TUBIGON COMMUNITY

HOSPITAL
ADMINISTRATIVE SERVICES
 SECURING A BIRTH CERTIFICATE/DEATH CERTIFICATE

Schedule of Availability of Service:

8:00 am – 5:00 pm
Mondays to Fridays

Who May Avail of the Service:

Parents or authorized representative
Next of Kin
Guardians (minor parent)
What are the Requirements:
Birth Certificate:
1. Data for Registration
2. Official Receipt
Additional Requirement:
If Married:
1. Photocopy of Marriage Certificate
If Not Married (for use of surname of father)
1. Photocopy of cedula of Mother and Father
2. Presence of Father for acknowledgement (RA 9255 Affidavit)

Duration: 36 minutes

Step Applicant/Client Action Officer Duration of Person in Fees Form

Activity Charge
(Under Normal
Circumstances)
Data for
Go to medical records and
Provide data for Medical Registration
1. fill out data form for 5 minutes
registration form Records Form for
registration
Birth/Death
Interview and counter Data for
Submit data for registration
check information for Medical Registration
2. form to the Medical 3 minutes
completeness and Records Form for
Records
accuracy Birth/Death
Married:
Marriage
Certificate

Check requirements. Not Married

Provide additional
Medical for
3. necessary requirements. 5 -10 minutes
Process birth/death Records Acknowledge
certificate ment:
Photocopy of
cedula and
RA 9255
Affidavit
Receive payment and
Go to the cashier for issue Official Receipt.
4. payment 1-3 minutes Cashier
60.00
Advice client to go to
the Medical Records

Present official receipt and Medical

5. confirm information Let doctor sign the birth Records Official
5-10 minutes
written on the certificate certificate. Receipt
Medical Officer
6. Affixed signature on Issue Birth Certificate 1-3 minutes Medical
 informant’s space. and other documents Records
needed
Let informant sign the
logbook and instruct
client to proceed to:

*Certificate of Live
Birth: LCR for Certificate of
registration Medical Live Birth/
7. Sign logbook. 1-2 minutes
Records Death
*Death Certificate: Certificate
RHU for MHO’s
signature and then to
LCR for registration

Fill-out the Client Satisfaction Rating Form

END OF TRANSACTION

SECURING A MEDICAL RECORD

Schedule of Availability of Service:
8:00 am – 5:00 pm
Mondays to Fridays

Who May Avail of the Service:

• Patient of legal age
• Parent or Legal Guardian for Minor or Incompetent Patient
• Nearest kin
• Authorized Representative
What are the Requirements:
1. OPD, Admission or ER Record
2. Official Receipt
3. In the absence of the patient:
-Authorization and identification card of the patient
-Valid identification card of authorized representative

Duration: For simple transaction:

Certificate of Confinement – 25 mins
Medical Certificate – 1 day for In Patient & 25 mins for Out Patients
Medical Abstract – 1 day if attending physician is on duty
Insurance Forms – 1 day if attending physician is on duty
Laboratory Results – 5-15 mins
For complex transaction: until physician is available
Patients whose attending physicians are either by appointment schedule, visiting or out of
the country.

Step Applicant/Client Action Officer Duration of Person in Fees Form

Activity Charge
(Under Normal
Circumstances)
Interview and verifies
Proceed to Medical Client’s/Patient’
Medical
1. Records Section and state request. 5 mins
Records
your request.
Explain processing time
 and fees

Certificate of
Confinement -
30.00
Medical
Certificate –
Receive payment and 30.00 (Local
issue official receipt. use)
100.00
2. Pay applicable fees. 5 mins Cashier (Abroad)
Advice client to go to
the Medical Records Medical
Abstract –
30.00
Insurance –
100.00
Laboratory
Results –
3.00/copy
Process request of
Submit the official receipt Official
client or patient.
to the medical records. Receipt
Medical
3. 5-10 mins
Ask patient to claim Records
Provide insurance form for Insurance
requested record as
Insurance Form
scheduled
Claim requested record as Issue requested record Medical
4. 3 mins
scheduled to client or patient Records
Document the release Medical
5. Sign logbook 1-2 mins
of requested record. Records
Fill-out the Client Satisfaction Rating Form
END OF TRANSACTION

