deaths
3.8.1 Types of Deaths
Types of Deaths Number Rate
1 Fetal Death
a. <22 completed weeks or <500 g. birth weight
b. 22 or more completed weeks or 500 g. or more birth weight
Born in the Born outside the
2 Neonatal Death Hospital hospital
Total
3 Maternal Death
a. Early Maternal Death
(while pregnant or within 42 days of termination of pregnancy)
1) Direct Obstetric Death
2) Indirect Obstetric Death
b. Late Maternal Death
(more than 42 days but less than 1 year after termination of pregnancy)
1) Direct Obstetric Death
2) Indirect Obstetric Death
4 Post O.P. Death
5 Gross Death Rate
6 Net Death Rate
7 ER Death
8 Dead on Arrival (DOA)
* Gross Death Rate = Total Deaths (including newborn for a given period ) X 100
Total Discharges and Deaths for the same period
10
* Net Death Rate = Total Deaths (including newborn for a given period ) - Deaths <48 hours for the period X 100
Total Discharges (including deaths and newborn) - death<48 hours for the period
10
2. 0 0 0 #DIV/0!
3. 0 0 0 #DIV/0!
4. 0 0 0 #DIV/0!
5. 0 0 0 #DIV/0!
6. 0 0 0 #DIV/0!
7. 0 0 0 #DIV/0!
8 0 0 0 #DIV/0!
9. 0 0 0 #DIV/0!
10. 0 0 0 #DIV/0!
11 0 0 0 #DIV/0!
12 0 0 0 #DIV/0!
13 0 0 0 #DIV/0!
14 0 0 0 #DIV/0!
15 0 0 0 #DIV/0!
16 0 0 0 #DIV/0!
17 0 0 0 #DIV/0!
18 0 0 0 #DIV/0!
19 0 0 0 #DIV/0!
20. 0 0 0 #DIV/0!
21 Others 0 0 0 #DIV/0!
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 xxx
11
2. 0 0 0 #DIV/0!
3. 0 0 0 #DIV/0!
4. 0 0 0 #DIV/0!
5. 0 0 0 #DIV/0!
6. 0 0 0 #DIV/0!
7. 0 0 0 #DIV/0!
8 0 0 0 #DIV/0!
9. 0 0 0 #DIV/0!
10. 0 0 0 #DIV/0!
11 0 0 0 #DIV/0!
12 0 0 0 #DIV/0!
13 0 0 0 #DIV/0!
14 0 0 0 #DIV/0!
15 0 0 0 #DIV/0!
16 0 0 0 #DIV/0!
17 0 0 0 #DIV/0!
18 0 0 0 #DIV/0!
19 0 0 0 #DIV/0!
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 xxx
12
3.8.3.2 Surgical
Age Distribution of Patients
Total ICD 10
Cause of Death (Underlying) <1 1-4 5-9 10-14 15-19 20-44 45-64 =>65 % of Total Total Cost Code
M F M F M F M F M F M F M F M F M F T
1. 0 0 0 #DIV/0!
2. 0 0 0 #DIV/0!
3. 0 0 0 #DIV/0!
4. 0 0 0 #DIV/0!
5. 0 0 0 #DIV/0!
6. 0 0 0 #DIV/0!
7. 0 0 0 #DIV/0!
8 0 0 0 #DIV/0!
9. 0 0 0 #DIV/0!
10. 0 0 0 #DIV/0!
11 0 0 0 #DIV/0!
12 0 0 0 #DIV/0!
13 0 0 0 #DIV/0!
14 0 0 0 #DIV/0!
15 0 0 0 #DIV/0!
16 0 0 0 #DIV/0!
17 0 0 0 #DIV/0!
18 0 0 0 #DIV/0!
19 0 0 0 #DIV/0!
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 xxx
13
3.8.3.3 Obstetrics
Age Distribution of Patients
ICD 10
Cause of Death (Underlying) 10-14 15-19 20-44 45-64 =>65 Total % of Total Total Cost Code
1. 0 #DIV/0!
2. 0 #DIV/0!
3. 0 #DIV/0!
4. 0 #DIV/0!
5. 0 #DIV/0!
6. 0 #DIV/0!
7. 0 #DIV/0!
8 0 #DIV/0!
9. 0 #DIV/0!
10. 0 #DIV/0!
11 0 #DIV/0!
