Republic of the Philippines

Department of Health

OFFICE OF THE SECRETARY

25

April2}ll

DEPARTMENT MEMORANDUM No.2011 - 0l?5

FOR:

HOSP

SUBJECT: ''A
Nationwideo'

ilable

The DOH through the Bureau of Health Facilities and Services (BHFS), Standards Development Division (SDD) is currently conducting a study entitled "A Survey of Services and Equipment Available in Hospitals Nationwide.'i The study focuses on the distribution of services and equipment in each hospital. This would enable the DOH management to view and, analyze what particular health services are utilized and needed in a specific community as well as provide insights on the classification of hospitals and other hoipital-based facilities. Furthermore, it empowers the h:u]ft Tency in planning activities whilh would improve access to medical services in line with Ao No' 2010 - 0036 "The Aquino Health Agenda: Achieving Universal Health Care for All Filipinos."

In view of the above, heads of hospitals are required to participate in the study by submitting, not later than 15 July 201I, the duly u.ro*plirhed survey questionnaire posted at the DoH website rrayw.doh.gov.ph to personnel fromjhe BHFS nu-.iy' Atty. Nicolas B. Lutero III, Director IV, BHFS, Di. Cynthia R. Rosuman, Chief Standards Development Division (SDD), BHFS, Ms Aida Cuadra, Nursing Adviser, SDD, BHFS. The same may be reached at 7119572 (direct line),65r7gb0 locai 2525 (trunk line), email nblutero@smail.com, cvros8S@gmail.com, or @.
For strict compliance.

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A SURVEY ON THE SERVICES AND EQUIPMENT AVAILABLE IN HOSPITALS NATIONWIDE

GENERAL INSTRUCTIONS 1. Check to make sure that you have the complete questionnaire with a total of ten (10) pages. 2. This self-administered questionnaire is composed of two (2) parts. Part I is about the hospital profile.
Part II is the survey on the services and equipment available in the health facility. a) Contents of Part I: Hospital Profile 1) General Information 2) Hospital Classification 3) Hospital Ancillary and Other Clinical Services 4) Hospital Accreditation and/ or ISO Certification 5) For Level 4 Hospitals Accredited Residency Training Program(s) b) Contents of Part II: Survey on Services and Equipment Available in the Hospital Medicine Pediatrics Surgery Obstetrics and Gynecology Neurology Radiology Ophthalmology Laboratory Otorhinolaryngology Outsourced Hospital Serivces Psychiatry Critical Care Orthopedics Emergency Room Services Rehabilitation Medicine Ecumenical Services

3. The Chief of Hospital/ Medical Director, Chief of Clinics/ Chief of Professional Medical Services,
Department Heads, Chief Nurse and/ or concerned professional hospital staff knowledgeable on the services and equipment available in the hospital facility, shall properly fill-out this questionnaire to ensure the accuracy and reliability of the data presented in this tool.

4. In Part I of the questionnaire from pages 2 to 3, enter the data called for and put a check () mark in
the appropriate box [ ].

5. In Part II of the questionnaire from pages 4 to 10, shade the ticker () in the appropriate column
alongside each corresponding item. Under column B, YES means the services and equipment in your hospital are present and functional. Provide additional sheets whenever necessary for remarks and/ or further information on other hospital services and equipment not enumerated in the questionnaire. It is essential to capture all the services your hospital is capable of providing.

6. Make sure to fill-in the blanks with the needed information. Do not leave any items blank. 7. The concerned hospital staff who accomplished the questionnaire shall write down his/ her printed
name, position, affix his/ her signature and indicate the date the tool has been accomplished on the last page of this questionnaire. The medical director or the head of the hospital shall likewise affix his/ her signature to attest to the completeness and truthfulness of the information provided herein.

8. Submit the duly accomplished questionnaire on or before 15 July 2011 at the Standards
Development Division (SDD), Bureau of Health Facilities and Services (BHFS), DOH San Lazaro Compound, Rizal Avenue, Manila. You can get in touch with Dr. Cynthia R. Rosuman, Chief, SDD, BHFS and/ or Ms. Aida Cuadra, Nursing Adviser, SDD, BHFS at the following numbers: 711-9572 direct line, trunk line 651-7800 local 2525 and email addresses: cyros88@gmail.com or aida_cuadra@yahoo.com.