SECURING A RECORD FOR MEDICO LEGAL

Schedule of Availability of Service:

8:00 am – 5:00 pm
Mondays to Fridays

Who May Avail of the Service:

• Patient of legal age
• Parent or Legal Guardian for Minor or Incompetent Patient
• Nearest kin
• Authorized Representative
What are the Requirements:
4. OPD, Admission or ER Record
5. In the absence of the patient:
-Authorization and identification card of the patient
-Valid identification card of authorized representative

Duration: 11 minutes

Step Applicant/Client Action Officer Duration of Person in Fees Form

Activity Charge
(Under Normal
Circumstances)

Proceed to Medical Interview and verifies

Medical
1. Records Section and Client’s/Patient’ 5 mins
Records
request for patient’s record request.
 Retrieve patient’s
record, photocopy and
Medical Photocopy – 3.00
2. Pay applicable fees. certify the patient’s 3 mins
Records
record.

Document the release

of requested record.
Medical
3. Sign logbook 3 mins
Accompany patient to Records
RHU and give patient’s
record to the MHO
Fill-out the Client Satisfaction Rating Form
END OF TRANSACTION

AVAILING OF OUTPATIENT CONSULTATION

Schedule of Availability of Service:

Monday to Fridays
Friday to Saturday
8:00 a.m. – 12:00 noon
1:00 p.m. – 5:00 p.m.
Who May Avail of the Service:
Anybody whose treatment does not require an overnight stay in Tubigon Community Hospital.
What are the Requirements:
1. Patient Information Sheet for Registration
2. Filled out OPD Form
3. Official Receipt
4. Laboratory Results if needed

Duration: 44 to 90 minutes
Step Applicant/Client Action Officer Duration of Person in Fees Form
Activity Charge
(Under Normal
Circumstances)

Interview and assist PACD: OPD

Go to PACD for
patient/companion in Krizia F. Form/Patient
1 Registration/Filling up of 1-3 minutes
filling out forms Manigo/Chielo Information
forms
Legaspi Sheet
Register patient
Pay Consultation Fee to the Receive payment & issues
2 1-2 minutes Cashier 130.00 OR
cashier official receipts
Go to the OPD Section
Interview patient, take Aileen OPD Form
3 vital signs and record to 1-3 minutes Lamanilao, RN
Present Official Receipt
the OPD Form OPD Nurse OR
(OR)

Go to the OPD Assess the patient Meyzadel B. OPD Form

Physician when called. 5-10 minutes Mante, MD
3
Prescribe medications OPD Physician
and/or laboratory
examinations

Listen to the instruction Give instructions on 5 mins Aileen OPD Form

4
medications, laboratory Lamanilao, RN
tests and follow up. OPD Nurse
4 If for laboratory work up, go Receive payment and 1-2 minutes Cashier Case to Laboratory
 to the cashier for payment issue Official Receipt case Request
of desired laboratory test. (OR) basis
Receive the laboratory Madelyn
Go to the laboratory for request. 1-3 minutes Piezas, RMT
OR
laboratory desired John Mark
5 Laboratory
examination Process laboratory exam Ochavillo,
Request
30 minutes to 1 RMT
Wait for the result. hour Mar Aquiles
Once result is in, patient Attach laboratory result to
Aileen
send result back to the OPD the OPD form and Laboratory
6 1-3 minutes Lamanilao, RN
Section for reassessment forward to the OPD result
OPD Nurse
physician
Check laboratory result.
Prescribe appropriate
Meyzadel B.
Approach the physician medicines and give
3-5 minutes Mante, MD Prescription
once called. medical advise.
OPD Physician
If needed, advice
admission.
Fill-out the Client Satisfaction Rating Form
END OF TRANSACTION

AVAILING DENTAL SERVICES

Schedule of Availability of Service:

