PCPAccFrm E-4D1F1 Rev2014

Enter N
Hospita
Hospital: EAST AVENUE MEDICAL CENTE
Enter the
census i.
Admissions: OPD Census ICU, ER,
Enter the Month
and Year Ma
dis
Case-load (case census per year) and results of care you
and

Month/Year: OCTOBER 2014

Enter Total IM
Admisssions
Total IM Admissions: 784 (Patient person
count) for the
Month

% of Total OPD # of patient-

IM Cases (# of cases with
CARDIOLOGY ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 Essentially Normal Z10.0 51 6.51% 1

2 Hypertensive Cardiovascular Disease I11.9 24 3.06% 12
3 Hypertension I10.9 93 11.86% 69
4 Ischemic Heart Disease I25.9 4 0.51%
5 Prehypertension 1 0.13%
6 Stable Angina 120.9 4 0.51% 1
7 Thoracic Aneurysm I71.9 2 0.26%
8 Rheumatic Heart Disease I09.9 2 0.26%
9 Venous Insufficiency 3 0.38%
10 Mitral Valve Prolapse I34.1 1 0.13%
11 Hypertensive Heart Disease I11.9 1 0.13%
12 Congestive Heart Failure I50.0 4 0.51%
13 Dilated Cardiomyopathy I42.0 4 0.51%
14 Acute Coronary Syndrome, STEMI 6 0.77%
15 Acute Coronary Syndrome, NSTEMI 2 0.26%
16 Atrial Fibrillation I48 5 0.64%
17 Abdominal Aortic Aneurysm I71.9 1 0.13%
18 Obesity E66.9 1 0.13% 1
19 Orthostatic Hypotension 1 0.13%
20 Subclavian Vein Thrombosis I82.8 1 0.13%
21 Unstable Angina I20.0 1 0.13%
22 Edema, Drug-induced 1 0.13%
23 0.00%
24 0.00%
25 0.00%
TOTAL 213 27.17% 84

% of Total OPD # of patient-

IM Cases (# of cases with
INFECTIOUS DISEASES ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 Measles B05.9 3 0.38% 1

2 Syphilis A53.0 3 0.38%
3 Systemic Viral Infection B34.9 2 0.26%
4 Cellulitis L03.9 3 0.38% 1
5 Herpes Zoster Infection 2 0.26%
6 Varicella Zoster Infection 1 0.13%
7 Ascariasis B77.9 1 0.13%
8 Acute Tonsillopharyngitis J06.8 5 0.64%
9 Sexually Transmitted Infection 1 0.13%
10 Viral Exanthem 1 0.13%
11 Plantar Fascitis 1 0.13%

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12 Chalazion H00.1 1 0.13%

13 Carbuncle 1 0.13% 1
14 Sinusitis 1 0.13%
15 Spondylitis 1 0.13%
16 Rheumatic Fever 2 0.26%
17 0.00%
18 0.00%
19 0.00%
20 0.00%
21 0.00%
22 0.00%
23 0.00%
24 0.00%
25 0.00%
TOTAL 29 3.70% 3

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 PCPAccFrm E-4D1F1 Rev2014

% of Total OPD # of patient-

IM Cases (# of cases with
PULMONARY MEDICINE ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 Allergic Cough R05 5 0.64% 1

2 Bronchial Asthma J45.99 8 1.02% 1
3 Bronchiectasis J47 1 0.13%
4 Community Acquired Pneumonia J18.9 50 6.38% 23
5 Chronic Obstructive Pulmonary Disease J44.9 10 1.28% 1
6 Pleural Effusion J90 10 1.28% 10
7 Pulmonary Tuberculosis A16.2 42 5.36% 34
8 Upper Respiratory Tract Infection J06.9 16 2.04%
9 Mass, Pulmonary R91 2 0.26%
10 Pneumonia in the Immunocompromised J18.93 1 0.13%
11 Lower Respiratory Tract Infection 1 0.13%
12 Methamphetamine Inhalation 1 0.13%
13 0.00%
14 0.00%
15 0.00%
16 0.00%
17 0.00%
18 0.00%
19 0.00%
20 0.00%
21 0.00%
22 0.00%
23 0.00%
24 0.00%
25 0.00%
TOTAL 147 18.75% 70

% of Total OPD # of patient-

IM Cases (# of cases with
GASTROENTEROLOGY ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 Acute Gastritis K29.1 21 2.68%

2 Acute Gastroenteritis A09 9 1.15%
3 Cholecystolithiasis K80.2 3 0.38%
4 Cholelithiasis K80.2 12 1.53%
5 Dyspepsia K30.9 15 1.91%
6 GERD K21.9 6 0.77%
7 Hapatitis A Infection B15.9 2 0.26%
8 Hepatitis B Infection B16.9 12 1.53%
9 Functional Constipation K59.0 3 0.38%
10 Peptic Ulcer Disease K27.9 15 1.91%
11 Chronic Diarrhea A09 2 0.26%
12 Diverticulitis K57.2 2 0.26%
13 Bleeding Peptic Ulcer Disease K27.4 6 0.77%
14 Colonic New Growth D48.9 2 0.26%
15 Gastric Outlet Obstruction K56.6 2 0.26%
16 Hepatic Mass R93.2 2 0.26%
17 Obstructive Jaundice R17 2 0.26%
18 Viral Hepatitis B19.9 2 0.26%
19 Acute Pancreatitis K85.9 2 0.26%
20 Hemorrhoid I84.9 6 0.77%
21 Gallbladder Polyp 1 0.13%
22 Esophageal Varices K74.6 1 0.13%
23 Fatty Liver K76.0 1 0.13%
24 Fecal Impaction K56.4 1 0.13%
25 Drug-induced hepatitis K71.6 1 0.13%

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 PCPAccFrm E-4D1F1 Rev2014

131 16.71% 0

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 PCPAccFrm E-4D1F1 Rev2014

% of Total OPD # of patient-

IM Cases (# of cases with
NEPHROLOGY ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 Urinary Tract Infection N39.0 25 3.19% 2

2 Urinary Tract Infection, Complicated N39.0 3 0.38%
3 Nephrolithiasis N20.0 5 0.64%
4 Acute Pyelonephritis N10 2 0.26%
5 Chronic Kidney Disease N18.8 3 0.38%
6 Nephrotic Syndrome N04.9 2 0.26%
7 Nephritic Syndrome N00.0 1 0.13%
8 Obstructive Uropathy N13.6 2 0.26%
9 Uremia N19 1 0.13%
10 Hyperurecemia 1 0.13%
11 Acute Cystitis N30.0 1 0.13%
12 Urinary Tract Infection, Recurrent N39.0 1 0.13%
13 0.00%
14 0.00%
15 0.00%
16 0.00%
17 0.00%
18 0.00%
19 0.00%
20 0.00%
21 0.00%
22 0.00%
23 0.00%
24 0.00%
25 0.00%
TOTAL 47 5.99% 2

% of Total OPD # of patient-

IM Cases (# of cases with
ENDOCRINOLOGY ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 Diabetes Mellitus Type 2 E11.9 39 4.97%

