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  • Death Report Form

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    Bhell Mendiola
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    1) John Doe, a 31-year old male prisoner at Manila City Jail, died on March 22, 2019 at 0800H at East Avenue Medical Center. 2) The immediate cause of death was hypovolemic shock from dengue hemorrhagic fever and other comorbidities like pneumonia. 3) The document provides details of the deceased prisoner like name, age, charges, attending physician, and circumstances of death to comply with reporting of death of persons deprived of liberty (PDLs) in the Philippines.

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    1) John Doe, a 31-year old male prisoner at Manila City Jail, died on March 22, 2019 at 0800H at East Avenue Medical Center. 2) The immediate cause of death was hypovolemic shock from dengue hemorrhagic fever and other comorbidities like pneumonia. 3) The document provides details of the deceased prisoner like name, age, charges, attending physician, and circumstances of death to comply with reporting of death of persons deprived of liberty (PDLs) in the Philippines.

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    © All Rights Reserved
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    136 Ansichten1 Seite

    Death Report Form

    Hochgeladen von

    Bhell Mendiola
    1) John Doe, a 31-year old male prisoner at Manila City Jail, died on March 22, 2019 at 0800H at East Avenue Medical Center. 2) The immediate cause of death was hypovolemic shock from dengue hemorrhagic fever and other comorbidities like pneumonia. 3) The document provides details of the deceased prisoner like name, age, charges, attending physician, and circumstances of death to comply with reporting of death of persons deprived of liberty (PDLs) in the Philippines.

    Copyright:

    © All Rights Reserved
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    DHS FORM 01

    Republic of the Philippines


    DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
    BUREAU OF JAIL MANAGEMENT AND PENOLOGY
    NATIONAL HEADQUARTERS
    144 Mindanao Avenue, Quezon City
    Email Address: bjmphealthservice@gmail.com

    DEATH REPORT OF PDL


    Name of Reporting Facility Date and Time of Report Control No.
    Manila City Jail March 21, 2019/0800H 2019-08-#01
    Name of PDL Sex Age
    John Doe Male 31
    Last Known Address
    144 Mindanao Avenue, Quezon City
    Offense/s Charges Criminal Case No. Court/Branch
    Rape 1234-5678-890 RTC 23
    Particulars
    Date of Death Time of Death Name of Hospital
    March 22, 2019 0800H East Avenue Medical
    Center
    Immediate Cause
    Hypovolemic Shock
    Antecedent Cause
    Dengue Hemorrhagic Fever
    Underlying Cause
    Co-morbidities (e.g. Pneumonia)
    Name of Attending Physician License No.
    Dr Joselito Perez 12345678
    Circumstances of Death
    (May come with an Incident Report if cause of DEATH is not due to illness)

    PDL Medical History


    (Summary of previous ailments, hospitalization records)

    Actions Taken

    List of Attachments (if any)

    Prepared by: Noted by:


    JO1 Maria Palanggana, RN SINSP MARIO MARIANO
    Nurse on Duty Warden, Manila City Jail

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