8:00 am – 5:00 pm
Tuesdays to Saturdays
Who May Avail of the Service:
Anyone who needs dental care to maintain a healthy teeth and to prevent dental disorders.
What are the Requirements:
6. Medical Clearance for tooth extraction
Duration: Case to case basis
Step Applicant/Client Action Officer Duration of Person in Fees Form
Activity Charge
(Under Normal
Circumstances)
PACD:
Krizia F.
Direct patient/client to
1 Go to PACD for inquiries. 1-2 minutes Manigo/Chielo
go to the Dental Clinic
Legaspi

Retrieve old record,

make new record for
new client.
Ma. Cristina
Get priority number at the
2 1-3 minutes Bagolor
Dental Clinic. Interview and get vital
Dental Aide
signs for clients who
will undergo tooth
extraction.
Conduct consultation
then perform necessary
procedure.
Go to the dentist when Case to case Dr. Jonalyn N.
3
called. basis Resullar
After the procedure
direct client to go to the
cashier.
Go to the cashier for
Receive charge slip and
payment.
4 payment and issue 1-2 minutes Cashier Charge Slip
Official Receipt.
 Extraction:
  Adult 250.00
 Pedia 200.00
 Topical 100.00
 Restoration:
 Permanent 350.00
 Temporary 200.00
 Scaling/Polishing:
 Severe 400.00
 Moderate 300.00
 Mild 200.00
Fill-out the Client Satisfaction Rating Form
END OF TRANSACTION

AVAILING LABORATORY EXAMINATION

Schedule of Availability of Service:

7:00am – 5:00pm Daily

Who May Avail of the Service:

Anybody to facilitate the doctors determine a diagnosis, plan treatment, check to see if treatment is
working, or monitor the disease over time.

What are the Requirements:

7. Laboratory Request Form
8. Official Receipt
9. Specimen

Duration: 30 minutes to 70 minutes

Duration of
Activity
Step Applicant/Client Action Officer (Under Normal Person in Fees Form
Circumstances) Charge

Receive laboratory
request Krizia F.
Approach PACD for
Manigo /
inquiries and registration
1. Instruct to pay for 1-3 minutes Chielo
laboratory request Legaspi
Present laboratory request.
Give specimen bottle if
needed

Assist patient in filling

For new patients with out applicable forms Krizia F.
laboratory request: Fill out 3-5 minutes Manigo /
applicable forms. Process registration for Chielo
new patients Legaspi

For patients without

Advice client to seek
laboratory request: Advised
consultation first for
to consult a doctor for
desired laboratory test.
desired laboratory test.
Pay desired laboratory test:

 Anti-Treponema Receive Laboratory 250.00 Laboratory

2 1-2 minutes Cashier
Pallidum/Syphillis Ab Request and payment Request
Testing Form
 Blood Chemistry
  Blood Uric Acid 190.00
(BUA)
 Cardiac Panel 1,783.00
 CBS 110.00
 Creatinine 150.00
 Fasting Blood Sugar 140.00
(FBS)
 HbA1C 600.00
 HDL 195.00
 LDL 78.00
 Potassium 300.00
 RBS 140.00
 Serum Albumin Test 200.00
 Serum Chloride Test 300.00
 Serum ionized 300.00
Calcium Test
 Sodium 300.00
 Triglycerides 250.00
 Total Cholesterol 190.00

 Clinical Microscopy
Test:
 Fecalysis/ Stool 70.00
Examination
 Routine Urinalysis 70.00
 50 grams OGCT 490.00
 75 grams OGTT 490.00
without Urine Test
 75 grams OGTT with 620.00
Urine Test

 Hematology:
 Complete Blood 100.00
Count (CBC)
 CBC with Platelet 170.00
Count (Automation)
 Hemoglobin & 110.00
Hematocrit
 Hematocrit 75.00
 Platelet Count 100.00