2 Diabetes Mellitus Type 1 E10.9 1 0.13%
3 Euthyroid 1 0.13%
4 Toxic Goiter E05.0 3 0.38%
5 Hyperthyroidism E05.9 8 1.02%
6 Hyperthyroidism, Graves Disease E05.0 5 0.64%
7 Hyperthyroidism, Non-toxic goiter E03.0 4 0.51%
8 Hypokalemic Periodic Paralysis G72.3 3 0.38%
9 Hypothyroidism E89.0 4 0.51%
10 Neuropathic foot 2 0.26%
11 Impaired Glucose Tolerace 1 0.13%
12 Hashimoto's Disease E06.3 1 0.13%
13 0.00%
14 0.00%
15 0.00%
16 0.00%
17 0.00%
18 0.00%
19 0.00%
20 0.00%
21 0.00%
22 0.00%
23 0.00%
24 0.00%

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 PCPAccFrm E-4D1F1 Rev2014

25 0.00%
TOTAL 72 9.18% 0

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 PCPAccFrm E-4D1F1 Rev2014

% of Total OPD # of patient-

IM Cases (# of cases with
HEMATOLOGY ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 Idiopathic Thrombocytopenic Purpura D69.3 2 0.26%

2 0.00%
3 0.00%
4 0.00%
5 0.00%
6 0.00%
7 0.00%
8 0.00%
9 0.00%
10 0.00%
11 0.00%
12 0.00%
13 0.00%
14 0.00%
15 0.00%
16 0.00%
17 0.00%
18 0.00%
19 0.00%
20 0.00%
21 0.00%
22 0.00%
23 0.00%
24 0.00%
25 0.00%
TOTAL 2 0.26% 0

% of Total OPD # of patient-

IM Cases (# of cases with
NEUROLOGY ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 Bell's Palsy G51.0 3 0.38%

2 Benign Paroxysmal Positional Vertigo H81.1 2 0.26%
3 Cluster Headache G44.0 3 0.38%
4 Cerebrovascular Accident, Hemorrhagic I61.9 10 1.28% 4
5 Cerebrovascular Accident, Infarct I63.9 44 5.61% 34
6 Tension Headache G44.2 1 0.13%
7 Contussion, Occipital area S06.20 1 0.13%
8 Transient Ischemic Attack G45.9 4 0.51%
9 Seizure Disorder R56.8 4 0.51%
10 Spinal Cord Compression G95.2 2 0.26%
11 Intracranial Mass 3 0.38%
12 Post Gliotic Seizure 1 0.13%
13 Mental Retardation F79.8 1 0.13%
14 Parkinson's Disease G20 1 0.13%
15 Anxiety Disorder F41.1 1 0.13% 1
16 Syncope F48.8 1 0.13%
17 Menstrual Migraine N94.3 1 0.13%
18 Migraine Headache G43.9 1 0.13%
19 Sciatica M54.39 1 0.13%
20 Subarachnoid Hemorrhage I60.9 1 0.13% 1
21 Disc Herniation 2 0.26%
22 Insomnia 1 0.13%
23 Lacunar Infarct I63.9 2 0.26%
24 Major Depressive Disorder F33.9 1 0.13%

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 PCPAccFrm E-4D1F1 Rev2014

25 Somatoform Disorder F45.8 1 0.13%

TOTAL 93 11.86% 40

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 PCPAccFrm E-4D1F1 Rev2014

% of Total OPD # of patient-

IM Cases (# of cases with
ONCOLOGY ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 Gastric CA C16.9 1 0.13%

2 Lymphoma C85.9 2 0.26%
3 Micropapillary Ca of the Thyroid C73 1 0.13%
4 Chronic Myelogenous Leukemia C92.1 1 0.13%
5 Fibrocystic Change 1 0.13%
6 Myoma uteri D25.9 1 0.13%
7 0.00%
8 0.00%
9 0.00%
10 0.00%
11 0.00%
12 0.00%
13 0.00%
14 0.00%
15 0.00%
16 0.00%
17 0.00%
18 0.00%
19 0.00%
20 0.00%
21 0.00%
22 0.00%
23 0.00%
24 0.00%
25 0.00%
TOTAL 7 0.89% 0

% of Total OPD # of patient-

IM Cases (# of cases with
DERMATOLOGY ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 Pyoderma Gangenosum 1 0.13%

2 0.00%
3 0.00%
4 0.00%
5 0.00%
6 0.00%
7 0.00%
8 0.00%
9 0.00%
10 0.00%
11 0.00%
12 0.00%
13 0.00%
14 0.00%
15 0.00%
16 0.00%
17 0.00%
18 0.00%
19 0.00%
20 0.00%
21 0.00%
22 0.00%
23 0.00%
24 0.00%

We attest to the truthfulness of the above documentation: Page 9 of 76

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 PCPAccFrm E-4D1F1 Rev2014

25 0.00%
TOTAL 1 0.13% 0

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 PCPAccFrm E-4D1F1 Rev2014

% of Total OPD # of patient-

IM Cases (# of cases with
RHEUMATOLOGY ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 Rheumatoid Arthritis M06.99 1 0.13%

2 Gouty Arthritis M10.09 6 0.77%
3 Osteoarthritis M19.99 7 0.89%
4 Musculoskeletal Strain M62.69 13 1.66%
5 Bursitis M71.5 1 0.13%
6 Costochondritis 2 0.26%
7 Fracture, Hip 2 0.26%
8 0.00%
9 0.00%
10 0.00%
11 0.00%
12 0.00%
13 0.00%
14 0.00%
15 0.00%
16 0.00%
17 0.00%
18 0.00%
19 0.00%
20 0.00%
21 0.00%
22 0.00%
23 0.00%
24 0.00%
25 0.00%
TOTAL 32 4.08% 0

% of Total OPD # of patient-

IM Cases (# of cases with
ALLERGOLOGY & IMMUNOLOGY ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 Allergic Dermatitis L23.9 1 0.13%

2 Allergic Rhinitis J30.4 2 0.26%
3 Contact Dermatitis L25.9 1 0.13%
4 Hypersensitivity Reaction T78.4 3 0.38%
5 Urticaria T78.3 1 0.13%
6 Dishidrotic Eczema 1 0.13%
7 PND secondary to Allergic Rhinitis 1 0.13%
8 0.00%
9 0.00%
10 0.00%
11 0.00%
12 0.00%
13 0.00%
14 0.00%
15 0.00%
16 0.00%
17 0.00%
18 0.00%
19 0.00%
20 0.00%
21 0.00%
22 0.00%
23 0.00%
24 0.00%

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 PCPAccFrm E-4D1F1 Rev2014

25 0.00%
TOTAL 10 1.28% 0

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 PCPAccFrm E-4D1F1 Rev2014

Enter Name of
Hospital
EAST AVENUE MEDICAL CENTER
Enter the place of
census i.e. Ward,
ICU, ER, or OPD
Manually count the
disease entity from
your monthly census
and enter here.

