...

••
Republic of the PhilippineSiiii
Department of Health
HEALTH FACILITIES AND SERVICES REGULATORY BUREAU

ANNEX H-6a
A.O. No. 2016- DO 2.-- 4
CHECKLIST FOR REVIEW OF FLOOR PLANS
LEVEL 1 HOSPITAL

Name of H o s p i t a l : - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Address: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

Date: _ _ _ _ _ _ _ _ _ _ _ __ Review: 151 2nd ___ 3rd _ __

1. PHYSICAL PLANT
1.1 Administrative Service
__ 1.1.1 Lobby
1.1.1.1 WaitingArea
1.1.1.2 Information, Reception Area and Admitting Section
1.1.1.3 Public Toilet (Male/Female/PWD)
1.1.1.4 Staff Toilet
1.1 .2 Business Office
1.1.3 Medical Records Office
__ 1.1.4 Prayer Area/Room
__ 1.1.5 Office of the Chief of Hospital
__ 1.1.6 Laundry* and Linen Section
__ 1.1. 7 Maintenance and Housekeeping Section*
__ 1.1.8 Parking Area for Transport Vehicle
__ 1.1.9 Supply Room
__ 1.1.1 0 Waste Holding Room
__ 1.1.11 Dietary*
1.1 .11.1 Dietitian Area
1.1.11.2 Supply Receiving Area*
1.1.11.3 Cold and Dry Storage Area*
1.1.11.4 Food Preparation Area*
1.1.11.5 Cooking and Baking Area*
1.1.11.6 Serving and Food Assembly Area
1.1.11.7 Washing Area
1.1 .11 .8 Garbage Disposal Area
1.1.11.9 Dining Area
1 .1 .11 .1 0 Toilet
__ 1 .1.12 Cadaver Holding Room
1.2 Clinical Service
__ 1.2.1 Emergency Room
1.2.1.1 Waiting Area
1.2.1.2 Toilet
1.2.1 .3 Nurses' Station with Work Area with Lavatory/Sink
1.2.1 .4 Minor Operating Room/Surgical Area
1.2.1.5 Examination and Treatment Area with Lavatory/Sink
1.2.1.6 Observation Area
1.2.1. 7 Equipment and Supply Storage Area
1.2.1.8 Wheeled Stretcher Area

*When the services are contracted out, these areas are not required. However, a contract of service or
memorandum of agreement with a service provider should be secured as a prerequisite for license to operate.

......................................................
j HOS-PTC-CR-L 1 j
l Revision:OO l
j 12/14/2016 j
L..~~9..~ . ~. ~!..~.......................l
t
' .
__ 1.2.2 Outpatient Department (Separate from ER Complex)
1.2.2.1 Waiting Area
1.2.2.2 Toilet (Male/Female/PWD)
1.2.2.3 OPD Nurses' Station with work area with Lavatory/sink
1. 2. 2.4 OPD Medical Records Section
1.2.2.5 Consultation Area
1.2.2.6 Examination and Treatment Area with Lavatory/Sink
(08, Medicine, Pedia, Surgery, Dental-optional)
__ 1.2.3 Surgical and Obstetrical Service
1.2.3.1 Major Operating Room
1.2.3.2 Labor Room with toilet
1.2.3.3 Delivery Room
1.2.3.4 Recovery Room
1.2.3.5 Sub-sterilizing Area/Work Area
1.2.3.6 Sterile Instrument, Supply and Storage Area
1.2.3. 7 Scrub-up Area
1.2.3.8 Clean-up Area
1.2.3.9 Dressing Room
1.2.3.1 0 Toilet
1.2.3.11 Nurses' Station with Work Area
1.2.3.12 Wheeled Stretcher Area
1.2.3.13 Janitor's Closet (with mop sink)
__ 1.2.4 Nursing Unit
1.2.4.1 Patient Room with toilet
1.2.4.2 Isolation Room with Toilet and Ante Room with sink, PPE
Rack and hamper
1.2.4.3 Nurses' Station with Medication Area with Lavatory/Sink
1.2.4.4 Treatment Area
__ 1.2.5 Central Sterilizing and Supply Room
1.2.5.1 Receiving and Cleaning Area
1.2.5.2 Inspection and Packaging Area
1.2.5.3 Sterilizing Room
1.2.5.4 Storage and Releasing Area
_ _ 1.3 Nursing Service
1.3.1 Office of the Chief Nurse
_ _ 1.4 Ancillary Service
__ 1.4.1 Secondary Clinical Laboratory with Blood Station
1.4.1.1 Clinical Work Area with Lavatory/Sink
(min. Floor Area: 20.00 sq. m.)
1.4.1.2 Pathologist Area
1.4.1.3 Toilet
1.4.1.4 Extraction Area Separate from Clinical Lab. Work area
__ 1.4.2 Radiology- 1st Level
1.4.2.1 X-Ray Room with Control Booth, Dressing Area and
Toilet
1.4.2.2 Dark Room
1.4.2.3 Film File and Storage Area
1.4.2.4 Radiologist Area
__ 1.4.3 Pharmacy (with work counter and sink)

r· . ·~os~~~c~c·R~·i:·~ ......l
! Revision:OO !
i 12/14/2016 i
!.. ...~~.~:.~.~!. ~........................ ]
.
'
. c ..