 Newborn Screening 660.00

 Peripheral Smear 165.00
 Pregnancy Test 200.00

 Serology:
 Blood Typing (A,B,O) 330.00
 Dengue IgG/IgM 550.00
 Dengue Ns1Ag 550.00
 HBsAg 200.00
Determination
 HDbsAg 200.00
 IgG/IgM for 390.00
Samonella Typhi
John mark
Proceed to Laboratory and Receive Laboratory Laboratory
Ochavillo,
present Laboratory request Request form and O.R Request
RMT/
and Official Receipt and instruct patient for Form
3 1-3 minutes Madelyn
the procedure
Piezas, RMT/
Official
Mar Aquiles,
Receipt
Lab Tech
Give specimen or cooperate Receive specimen and MedTech/
4. 3-5 minutes
with the procedure perform procedure. LabTech
Wait for the laboratory MedTech/
Process laboratory tests 30-60 minutes
5. result LabTech
 Receive the Laboratory Release laboratory MedTech/ Official
6. 1-3 minutes
results. result. LabTech Receipt
Fill-out the Client Satisfaction Rating Form
END OF TRANSACTION

AVAILING ADMISSION and DISCHARGE

Schedule of Availability of Service:

Daily, 24 hours

Who May Avail of the Service:

A patient who will be provided with room, board, and continuous nursing and medical service.

What are the Requirements:

10. PhilHealth requirements if a member

Duration: Case to case basis

Duration of
Activity
Step Applicant/Client Action Officer (Under Person in Fees Form
Normal Charge
Circumstan
ces)
Interview the patient and
record reason for
admission.

Taking of vital signs.

Admission
Retrieval of old record if
Chart
Go to the Emergency there is any.
1 3-5 minutes ER Nurse
Room
Admission
Ask if she/he is a
Slip
Philhealth member.
SO is advised to go to the
Philhealth Office for the
requirements.

Inform the ROD.

Wait while the doctor is
doing examination.
Examines the patient, takes
Answer pertinent Admission
2 patient’s history and writes 5-15 minutes Resident on Duty
patient information Chart
an admission order.
asked by the doctor
regarding her/his
condition.
Let patient/SO sign the
Consent for Admission Admission
Sheet. Chart

Carries out Doctor’s Order. ER Charge

Sign Consent for Case to case Slip
3 ER Nurse
Admission Completes all necessary basis
data in the admission Laboratory
forms. Request Form

Records patient’s data to

the ER Logbook,
 Admission Logbook,
Census.

Transport and endorse

patient to ward.
Upon Discharge:
Patient’s
ROD writes discharge
4 Ask the doctor during 3-5 minutes Resident on Duty Admission
order to the patient’s chart.
rounds for discharge Chart
order.
Carries out doctor’s
discharge order.

Facilitate patient if
Go to the PhilHealth
Philhealth requirements are
Office to inquire and Ward Nurse on Admission
5 already submitted. 5-15 minutes
submit the Duty Chart
requirements.
Forward chart to Philhealth
Office for clearance, to the
Pharmacy then to the
Billing Section.
Portal
(PhilHealth
Check for completeness of
Mara Joyce Benefit
Philhealth requirements
Torreon, RN / Eligibility
Hazel Balaga, Form)
6 Sign Clearance Slip 1-3 minutes
RN /
Quennie Mag- CF1, MDR for
Forward chart to the
uyon, RN Pvt Category
Pharmacy
Clearance Slip
Check all medicines and
supplies used during Ma. Jennifer
admission and stay in the Añora Patient’s Chart
hospital. Pharmacist/
7 Wait for the bill. 3-5 minutes Raquel Bagolor / Charge Slips
Sign Clearance Slip Angelie Joy
Villarobe Clearance Slip
Forward Chart to the Clerk, Pharmacy
Billing Section
Wait while the bill is
still being processed. Bill all medicines, supplies
and the patient’s stay in the
Hospital Fee: hospital.
 Private Room 1000.00
Patient’s Chart
without TV, Aircon Attach to the bill the
and Meals following Forms to be Juville Masing
Charge slips
 Private Room with filled out by the patient: / 1200.00
8 5-10 minutes
AC. TV and Meals CF2 Page 2 Ma. Kristina
Clearance Slip
 Semi Pvt Room Waiver Cordova 500.00
 Ward 150.00
 ER Stay Sign Clearance Slip 60.00
 Medicines Case to case
Forward bill to the nurse basis
 Supplies Station Case to case
basis
Bill
Give discharge instruction
and extra medicines.
Filled out and
Submit OR to the Nurse
Ward nurse on signed CF2
10 on Duty at the station Sign Clearance Slip and 1-3 minutes
Duty Form
and the Clearance Slip advise patient to give the
Waiver
clearance slip to the guard
upon exit to the hospital.
Clearance Slip
 Receive, sign and keep the Security Guard
Clearance Slip.