Manually count the

number of death per
disease entity from Type the Primary
your monthly census Diagnosis here. If y
% of patients
and enter here.
with one or more need more space
than 1 follow-up (rows), just insert r
(# of patients Yellow boxes before the row of To
with one more automatically to maintain the
than 1 ff-up/# ofcomputed from data calculation formula.
Cases) entered in the shaded
boxes. DO NOT WRITE
ANYTHING ON THE
1.96% YELLOW BOXES.
Type here the ICD 10
50.00%
code of the Primary
74.19% diagnosis
0.00%
0.00%
25.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
0.00%
#DIV/0!
#DIV/0!
#DIV/0!
39.44%

% of patients
with one or more
than 1 follow-up
(# of patients
with one more
than 1 ff-up/# of
Cases)

33.33%
0.00%
0.00%
33.33%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

We attest to the truthfulness of the above documentation: Page 13 of 76

Chairman, Dept. of Medicine
 PCPAccFrm E-4D1F1 Rev2014

0.00%
100.00%
0.00%
0.00%
0.00%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
10.34%

We attest to the truthfulness of the above documentation: Page 14 of 76

Chairman, Dept. of Medicine
 PCPAccFrm E-4D1F1 Rev2014

% of patients
with one or more
than 1 follow-up
(# of patients
with one more
than 1 ff-up/# of
Cases)

20.00%
12.50%
0.00%
46.00%
10.00%
100.00%
80.95%
0.00%
0.00%
0.00%
0.00%
0.00%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
47.62%

% of patients
with one or more
than 1 follow-up
(# of patients
with one more
than 1 ff-up/# of
Cases)

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

We attest to the truthfulness of the above documentation: Page 15 of 76

Chairman, Dept. of Medicine
 PCPAccFrm E-4D1F1 Rev2014

0.00%

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 PCPAccFrm E-4D1F1 Rev2014

% of patients
with one or more
than 1 follow-up
(# of patients
with one more
than 1 ff-up/# of
Cases)

8.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
4.26%

% of patients
with one or more
than 1 follow-up
(# of patients
with one more
than 1 ff-up/# of
Cases)

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

We attest to the truthfulness of the above documentation: Page 17 of 76

Chairman, Dept. of Medicine
 PCPAccFrm E-4D1F1 Rev2014

#DIV/0!
0.00%

We attest to the truthfulness of the above documentation: Page 18 of 76

Chairman, Dept. of Medicine
 PCPAccFrm E-4D1F1 Rev2014

% of patients
with one or more
than 1 follow-up
(# of patients
with one more
than 1 ff-up/# of
Cases)

0.00%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
0.00%

% of patients
with one or more
than 1 follow-up
(# of patients
with one more
than 1 ff-up/# of
Cases)

0.00%
0.00%
0.00%
40.00%
77.27%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
0.00%

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Chairman, Dept. of Medicine
 PCPAccFrm E-4D1F1 Rev2014

0.00%
43.01%

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 PCPAccFrm E-4D1F1 Rev2014

% of patients
with one or more
than 1 follow-up
(# of patients
with one more
than 1 ff-up/# of
Cases)

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
0.00%

% of patients
with one or more
than 1 follow-up
(# of patients
with one more
than 1 ff-up/# of
Cases)

0.00%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

We attest to the truthfulness of the above documentation: Page 21 of 76

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 PCPAccFrm E-4D1F1 Rev2014

#DIV/0!
0.00%

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Chairman, Dept. of Medicine
 PCPAccFrm E-4D1F1 Rev2014

% of patients
with one or more
than 1 follow-up
(# of patients
with one more
than 1 ff-up/# of
Cases)

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
0.00%

% of patients
with one or more
than 1 follow-up
(# of patients
with one more
than 1 ff-up/# of
Cases)

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

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 PCPAccFrm E-4D1F1 Rev2014

#DIV/0!
0.00%

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Chairman, Dept. of Medicine
 PCPAccFrm E-4D1F1 Rev2014

Hospital: EAST AVENUE MEDICAL CENTE

Admissions: OPD Census

E
Case-load (case census per year) and results of care M
Y

Month/Year: NOVEMBER 2014 Enter To

Admiss
person
Total IM Admissions: 732 Month

% of Total OPD # of patient-

IM Cases (# of cases with
CARDIOLOGY ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 Essentially Normal Z10.0 51 6.97%

2 Hypertensive Cardiovascular Disease I11.9 24 3.28% 12
3 Hypertension I10.9 93 12.70% 56
4 Ischemic Heart Disease I25.9 4 0.55% 1
5 Prehypertension 1 0.14%
6 Stable Angina 120.9 4 0.55%
7 Thoracic Aneurysm I71.9 2 0.27%
8 Rheumatic Heart Disease I09.9 2 0.27%
9 Venous Insufficiency 3 0.41%
10 Mitral Valve Prolapse I34.1 1 0.14%
11 Hypertensive Heart Disease I11.9 1 0.14% 1
12 Congestive Heart Failure I50.0 4 0.55% 1
13 Dilated Cardiomyopathy I42.0 4 0.55% 1
14 Acute Coronary Syndrome, STEMI 6 0.82% 4
15 Acute Coronary Syndrome, NSTEMI 2 0.27%
16 Atrial Fibrillation I48 5 0.68%
17 Abdominal Aortic Aneurysm I71.9 1 0.14%
18 Obesity E66.9 1 0.14%
19 Orthostatic Hypotension 1 0.14%
20 Subclavian Vein Thrombosis I82.8 1 0.14%
21 Unstable Angina I20.0 1 0.14%
22 Edema, Drug-induced 1 0.14%
23 0.00%
24 0.00%
25 0.00%
TOTAL 213 29.10% 76

% of Total OPD # of patient-

IM Cases (# of cases with
INFECTIOUS DISEASES ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 Measles B05.9 3 0.41%

2 Syphilis A53.0 3 0.41%
3 Systemic Viral Infection B34.9 2 0.27%
4 Cellulitis L03.9 3 0.41%
5 Herpes Zoster Infection 2 0.27%
6 Varicella Zoster Infection 1 0.14%
7 Ascariasis B77.9 1 0.14%
8 Acute Tonsillopharyngitis J06.8 5 0.68%
9 Sexually Transmitted Infection 1 0.14%
10 Viral Exanthem 1 0.14%
11 Plantar Fascitis 1 0.14%

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 PCPAccFrm E-4D1F1 Rev2014

12 Chalazion H00.1 1 0.14%

13 Carbuncle 1 0.14%
14 Sinusitis 1 0.14%
15 Spondylitis 1 0.14%
16 Rheumatic Fever 2 0.27%
17 0.00%
18 0.00%
19 0.00%
20 0.00%
21 0.00%
22 0.00%
23 0.00%
24 0.00%
25 0.00%
TOTAL 29 3.96% 0

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 PCPAccFrm E-4D1F1 Rev2014

% of Total OPD # of patient-

IM Cases (# of cases with
PULMONARY MEDICINE ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 Allergic Cough R05 5 0.68% 1