12 0 #DIV/0!
13 0 #DIV/0!
14 0 #DIV/0!
15 0 #DIV/0!
16 0 #DIV/0!
17 0 #DIV/0!
18 0 #DIV/0!
19 0 #DIV/0!
Total 0 0 0 0 0 0 xxx
14
3.8.3.4 Gynecology
Age Distribution of Patients
ICD 10
# Cause of Death (Underlying) 10-14 15-19 20-44 45-64 =>65 Total % of Total Total Cost Code
1. 0 #DIV/0!
2. 0 #DIV/0!
3. 0 #DIV/0!
4. 0 #DIV/0!
5. 0 #DIV/0!
6. 0 #DIV/0!
7. 0 #DIV/0!
8 0 #DIV/0!
9. 0 #DIV/0!
10. 0 #DIV/0!
11 0 #DIV/0!
12 0 #DIV/0!
13 0 #DIV/0!
14 0 #DIV/0!
15 0 #DIV/0!
16 0 #DIV/0!
17 0 #DIV/0!
18 0 #DIV/0!
19 0 #DIV/0!
Total 0 0 0 0 0 0 xxx
15
3.8.3.5 Pediatric
Age Distribution of Patients
Total
<1 1-4 5-10 10-14 ICD 10
# Cause of Death (Underlying) % of Total Total Cost Code
M F M F M F M F M F T
1. 0 0 0 #DIV/0!
2. 0 0 0 #DIV/0!
3. 0 0 0 #DIV/0!
4. 0 0 0 #DIV/0!
5. 0 0 0 #DIV/0!
6. 0 0 0 #DIV/0!
7. 0 0 0 #DIV/0!
8 0 0 0 #DIV/0!
9. 0 0 0 #DIV/0!
10. 0 0 0 #DIV/0!
11 0 0 0 #DIV/0!
12 0 0 0 #DIV/0!
13 0 0 0 #DIV/0!
14 0 0 0 #DIV/0!
15 0 0 0 #DIV/0!
16 0 0 0 #DIV/0!
17 0 0 0 #DIV/0!
18 0 0 0 #DIV/0!
19 0 0 0 #DIV/0!
20. 0 0 0 #DIV/0!
21 Others 0 0 0 #DIV/0!
Total 0 0 0 0 0 0 0 0 0 0 0 xxx
16
Grand Total 0 0 0 0 0 0 0 0 0 0 0
17
4 ER SERVICES
4.1 Total No. of Patients Attended: New : Revisit : Total :
4.2 Classification of ER Patients: Emergency : Non-emergency : Total :
4.3 Average Number of ER Patients per Day ---------------------------> :
4.4 Twenty Leading Causes of Emergency Cases in the ER Department
1 0 0 0 #DIV/0!
2 0 0 0 #DIV/0!
3 0 0 0 #DIV/0!
4 0 0 0 #DIV/0!
5 0 0 0 #DIV/0!
6 0 0 0 #DIV/0!
7 0 0 0 #DIV/0!
8 0 0 0 #DIV/0!
9 0 0 0 #DIV/0!
10 0 0 0 #DIV/0!
11 0 0 0 #DIV/0!
12 0 0 0 #DIV/0!
13 0 0 0 #DIV/0!
14 0 0 0 #DIV/0!
15 0 0 0 #DIV/0!
16 0 0 0 #DIV/0!
17 0 0 0 #DIV/0!
18 0 0 0 #DIV/0!
19 0 0 0 #DIV/0!
20 0 0 0 #DIV/0!
21 Others 0 0 0 #DIV/0!
18
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18
4 ER SERVICES (Cont.)
1 0 0 0 #DIV/0!
2 0 0 0 #DIV/0!
3 0 0 0 #DIV/0!
4 0 0 0 #DIV/0!
5 0 0 0 #DIV/0!
6 0 0 0 #DIV/0!
7 0 0 0 #DIV/0!
8 0 0 0 #DIV/0!
9 0 0 0 #DIV/0!
10 0 0 0 #DIV/0!
11 0 0 0 #DIV/0!
12 0 0 0 #DIV/0!
13 0 0 0 #DIV/0!
14 0 0 0 #DIV/0!
15 0 0 0 #DIV/0!
16 0 0 0 #DIV/0!
17 0 0 0 #DIV/0!