Submit Clearance Slip Cut the Admission

11 1-3 minutes Clearance Slip
to the Security Guard. Bracelet

Escort the patient to the

transportation.
Fill-out the Client Satisfaction Rating Form
END OF TRANSACTION

AVAILING OF AMBULANCE SERVICES

Schedule of Availability of Service:

Daily

Who May Avail of the Service:

A patient who needs to be transported to other higher level hospitals for treatment, for further management
of illness and of emergency cases.

What are the Requirements:

11. Referral note from the ROD
12. Official Receipt
13. Clearance

Duration: Case to case basis

Step Applicant/Client Action Officer Duration of Person in Fees Form

Activity Charge
(Under Normal
Circumstances)
Order referral for
further management of
Process necessary
the patient after given Resident on
1 requirements like payment 3-5 minutes Referral Form
treatment. Duty
of bills.
Fill out Referral Form
Prepare Referral Form

Attach all laboratory

result if there is any.
Referral Form
Call the patient’s ER or Station
2 Wait for the processing. 5-15 minutes Photocopy of
hospital of choice for nurse
laboratory/X-
endorsement.
ray results
Give the bill from ward
or charge slip from ER
to the patient/SO.
Pay desired hospital bill
plus

Ambulance Services Fee:

 To Tagbilaran City
from TCH None
Receive bill/charge slip
3 1-2 minutes Cashier 750.00
• Tubigon resident from the patient.
• Non Tubigon
resident
 Pick up from any point
in Tubigon to TCH:
100.00
• Within 3 km from
 TCH 33.00
• Additional for every
1 km excess 200.00
 Ambulance Nurse
Ambulance
Referral Slip,
Bring necessary papers Nurse/midwife
4 Prepare for transport. 1-5 minutes laboratory
for referral. or Nursing
results
Attendant
Fill-out the Client Satisfaction Rating Form
END OF TRANSACTION

AVAILING OF DELIVERY SERVICES

Schedule of Availability of Service:

Mondays to Fridays
8:00 am – 5:00 pm

Who May Avail of the Service:

Pregnant women having labor pains about to deliver a baby via normal spontaneous vaginal deliveries.

What are the Requirements:

14. Admission Chart
15. PhilHealth Requirements
16. Prenatal Record
17. Laboratory Tests Results

Duration: Case to case basis

Step Applicant/Client Action Officer Duration of Person in Fees Form

Activity Charge
(Under Normal
Circumstances)
Interview and register
the patient.

Get vital signs, BP,

Fetal Height, Fetal
Prenatal
Heart Beat
Record
Retrieval of old record
Admission
1 Go to the ER if there is any. 5-10 minutes ER Nurse
Chart
Ask if she is a
Laboratory
Philhealth member.
Results
SO is advised to go to
the Philhealth Office
for the requirements.

Inform the ROD.

Wait while the doctor is
doing examination. Gives initial orders,
performs the initial
Resident on Admission
2 Answer pertinent patient evaluation & 5-15 minutes
Duty Chart
informations asked by the assessment of the
doctor regarding her patient at ER.
condition.
Let patient/SO sign the Admission
Wait for the admission Consent for Admission Case to case Chart
3 ER Nurse
process to be finished. Sheet. basis
Admission
 Carries out Doctor’s Slip
Order.

Completes all necessary

data in the admission
forms.

Records patient’s data

to the ER Logbook,
Admission Logbook,
Census.

Transport and endorse

patient to ward.