2 Bronchial Asthma J45.99 8 1.09% 3
3 Bronchiectasis J47 1 0.14%
4 Community Acquired Pneumonia J18.9 50 6.83% 12
5 Chronic Obstructive Pulmonary Disease J44.9 10 1.37% 2
6 Pleural Effusion J90 10 1.37%
7 Pulmonary Tuberculosis A16.2 42 5.74% 34
8 Upper Respiratory Tract Infection J06.9 16 2.19%
9 Mass, Pulmonary R91 2 0.27%
10 Pneumonia in the Immunocompromised J18.93 1 0.14%
11 Lower Respiratory Tract Infection 1 0.14%
12 0.00%
13 0.00%
14 0.00%
15 0.00%
16 0.00%
17 0.00%
18 0.00%
19 0.00%
20 0.00%
21 0.00%
22 0.00%
23 0.00%
24 0.00%
25 0.00%
TOTAL 146 19.95% 52

% of Total OPD # of patient-

IM Cases (# of cases with
GASTROENTEROLOGY ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 Acute Gastritis K29.1 21 2.87% 3

2 Acute Gastroenteritis A09 9 1.23%
3 Cholecystolithiasis K80.2 3 0.41%
4 Cholelithiasis K80.2 12 1.64%
5 Dyspepsia K30.9 15 2.05%
6 GERD K21.9 6 0.82%
7 Hapatitis A Infection B15.9 2 0.27%
8 Hepatitis B Infection B16.9 12 1.64% 6
9 Functional Constipation K59.0 3 0.41%
10 Peptic Ulcer Disease K27.9 15 2.05% 10
11 Chronic Diarrhea A09 2 0.27%
12 Diverticulitis K57.2 2 0.27%
13 Bleeding Peptic Ulcer Disease K27.4 6 0.82%
14 Colonic New Growth D48.9 2 0.27%
15 Gastric Outlet Obstruction K56.6 2 0.27%
16 Hepatic Mass R93.2 2 0.27%
17 Obstructive Jaundice R17 2 0.27%
18 Viral Hepatitis B19.9 2 0.27%
19 Acute Pancreatitis K85.9 2 0.27%
20 Hemorrhoid I84.9 6 0.82%
21 0.00%
22 0.00%
23 0.00%
24 0.00%
25 0.00%

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TOTAL 126 17.21% 19

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% of Total OPD # of patient-

IM Cases (# of cases with
NEPHROLOGY ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 Urinary Tract Infection N39.0 25 3.42% 2

2 Urinary Tract Infection, Complicated N39.0 3 0.41%
3 Nephrolithiasis N20.0 5 0.68%
4 Acute Pyelonephritis N10 2 0.27%
5 Chronic Kidney Disease N18.8 3 0.41%
6 Nephrotic Syndrome N04.9 2 0.27%
7 Nephritic Syndrome N00.0 1 0.14%
8 Obstructive Uropathy N13.6 2 0.27%
9 Uremia N19 1 0.14% 1
10 Hyperurecemia 1 0.14%
11 Acute Cystitis N30.0 1 0.14%
12 Urinary Tract Infection, Recurrent N39.0 1 0.14%
13 0.00%
14 0.00%
15 0.00%
16 0.00%
17 0.00%
18 0.00%
19 0.00%
20 0.00%
21 0.00%
22 0.00%
23 0.00%
24 0.00%
25 0.00%
TOTAL 47 6.42% 3

% of Total OPD # of patient-

IM Cases (# of cases with
ENDOCRINOLOGY ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 Diabetes Mellitus Type 2 E11.9 39 5.33% 12

2 Diabetes Mellitus Type 1 E10.9 1 0.14%
3 Euthyroid 1 0.14%
4 Toxic Goiter E05.0 3 0.41%
5 Hyperthyroidism E05.9 8 1.09%
6 Hyperthyroidism, Graves Disease E05.0 5 0.68%
7 Hyperthyroidism, Non-toxic goiter E03.0 4 0.55%
8 Hypokalemic Periodic Paralysis G72.3 3 0.41% 3
9 Hypothyroidism E89.0 4 0.55%
10 Neuropathic foot 2 0.27%
11 Impaired Glucose Tolerace 1 0.14%
12 Hashimoto's Disease E06.3 1 0.14%
13 0.00%
14 0.00%
15 0.00%
16 0.00%
17 0.00%
18 0.00%
19 0.00%
20 0.00%
21 0.00%
22 0.00%
23 0.00%
24 0.00%

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25 0.00%
TOTAL 72 9.84% 15

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% of Total OPD # of patient-

IM Cases (# of cases with
HEMATOLOGY ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 0.00%
2 0.00%
3 0.00%
4 0.00%
5 0.00%
6 0.00%
7 0.00%
8 0.00%
9 0.00%
10 0.00%
11 0.00%
12 0.00%
13 0.00%
14 0.00%
15 0.00%
16 0.00%
17 0.00%
18 0.00%
19 0.00%
20 0.00%
21 0.00%
22 0.00%
23 0.00%
24 0.00%
25 0.00%
TOTAL 0 0.00% 0

% of Total OPD # of patient-

IM Cases (# of cases with
NEUROLOGY ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 Cerebrovascular Accident, Hemorrhagic I61.9 14 1.91% 12

2 Cerebrovascular Accident, Infarct I63.9 22 3.01% 14
3 Uremic Encephalopathy G93.4 1 0.14%
4 Transient Ischemic Attack G45.9 12 1.64%
5 Subdural Hematoma S06.50 1 0.14%
6 Tension Headache G44.2 4 0.55%
7 Generalized Tonic-Clonic Seizure G40.3 1 0.14% 1
8 Migraine Headache G43.9 1 0.14%
9 Bell's palsy G51.0 1 0.14% 1
10 Stroke in the Young I64 2 0.27%
11 Central Nervous System infection G04.9 1 0.14%
12 Tardive Dyskinesia G24.9 1 0.14%
13 0.00%
14 0.00%
15 0.00%
16 0.00%
17 0.00%
18 0.00%
19 0.00%
20 0.00%
21 0.00%
22 0.00%
23 0.00%
24 0.00%

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25 0.00%
TOTAL 61 8.33% 28

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% of Total OPD # of patient-

IM Cases (# of cases with
ONCOLOGY ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 Mass, Abdominal, probably malignant C76.2 3 0.41%

2 Mass, Anterior neck, probably malignant C49.0 4 0.55%
3 Breast Cancer C50.9 2 0.27%
4 Endometrial Ca C54.1 1 0.14%
5 Cervical papillary Adenocarcinoma C53.9 1 0.14%
6 Mass, Retroperitoneal C48.0 2 0.27%
7 Ovarian New Growth D39.1 5 0.68%
8 Pulmonary metastasis of neck mass C78.3 1 0.14%
9 Colonic new growth D48.9 2 0.27%
10 Malignant Neoplasm of Duodenum C17.0 1 0.14%
11 HCC probably Metastatic C22.0 1 0.14%
12 Prostate CA C61 2 0.27%
13 0.00%
14 0.00%
15 0.00%
16 0.00%
17 0.00%
18 0.00%
19 0.00%
20 0.00%
21 0.00%
22 0.00%
23 0.00%
24 0.00%
25 0.00%
TOTAL 25 3.42% 0

