Annual Hospital Statistical Report – PH DOH – 2014Jan7

ROJoson's Writings on Hospital Administration

annex_e_hospital_stat_report_revised_7jan2014

ANNUAL HOSPITAL STATISTICAL REPORT

YEAR __________

 

 

Name of Hospital: _____________________________________________ Street Address: _____________________________________

Municipality: __________________   Province ______________ Region: ______________________________

Contact No.: __________________________________ Fax Number:__________________________________

Email Address: _____________________________________________________________________________

(PLEASE FILL OUT ALL ITEMS.  PUT N/A IF NOT APPLICABLE.)

  1. GENERAL INFORMATION
  2. Classification
    1. Service Capability
  • Service capability: Capability of a hospital/other health facility to render administrative, clinical, ancillary and other services

 

General:                                                          Specialty:  (Specify)

[    ] Level 1 Hospital                                       [    ] Treats a particular disease (Specify):_______________

[    ] Level 2 Hospital                                       [    ] Treats a particular organ (Specify):________________

[    ] Level 3 Hospital (Teaching/ Training)      [    ] Treats a particular class of patients (Specify):________

[    ] Others (Specify):____________

Trauma Capability:    [    ] Trauma Capable               [    ] Trauma Receiving           

  1. Nature of Ownership

Government:                                                  Private:

[    ] National –DOH Retained/ Renationalized            [    ] Single Proprietorship/Partnership/Corp.

[    ] Local (Specify):                                       [    ] Religious

[    ] Province                                       [    ]…

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