When patient is on
active labor:

Transfer patient direct

to the Labor
Room/Delivery Room
When patient is on
Wait for the progress of
active labor:
labor
Transfer patient to the Case to case Station Nurse
4 Prepare clothing for the
Labor Room or basis or
newborn and expectant
Delivery Room. Midwife
mother, adult diaper
Labor Watch
Assist the patient on the
DR table in a lithotomy
position as per Doctor’s
order.
Cooperate during internal Nurse on Duty
Case to case
5 examination, labor and Inform the ROD that or
basis
delivery. the patient is ready for Midwife
the delivery procedure.

Assist the ROD during

delivery.
Patient’s
Admission
Chart
After delivery: Carries out postpsrtum
Nurse on Duty
orders of the ROD & Case to case
6 or Delivery
Breastfeed the baby. the routine newborn basis
Midwife Logbook
care.
Nursery
Logbook
Carries out Discharge
order of the ROD

Carries out doctor’s

discharge order.
Upon Discharge:
Facilitate patient if
Ward Nurse on Admission
7 Prepares all Philhealth Philhealth requirements 5-15 minutes
Duty Chart
reqirement if member, and for Philhealth patients
fill-up Data para Rehistro are already submitted.

Forward chart to
Philhealth Office for
clearance, to the
Pharmacy then to the
 Billing Section.
Pay the bill.
Bill
Hospital Fees plus
For
Delivery Fee Receive and issue
PhilHealth
(Professional Fee): official receipt for non
patient:
Philhealth patient and
8 1-3 minutes Cashier
 Nulliparous w/ non- NBB patient. 2,000.00
Filled out and
Episiotomy (Primi)
signed CF2
 Multiparous w/ Sign Clearance Slip 2,000.00
Form
Episiotomy
Waiver
 Multiparous w/o 1,100.00
Episiotomy
Give discharge
instruction and extra
medicines.
Submit OR to the Nurse on
9 Duty at the station and the Sign Clearance Slip and 1-3 minutes Ward Nurse
Clearance Slip advise patient to give
the clearance slip to the
guard upon exit to the
hospital.
Receive, sign and keep
the Clearance Slip.

Submit Clearance Slip to Cut the Admission Clearance

10 1-3 minutes Security Guard
the Security Guard. Bracelet Slip

Escort the patient to the

transportation.
Fill-out the Client Satisfaction Rating Form
END OF TRANSACTION

AVAILING OF PROCEDURES AND TREATMENT OF MI NOR MEDICAL CASES AND

EMERGENCIES

Schedule of Availability of Service:

Opens 24 hours a day 7 days a week (24/7)

Who May Avail of the Service:

Anybody who needs minor and emergency treatment.

What are the Requirements:

18. Registration
19. Filled out Emergency Room (ER) Form
20. ER Fee Receipt

Duration:
Case to case basis

Step Applicant/Client Action Officer Duration of Person in Fees Form

Activity Charge
(Under
Normal
Circumstan
ces)
Interview the patient ER Form
1 1-3 minutes ER Nurse
or significant others Laboratorie
 for the reason of s
Enters Emergency seeking treatment
Room while assisting
patient to lie on
bed.

Taking patient’s vital

signs.
Ask if the patient
already has a
2 Registration 1-2 minute ER Nurse
record for retrieval
of the case number.
Examines, treats and
do procedures tothe
Listens and patient. Resident
Case to
3 cooperates in the Doctor on ER Form
case basis
treatment given. Writes doctor’s Duty
order.

Participates in the ER Nurse carries out Case to ER Charge

4 Doctor’s Order. case basis ER Nurse Slip
procedure.
Pay desired
procedures done
and supplies used:

 Blood extraction 70.00

 Catheterization 35.00
 Circumcision 600.00
 Excision 70.00
 Electrocardiogra 220.00
m (ECG)
 ECG Reading 30.00
Fee
 Incision and 70.00
Drainage
 Injection 10.00
 Internal 80.00
Write the procedure
Examination (IE)
performed in the ER
 IV Insertion Case to 20.00 ER charge
5 Charge Slip, the Cashier
 IV Reinsertion case basis 10.00 slip
medicines and
 NGT Insertion 70.00
supplies used.
 Removal of 70.00
foreign bodies
 Suction of 12.00
Secretions
 Surgical dressing:
• Small sized 25.00
wound
• Medium size 35.00
• Large sized 60.00
 Suturing
(depending on
type of suture 150.00
used)
• Silk
• Chromic
 Suture removal 6.00/stitch
If patient is for Resident
5-10
4 referral: Doctor on
minutes
After initial Duty
 treatment has been
done, patient and
significant others are
advised to transfer
Wait for further advise to higher center.
from the doctor.
Issue referral note.