% of Total OPD # of patient-

IM Cases (# of cases with
DERMATOLOGY ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 0.00%
2 0.00%
3 0.00%
4 0.00%
5 0.00%
6 0.00%
7 0.00%
8 0.00%
9 0.00%
10 0.00%
11 0.00%
12 0.00%
13 0.00%
14 0.00%
15 0.00%
16 0.00%
17 0.00%
18 0.00%
19 0.00%
20 0.00%
21 0.00%
22 0.00%
23 0.00%
24 0.00%

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 PCPAccFrm E-4D1F1 Rev2014

25 0.00%
TOTAL 0 0.00% 0

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 PCPAccFrm E-4D1F1 Rev2014

% of Total OPD # of patient-

IM Cases (# of cases with
RHEUMATOLOGY ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 Osteoarthritis M19.99 13 1.78%

2 0.00%
3 0.00%
4 0.00%
5 0.00%
6 0.00%
7 0.00%
8 0.00%
9 0.00%
10 0.00%
11 0.00%
12 0.00%
13 0.00%
14 0.00%
15 0.00%
16 0.00%
17 0.00%
18 0.00%
19 0.00%
20 0.00%
21 0.00%
22 0.00%
23 0.00%
24 0.00%
25 0.00%
TOTAL 13 1.78% 0

% of Total OPD # of patient-

IM Cases (# of cases with
ALLERGOLOGY & IMMUNOLOGY ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 0.00%
2 0.00%
3 0.00%
4 0.00%
5 0.00%
6 0.00%
7 0.00%
8 0.00%
9 0.00%
10 0.00%
11 0.00%
12 0.00%
13 0.00%
14 0.00%
15 0.00%
16 0.00%
17 0.00%
18 0.00%
19 0.00%
20 0.00%
21 0.00%
22 0.00%
23 0.00%
24 0.00%

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 PCPAccFrm E-4D1F1 Rev2014

25 0.00%
TOTAL 0 0.00% 0

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 PCPAccFrm E-4D1F1 Rev2014

Enter Name of
Hospital
EAST AVENUE MEDICAL CENTER
Enter the place
of census i.e.
Ward, ICU, ER, or
OPD
Enter the
Month and
Year
Type the Primary
Enter Total IM Diagnosis here. If you
Admisssions (Patient
person count) for the
need more space
Manually count(rows),
the just insert row
Month
disease entity from
before the row of Tota
your monthly census
to maintain the
and enter here.
calculation formula.
% of patients
with one or more
than 1 follow-up
(# of patients Manually count the
with one more number of death per
than 1 ff-up/# of disease entity from
Cases) your monthly census
and enter here. Type
0.00% code
50.00% diag
60.22%
Yellow boxes
25.00% automatically computed
0.00% from data entered in the
shaded boxes. DO NOT
0.00% WRITE ANYTHING ON
0.00% THE YELLOW BOXES.
0.00%
0.00%
0.00%
100.00%
25.00%
25.00%
66.67%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
#DIV/0!
#DIV/0!
#DIV/0!
35.68%

% of patients
with one or more
than 1 follow-up
(# of patients
with one more
than 1 ff-up/# of
Cases)

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

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 PCPAccFrm E-4D1F1 Rev2014

0.00%
0.00%
0.00%
0.00%
0.00%
#DIV/0!
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0.00%

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 PCPAccFrm E-4D1F1 Rev2014

% of patients
with one or more
than 1 follow-up
(# of patients
with one more
than 1 ff-up/# of
Cases)

20.00%
37.50%
0.00%
24.00%
20.00%
0.00%
80.95%
0.00%
0.00%
0.00%
0.00%
#DIV/0!
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35.62%

% of patients
with one or more
than 1 follow-up
(# of patients
with one more
than 1 ff-up/# of
Cases)

14.29%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
50.00%
0.00%
66.67%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
#DIV/0!
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 PCPAccFrm E-4D1F1 Rev2014

15.08%

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 PCPAccFrm E-4D1F1 Rev2014

% of patients
with one or more
than 1 follow-up
(# of patients
with one more
than 1 ff-up/# of
Cases)

8.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
#DIV/0!
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6.38%

% of patients
with one or more
than 1 follow-up
(# of patients
with one more
than 1 ff-up/# of
Cases)

30.77%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
0.00%
#DIV/0!
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 PCPAccFrm E-4D1F1 Rev2014

#DIV/0!
20.83%

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 PCPAccFrm E-4D1F1 Rev2014

% of patients
with one or more
than 1 follow-up
(# of patients
with one more
than 1 ff-up/# of
Cases)

#DIV/0!
#DIV/0!
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% of patients
with one or more
than 1 follow-up
(# of patients
with one more
than 1 ff-up/# of
Cases)

85.71%
63.64%
0.00%
0.00%
0.00%
0.00%
100.00%
0.00%
100.00%
0.00%
0.00%
0.00%
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 PCPAccFrm E-4D1F1 Rev2014

#DIV/0!
45.90%

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 PCPAccFrm E-4D1F1 Rev2014

% of patients
with one or more
than 1 follow-up
(# of patients
with one more
than 1 ff-up/# of
Cases)

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
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% of patients
with one or more
than 1 follow-up
(# of patients
with one more
than 1 ff-up/# of
Cases)

#DIV/0!
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 PCPAccFrm E-4D1F1 Rev2014

#DIV/0!
#DIV/0!

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 PCPAccFrm E-4D1F1 Rev2014

% of patients
with one or more
than 1 follow-up
(# of patients
with one more
than 1 ff-up/# of
Cases)

0.00%
#DIV/0!
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% of patients
with one or more
than 1 follow-up
(# of patients
with one more
than 1 ff-up/# of
Cases)

#DIV/0!
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#DIV/0!
#DIV/0!

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Hospital: EAST AVENUE MEDICAL CENTE

Admissions: OPD Census

Ent
Case-load (case census per year) and results of care Mon

Month/Year: DECEMBER 2014 Enter Total IM

Admisssions (
person count)
Total IM Admissions: 1,045 Month

% of Total OPD # of patient-

IM Cases (# of cases with
CARDIOLOGY ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 Hypertension I10.9 128 12.25% 89

2 Essentially Normal Z10.1 65 6.22% 0
3 Hypertensive Cardiovascular Disease I11.9 42 4.02% 1
4 Congestive Heart Failure I50.0 21 2.01% 12
5 Dilated Cardiomyopathy I42.0 11 1.05% 3
6 Stable Angina I20.8 9 0.86%
Manually count the
7 Acute coronary Syndrome 6 0.57%entity from 1
disease
8 Ischemic Heart Disease I25.9 6 your monthly
0.57% 1
Type here the ICD and enter
census
9 Atrial Fibrillation I48 2
10 code of the0.19%
here.
10 Rheumatic Heart Disease I09.9 2
Primary 0.19%
diagnosis
11 Valvular Heart Disease I38 2 0.19%
12 Chronic Venous Insufficiency 1 0.10%
13 Dyslipidemia E78.9 2 0.19% 2
14 Left Atrial Enlargement 1 0.10%
15 Angina Pectoris I20.0 1 0.10%
16 Venous Valve Reflux 1 0.10%
17 Thyrotoxic Heart Disease E05.9 1 0.10%
18 0.00%
19 0.00%
20 0.00%
21 0.00%
22 0.00%
23 0.00%
24 0.00%
25 0.00%
TOTAL 301 28.80% 109