2 .PLANNING AND DESIGN

__ 2.1 Floor plans properly identified and completely labeled
__ 2.2 Conforms to applicable codes as part of normal professional service:
2.2.1 Exits restricted to the following types: door leading directly outside the
building, interior stair, ramp, and exterior stair
2.2.2 Minimum of two (2) exits, remote from each other, for each floor of the
building
2.2.3 Patient Corridors for ingress and egress shall be at least 2.44 meters in
clear and unobstructed width
2.2.4 Exits terminate directly at an open space to the outside of the building
2.2.5 Minimum of one (1) toilet on each floor accessible to the disabled
__ 2.3 Meets prescribed functional programs:
__ 2.3.1 Main entrance of the hospital directly accessible from public road
__ 2.3.2 Ramp or elevator for clinical, nursing and ancillary services located on
the upper floor
2.3.3 Administrative Service
2.3.3.1 Business office located near the main entrance of the
hospital
__ 2.3.4 Emergency Room
2.3.4.1 Located in the ground floor to ensure easy access for
patients
2.3.4.2 Separate entrance to the emergency
2.3.4.3 Ramp for wheelchair access (with a clear width of at least
1.22 m. or 4ft.)
2.3.4.4 Easily accessible to the clinical and ancillary services
(laboratory, radiology, pharmacy, operating room)
2.3.4.5 Nurses' station located to permit observation of patient
and control of access to entrance, waiting area, and
treatment area
__ 2.3.5 Outpatient Department
2.3.5.1 Located near the main entrance of the hospital to
ensure easy access for patients
2.3.5.2 Separate toilets for patients and staff (Male!Female!PWD)
__ 2.3.6 Surgical and Obstetrical Service
2.3.6.1 Located and arranged to prevent non-related traffic
through the suite
2.3.6.2 Operating room and delivery room located as remote
as practicable from the entrance to the suite to
provide greater asepsis
2.3.6.3 Operating room and delivery room arranged to
prevent staff and patients to travel from one area to
the other area
2.3.6.4 Dressing room arranged to avoid exposure to dirty
areas after changing to surgical garments
2.3.6.5 Nurses' station located to permit visual observation of
patient and movement into the suite
2.3.6.6 Scrub-up area recessed into an alcove or other open
space out of the main traffic
2.3.6.7 Sub-sterilizing area shall be provided and shall be accessible
from the Operating room and delivery room

r····~~~~fo~~~c;-~:·~·; ......1
i 12114/2016 i
L. .~~.~:.~.~~. ~. . . . . . . . . . . ..J
 ' .
__ 2.3. 7 Nursing Service
2.3.7.1 Nurses' station located and designed to allow visual
observation of patient and movement into the nursing unit
2.3.7.2 Nurses' station provided in all nursing units of the
hospital with a ratio of at least one (1) nurses' station
for every thirty-five (35) beds
2.3.7.3 Toilet immediately accessible from each room in a nursing unit
2.3. 7.4 Separate rooms with toilets for male and female patients
__ 2.3.8 Dietary, maintenance and other non-patient contact services located
in areas away from normal traffic within the hospital, or located in
separate buildings within the hospital premises
2.3.8.1 The dietary service shall be away from morgue with
at least 25-meter distance

COMMENTS:

r·····~os~~~c~c·R:·L·; ......!
! Revision:OO !
i 12/14/2016 i
!. ....~?..~:.~ ..~!. ~........................ )
•

Republic of the Philippinej....

Department of Health
HEALTH FACILITIES AND SERVICES REGULATORY BUREAU

Name of Health F a c i l i t y : - - - - - - - - - - - - - - - - - - - - - - -
Address:

COMMENTS:

HEALTH FACILITIES EVALUATION AND REVIEW COMMITTEE (HFERC)

[ ] Approved [ ] Disapproved

Chairperson, HFERC

Vice-Chairperson, HFERC

Member Member Member

Member Member Member

r. ·~·;5~~~c;~c;~~~·; ......!
! Revision:OO !
i 12/14/2016 i
l...................................................
:
Page5of5
,i