If patient needs to
be admitted:
ROD admits the
patient.

Take the ER Charge List all used items

slip and pay desired and give the ER Case to case ER Charge
5 1-3 minutes Cashier
payment. charge slip to the SO basis Skip
for payment.
Fill-out the Client Satisfaction Rating Form
END OF TRANSACTION

AVAILING OF X-RAY SERVICES

Schedule of Availability of Service:

8:00AM – 5:00PM Daily

Who May Avail of the Service:

Anybody with a doctor’s request to help diagnose or manage a painful condition.

What are the Requirements:

21. X-ray Request Form
22. Official Receipt

Duration: 5-30 minutes

Duration of
Activity
Step Applicant/Client Action Officer (Under Normal Person in Fees Form
Circumstances) Charge
Check if patient has Case to
Krizia F.
request form. case basis X-ray
Manigo /
1 Go to the PACD for 1-2 minutes depending Request Form
Chielo
inquiries. Advise patient to go to on the X-
Legaspi
the cashier for payment. ray request
Pay desired examination:

 Abdominal AP 330.00
 Ankle AP/L 330.00
 Arm AP/L Receive X-ray Request, 352.00
 Cervical Spine AP/L payment and issue 330.00
 Cervical Spine AP/L/O official receipt. 750.00
X-ray
2  Cervical Spine w/ Open
1-2 minutes Cashier Request Form
Mouth Refers patient to the X- 500.00
 Chest Bucky Ray Department 275.00
 Coccyx 550.00
 Cranial 550.00
 CXR AP/L Pedia 280.00
 CXR L 198.00
 CXR LDR 198.00
 CXR PA 198.00
  CXR PA/LDR/LAT 550.00
 CXR PAL 385.00
 Elbow APL 275.00
 Forearm 330.00
 Font AP/O 440.00
 Hand AP/L 330.00
 Hips AP/L 300.00
 Knee AP/L 330.00
 Leg AP/L 550.00
 Lumbo Sacral AP/L 550.00
 Mandible AP/O 350.00
 Modified Sinuses 390.00
 Pelvic AP 275.00
 Shoulder APL 275.00
 Skull AP/L 330.00
 Skull Series 900.00
 Thoracic Lumbar AP/L 850.00
 Water’s View 275.00
 Water’s View LAT 550.00
 Wrist AP/L 275.00
 READING FEE 55.00 to
110.00
Receives request and
record it in the logbook.

Perform specific
Helda
examination.
Bongcales X-ray
Present the X-ray request Rad Tech Request Form
Inform the patient when
3 and official receipt to the X- 5-10 minutes Or
to come back for the
ray Technologist Bernardito Official
releasing schedule of the
Amigo Receipt
X-ray result.
X-ray Tech
Process and prepare X-
ray for interpretation of
the Radiologist.
Helda
Bongcales
Rad Tech
Go back to the X-ray Release the Official X- Official
4 1-3 days Or
Department for the result. ray Result to the patient Receipt
Bernardito
Amigo
X-ray Tech
For Admitted patient:

Pay reading fee to the

cashier with the request Receive X-ray Request, None
X-ray
form: payment and issue 55.00-
6 1-2 minutes Cashier Request Form
 For NBB patients official receipt. 110.00
 For NBB patient in Pvt
room 55.00-
 Fon non-Philhealth 110.00
patients

Give X-ray request form to Patient will be brought to 3-5 minutes X-ray Case to X-ray
7
the X-ray Department the X-ray Department minutes personnel case basis Request Form

Fill-out the Client Satisfaction Rating Form

END OF TRANSACTION

AVAILING OF X-RAY SERVICES

 Schedule of Availability of Service:
8:00AM – 5:00PM Daily

Who May Avail of the Service:

Anybody with a doctor’s request to help diagnose or manage a painful condition.