% of Total OPD # of patient-

IM Cases (# of cases with
INFECTIOUS DISEASES ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 Measles B05.9 3 0.29%

2 Syphilis A53.0 3 0.29%
3 Systemic Viral Infection B34.9 2 0.19%
4 Cellulitis L03.9 3 0.29%
5 Herpes Zoster Infection 2 0.19%
6 Varicella Zoster Infection 1 0.10%
7 Ascariasis B77.9 1 0.10%
8 Acute Tonsillopharyngitis J06.8 5 0.48%
9 Sexually Transmitted Infection 1 0.10%
10 Viral Exanthem 1 0.10%
11 Plantar Fascitis 1 0.10%

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12 Chalazion H00.1 1 0.10%

13 Carbuncle 1 0.10%
14 Sinusitis 1 0.10%
15 Spondylitis 1 0.10%
16 Rheumatic Fever 2 0.19%
17 0.00%
18 0.00%
19 0.00%
20 0.00%
21 0.00%
22 0.00%
23 0.00%
24 0.00%
25 0.00%
TOTAL 29 2.78% 0

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% of Total OPD # of patient-

IM Cases (# of cases with
PULMONARY MEDICINE ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 Community Acquired Pneumonia J18.9 67 6.41% 34

2 Pulmonary Tuberculosis A16.2 102 9.76% 89
3 Upper Respiratory Tract Infection J06.9 28 2.68%
4 COPD J44.9 4 0.38%
5 Pleural Effusion J90 4 0.38% 4
6 Extrapulmonary TB A18.2 1 0.10%
7 Bronchial Asthma J45.99 13 1.24% 4
8 Allergic Cough R05 3 0.29%
9 Emphysema J44.0 1 0.10%
10 Pneumothorax J93.9 1 0.10% 1
11 Pulmonary Congestion J81 1 0.10%
12 Pulmonary Mass prob Malignant R91 1 0.10%
13 Lower Respiratory Tract Infection 1 0.10%
14 Consolidation 1 0.10%
15 0.00%
16 0.00%
17 0.00%
18 0.00%
19 0.00%
20 0.00%
21 0.00%
22 0.00%
23 0.00%
24 0.00%
25 0.00%
TOTAL 228 21.82% 132

% of Total OPD # of patient-

IM Cases (# of cases with
GASTROENTEROLOGY ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 Acute Gastritis K29.1 21 2.01% 4

2 Acute Gastroenteritis A09 9 0.86%
3 Cholecystolithiasis K80.2 3 0.29%
4 Cholelithiasis K80.2 12 1.15%
5 Dyspepsia K30.9 15 1.44% 1
6 GERD K21.9 6 0.57%
7 Hapatitis A Infection B15.9 2 0.19%
8 Hepatitis B Infection B16.9 12 1.15%
9 Functional Constipation K59.0 3 0.29%
10 Peptic Ulcer Disease K27.9 15 1.44%
11 Chronic Diarrhea A09 2 0.19%
12 Diverticulitis K57.2 2 0.19%
13 Bleeding Peptic Ulcer Disease K27.4 6 0.57%
14 Colonic New Growth D48.9 2 0.19%
15 Gastric Outlet Obstruction K56.6 2 0.19%
16 Hepatic Mass R93.2 2 0.19%
17 Obstructive Jaundice R17 2 0.19%
18 Viral Hepatitis B19.9 2 0.19%
19 Acute Pancreatitis K85.9 2 0.19%
20 Hemorrhoid I84.9 6 0.57%
21 Gallbladder Polyp 1 0.10%
22 0.00%
23 0.00%
24 0.00%
25 0.00%

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TOTAL 127 12.15% 5

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 PCPAccFrm E-4D1F1 Rev2014

% of Total OPD # of patient-

IM Cases (# of cases with
NEPHROLOGY ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 Urinary Tract Infection N39.0 25 2.39% 2

2 Urinary Tract Infection, Complicated N39.0 3 0.29%
3 Nephrolithiasis N20.0 5 0.48%
4 Acute Pyelonephritis N10 2 0.19%
5 Chronic Kidney Disease N18.8 3 0.29%
6 Nephrotic Syndrome N04.9 2 0.19%
7 Nephritic Syndrome N00.0 1 0.10%
8 Obstructive Uropathy N13.6 2 0.19%
9 Uremia N19 1 0.10%
10 Hyperurecemia 1 0.10%
11 Acute Cystitis N30.0 1 0.10%
12 Urinary Tract Infection, Recurrent N39.0 1 0.10%
13 0.00%
14 0.00%
15 0.00%
16 0.00%
17 0.00%
18 0.00%
19 0.00%
20 0.00%
21 0.00%
22 0.00%
23 0.00%
24 0.00%
25 0.00%
TOTAL 47 4.50% 2

% of Total OPD # of patient-

IM Cases (# of cases with
ENDOCRINOLOGY ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 Diabetes Mellitus Type 2 E11.9 39 3.73% 5

2 Diabetes Mellitus Type 1 E10.9 1 0.10%
3 Euthyroid 1 0.10%
4 Toxic Goiter E05.0 3 0.29%
5 Hyperthyroidism E05.9 8 0.77%
6 Hyperthyroidism, Graves Disease E05.0 5 0.48%
7 Hyperthyroidism, Non-toxic goiter E03.0 4 0.38%
8 Hypokalemic Periodic Paralysis G72.3 3 0.29%
9 Hypothyroidism E89.0 4 0.38%
10 Neuropathic foot 2 0.19%
11 Impaired Glucose Tolerace 1 0.10%
12 Hashimoto's Disease E06.3 1 0.10%
13 0.00%
14 0.00%
15 0.00%
16 0.00%
17 0.00%
18 0.00%
19 0.00%
20 0.00%
21 0.00%
22 0.00%
23 0.00%
24 0.00%

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25 0.00%
TOTAL 72 6.89% 5

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% of Total OPD # of patient-

IM Cases (# of cases with
HEMATOLOGY ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 Iron deficiency Anemia D50.9 2 0.19% 1

2 Idiopathic Thrombocytopenic Purpura D69.3 2 0.19%
3 Polycythemia Vera D45 2 0.19% 2
4 Autoimmune Hemolytic Anemia D59.1 1 0.10% 1
5 Anemia Etiology to be Determined D64.9 3 0.29%
6 Anemia secondary to UGIB D50.0 1 0.10%
7 Anemia, Refractory 1 0.10%
8 0.00%
9 0.00%
10 0.00%
11 0.00%
12 0.00%
13 0.00%
14 0.00%
15 0.00%
16 0.00%
17 0.00%
18 0.00%
19 0.00%
20 0.00%
21 0.00%
22 0.00%
23 0.00%
24 0.00%
25 0.00%
TOTAL 12 1.15% 4

% of Total OPD # of patient-

IM Cases (# of cases with
NEUROLOGY ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 Cerebrovascular Disease, Infarct I63.9 70 6.70% 34