Page 1 of 10

A SURVEY ON THE SERVICES AND EQUIPMENT AVAILABLE IN HOSPITALS

PART I: HOSPITAL PROFILE
Name of Hospital Complete Address No. & Street City/ Municipality Region Telephone and/or Fax Number Name of Owner Chief of Hospital/Medical Director Chairman of the Board (If Corporation) Authorized Bed Capacity Classification: Ownership [ ] Government [ ] DOH [ ] LGU : :

: : : : :

[ ] Military

Function [ ] General [ ] Special

[ ] Private Others, pls. specify________ Ancillary and Other Clinical Services: [ ] Clinical Laboratory [ ] Primary [ ] Secondary [ ] Tertiary [ ] Blood Bank [ ] Blood Collection Unit [ ] Blood Station [ ] Apheresis Facility [ ] HIV Testing Laboratory [ ] Laboratory for Drinking Water Analysis [ ] Drug Testing Laboratory [ ] Screening [ ] Confirmatory [ ] Pharmacy No. of satellite, please specify__________ [ ] Dialysis Clinic [ ] Kidney Transplant Facility [ ] Birthing Home [ ] BEmONC [ ] CEmONC [ ] Ambulatory Surgical Clinic [ ] Dental Clinic

[ [ [ [

] ] ] ]

Service Capability Level 1 Level 2 Level 3 Level 4

[ ] Diagnostic X-ray Services [ ] Level 1 [ ] Level 2 [ ] Level 3 [ ] Specialized Diagnostic X-ray Services [ ] Computed Tomography [ ] Mammography [ ] Digital Subtraction Angiography [ ] Cardiac Catheterization [ ] Angiocardiography [ ] Percutaneous Transluminal Angioplasties [ ] Bone Densitometry [ ] Tumor Localization and Simulation [ ] Cephalometric [ ] Others, please specify [ ] Dental [ ] Panoramic [ ] Peri-apical [ ] Radiation Oncology [ ] Conventional Radiation Therapy [ ] Stereotactic Radiosurgery (SRS) [ ] Intensity Modulated Radiation Therapy (IMRT) [ ] 3D Conformal Radiation Therapy [ ] Total Body Irradiation (TBI) [ ] Image Guided Radiation Therapy (IGRT)

Hospital Accreditation:

[ ] International [ ] Local

Specify accrediting body ________________________________ [ ] Center of Safety [ ] Center of Quality [ ] Center of Excellence [ ] Non-Philhealth Accredited [ ] Yes [ ] No Philhealth Accredited:

Mother Baby Friendly Hospital Initiative (MBFHI) Certification: Hospital ISO Certification: [ ] Yes [ ] No

If yes, specify ISO certifying body ______________________________________ Specify ISO certified areas in the hospital ________________________________
Page 2 of 10

For Level 4 Hospitals [ [ [ [ [ ] ] ] ] ]

: Residency training program(s) for physicians accredited by the medical specialty and/or subspecialty societies Anesthesiology Dermatology Emergency Medicine Family Medicine Internal Medicine (Please check if only General Medicine) [ ] Cardiology [ ] Endocrinology [ ] Pulmonology [ ] Gastroenterology [ ] Geriatric [ ] Hematology [ ] Immunology [ ] Infectious Diseases [ ] Nephrology [ ] Oncology [ ] Rheumatology Neurology Obstetrics and Gynecology Ophthalmology Otolaryngology Pathology [ ] Anatomic Pathology [ ] Clinical Pathology Pediatrics (Please check if only General Pediatrics) [ ] Ambulatory Pediatrics [ ] Adolescent Medicine [ ] Cardiology [ ] Endocrinology [ ] Pulmonology [ ] Gastroenterology [ ] Genetics [ ] Hematology/Oncology [ ] Allergology/ Immunology [ ] Infectious Diseases [ ] Neonatology [ ] Nephrology [ ] Rheumatology [ ] Developmental Pediatrics Psychiatry Radiology and Radio-Oncology Rehabilitation Medicine Surgery (Please check if only General Surgery) [ ] Cardiothoracic/ Thoracovascular Surgery [ ] Laparoscopic Surgery [ ] Pediatric Surgery [ ] Plastic and Reconstructive Surgery [ ] Neurosurgery [ ] Oncology/Cancer Surgery [ ] Transplant Surgery [ ] Urologic Surgery Orthopedic Surgery Others, specify: ___________________

[ [ [ [ [

] ] ] ] ]

[ ]

[ [ [ [

] ] ] ]

[ ] [ ] [ ] [ ]

Teaching hospital with a medical school, specify medical school _________________________________ Hospital with affiliation to medical school(s), specify medical school(s) ____________________________
Page 3 of 10

PART II: SURVEY ON THE SERVICES AND EQUIPMENT AVAILABLE IN THE HOSPITAL
A Services/ Equipment 1. MEDICINE 1.1. Services available in the hospital 1.1.1. General Medicine 1.1.2. Cardiology 1.1.2.1. Interventional Cardiology 1.1.2.2. Coronary Angiography 1.1.2.3. 2D-Echo 1.1.2.4. Others, specify 1.1.3. Pulmonology 1.1.4. Nephrology 1.1.5. Gastroenterology 1.1.6. Geriatrics 1.1.7. Endocrinology 1.1.8. Diabetology only 1.1.9. Infectious Diseases 1.1.9.1. Infection Control Committee 1.1.10. Allergology/ Immnunology 1.1.11. Rheumatology 1.1.12. Hematology 1.1.13. Oncology 1.1.14. Stem Cell Unit 1.1.15. Hyperbaric Oxygen Therapy 1.1.16. Pain Management Center 1.1.17. Extra Shock Wave Lithotripsy (ESWL) 1.1.18. Others, specify 1.2. Facilities/equipment available in the hospital 1.2.1. Esophagogastroduodenoscopy (EGD) or upper endoscopy 1.2.2. Percutaneous Endoscopic Gastrostomy (PEG) 1.2.3. Echocardiogram (2D Echo) 1.2.4. Treadmill/ Stress ECG test 1.2.5. Holter Monitor 1.2.6. Hemodialysis machine 1.2.7. Others, specify 2. SURGERY 2.1. Services available in the hospital 2.1.1. General Surgery 2.1.2. Thoracic and Cardiovascular Surgery 2.1.3. Urologic Surgery 2.1.4. Plastic Surgery 2.1.5. Neurosurgery 2.1.6. Laparoscopic Surgery 2.1.7. Microsurgery 2.1.8. Colorectal Surgery 2.1.9. Others, specify 2.2. Facilities/equipment available in the hospital 2.2.1. Rigid Bronchoscope 2.2.2. Fiberoptic Bronchoscope 2.2.3. Colonoscope 2.2.4. Proctoscope 2.2.5. Laparoscopic Surgery Equipment 2.2.6. Laparotomy Set 2.2.7. Tracheostomy Set 2.2.8. Others, specify 3. NEUROLOGY 3.1. Services available in the hospital 3.1.1. Stroke Unit 3.1.2. Sleep Center 3.1.3. Others, specify B YES C NO

Page 4 of 10

4.

5.

6.

7.

8.

9.

A Services/ Equipment 3.2. Facilities/equipment available in the hospital 3.2.1. Arterial Doppler Study 3.2.2. Arterial/ Venous Duplex Scan 3.2.3. Brain Perfusion Study 3.2.4. Others, specify OPHTHALMOLOGY 4.1. Services Available in the hospital 4.1.1. Extracapsular Cataract Extraction 4.1.2. Phacoemulsification 4.1.3. LASIK 4.1.4. Others, specify 4.2. Facilities/equipment available in the hospital 4.2.1. Ophthalmoscope 4.2.2. Slit Lamp 4.2.3. Phacoemulsification Machine 4.2.4. Eye Laser Surgery Equipment 4.2.5. Others, specify OTORHINOLARYNGOLOGY 5.1. Services available in the hospital 5.1.1. Ear/Audiology Unit 5.1.2. Others, specify 5.2. Facilities/equipment available in the hospital 5.2.1. Otoscope 5.2.2. Audiometer 5.2.3. Others, specify PSYCHIATRY 6.1. Services available in the hospital 6.1.1. Psychiatry Unit/Ward 6.2. Facilities/equipment available in the hospital 6.2.1. Recreational/treatment facilities ORTHOPEDICS 7.1. Services available in the hospital 7.1.1. Spine Unit 7.1.2. Arthroplasty 7.1.3. Others, specify 7.2. Facilities/equipment available in the hospital 7.2.1. Basic Orthopedic Surgical Equipment (e.g. Bone Saw) 7.2.2. Others, specify REHABILITATION MEDICINE 8.1. Services available in the hospital 8.1.1. Physical Therapy 8.1.2. Occupational Therapy 8.1.3. Speech Therapy 8.1.4. Others, specify 8.2. Facilities/equipment available in the hospital 8.2.1. Bicycle Ergonometer 8.2.2. Electrical Stimulator 8.2.3. Exercise Plinth/Bed 8.2.4. Exercise Stair with Rail 8.2.5. Overhead Pulley 8.2.6. Paraffin Wax 8.2.7. Parallel Bars with Postural Mirror 8.2.8. Trans-electrical Nerve Stimulator (TENS) 8.2.9. Ultrasound for physical therapy 8.2.10. Others, specify PEDIATRICS 9.1. Services available in the hospital 9.1.1. General Pediatrics 9.1.2. Essential Newborn Care (ENC) 9.1.2.1. Four Core Steps in Immediate Newborn Care 9.1.2.2. Newborn Resuscitation

B YES

C NO

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A Services/ Equipment 9.1.2.3. Kangaroo Mother Care 9.1.2.4. Newborn Hearing Screening 9.1.3. Ambulatory Pediatrics 9.1.4. Developmental Pediatrics 9.1.5. Cardiology 9.1.6. Pulmonology 9.1.7. Nephrology 9.1.8. Gastroenterology 9.1.9. Genetics 9.1.10. Endocrinology 9.1.11. Infectious Diseases 9.1.12. Allergology/Immunology 9.1.13. Hematology 9.1.14. Child Protection Unit 9.1.15. Others, specify 9.2. Facilities/equipment available in the hospital 9.2.1. Incubator(s) 9.2.2. Transport incubator(s) 9.2.3. Self-inflating (Ambu) bag, neonatal 9.2.4. Self-inflating (Ambu) bag, infant 9.2.5. Infant weighing scale 9.2.6. Bassinet(s) 9.2.7. Phototherapy units 9.2.8. Stethoscopes, neonatal 9.2.9. Stethoscopes, infant 9.2.10. Stethoscopes, pediatrics 9.2.11. Sphygmomanometer(s) 9.2.12. Neonatal cuff(s) 9.2.13. Pediatric cuff(s) 9.2.14. Nebulizer 9.2.15. Piped-in Oxygen 9.2.16. Suction apparatus 9.2.17. Pediatric laryngoscope 9.2.18. Neonatal blade 0 9.2.19. Neonatal blade 1 9.2.20. Pediatric blades 9.2.21. Pulse oximeter(s) 9.2.22. Radiant warmer(s) 9.2.23. Others, specify 10. OBSTETRICS AND GYNECOLOGY 10.1. Services available in the hospital 10.1.1. Normal deliveries 10.1.2. Cesarean section 10.1.3. Forceps deliveries 10.1.4. Vacuum extraction 10.1.5. Breastfeeding or MBFHI Committee 10.1.6. Essential and Intrapartum Newborn Care (EINC) Working Group 10.1.7. STD clinic 10.1.8. HIV Clinic 10.1.9. 24-hour social service coverage 10.1.10. Others, specify 10.2. Facilities/equipment available in the hospital 10.2.1. OB normal 10.2.2. Adjustable delivery beds 10.2.3. CS kit 10.2.4. Doppler ultrasound 10.2.5. Fetal monitor 10.2.6. Foetoscope 10.2.7. Hysteroscope 10.2.8. Transvaginal Sonogram (TVS)

B YES

C NO

Page 6 of 10

A Services/ Equipment 10.2.9. Pelvic ultrasound 10.2.10. Others, specify 11. RADIOLOGY 11.1. Services available in the hospital 11.1.1. Interventional radiology 11.1.2. Radiotherapy 11.1.3. Mammography 11.1.4. CT scan 11.1.5. PET scan 11.1.6. MRI 11.1.7. Others, specify 11.2. Facilities/equipment available in the hospital 11.2.1. X-Ray 11.2.2. Portable x-ray machines 11.2.3. Ultrasound 11.2.4. 7.5 mHz transducer for neonatal cranial ultrasound 11.2.5. Angiogram 11.2.6. Fluoroscopy Machine 11.2.7. Cobalt Treatment Machine 11.2.8. LINAC 11.2.9. Conventional Computerized Tomography (CT) scan 11.2.10. Spiral CT scan 11.2.11. Magnetic Resonance Imaging (MRI) 11.2.12. Magnetic Resonance Angiography (MRA) 11.2.13. DEXA 11.2.14. Mammogram 11.2.15. PET Scan 11.2.16. Bone Scan 11.2.17. Radioactive Iodine Uptake 11.2.18. Others, specify 12. LABORATORY 12.1. Services available in the hospital 12.1.1. General 12.1.1.1. Complete Blood Count (CBC) with quantitative platelet count 12.1.1.2. Electrolytes 12.1.1.3. Electrolytes, micro-method 12.1.1.4. Gram Stain 12.1.1.5. Aerobic Culture BHI for neonatal BHI for pediatric 12.1.1.6. Anaerobic Culture 12.1.1.7. Blood typing and cross matching 12.1.1.8. Stool examination 12.1.1.9. Urinalysis 12.1.1.10. Arterial Blood Gases 12.1.1.11. Others, specify 12.1.2. Pulmonary 12.1.2.1. Pulmonary Function Tests 12.1.2.2. Arterial Blood Gases 12.1.2.3. Others, specify 12.1.3. Gastroenterology 12.1.3.1. AST, ALT 12.1.3.2. Alkaline Phosphatase 12.1.3.3. Albumin 12.1.3.4. Amylase 12.1.3.5. Complete Hepatitis Profile 12.1.3.6. Others, specify 12.1.4. Hematology 12.1.4.1. Prothrombin Time (PT) 12.1.4.2. Partial Thromboplastin Time (PTT)

B YES

C NO

Page 7 of 10

12.2.

12.1.4.3. 12.1.4.4. 12.1.4.5. 12.1.4.6. 12.1.4.7. 12.1.5. Endocrine 12.1.5.1. Serum Glucose 12.1.5.2. HbA1c 12.1.5.3. Free T4 12.1.5.4. T3 12.1.5.5. Thyroid Stimulating Hormone (TSH) 12.1.5.6. Others, specify 12.1.6. Rheumatology 12.1.6.1. Anti-Nuclear Antibodies (ANA) 12.1.6.2. Anti-Smith Antibodies 12.1.6.3. Anti-double Stranded DNA Antibodies 12.1.6.4. Others, specify 12.1.7. Nephrology 12.1.7.1. Blood Urea Nitrogen (BUN) 12.1.7.2. Blood Uric Acid 12.1.7.3. Creatinine 12.1.7.4. Kidney Biopsy 12.1.7.5. Others, specify 12.1.8. Cardiology 12.1.8.1. CK-MB 12.1.8.2. CK-Total 12.1.8.3. Lipid Profile 12.1.8.4. Troponin T/I 12.1.8.5. Others, specify 12.1.9. Infectious Diseases 12.1.9.1. Malaria thick and thin smears 12.1.9.2. Dengue serologic tests 12.1.9.3. Typhoid fever serologic tests 12.1.9.4. Kato-katz smear 12.1.9.5. Others, specify 12.1.10. Oncology 12.1.10.1. Carcinoembryonic Antigen (CEA) 12.1.10.2. BRCA 12.1.10.3. Alpha-fetoprotein (AFP) 12.1.10.4. Prostate Specific Antigen (PSA) 12.1.10.5. Others, specify 12.1.11. OB-GYNE 12.1.11.1. Pregnancy Test 12.1.11.2. OGCT/OGTT 12.1.11.3. Pap Smear 12.1.11.4. HIV-AIDS serologic tests 12.1.11.5. VDRL test 12.1.11.6. RPR test 12.1.11.7. Chlamydia culture 12.1.11.8. Gonorrhea culture 12.1.11.9. Others, specify 12.1.12. Pediatrics 12.1.12.1. Newborn Screening for the 5 metabolic disorders 12.1.12.2. Others, specify Facilities/equipment available in the hospital 12.2.1. Clinical centrifuge 12.2.2. Microhematocrit centrifuge 12.2.3. Microscope with oil immersion objective 12.2.4. Hemoglobinometer or its equivalent 12.2.5. Differential blood cell counter or its equivalent 12.2.6. Refrigerator exclusively used for specimens

A Services/ Equipment Bleeding Time Clotting Time Bone Marrow Aspiration Biopsy Lead levels Others, specify

B YES

C NO

Page 8 of 10

A Services/ Equipment 12.2.7. Photometer or its equivalent 12.2.8. Water bath or its equivalent 12.2.9. Serofuge or its equivalent 12.2.10. Blood Bank refrigerator (exclusive for blood bank use) 12.2.11. Platelet rotator 12.2.12. Automated hematology analyzer 12.2.13. Incubator 12.2.14. Balance, trip/ analytical 12.2.15. Rotator 12.2.16. Autoclave 12.2.17. Drying oven 12.2.18. Biosafety cabinet or its equivalent 12.2.19. ELISA reader or automated immunology equipment 12.2.20. Semi- or fully automated chemistry analyzer 12.2.21. Others, specify 13. OUTSOURCED HOSPITAL SERVICES Outsourced means the service is provided by external contractor/s. The hospital management shall ensure that documented agreements and/ or contracts covering external service providers shall be updated, valid and shall specify that the quality of services provided must be consistent with appropriate set standards. 13.1. Hospital Management Information System 13.2. Maintenance Services 13.3. Leased Medical Devices 13.4. Patient Directory Services 13.5. Magnetic Imaging Devices 13.6. CT Scan Imaging Devices 13.7. Other Imaging and Laboratory Services 13.8. Pharmacy Services 13.9. Security Services 13.10. Laundry Services 13.11. Accounting Services 13.12. Ambulance Services 13.13. Rehabilitation Services 13.14. Dietary Services 13.15. Hospital Waste Management 13.16. Others, specify 14. CRITICAL CARE 14.1. General ICU/CCU 14.2. CCU (separate from General ICU) 14.3. Pediatric ICU (separate from General ICU) 14.4. Neonatal ICU (separate from General and Pediatric ICU) 14.4.1. Ventilator(s) 14.4.2. Infusion pumps micro-volume 14.4.3. Pulse oximeter(s) 14.4.4. Umbilical cannulation set(s) 14.4.5. Radiant warmer(s) 14.4.6. Surfactant administration 14.4.7. Others, specify 14.5. Surgical ICU (separate from General ICU) 14.6. Facilities/equipment exclusive to the ICU (not being shared) 14.6.1. Ventilator(s)
14.6.2. 14.6.3. 14.6.4. 14.6.5. 14.6.6. 14.6.7. Cardiac monitors Infusion pumps Defibrillator Pulse oximeter Cut-down set Others, specify

B YES

C NO

Page 9 of 10

15. EMERGENCY ROOM SERVICES 15.1. Emergency Cart with basic medicines, equipment and supplies 15.2. Facilities/equipment exclusive to the ER (not being shared)

A Services/ Equipment 15.2.1. Oxygen

15.2.2. 15.2.3. 15.2.4. 15.2.5. 15.2.6. 15.2.7. 15.2.8. 15.2.9. 15.2.10. Laryngoscope with endotracheal tubes Suture set Defibrillator Glucometer Nebulizer ECG Machine Pulse oximeter Cut-down set Others, specify

B YES

C NO

16. ECUMENICAL SERVICES Ecumenical Prayer Room

Hospital staff who accomplished the questionnaire (if not the medical director):

______________________________ Signature over printed name ______________________________ Position __________________________________ Date

Concurred by the medical director/ head of hospital:

______________________________ Signature over printed name ______________________________ Medical Director/ Head of Hospital __________________________________ Date

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