What are the Requirements:

23. X-ray Request Form
24. Official Receipt

Duration: Taking of Result 1 to 3 days

Duration of
Activity
Step Applicant/Client Action Officer (Under Normal Person in Fees Form
Circumstances) Charge
Advise patient for
consultation.
For Outpatients: Krizia F.
Manigo /
1 Register the patient.
Approach PACD for 1-3 minutes Chielo 120.00 Charge Slip
inquiries and registration. Legaspi
Give charge slip for
consultation fee.
Go to the OPD Section
Receive/review the
2 1-2 minutes OPD Nurse OPD Record
accomplished form
Present Official Receipt
General consultation.
Meyzadel B.
Go to the OPD Physician Prepares request for Mante, MD X-ray
3 5-10 minutes
when called. examination and instruct OPD Request Form
the patient to proceed to Physician
the cashier.
Clients with X-ray
Request previously Case to
Saisona Yen
ordered and from private case basis
Advise patient to go to Jongco, RN/ X-ray
3 clinics: 1-3 minutes depending
the cashier for payment. Krizia F. Request Form
on the X-
Manigo
Register client and provide ray request
patient’s case number.
Pay desired examination:

 Abdominal AP 330.00
 Ankle AP/L 330.00
 Arm AP/L 352.00
 Cervical Spine AP/L 330.00
 Cervical Spine AP/L/O 750.00
 Cervical Spine w/ Open
Mouth Receive X-ray Request, 500.00
 Chest Bucky payment and issue 275.00
 Coccyx official receipt. 550.00
4  Cranial 550.00 X-ray
1-2 minutes Cashier
 CXR AP/L Pedia Refers patient to the X- 280.00 Request Form
 CXR L Ray Department 198.00
 CXR LDR 198.00
 CXR PA 198.00
 CXR PA/LDR/LAT 550.00
 CXR PAL 385.00
 Elbow APL 275.00
 Forearm 330.00
 Font AP/O 440.00
 Hand AP/L 330.00
 Hips AP/L 300.00
 Knee AP/L 330.00
 Leg AP/L 550.00
 Lumba Sacral AP/L 550.00
 Mandible AP/O 350.00
 Modified Sinuses 390.00
 Pelvic AP 275.00
 Shoulder APL 275.00
 Skull AP/L 330.00
 Skull Series 900.00
 Thoracic Lumbar AP/L 850.00
 Water’s View 275.00
 Water’s View LAT 550.00
 Wrist AP/L 275.00
 READING FEE 55.00 to
110.00
Receives request and
record it in the logbook.

Perform specific
Helda
examination.
Bongcales
X-ray
Present the X-ray request Rad Tech
Inform the patient when Request Form
and official receipt to the X- 5-10 minutes Or
to come back for the
ray Technologist Bernardito
releasing schedule of the OR
Amigo
X-ray result.
X-ray Tech
Process and prepare X-
ray for interpretation of
the Radiologist.
Helda
Bongcales
Rad Tech
Go back to the X-ray Release the Official X-
1-3 days Or OR
Department for the result. ray Result to the patient
Bernardito
Amigo
X-ray Tech
For In Patients:
Makes order in the Resident on Admission
1-3 minutes
Informed by the ROD of the patient’s chart Duty Chart
procedure.
Fill up the X-ray request
form.
Ward Nurse
Wait for the request form.
Give request Form to the on Duty
SO and advise to pay for
the reading fee.

Pay reading fee to the

cashier with the request
form: Receive X-ray Request,
X-ray
 For NBB patients payment and issue None
1-2 minutes Cashier Request Form
 For NBB patient in Pvt official receipt. 55.00-
room 110.00
 Fon non-Philhealth
patients 55.00-
110.00
Fill-out the Client Satisfaction Rating Form
END OF TRANSACTION