2 Cerebrovascular Disease, Hemorrhagic I61.9 13 1.24% 7
3 Transient Ischemic Attack G45.9 5 0.48%
4 Tension Headache G44.2 10 0.96%
5 Benign Paroxysmal Positional Vertigo H81.1 6 0.57% 3
6 Migraine G43.9 8 0.77%
7 Spinal Cord Compression G95.2 4 0.38%
8 Seizure Disorder R56.8 4 0.38%
9 Lacunar Infarct I63.9 3 0.29%
10 Bell's Palsy G51.0 3 0.29%
11 Myofascial Pain Syndrome M79.08 13 1.24%
12 Vasovagal Syncope F48.8 1 0.10%
13 Peripheral Neuropathy G62.9 2 0.19%
14 Sciatica secodary to herniated disc M54.39 3 0.29%
15 Stroke in the Young I64 1 0.10%
16 Cluster Headache G44.0 1 0.10%
17 Facial nerve Paralysis G51.0 1 0.10%
18 Intracranial Mass 1 0.10%
19 Carpal Tunnel Syndrome G56.0 1 0.10%
20 Multiple Sclerosis G35 1 0.10%
21 Lateral Rectus Palsy G80.9 1 0.10%
22 Disc Herniation 1 0.10%
23 Major Depressive Disorder 1 0.10%
24 thalamocapniloganglioma mass 1 0.10%

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 PCPAccFrm E-4D1F1 Rev2014

25 0.00%
TOTAL 155 14.83% 44

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 PCPAccFrm E-4D1F1 Rev2014

% of Total OPD # of patient-

IM Cases (# of cases with
ONCOLOGY ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 Mass, Abdominal, probably malignant C76.2 3 0.29% 1

2 Mass, Anterior neck, probably malignant C49.0 4 0.38%
3 Breast Cancer C50.9 2 0.19%
4 Endometrial Ca C54.1 1 0.10%
5 Cervical papillary Adenocarcinoma C53.9 1 0.10%
6 Mass, Retroperitoneal C48.0 2 0.19%
7 Ovarian New Growth D39.1 5 0.48%
8 Pulmonary metastasis of neck mass C78.3 1 0.10%
9 Colonic new growth D48.9 2 0.19%
10 Malignant Neoplasm of Duodenum C17.0 1 0.10% 1
11 HCC probably Metastatic C22.0 1 0.10%
12 Prostate CA C61 2 0.19%
13 Gastric malignancy C16.9 1 0.10%
14 Mass, Bladder D41.4 1 0.10%
15 Lipoma 2 0.19%
16 Fibroadenoma 1 0.10%
17 Mass, Breast 1 0.10%
18 Mass, hypogastric 1 0.10%
19 Mass, Anal, probably malignant 4 0.38%
20 Anal adenocarcinoma 1 0.10%
21 Hepatic Renal Cyst 1 0.10%
22 0.00%
23 0.00%
24 0.00%
25 0.00%
TOTAL 38 3.64% 2

% of Total OPD # of patient-

IM Cases (# of cases with
DERMATOLOGY ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 0.00%
2 0.00%
3 0.00%
4 0.00%
5 0.00%
6 0.00%
7 0.00%
8 0.00%
9 0.00%
10 0.00%
11 0.00%
12 0.00%
13 0.00%
14 0.00%
15 0.00%
16 0.00%
17 0.00%
18 0.00%
19 0.00%
20 0.00%
21 0.00%
22 0.00%
23 0.00%
24 0.00%

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 PCPAccFrm E-4D1F1 Rev2014

25 0.00%
TOTAL 0 0.00% 0

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 PCPAccFrm E-4D1F1 Rev2014

% of Total OPD # of patient-

IM Cases (# of cases with
RHEUMATOLOGY ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 Rheumatoid Arthritis M06.99 1 0.10%

2 Gouty Arthritis M10.09 6 0.57%
3 Osteoarthritis M19.99 7 0.67%
4 Musculoskeletal Strain M62.69 13 1.24%
5 Bursitis M71.5 1 0.10%
6 Costochondritis 2 0.19%
7 Fracture, Hip 2 0.19%
8 0.00%
9 0.00%
10 0.00%
11 0.00%
12 0.00%
13 0.00%
14 0.00%
15 0.00%
16 0.00%
17 0.00%
18 0.00%
19 0.00%
20 0.00%
21 0.00%
22 0.00%
23 0.00%
24 0.00%
25 0.00%
TOTAL 32 3.06% 0

% of Total OPD # of patient-

IM Cases (# of cases with
ALLERGOLOGY & IMMUNOLOGY ICD 10 # of Cases
cases/Total OPD one or more
IM cases) than 1 ff-up

1 Acute Anaphylaxis 1 0.10%

2 Hypersensitivity Reaction, not specified T78.4 1 0.10%
3 Hypersensitivity Reaction, Drug Induced T88.7 1 0.10%
4 Eczema 1 0.10%
5 0.00%
6 0.00%
7 0.00%
8 0.00%
9 0.00%
10 0.00%
11 0.00%
12 0.00%
13 0.00%
14 0.00%
15 0.00%
16 0.00%
17 0.00%
18 0.00%
19 0.00%
20 0.00%
21 0.00%
22 0.00%
23 0.00%
24 0.00%

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 PCPAccFrm E-4D1F1 Rev2014

25 0.00%
TOTAL 4 0.38% 0

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 PCPAccFrm E-4D1F1 Rev2014

EAST AVENUE MEDICAL CENTER Enter Name

of Hospital

Enter the Enter the place

Month and Year of census i.e.
Ward, ICU, ER, or
OPD
Enter Total IM
Admisssions (Patient
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% of patients
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Cases) disease entity from
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69.53% and enter here.
0.00%
Yellow boxes
2.38% automatically
57.14% computed from data
entered in the
27.27% shaded boxes. DO
0.00% NOT WRITE
16.67% ANYTHING ON THE
YELLOW BOXES.
16.67%
0.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
0.00%
#DIV/0!
#DIV/0!
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36.21%

% of patients
with one or more
than 1 follow-up
(# of patients
with one more
than 1 ff-up/# of
Cases)

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

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 PCPAccFrm E-4D1F1 Rev2014

0.00%
0.00%
0.00%
0.00%
0.00%
#DIV/0!
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0.00%

We attest to the truthfulness of the above documentation: Page 62 of 76

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 PCPAccFrm E-4D1F1 Rev2014

% of patients
with one or more
than 1 follow-up
(# of patients
with one more
than 1 ff-up/# of
Cases)

50.75%
87.25%
0.00%
0.00%
100.00%
0.00%
30.77%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
0.00%
#DIV/0!
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57.89%

% of patients
with one or more
than 1 follow-up
(# of patients
with one more
than 1 ff-up/# of
Cases)

19.05%
0.00%
0.00%
0.00%
6.67%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
#DIV/0!
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#DIV/0!

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 PCPAccFrm E-4D1F1 Rev2014

3.94%

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 PCPAccFrm E-4D1F1 Rev2014

% of patients
with one or more
than 1 follow-up
(# of patients
with one more
than 1 ff-up/# of
Cases)

8.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
#DIV/0!
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#DIV/0!
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4.26%

% of patients
with one or more
than 1 follow-up
(# of patients
with one more
than 1 ff-up/# of
Cases)

12.82%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
#DIV/0!
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 PCPAccFrm E-4D1F1 Rev2014

#DIV/0!
6.94%

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 PCPAccFrm E-4D1F1 Rev2014

% of patients
with one or more
than 1 follow-up
(# of patients
with one more
than 1 ff-up/# of
Cases)

50.00%
0.00%
100.00%
100.00%
0.00%
0.00%
0.00%
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
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33.33%

% of patients
with one or more
than 1 follow-up
(# of patients
with one more
than 1 ff-up/# of
Cases)

48.57%
53.85%
0.00%
0.00%
50.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

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 PCPAccFrm E-4D1F1 Rev2014

#DIV/0!
28.39%

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 PCPAccFrm E-4D1F1 Rev2014

% of patients
with one or more
than 1 follow-up
(# of patients
with one more
than 1 ff-up/# of
Cases)

33.33%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
#DIV/0!
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5.26%

% of patients
with one or more
than 1 follow-up
(# of patients
with one more
than 1 ff-up/# of
Cases)

#DIV/0!
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#DIV/0!
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#DIV/0!

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 PCPAccFrm E-4D1F1 Rev2014

#DIV/0!
#DIV/0!

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 PCPAccFrm E-4D1F1 Rev2014

% of patients
with one or more
than 1 follow-up
(# of patients
with one more
than 1 ff-up/# of
Cases)

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
#DIV/0!
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#DIV/0!

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#DIV/0!
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0.00%

% of patients
with one or more
than 1 follow-up
(# of patients
with one more
than 1 ff-up/# of
Cases)

0.00%
0.00%
0.00%
0.00%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

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#DIV/0!
#DIV/0!
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#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

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 PCPAccFrm E-4D1F1 Rev2014

#DIV/0!
0.00%

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 Philippine College of Physicians
PCPAccFrm E-4D1F2 Rev2014

SUMMARY OF CENSUS OPD Census

HOSPITAL EAST AVENUE MEDICAL CENTER

Month/Year % of patients with

% of Total OPD IM # of patient- one or more than 1
Cases (# of cases with one follow-up (# of
cases/Total OPD IM or more than 1 patients with one
OCTOBER 2014 # of Cases cases) ff-up more than 1 ff-up/#
of Cases)

Cardiology 213 27.17% 84 39.44%

Infectious Diseases 29 3.70% 3 10.34%
Pulmonary Medicine 147 18.75% 70 47.62%
Gastroenterology 131 16.71% 0 0.00%
Nephrology 47 5.99% 2 4.26%
Endocrinology 72 9.18% 0 0.00%
Hematology 2 0.26% 0 0.00%
Neurology 93 11.86% 40 43.01%
Oncology 7 0.89% 0 0.00%
Dermatology 1 0.13% 0 0.00%
Rheumatology 32 4.08% 0 0.00%
Allergology & Immunology 10 1.28% 0 0.00%

Total IM OPD Cases 784 Total Patients with follow-up 199

Total IM OPD Patients 784 Total Pts w/ ff-up/Total OPD IM Cases 25.38%

SUMMARY OF CENSUS OPD Census

HOSPITAL EAST AVENUE MEDICAL CENTER

Month/Year % of patients with

% of Total OPD IM # of patient- one or more than 1
Cases (# of cases with one follow-up (# of
cases/Total OPD IM or more than 1 patients with one
NOVEMBER 2014 # of Cases
cases) ff-up more than 1 ff-up/#
of Cases)

Cardiology 213 27.17% 76 35.68%

Infectious Diseases 29 3.70% 0 0.00%
Pulmonary Medicine 146 18.62% 52 35.62%
Gastroenterology 126 16.07% 19 15.08%
Nephrology 47 5.99% 3 6.38%
Endocrinology 72 9.18% 15 20.83%
Hematology 0 0.00% 0 #DIV/0!
Neurology 61 7.78% 28 45.90%
Oncology 25 3.19% 0 0.00%
Dermatology 0 0.00% 0 #DIV/0!
Rheumatology 13 1.66% 0 0.00%
Allergology & Immunology 0 0.00% 0 #DIV/0!

Total IM OPD Cases 732 Total Patients with follow-up 193

Total IM OPD Patients 732 Total Pts w/ ff-up/Total OPD IM Cases 26.37%
 Philippine College of Physicians
PCPAccFrm E-4D1F2 Rev2014

SUMMARY OF CENSUS OPD Census

HOSPITAL EAST AVENUE MEDICAL CENTER

Month/Year % of patients with

% of Total OPD IM # of patient- one or more than 1
Cases (# of cases with one follow-up (# of
cases/Total OPD IM or more than 1 patients with one
DECEMBER 2014 # of Cases
cases) ff-up more than 1 ff-up/#
of Cases)

Cardiology 301 38.39% 109 36.21%

Infectious Diseases 29 3.70% 0 0.00%
Pulmonary Medicine 228 29.08% 132 57.89%
Gastroenterology 127 16.20% 5 3.94%
Nephrology 47 5.99% 2 4.26%
Endocrinology 72 9.18% 5 6.94%
Hematology 12 1.53% 4 33.33%
Neurology 155 19.77% 44 28.39%
Oncology 38 4.85% 2 5.26%
Dermatology 0 0.00% 0 #DIV/0!
Rheumatology 32 4.08% 0 0.00%
Allergology & Immunology 4 0.51% 0 0.00%

Total IM OPD Cases 1,045 Total Patients with follow-up 303

Total IM OPD Patients 1,045 Total Pts w/ ff-up/Total OPD IM Cases 29.00%

SUMMARY OF CENSUS OPD Census

HOSPITAL EAST AVENUE MEDICAL CENTER

Months/Year % of patients with

% of Total OPD IM # of patient- one or more than 1
OCTOBER 2014 Cases (# of cases with one follow-up (# of
NOVEMBER 2014 # of Cases cases/Total OPD IM or more than 1 patients with one
cases) ff-up more than 1 ff-up/#
DECEMBER 2014 of Cases)

Cardiology 727 28.39% 269 37.00%

Infectious Diseases 87 3.40% 3 3.45%
Pulmonary Medicine 521 20.34% 254 48.75%
Gastroenterology 384 14.99% 24 6.25%
Nephrology 141 5.51% 7 4.96%
Endocrinology 216 8.43% 20 9.26%
Hematology 14 0.55% 4 28.57%
Neurology 309 12.07% 112 36.25%
Oncology 70 2.73% 2 2.86%
Dermatology 1 0.04% 0 0.00%
Rheumatology 77 3.01% 0 0.00%
Allergology & Immunology 14 0.55% 0 0.00%

Total IM OPD Cases 2,561 Total Patients with follow-up 695

Total IM OPD Patients 2,561 Total Pts w/ ff-up/Total OPD IM Cases 27.14%
 Philippine College of Physicians
PCPAccFrm E-4D1F2 Rev2014
 Philippine College of Physicians
PCPAccFrm E-4D1F2 Rev2014