18 0 0 0 #DIV/0!
19 0 0 0 #DIV/0!
20 0 0 0 #DIV/0!
21 Others 0 0 0 #DIV/0!
19
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19
5 OUT-PATIENT SERVICES
Number of Patients
Pay Service
Districts
PHIC HMO PHIC
Non OWW Non OWW % of Grand
PHIC Member/Dep Indigent w/ PHIC w/o PHIC A PHIC Member/Dep Indigent A Total Total
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
Grand Total 0 0 0 0 0 0 0 0 0 0 0
Medical 0 #DIV/0!
Obstetrics 0 #DIV/0!
Gynecologcy 0 #DIV/0!
Pediatrics 0 #DIV/0!
Surgery 0 #DIV/0!
Others (Specify) 0 #DIV/0!
EENT 0 #DIV/0!
Dental 0 #DIV/0!
Family Planning 0 #DIV/0!
TOTAL: 0 0 0 #DIV/0!
20
1 0 0 0 #DIV/0!
2 0 0 0 #DIV/0!
3 0 0 0 #DIV/0!
4 0 0 0 #DIV/0!
5 0 0 0 #DIV/0!
6 0 0 0 #DIV/0!
7 0 0 0 #DIV/0!
8 0 0 0 #DIV/0!
9 0 0 0 #DIV/0!
10 0 0 0 #DIV/0!
11 0 0 0 #DIV/0!
12 0 0 0 #DIV/0!
13 0 0 0 #DIV/0!
14 0 0 0 #DIV/0!
15 0 0 0 #DIV/0!
16 0 0 0 #DIV/0!
17 0 0 0 #DIV/0!
18 0 0 0 #DIV/0!
19 0 0 0 #DIV/0!
20 0 0 0 #DIV/0!
21 Others 0 0 0 #DIV/0!
21
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22
In Patient 0
Out Patient 0
ER Patients 0
Others 0
Total 0 0 0 0 0 0
Presciption Filled 0
Presciption Unfilled 0
Prescription bought outside by
0
hospital thru emergency purchase
Total 0 0 0 0 0
6.4.2 Out-Patient
Philhealth Pay Service Employee Total
Presciption Filled 0
Presciption Unfilled 0
Total 0 0 0 0 0
6.4.3 ER Patients
Philhealth Pay Service Employee Total
Presciption Filled 0
Presciption Unfilled 0
Total 0 0 0 0 0
24
C Bgry Total
A B D Veteran Sr. Citizen Official/
BHW
1 2 3
1. In Patients 0
2. Out Patients 0
3. ER Patients 0
4. Others 0
Total 0 0 0 0 0 0 0 0 0 0
Reasons Number
1
2
7
8
10
Total
Personnel/
Philhealth Pay Service
Employee
In-Patient % Out-Patient %
ECG
Echocardiogram
Others:
TOTAL 0 0 0 0 0 0
25
6.7 Referrals
7 STAFFING PATTERN
7.1 Personnel/Staff Assignment
8. Manpower Development
9. Committees
EXISTING FUNCTIONAL
YES NO YES NO REMARKS
9.1 Technical
9.1.1 Medical Audit
9.1.2 Clinical Conference
9.1.3 Infection Control Committee
9.1.4 Pharmaceutical/Therapeutic
9.1.5 Tissue Committee
9.1.6 Journal Committee (Nursing)
9.1.7 Medical Records Committee
9.1.8 Utilization Review
9.1.9 Accreditation Committee
9.1.10 Tumor Board
9.1.11 Waste Management Credential Committee
9.2 Administrative
9.2.1 Bidding and Awards Committee
9.2.2 Records Management Committee
9.2.3 Finance Committee
9.2.4 Medical Library Committee
9.3 Others
27
9. Committees
EXISTING FUNCTIONAL
YES NO YES NO REMARKS
27
10.6.1 Philhealth
10.6.2 Hospital Subsidy (Quantified Free Service)
10.6.3 Out of Pocket (Patients’ Payment/Participation)
10.6.4 Donors (Funds from PCSO, PDAF or other Philantrophic Agencies or Individuals)
10.6.5 Other Sources
10.7 Programs implemented e.g. Hospitals as Centers of Wellness, HIC, QAC, etc.
Prepared by:
Statistician/Statistician Designate
Submitted by:
Records Officer
Date: