RD / ARD Division

1. Division Performance Commitment and Review - RD / ARD

1.  ILHZ Functionality Monitoring Tool 

2. Integrated Monitoring  Tool for Health Centers 

3. Health Facility Supply Chain Management (SCM) Performing Monitoring 

4. PBI Selection Tool

5. BHW Registration and Accreditation Committee (BHW-RAC-Monitoring Tool)

6. Geographically Isolated and Disadvantaged Areas (GIDA) Profiling Tool 

7. Accredited BHW Registry Certification

8. Post Activity Feedback Report

9. Meeting Summary Notes

10. BHW Registration & Accreditation Form 1

11. BHW Registration & Accreditation Form 1

12. BHW Registration & Accreditation Form 1

1. Capacity Building – Conduct of Training and other health Promotion Activities

2. Approval of Activity Design

FORMS

1. Health Promotion Implementation Monitoring Tool

2. Health Promotion Unit Request for Services (Support to Advocacy Activities)

FORMS

1. Facebook Posting and Information Dissemination Form

2. Visual and Written Content Creation Request Form 

3. Declaration of Content and Release for Photograph, video and/or sound Recordings of Named Subjects

1. Availment of DOH CHD WV MAF at WVMC

2. Provision of Medicines and Supplies under the Public Assistance and complaints Unit

1. Plan Formulation and Plan Monitoring

2. Request for Approval of Supplemental/Catch up Plans

3. Preparation, Conduct and Documentation of the Regional Implementation & Coordination Team (RICT) Meeting

FORMS

1. Accomplishment Report for WFP

2. List of Trainings/Workshops/Orientations/Meetings/Monitoring Visits

3. Issues and Concerns 

4. Budget Utilization Summary

5. Quarterly Physical Report of Operations

6. (PBUR) Quarterly Physical and Financial Accomplishment Per Work and Financial Plan

7. Quarterly Performance Monitoring Tool 2021-2023 DOH Strategy Map

8. Office Performance Commitment and Review (OPCR) Monitoring of Accomplishment 

9. CSS Form2 Post Activity Report Form

10. CSS Form 2.0 (Workshop/Meeting Evaluation)

11. CSS Form 3.0 (Resource Person Evaluation Form)

1. Technical Assistance

2. PDO/Technical Assistance 

3. PDO/Monitoring and Evaluation 

4. Monitoring

5. Networking & Inter-Sectoral Collaboration

6. Quarterly Monitoring of ILHZ Board Meeting, ILHZ Technical Management Committee Meeting and Local Health Board Meetings 

7. DOH Complete Treatment Pack NCPAM/CHD Monitoring Tool for RHUs 

8. Technical Assistance Monitoring Tool 

9. PDO Weekly Accomplishment Report 

10. Individual Weekly Accomplishment Report 

11. Municipality Profile 

12. Vital Health Indices 

13. Human Resource for Health (HRH) 

14. Annual Program Accomplishment 

15. Quarterly Program Accomplishment 

16. Status of Local Health Board 

17. Status of Funds Transferred to LGUs 

18. Development Management Officer Technical Assistance (DMO TA) Plan 

19. Comprehensive LGU Health System’s Scorecard DMO Monitoring Tool 

20. Technical Assistance Plan 

21. Monitoring Tool/Checklist 

22. PDOHO-Monitoring Plan 

23. Integrated Monitoring Tool HSIMEC Proper

24. Local Health Systems Maturity Level Progress Monitoring Tool

1. Certificate of Appearance

1. Disease Surveillance (Deletion, Registration and Reporting) 

2. Event Based Surveillance and Response (ESR) Reporting

3. Outbreak Investigation 

4. Laboratory Specimen

5. Smart Verbal Autopsy Reporting

FORMS - RESU

1. RESU MBD and Weekly Report Monitoring Form 

2. RESU Event – Based Surveillance and Response (ESR) Tracking Form 

3. Functionality Assessment of PESUs/CESUs 

4. Assessment Form for PIDSR and VPD Surveillance Operations (LGU) 

5. Assessment Form for PIDSR and VPD Surveillance Operations (Hospital) 

6. RESU Staff Weekly / Monthly Mobility Report Tracking Sheet 

7. RESU MBD Files Submitted to EB Tracking Sheet 

8. RESU Monitoring Checklist 

9. Measles-Rebulla Close Contact Tracing Form

10. Assessment Tool for Epidemiology and Surveillance Unit for HESU

11. Assessment Tool for Epidemiology and Surveillance Unit for MESU

12. Accomplishment Report of HPDS (Extended Tasks and Roles)

13. Health Data Management 

14. FHSIS Recording and Reporting

FORMS - STAT

1. Rural Health Unit Monitoring and Evaluation on FHSIS/iClinicSys 

2. Integrated Clinic Information System (IclinicSys) Return Demonstration Evaluation Form 

3. Integrated Clinic Information System (IclinicSys) Program and System Monitoring Tool 

4. RHU / DHC / CHO Monitoring and Evaluation Form

5. RHU/DHC/CHO Monitoring and Evaluation Form 

6. Data Request Form RESU/FHSIS Cluster 

7. Assessment Tool for Epidemiology and Surveillance System

8. Integrated Monitoring and Evaluation (M&E) Tool

9. Level III Evaluation – Facility Assessment after iClinicSys Training

10. FHSIS Accomplishment Report

11. Retrospective Records Review Form RESU/FHSIS Cluster

1. Monitoring  of Events 

2. Response to Events 

3. Health Emergency Response 

4. DRRM-H Monitoring 

5. Processing and releasing of BLS Certificates and BLS ID’s 

6. Deployment Process on Emergency / Disaster Incidents on Events

7. DRRM-H Checklist for Local Government Units 

8. Health Emergency Management Staff Capacity Assessment Tool 

9. Request form

1. Referral of MAIPP Recipients in Private Hospitals

2. Reimbursement of Medical Assistance to indigent Patients (MAIP) Program Funds to Partner Private Hospitals

3. Hospital Monitoring Report 

4. Learning and Development Needs Survey/Assessment 

5. Integrated Hospital Operations And Management Program Monitoring Tool 

6. Medical Assistance to Indigent Patient (MAIP) Program Monitoring Tool 

7. Assessor’s Reference 

8. COVID-19 Sickness and Death Compensation Evaluation Form

9. Medical Assistance to Indigent Patients (AIP) Program Referral Form

10. BHW-Performance Based Incentives (PBI) Selection Tool

11. Primary Care Facility’s Status Self-Assessment and Monitoring 

12. Service Delivery 1 : Referral KRAS Monitoring Tool

13. Local Health Facility Development Plan (LHFDP) Monitoring Tool

FORMS - INFRA

1. Implementation of HFEP Infrastructure Projects 

2. Development of Detailed Architectural Engineering Designs 

3. Variation/Change Order 

4. Monitoring on the Implementation of Infrastructure Projects 

5. Inspection Report 

6. DOH RO VI Infra Project Monitoring Checklist for Time 

7. DOH RO VI Infra Project Monitoring Checklist for Workmanship 

8. Summary of Project Monitoring Report 

9. Validation Barangay Health Station in School 

10. Site Location Plan Barangay Health Station in School 

11. Punch List Form 

12. Corrective Action Request (CAR) 

13. Site Location Plan 

14. Site Validation Form 

15. Certificate of Project Completion 

16. Variation Work Order Plan 

17. Certificate of Project Acceptance 

18. Progress and Final Billing Form 

19. Tracking Form for the Approval of Schematic Plan and Detailed Architectural and Engineering Drawings (DAED) 

20. Routing Slip 

21. General and Earthquake Damage Inspection Checklist

22. Project Monitoring Report

23. Health Facility Enhancement Program Technical Assistant Form

24. Inspection Report

25. Minutes of Meeting

26. HFEP Travel Request Form

FORMS - EQUIPMENT

1. HFEP Equipment Feedback Form 

2. HDEP Equipment Consolidated Monthly Report Form 

3. HFEP Equipment Monitoring Form 

4. Checklist for Availment of Equipment for HFEP Funded BHS  

1. Legal Service 

2. 8888/PCC/CCB Citizen’s 

3. Complaint Center 

4. Public Assistance and Complaint Desk )PACD)

5. Freedom of Information (FOI) Request 

 FORMS

1. Data Privacy Act

2. FOI Request Form 

3. Legal Request Form

4. PACD – Information Sheet